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008-1082-90-150
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t. Croix Sanitary Permit No: Safety and Building Division INSPECTION REPORT 215 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 ()(m)] Parcel Tax No: Permit Holder's Name: City Village X Township 008-1082-90-150 Eau Galle, Town of Over I, Harold & Jean Section/Town/Range/Map No: CST BM Elev: Insp. BM Bev: BM Description: &A 29,28.16.439A06 .55 + ELEVATION DATA TANK INFORMATION STATION BS HI FS ELEV. TYPE MANUFACTURER CAPACITY W41 D Benchmark / / 1 ~Sy55 Septic G Alt. BM Y5 11q,G L Bldg. Sewer ' r i Fla 1~- 5 StMl"nlet F9 St+lt-Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Ven Air Intak ROAD Septic y Header/Man. I Dist. Pipe A Bot. System H FiLln 11 lid PUMPISIPHON INFORMATION ~S Demand St Cover Manufacturer GPM Model Number em Head TDH Ft TDH Lift Friction Loss Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid De h BED/TRENCH Width DIMENSIONS LL LAKE/STREAM LEACHING cturer: SETBACK SYSTEM TO P/L CHAMBERJOR~ INFORMATION Type Of System: Model Number: -1-100 DISTRIBUTION SYSTEM x Hole Size x Hole Spacing vent to Air Intake Header/Manifold Distribution Length Dia Length Dia Spacing xx Mound Or At-Grade Systems Only SOIL COVER x Pressure Systems Only ~ eeed/Sodded Depth Over ,a Mulched Depth Over Topsoil 0 Yes ,a~ No Yes 0 No BedlTrench Center Inspection Inspection COMMENTS: (Include code discrepencies, persons present, etc.) Parcel No: 29.28.16.439A06 Location: 170 222nd St Baldwin, /WI 54002 (SW 1/4 NW 1/4 29 T28N R16W) metes & bounds Lot 2 ~ S V,~ A~ V' \ 1.) Alt BM Description C6va- 2.) Bldg sewer length = I~' LUar 0A- bC ,r~5t~fltd ~ IU I„ n -amount of cover... ,nS~1►l p 'J t Plan revision Required? E Yes No - - Use other side for additional informag6n. ignature Cert. No. Date Insepcto s SBD-6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN Gp In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road $ Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner Name AA'' Sw 1/4 ~w1/4, Sec Zq galats /`ax ( d" G A)tl4o n. O✓efti Z9 N, R Ittp E (or) W Property Owner's Mailing Address Lot Number Block Number 2.2,7- 5d-ree-4- .4)4 /JA- City, State J////t ( Zip CCotd~e/y~ Phone Numer Subdivision Name or CSM Number A_ too G5/- ~fBZ -/(0(,0 1 I'11 Type of Building: (check one) laity ❑ Village own of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: i5❑ Public/Commercial (describe use): GCLo Gq /Le ❑ State-owned Nearest Road IL Type of Permit: (Check only on x on line A. Check box on line B if applicable) Parcel Tax Number(s) A) It.[] Repair 12. Reconnection 3.❑Non-plumbing 4. ❑ Rejuvenation s 14WZ- wDI f~ Sanitation otog y o B) Permit Number 1/7-77-3 Date IssuV1, State Sanitary Permit was previously issued I V. T POWT System: (Check all that apply) on-pressurized In-ground ❑ Mound ? 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other 11 1 ❑ At-grade 11 Aerobic Treatment Unit El Recirculating . Dispersal/Treatment Area Information: . Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade q50 Required Proposed (Gals./day/sq.ft.) (Min.Anch) Elevation VI. Tank Information Capaicty in Gallons Total # of af~facturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks X ADD / ❑ ❑ ❑ ❑ LJ i ems.` ❑ ❑ ❑ ❑ II. Resp risibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Pluf~ber's Name (print)n Plum ' Signature ( mps): P PRS No. Business Phone Number L~a~ df 3trti _ 22) '51S- 746 - o ns Plumber's Address (Street, City, State, Zip Code) V20 Y'Ack.J., VIII. County Use Only Disa roved Sanitary Permit Fee D to Is ed Issuing nt Signature ( slam A X pproved Owner Gi verse I ination L~ IX. Conditions of Approval/Reasons for Disapproval: . ylVvw, t v.", effluent filter and ,dispersal cell must all be services / maintained as per management plan provided by plumber. emen 2. },rtquir ts must be tpaistainad. st per ripptwcai~l~ Code/ otdif ~i>ic~ I's o I > ry) b7.✓n 4 ~ mil' j ,CCU y tl ` I 7'Y"YOJ11 ,Y n h ? I Shy ao ~ , o a C \ I 0 V, I Q3, ~~-44d r,i ~ a 1 i ~ ~ • ~ Ir b ry) h o tiJ Conventional POWTS Reconnecton Index & Title Sheet Project Name: Overn 3 bedroom Reconnection to existing Conventional POWTS Owners Name: Harold Kurt & Jean Nelson Overn Owner's address 170 222nd St., Baldwin, WI 54002 Site address: Same Project Location: Subdivision: Na Legal Description: SWIANW/4, Sec. 29, T.28N., R. 16W., Tn. ofEau Galle, St. Croix Co., WI. Parcel ID 008-1082-90-150 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Septic Tank Cross section Page 4 Filter Specifications Page 5 System Management Plan Page 6 Septic Tank Maintenance Agreement Page 7 Certification for Utilization of existing septic tank Page 8 Warranty Deed Page 9 Parcel map Attachments: Soil Evaluation Report Mater Plumber Restricted Service: Dale Hudson, DSPS Credential #220853 Signature: Date: Page 1 Of 9 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ~ Y M t~J \o~ ao ~ ~ Q ~cl v ~h ~ 'ti aJ0 ~d P-OUM :3113 99 9-9Zc-009 ZIOZ 'NVr 03SIA3L sOd ZI/9/~ :31N0 z1oz ANVnNVr :31VO OSL45 IM 'N008 N3OIVW Oi AMN Sn 9iam idnNdW 911d3S Nr0d-3Lc „0-~=~b/l :31t+0S 3WS :A8 NMV70 313HOUGO 83331M NW-OZ£M W N ~ x H~ z w 0 -j I w 0 Z) OU Of w ? z m O O w d m L'i ~ (n c O w CL ! O F F- w N u, w Vl Q o z CA OY0 U-0F- 0 Q d H w O ¢ Om o%Q a W~ v Z 0= c o z F- w p Q < c) z ¢ ~ o z CL t¢- 3 O v, QI a p mown wrQ- w _j z a u m m 0 Q CL U) -J UJ QQ ~pN r Oz (A ~ U ¢ °a o°c T ~Mm f v I -~0oar-' Lj mw( O ¢ Z vv Y ¢ C L-1 r~ O o _i co dI <n to col p ° a X00 J,~ JQU JLLJ ZF' } Uw7 = 2 (A ;r O t' F- r-N r- Z O O2 x o &2F- 3or O< V) LLJ O00w a w m v wW < P- Z_iF- W,=b~O-= OUVI l~U~ LL d x0 wwU (A L< ~¢JO OQwW~wQw Q`ac49 Q~s~ V u ¢ 0- 0 Z Z co U~=J mJ'S 0 Z U 5~ NOY 'Gl w w D xa: O F-. o z z 0 a (A 0 J LLJ Q U 1 `a - i•. :aJ w 1 J y nor 0 I,.9b ®f I SVO ,b 17 „9b do II II ~ ~ 1-7: T > W II II ~s a w W L J I w ° 11 .,fib _ sVO „b U- m „Zti do 2 0 J W J ¢ w z w w „Sb N „05 _ ¢ Q 0038 ES Sd ¢ w C Y Z ¢ r Technical . ` ecificatians PL-.525 EFFLUENT FILTER (COMMERCIAL) ~slaeruCHECK - _ - EXCEPTSTM40 FORWLETEXIENTION I 14.35 t,.57 OUTLETBUSNINGEXCEPTS - r$C},40{fiSCH40~~ a10 ttt 123 ~ 3x02 .I. PL525FILTER HOUSING a I - 18.34 ` 7,7-- PARTNO.-30142525 MATERIAL F HOUSING - POLYPROPYLENE OUTLET BUSHING • PVC 65 BALL -HDPE SOOKETEXCEPTSFLOAT SWTCH 10.23 EXCEPTSI'SCH40 .98 P' FORHWUEXOTION 1084 J 530'OF'IhrSLOTS 9 Q a24 - ALL S ROD B as PUSH H ROD / N.L PUSH i OPO4ING ` 7.09 OPEMf10 2Q71 L 1 O O 0 1902 2244 ~ I © O a POLYLOK PL525 FILTER CARTRIDGE . PART NO, - 30141525 MATERIAL -POLYPROPYLENE d r0; o a i~ In-Ground POWTS Dispersal Cell Management Plan Pursuant to Dep't. of Safety & Professional Services 383.54, Wis. Adm. Code General The In-Ground septic system shall be operated in accordance with Dep't. of Safety & Professional Services 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10706-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Dale Hudson at (715) 684-3378 or your County Zoning Inspector at (715) 3864680. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every year by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The addition of biological additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Dep't. of Safety & Professional Services, Safety and Buildings Division. No chemical additives should be added to the system. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or other component. No individual should ever enter a septic tank as dangerous gases may be present that could cause death. Dispersal Cell Observation and vent pipes within the dispersal cell shall be checked for effluent ponding annually. Ponding levels shall be reported to the owner. Persistent ponding of 3" or more will be deemed to indicate an impending hydraulic failure requiring semiannually monitoring. Effluent quality: The sewage effluent generated at this site may not exceed the high strength effluent concentration levels as established by the Wisc. Dep't. of Safety & Professional Services. Influent quality entering the dispersal component of the POWTS may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Contingency Plan: If any portion of the system becomes defective, the defective component shall be immediately repaired or replaced with a component of the same or equal performance to keep the system in proper operating condition. If the dispersal cell component fails to accept wastewater, the existing dispersal trenches will be replaced by installation of a new dispersal cell. Pg. 5 of 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Harold Karl Overn Mailing Address 170 222nd St., Baldwin, WI 54002 Property Address 170 222nd St. (Verification required from Planning & Zoning Department for new construction.) City/State Baldwin, Wl Parcel ldentificationNumber 008-1082-90-080 LEGAL DESCRIPTION Property Location SW 1/4 , NW 1/4 , Sec. 29 , T 28 N R 16 W, Town of Eau Galle Subdivision Plat. Na , Lot # Na Certified Survey Map # Na , Volume Na , Page # Na Warranty Deed # 911507 (before 2007)Volume Na , Page # Na Spec house 13yesE]no Lot lines identifiable El yes[:] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on th' form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Number of b dro s 3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) I 4 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 170 222nd St., Baldwin, SI 54002 located at: SW I/4, NW '/4, Section 29 , Town 28 N, Range 16 W, Town of Eau Galle , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service May 15, 2015 - Darrell's Septic Service Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gal. Construction: Prefab Concrete X Steel Other Manufacturer (if known): Weeks Concrete Age of Tank (if known): 27 years, instaked 9/21/88 Permit number (if known) 112773 le- (Licensed Plumber Signature) (Print Name) Master Plumber 220853 (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 s w8~ n N a^~ ° rte- _ Z w wiN $gg o b S ~ CD x . ` -t A + M ~ f V ' 215TH ST Y f 3 7 t { 4 222NO S7 z ° A < i tD tp Y _ s a g t P9. 9e~9 i 2392 Wisconsin Department of SOIL EVALUATION REPORT Page 1 of 3 Commerce in accordance with Comm-85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Pla St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio percent slope, scale or dimemsions, north arrow, and location and distance tc Parcel I. D. 008-1082-90-15'0 Please print all information. Revi d By Lz- Personal information you provide may be used for secondary purposes (Privacy Law, s. L15 Property Ownei Property Location Karl & Jean Overn Govt. Lot SW 114 NW /4 S 29 T 28 N R 16 W Property Owner's Mailing Address Lot # Block # Subd. Na a or CSM# 170 222nd St. na na Na City State Zip Code Phone Number City Village Town Nearest Road Baldwin WI 54002 (715) 482-1661 Eau Galle 20Th Ave. V New Constructior Use: V Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comment and recommendations: Soil evaluation completed to verify soil conditions and determine suitability of re-connecting to existing dispersal cell. Infiltrative surface elev. = 94.68'. Boring # Boring V' Pit Ground Surface elev 98.76 ft. Depth to limiting factor >97" in. Soil Application Rat Horizon I Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 * ff#2 1 0-3 1Oyr3/3 none scl lfsbk mvfr cs 2fm 0.2 0.3 2 3-20 1Oyr4/6 none scl lcsbk mfr cs 2fm 0.2 0.3 3 20-28 7.5yr4/6 none sl 1msbk mfr cw 1vf,f 0.4 0.7 4 28-97 1Oyr3/6 none Icos&gr Osg ml cw 1vf,f 0.5 1.0 H#4 contains approx 20% coarse fragments by volume. Horizon contains a high percentage of clay. Loading rate reduced to reflect reduced permiability associated with high clay percentage. 2 ] Boring # Boring F V' Pit Ground Surface elev 98.21 ft. Depth to limiting factor >86" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft, in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-10 1Oyr3/3 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 10-23 1Oyr4/4 none sicl 2fsbk mfr cs 2vf,f 0.4 0.6 3 23-29 7.5yr4/4 none sicl 2fsbk mfr cw 1vf,f 0.4 0.6 4 29-39 7.5yr4/6 none Is Osg ml cw 1vf,f 0.7 1.6 5 39-86 1Oyr4/6 none s Osg ml - - 0.5 1.0 H#5 contains irregular, discontinuous bale-4/4 Ifs. Loading rate of horizon reflects reduced permeability of horizon associated with banding. * Effluent #1 = SOD > 30 <220 mg/L and SS >30 < 15 mg * Ef uent #2 = BOD5< 30 mg/L and TSS < 30 mg, CST Name (Please Print) CST Number James K. Thompson Z--- 3= 3002.( Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Numbei 340 Paulson Lake Lane, Osceola, WI 54020 4/23/2015 715-248-7767 PROPERTY OWNU%rI & Jean Overn SOIL AND SITE EVALUATION 2392 Page Z of 3 PARCEL I.D.*08-1082-90-080 A.C.E. Soil & Site Evaluatia REPORT MEMO Evaluation completed to determine code compliance of existing in-ground POWTS with separation from limiting factor. Infiltrative surface is > 36" above seasonal saturation or other limiting factors. Replacement system area was not evaluated. Accordingly, all possible measures should be taken to maximize longevity of existing dispersal cell. The POWTS was designed and installed as per codes in effect at the time of installation to accommodate a three (3) bedroom residence consisting of 750 sq. ft. of dispersal area with a maximum soil loading rate of 0.6 gpd./sq. ft. eda/uoY~~i~ ® Soil CX/S i G~ w s vUV ♦ 1-7 X.5~in~ ~r~t do ¢ (e ~ n I e = //0, A' /~Q~ ~Z39z x/.3.96 170 ZZ2 L-d.5-E . /o/aL o, 1l. ~yCc2 E is~:n 5~y I~WbS/ 5ec.2 T 2,61(. ~esidc, Ce ~ ~0 6 e \ .QCE.4 rv(,:7old~' ra 00~-/UB2-Yo-080 0 ~•su/~y e ~~hE /;~e~ ~'77'CJ✓eol vF wad, SSu.n-Gc/ e lug = /G®.o Gvd • u E d4-0 9A 6•, µ o ~`~3G o v i3 z L //SDing SP&-ja~C't-rtc;o (zj -&Ii,C~SaZ f 75 S,Oace.c/a Ord Cg,4 7 Le" . (f., ~cr~~ c.-jo r & //Z 77-3 On .3c4-3 -0 0 -O o o o O 3 0 p 6o O 01 a) r.; a go I C a~ c (U r _ a) N~~N EEm N aYi C' , w 0) - 0 a) _ N ~ a) N op dam' a c co N c Cl. A Op 2 C. N N ,O a' o f °NENE ~ninN° Lev cn a~i c 3 3rnao a o n N O ~ a) N C N O o - c Z o ~(°D Q) (L c Z o u) ro 3 7 cu in U L O a3 C O" N to LL o n(DOrfl-O LL o O~ w X 'd C a) C O N :a Y I` U 'a 7 N w O 3 O Q N 3 n w Q c~ o) co N - i I 3 I ~ 3 M I ~ M a~ o z " O = 0 cn v v 73 Z d d v a m a N m ~L N Z CL ~ 3 I U C O Z c m m N a 0 Z a ° c c EO o m f- o E a8ia v m 3 .S rn a) m 9 0 cc ~ 0 CL 0 a) cn a) a) a) cr ca 0 0 N cn o ® c co •IV III L t 'O N 2 OU ar U Q a c O o O a.E0 .2 w o o a) Q O Q Q Z N O Z H Z Z Z o Z o I N N i ~l, ~l o CL 0 cn N y N d N w N 0 0 IL L N .N-. 0 0 0 4 0 m 0 a cn _ U) E -0 E :3 LO 4i -CLaa Il~aaa trN _ ~i a 3 1 3 I _ v co oo u) p m m rn (U m M rn Z (D (n J U M T rn } o O c: E N O O TJ 3 N 7 a3 O N (V m N O CL N m tT a) L C) . , N a) (0 ° 2 cu Q d QI Z u7 m 0 I N ~r O O 0 r d 0 b S~ p a) N Q N N O O (D C! L N C N = o E O r: -0 E LO 0) C~ O Q o w U d O Y, c t d O C U d 0 0 O M a) o C a 0 O a) G -O N N (n cn E "t to 40. O m E M a) a) N M L a) D O N C ° ao t v d z z c S rn li H c m t~/C,i w.r oC.4 m cu N o c'n o Eo v a_° O N E o o • ~1 O N W O z N H I-- .2 fn E N O .mac.' O 'r - E I ~d z% d ~o €a (Da 3 at o a L: a • a w .2 m c m m c _ 0 ((n 0 1 A U a 2 O y u Safety and Buildings Division 11 ~•p`ri~ SANITARY PERMIT APPLICATION Bureau of Building water system: 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 sanitkre ar Permit Numger The information you provide may be used by other government agency programs Check i~ i tb p7L~vious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION IS I ' L J Property Owner Name N roe Location ID ah 10JI'lelf ~h ~+h IV Wf is 1/4, S T r Nr R 6 (o Property Owner's Mailing Address Lot Number Block Number j 2 h d s. City, S Ate Zip Code Phone Number Subdivision Name or CSM Number Nearest Road El 11. TYPE F BUILDING: (check one) E] State Owned ❑ Cityage _ own of Eke' R Z2h Public 1 or 2 Family Dwelling - No. of bedrooms Vll 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) Gbh'-- /U F Q 25TO-16 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.y Iew 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an -------stem --------System Tank Only______________ Existing system Existing ---stem B) A Sanitary Permit was previously issued. Permit Number Date Issued J V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 gviound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 2 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requir d (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation ) U + S , ~ 110.2,7 ~ Feet 110Y47 Feet VII. TANK " Capacity in gallons Total # of Prefab. Site Fiber- Plastic INFORMATION Gallons Tanks Manufacturer's Name Concrete strutted Con- steel glass App. New Existing Exper. Tank Tanks Septic Tank or Holding Tank l~C~/ir~► G ❑ ❑ ❑ ❑ ❑ X Lift Pump Tank /Siphon Chamber /Y El ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's SignatureNStamps) MP/MPRSW NO.: Business Phone Number- Plumber's Address (Street, City, State, Zip Code): q iol r" / f/ C1/ IX. COUNTY/DEPARTMENT SE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Si ture (No am WApproved Surcharge Fee) :OL ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t ~ . 1. A sanitary permit is valid for two (2) years- 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and - manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Wisconsin`DepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor ahd Human Relations INSPECTION REPORT ST. CROIX Safety an&Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PIA DULLINGER, DAN & JAN X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax RP! TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 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 I Loss Friction System TDH Ft FDH Lift Forcemain Length Did. I i Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded TXX Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.29.28.16W,NW,NW,222ND STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspectors Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: ` ~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CO NTv ---,.s Afjll ERMIT # Attach complete plans (to the county copy only) for the system, on paper not less than STATE S~ (095 ~-8'fi x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 57 9- _ 3 2 4,? PROPERTY OWNER + PROPERTY LOCATION ocio `c- Teal vulllrk er Wa' Y. S 2 l T N, R lD (or PROPERTY OWNER'S MAILING AD RESS LOT # BLOCK # 1..7 2 2 2. VA CITY, ST~ATTE~rs C ZIP CODE FP-HC-ONE NUMBER SUBDIVISION NAME OR CSM NUMBER (v~ S10~L II. TYPE OF BUILDING: (Check one) C1TNEAREST ROAD, ❑ State Owned ❑ VILLAGE 0 C~~"e v1 Z,) El Public1 or 2 Fam. Dwellings of bedroomg PARCEL s- Ill. BUILDING USE: (If building type is public, check all that apply) v 13 - 0 p so Ja 0 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 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.}},~New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 21pAound 30 El Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE L.~ 0 n REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ^ / ELEVATION 1 1, 2" 3 7. [ 1~ 10235 Feet / aJ - Feet VII. TANK CAPACITY Site in alCl s I Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank G~ r Y i iH '"rs1 I Li Lift Pump Tank/Si hon Chamber a- VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) JM~PP/MPRSGW No.: Business Phone Number: Piu ber's Address (Street, City, State, Zip Code): covh Li✓a~i~~ S . C IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee (Includes Groundwater Date Issued Issuing ent sign ture (No S ps) Approved El Owner Given Initials -0~ Surcharge Fee) Q LCJ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. You*r sanitary permit may be renewed before the expiration date, and at the time c-f rer:ev, al any new criteria in the Wiscot-;sin Administrative Code will be applicable. 3. All revisions to the permit must be approved by the permit issuing authorii.y. 4. Changes in owoetship or plumber requires a Sanitary re`ro°f Transfer/Peal-awa! Farr i M F; i 6399) to be submitted to ll,e co< :nty prier to installation. 5. Or sire 4rwd- j+,:-~rns must be Propeiiy rr,aintai'ied :.F tic tar . , rr, _.t be l c ,.t.t pumper wher:e~-r neces3ary, usually every 2 to 3 years 6. If you shave questions concerning your onsite sewage systerx,, uryntact your local code .~dioi :istrator or tft State. of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax no,-nber(s) of where the system is to be nstalled. Il. Type of building being served. Check only one and complete # of bedre:orns f 1 or.~ 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 Vil. Tank: information Fill in the capacity of ever, •-D.w and, 'or existing talk. ? P- lo la! wmber of tanks and rnanu!acturer's narne. Indicate prefab or site constructed an :C-Ink material. (.::ruin tae for ah septic, pump/siphon and holding tanks for this system. Check experin).:rn'Ai -approval only 0 tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license n,:iinbe- with a.ppropriH,.e 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 m!-,sit be submitted t':r ti- E county. The plans must include the following: A) plot plan, drawn to scalp cr •.witr 1,-Pwp!0e di ni %ation of holding tank(s), septic t2r,i or other treatm+;)t tanks; build r , WE" s; w<afc r a r-r er service; streams and lakes; puma car ,iphon tanks; disfrlbut,on boxes +r~ ~t-itiom system,,, !,F,0,- rnent system areas; and the location of the ouilding served, P! horizontal G ale,,ati sr r~'Or . -:c points; C) complete specifications for pumps and controls; dose volume; elevation c: fferen, es; frid:.on loss; pump performance curve; pump model and pump manufacturer; D) cross section c f the so0 abso lotion system if required by the county; E) soil test data on a 115 .form; and F) all sizing information. - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE t 1983 Wisconsin Act 410 included the creation of surchrryras (fees) for o r i::rr ',:,ter regulated practices hhich can effect groundwater. The monies ce.;iiected through ,niese surcharges ai s f:,, monit^r` r, ter r . water contamination investigations and establishment 0 sl.an cards. SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BRUCE WEBSTER Owner: DAN & JAN DULLINGER RT 3 BOX 231 173 222ND ST ELLSWORTH WI 54011 BALDWIN WI 54002 RE: Plan Number: S92-03248 Date Approved: October 5, 1992 Gallons Per Day: 450 Date Received: September 16, 1992 Project Name: DULLINGER, DAN & JAN Location: NW,NW,29,28,16W Town of EAU GALLE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW PETITION - NEW MOUND SBD•6423 (R. 61/81) • • 5 f r SAFETY & BUILDINGS DIVISION . State of Wisconsin Department of Industry, Labor and Human Relations BRUCE WEBSTER Page 2 Inquiries concerning this approval may be made by calling (608) 266-2889. Si ncer y, PETER E. PAGEL Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 5 cc: DAN & JAN DULLINGER -Private Sewage Consultant _County _UW-SSWMP -Plumbing Consultant Owner Plumber Environmental Health i SBD.6423 (R. 01/81) 1 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations October 2, 1992 DANIEL A DULLINGER 173 222ND ST BALDWIN WI 54002 Petition No. S92-03248-P Dear Mr. Dullinger: Re: Daniel A. Dullinger - Residence Private Sewage System NW,NW,29,28,16W Town of Eau Galle, St. Croix County, WI Your petition for a variance to section ILHR 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The petition has been approved. The rule being petitioned requires that a new mound system site have a minimum 24-inches of suitable natural soil. The variance requested was to install a new mound system on a site with 17-inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Si nc rely, R c e , Archi ec c Director, Office of Div si n Codes and Application (608) 266-3080 RM:732WPP4 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Bruce Allen Webster, Plumber SBD 69 iR.6119U v o J~ ~ v D r t ~ Ca 14`` Ox, Q V w T \ \ Y D N \j ~ T r S 1s ~ ~ `A ~~l. s CA o w ~ o p ~ ~ ~ I st ti ao ~ o o - f Y - • L~ncuf~oh 2~ W 1~y s I w iY N ~T ~.2„J Strut ~ i ~-y00 Z~_.._.- ,6sk,, C5T Wf rye ti ~3~ J~, vVe Jev Pic, vi PRIVATE SEWAGE SYSTEM Cem n (Utionally v V= OR & HUMA ON F ETY 8 D S SEE GORRESPON NCE I r~2 Q5 . L~ ONAI WORKSHEET., r.a7 Page 9f . SYSfEM II. 10. Fo UNI) PRESSURE SYSTEM-Continued- MOUND I. Wastewater Load, Total Daily Flow= .L= gal. i 10. Force Mam: Use s. ILHR 83. 15,. (3) .(c) Minimum Dosing Rate gprr Adm. Code and PROV11) A DETAILED Diameter in. LIS I OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor=, ft. System Head 2.5 ft. 3. Landslope = Vertical Lift = /9- ft. 4. 'Distance from Dose Chamber to Friction Loss =.~:GS'ISO=lull, r 3•Sft. Distribution System = 5d ft. TDH = 1 S ft. 5. Elevation Difference Between I a I 12. Pump Selection: 3 y Pump and Distribution System - _l q ft. 9^~y. Pump will discharge at least apm 6. Absorption Area Sizing: 13 at I SZ ft. total dynamic head. Area Required = 395 sq. ft, Pump model and manufacturer) Zo{lJ~~ Bed or Trench Length (B) ■ off' 0 ft. I ~r7 Bed or Trench Width (A) ■ 5•57 ft. ' 13. Dose Volume: Trench Spacing (C) ■ ft. 10 Times Void Volume of 7. Mound Height: )r ~7 Distribution Lines= ,oW- Y- j -I gal. Fill Depth (D) = ft. Daily Wastewater Volume r Fill Depth Downslope (E) ■ ~'r0~ ft. 4 Doses In 24 hrs. = 45'0-'1 113 Bed or Trench Depth (F) ■ 75 ft. Backflow gal /so 2 gal. Cap and Topsoil Depth (G) ■ •00 ft. Minimum Dose = I `1 D gal, Cap and Topsoil Depth (H) ■ 5-0 ft. 14. Dose Chamber: 8. Mound Length: Volume = t) SO gal End Slope (K) _ q~S ft Total Mound Length (L) ■ ~..t:~, fL 1111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. UpslopeCorrection Factor ■ 'ql~ , Use s. ILHR 83.15 (3)(c),,, Wis. Upstope Width ■ ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor ■ J,' 2 Z ' LIST OF SIZING ON PLANS. Downslope Width (1) ■ t 7 ft. 2. Required Septic Tank Capacity = Total Mound Width W ■ gal. O a9 ft. 3• Percolation Rate ■ min./ 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of os- Refer to Table 2 in ch. ILHR 83 Natural Soil = Elal./Irq.ftjday and PROVIDE A DETAILED LIST OF Basal Area Required = 5,00 sq• ft, SIZING ON PLANS. Basal Area Available ■ -)YOO sq. ft. 1v 7v Required Area ■ sq. ft. 11. If Standard Tables from Chapter ILHR 83 Length = ft. are used, Indicate Table # width = .ft. 12. For the Distribution Network, Use Numbers 5.14 In Section If. Number of Trenches = m OtJIVn Trench Spacing = ft. If. dfT:GX0VND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor ■ ft. Lateral Length ■ ft, 2. Landslope ■ % Number of Laterals ■ 3. Percolation Rate ■ ~y m n n, Lateral Spacing '6 in. 4. Proposed System Elevation ■ 10 , / 1 ft. Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Dail Flow: 'y 9-0 gal. System Elevation = ft. Use s. ILHR 83. 15 (3) (c) , Wis. Adm. Code and PROVIDE A DETAILED IV, SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Items from Section 111 Required Septic Tank Capacity ■ ! gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate ■ min./In. 1. Capacity =_l 00 gal. Area Required = sq. ft. 2. Manufacturer:Mfvt•✓Lj,- Pre,..ct System Length ■ 70 ft. 3. Show Site Constructed Tank Details on Plan System Width= S 5 ft. 7. Distribution Pipe Sizing: 11q /~VI. DOSING TANK Hole Sire = In. 8" L10 1. Capacity = • S G gal. Hole Spacing = 5,31 , ,3r ft. r3.;.5 2. Manufacturer. IILurcf 18rPrGr*- Lalcral Length - 65 r Ewcc 34'~ fl. I ' 3. Pump Manulaclurer: ? Q~~ n^ Latcr•d Si/e 1,U. In. 13.90 4. Pwnp Mn(icl: I .urral Sp.icinK ,.~e,~ II• 2q'1~ 5. Operating Head= I ft. DiO.llllt• Irnrn Sidi-WAI Ill Pilrc _..1 , in. 39•61P) (i. I low Rate = gpm. 11. 010ribution Pipe Discharge Raw n 7• Show Site Constructed Tank-Details on Plans Number of Ilolv%Pct Pipe / I low Pei five : 8 . S 1lpm. VII. IIUI.UING 1 ANK Manilold Sizing: I. Capacity = gal. I Yiw (ccntcr or end) Gei t~ t' 2. Manufaclurer: Length = 2,5- It. 3. Show Site Comlructcd Tank Details on Plans Diameter = a. • O lip. -SHOW ALL INFORMATION ON PLANS- &I DILHR SOD-6761 (R.03/82) Page_LOf / Distribution P Aeta 1A Four Lateral Network Alternate Position Of Cap Force Main 00 w s~ PVC Distribution Pipe C F r ain P Holes Equally Spaced PVC Manifold Pipe On Bottom ~X S X X 2 * Last Hole Should Be Next To End Cap Y P 4Ft. s 3.5 Ft. ~X- Inches i Y Inches Signed: 11~11Uw Hole Diameter Inch License Number: P Lateral Diameter Inch(es) Date: Manifold Diameter -210 Inches Force Main Diameter Inches / Holes Per Pipe Invert Elevation Of Laterals I 05"P-7t. . 3. a {;tip t ' ~ ,t C, ~ ~ ~ t , Page Of f I Straw, Marsh Hay, Or Synthetic Covering • Distribution Pipe ios. Medium Sand for- i z 611 soil H = G /05---?7 _.1 1 , F ioY.G 2 P~ 3 E p 10 0 AN e.0 4` B f - 2 1 " i Force Main Plowed ~w ggregata Layer . ~E JCL 611 Below Pipe) . I,~c`D Ft. ®©Q~~~` Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F 0-?5- Ft. G -d Ft. i A S- Ft. H -S~ Ft. Signed: . ~ Ft., License Number: K K 12,S- , S' Ft. Date: r a- y ~j~12 L 9D Ft. J 9• Ft. Alternate Position I Ft. of Force Main W Ft. Observation Pipe i3 K W ~o ----j ------------------------------------~I 0 ain CDistribution Bed Of i 2 i • Pipe I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area i. J yi E ~ ~Z t j\ ` ~ p, ~ ' ~ ~ ~ a ~ ~~V~4 .y - L PUMP CHAMBER CROSS S PAGE GF~ i. ECTIOU AUD SPECIFICATICIUS a VEUT CAP 4"C.Z. VENT PIPE WEATHERPROOF APPROVED LOCKINIG 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MILD, AIR IkITAKE GRADE I ~ I y"MIN. s DUIT IB"Mlu. P 18"MIN. V(se~ e v~~ S PN~ A TIG AL III T WWI, 14 Q PO I III I III ALARM B I II i 1 c *APPROVED I I ON S~-f 2 JOINTS WITH I ELEV. FT. 3 APPROVED PIPE /h ~rcrv,od 1y®m 3' ONTO -_J . ' Sys.rN, FrrtNuti).S` =~.0 PUMP-~ D SOLID SOIL OFF hiodd 161 wrll t,Gtid `~y TON or oIP h a} tr' $•d COUCKETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI'CATIOAJS DOSE TAWKS MANUFACTURER: 49)WPS} PI~P(c7S7 n IJUMBER OF DOSES: PER DA8 TA" SIZE : ~GALLOWS DOSE VOLUME / L ALARM MANUFACTURER: _rS.rT, ^~ec}y,`Gh S _ INCLUDING BACKFLOW: 6✓ GALLO MODEL IJUMBEK: - II DI H W 2 2?~ CAPACITIES: A---_IAlCHESOR J GALLO SWITCH TYPE Mrrcvv4 PUMP B = INCHES OR ~ GALLO MANUFACTURER: ~lrell.r D C INCHES OR y~ GALLON MODEL NUMBER: 13 7 D•- T INCHES OR GALLO SWITCH TYPE: /Ile~cW7 _ MOTE: PUMP ARID ALARM ARE TO BE MINIMUM DISCHARGE RATE 2' Gpp,1 (INSTALLED OW SEPARATE CIRCUITS `I VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. -r O FEET + MINIMUM NETWORK SUPPLY PRESSURE . . + `S 2.5 FEET FEET OF FORCE MAIN X ~.O~ F~ Ioo rtFRICT1oW FACTOR. 'FEET TOTAL DtJkJAMIG HEAD c S FEET I INTERNAL DIMENSIONS OF TANK: LENGTH I ,WIDTH LIQUID DEPTH SIGUED: i LICEIJSE fJUMBER: ~v 3 7 DATE:JP- n M2- fr .7 W. w HEAD CAPACITY CURVE 2 LL EFFLUENT MODELS 14 -I - _ I TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE a - i.__- . EFFLUENT AND DEWATERING _ 6566 - 1 l! SERIES 67.60 07 N 137.130 181 163 165 186 1b 108 169 - - FT. M. Gat Ltr4 GaL Loa GA Ltrf Gal LYt Gat Un GA LVS Oi Ltw. 41;t Life. Got L94. G4l O,aL'l6a U q 5 1.62 43 163 56 212 72 213 ,04 IN 106 401 at 731 m 231 6/ 225 166 !i9'f 166 i697 10 US 34 .129 46 171 61 231 79 800 100 X370 Of 231.' N . 231' : W 220 ,48 i480 161 ' 672 15 467 19 72 J6 i33 46 170 N 942 N 341 80 277 e0 227 54 220 142 :.637 14S 649 26- 20 410. 16 A 26 '0 30 -130 82 -310: 50 :..223 eo '.227 as 720 138 .616 1b .630 2S 7,82 • 00.. 74 080 67 £t4 69 223 59 ' 220 120 „.181 133 603 "4- - - - r 30 0.14 es 248 66 .208 68 220 90 340 68 920 121 A68 127 481 j1 - - - 40 1219 4e 174 48 in 66 200 76 283 6e 220 106 '307 114 A31 Z7_ - I 1 !~6 60 1624 . 21 80 33 126 61 191 60 219 N P20 90 '.541 100 319 -1 - - - - 60 t 420 16 67 43 181 36.1130 i W '.1np 71 860 ..70 21.31 as e6 322 114 10 5 -16 i BO 2A_3B 62 197 61 .IW 70 286 18 55__ _Y. - - 'T- 14 67 - 46 1701 29. foe W 2W 90 27.43 32 121 2 6 37 1b 1- III1 _ 100 3049 I G l 110 3200 18 68 21 79 . - LLxk Valva: 19.26' 2376' 23' 28• 66' 14 66' BT 73' HP 01' ItY - - - - - EFFLUENT & DEWATERING 165 Warning: Model 185 should not be subjected to less ° - than 30 feet TDH. t!- - 189 - - - - - Note: For Head Capacity on Model 112, industrial 6_,--"_ ----1 - - - column-explosion proof pump, see FM 219. 4- - ° SEWAGE & DEWATERING GALLONS WARNING: Model 293 should not be subjected LITERS I 90 160 140 310 100 480 S60 ° to less than 15 feet TDH. y Q W ~ ~ W W ! ~ u ~ I I TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING 22 _ SERIES 262 268 _ 267 260 282- 284 292 293 294 22S 70 FT M Gal LM. Gal Ltm. Gal. L6[ Gl. tyl Gal Gal. 1fe, Gal. LtrO. Gal. Q4. Gal tlj,:' Gal. life. 20 5 162 _ 90 311 128 484 128 481 126 130 4¢1 160 140 6~ 196 INIV 225 862 65 10 3.05 60 227 89 337 - _89 337 89 t 95 300 158 696 124 460 k . 181 885 205,778 15 4.57 22.5 65 SO 189 50 tll# ' 50 89 63 238 135 bit 106 401 t30 50 155 D25 185 100 20 e.I0 18 80 10 38 10 >I8 f0 ~ 33 128. 106401 BB 3,13 119'460 15p C81-. 186 638 25 7.1 e 1 IB 865 68 !07` 108:401 136918, . 153 880 55 30 9.11 - 43 183 47 176 90 3q; 12f458 uo 630 40 12 14 5' 19 So 180 94,350 115 436 50 15.21 - 50 50 t8.29 - - f'~. M' 1 If'4. Sa 2w 89 337 P =3, 59 273 i 14 _ 70 2134 2 45 --_LCCk 'ldIVS 18' 215' 27 S' 21.5' 26' 35' 42"50'!• 87 77' 77 12 40 35 - - 10 - - 30 - 3. 8 293 i'w 25 8 20 15 4 - - - 282 I - _ 10 - - I- - - - 292 2 5___ - - L 282 268, 287, 288 280 290 295 0 1 GALLONS 10 20 30 40 50 6' I 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 I I LITERS 0 80 180 240 320 r 400 L-.) I in accord with ILHR 53.05, Wis. Adm. Code COUNTY Sr Cy r X ` Attach complete silo plan on papor not loss than 8 1/2 x 11 inches in size. Ulan must include, but 4 not limited to vortical and horizontal roforunco point (SM), directicn and % of slope, scale or PARCEL I.D. I dimensioned, north arrow, and Iocn ion and distance to nonrost road. APPLICANT INFORMATION-PLEASE P RINT ALL INfO ATA REVIEWED BY DATE d PROPERTYOWNER: / PROPERTY LOCATION rl,It+~,xrr J Buffer QAh _Ptrr - GOVT. LOT tyUj 114NW 1/4,S 21 T N.R t6 (oroW t3. pD. NAME OR GSM N PROPERTY OWNERS MAILING ADORSS v, LOT M, _ Q40GK N, - 3/7-r Vt. 17 New Construction Use [ Residential f Number of bedrooms j J Replacement ( j Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/9 trench, gpd/f12 Absorption area required 37~- b, j, f12 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpolf? Recommended infiltration surface elevation(s) 171K to It (as referred to site plan benchmark) Additional design I site considerations Mo v O r) ~Q Q (I rid , ft Parent material IoPSses -T Flood plain elevation, if applicable IV 14 S =Suitable for system CONVENTIONAL MOUND GGROUNDPRESSURE AT-GRADE SYSTEM IN FILL MOLDING fiANK U=Unsuitable for system ❑ S U S❑ U ❑ S U El 5 jf U 11 S RU ❑ S U 5Wel.(Y SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bas~aly Roots Bed Trt* F::•v:: o~s to f k 31J ~a6k w, l CS 'If idt, 0 S - - - 1 yF- > 2 S -2 Y t o R 5-13 S f n, r o s Ground 3 9y"~~ )D Yfl: S~~ - - J - n ~bk m ,cam d to { b~S elev. JL-5-ft. 30-33 10 Yj? S16 { 2 S YR GlS 5i mcaa ( N, Fr. C W 1 rvF 8.5 Depth to S 33- `I~' 15 Y2 y /6 _ - cl - p f ~F limiting 6 y- `t`d p Y s I f-ab~t ►r~, Fv a factor,, 30 7 48- 57 to YR 5/6 f'lp 5' Y S ed G 0 ►n fij c 59-6X to YR lb IC 5 Y~ Slit sic I v}, tx~ k ~-T7 Remark's: - - eo 9 o- to YR 3/2 _ 5;) 3 F ab► m { C, S <a 17 !o YR Vq s; I 2 ACA ,n fr C S Ground 3 l9-Z 10 YR Sl~ Sit 1 ab~ m fr -.C S - e 15-33 9,sq 6M _ c i i 7,S yk519 c l j ' otbtt w, fr c s 0'2 l s 3-38 Pm 816 n2 P 5- 1 G/9- . sr oi_ I~ a~ ~ ~ c s 1P Depth to - - limiting 32' 11_ 10 Y R 516 2, ~/.2 Sr-1 L f ~k ~G,3- n' ~b'(R rn SYRy C1 d M I Remarks: CST Name:-Please Print Phone: Blru Ce f}lle,, We b5tP, 5'9y 3-08'0 Address: ~ ~ix 2~! _FlfSwo~'f!• ~ `{/~'s 7 yell Signature: Date: CST Number: SW_p~ -y SOIL. DESCRIPTION REPOM Depth, Dominant Color Mottles Structure ' Boring # Horizon Texture Consistence Bw~j Roots GPO~i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed v Ground 3 io YA r16 - jS c I ~i C S 14 (14 . ?/-troy-. • ~o,,~ n. y 21-33 n YR s"~y Y 9.5 YR6/8 m aG~C yin ~i cs )V4 b.,2 ` j . Depth to 5 35- Y2 10 Y9 61q limiting IOF c I O t~, r CS I.~ ' facts 6 42-5'] to YR /Y ~2 Sri R ~ $ c! 0 h, ~i 4 . Zy - Remarks. Boring # 13 t Ground - 'v • elev. i - i Depth to limiting { ,Factor Remark's: _ Boring # Ground i elev. Depth to limiting' c factor } i Remarks: Boring # _ Ground elev. i Depth to - - - limiting t . factor ' ` Remarks: ('lot r Play. so1~ Fva hAtl0L, Report- to{erred iti NI~'Iv OF NW V4 SEA col9 T 28 J R 16 w ~ u Ife ' owns ~~p Lackrrd ow Ro6for 1'(40i,r1 ~.,Yor Fav Not- -1o sccd 'K N 0 PIC 100 ~-SW carrr~ 04- SE'lyo( HW A o~ NW'/y sec 27 T.28ty R 16u,~ Yerilclve qm) hoV ] s2oY~ta Ye~crc~c~ ,,f of ~ -3 Smoke I ~PC.~v~ StR~c- s 1at6't G' ElevaNo~ Red+rthcw 100' EtrvaY~o~ Cior~. 'x.. 98.5. Clevc,foo" owe, ~ 10q-0;' ~a5Frv.. Oro rd. We ,y Rr. 3 gox 23 E l1 s wov t LiJps ;Y011 r9 a 2 T S G WisconsM Department of Industry, SOIL AND SITE EVALUATION REPORT Page _of Labor and Human Relations division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 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 reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE ,2 2 PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1 /4 IJ /J 1/4,S ,2p T g N,R W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # OAD CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE N~~n NEAREST F' ( ) ~a u.(~a e 2 z ~4L . 20 "j~u~ [Construction Use [ idential / Number of bedrooms 7 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material 11'' Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U [Is ❑U [Is ❑U ❑S ❑U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourlday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench - KG Y - I c r ry Ground ~W 112--17 elev. ft. 17 - Z I S% 2 vvt S!~ m; Depth to ~z~ 2~!`3z r1 Zc1 2 2+ m St? rYi, limiting , factor c- 2-66 nn CD i?- C re, Im 1 I Remarks: Boring # Ground elev. ft. Depth to limiting y. factor Remarks: f u7 . Vc l CST Name: Please Print Phone: Address: Signature: Date: CST Number. PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/ft Gr. Sz. Sh. Bed Trench ~ n I Ground elev. h. Depth to limiting factor - Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 4•`........¢ Ground elev. Depth to limiting factor Remarks: Boring # N.A<> Ground elev. ft. Depth to limiting factor Remarks: SB D -8330(8.05/92) r nn ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE _r HUDSON WI 54016 911 FOURTH STREET • 4 (715) 386-4680 Aug. 12, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Robert Kachelmyer property, located in the NW1/4 of the NW1/4, Sec.29, T28N, R16W, Town of Eau Galle, St. Croix County, WI., has been conducted with the assistance of Bruce Webster, CST# 1902. This site was located in the south western most portion of the parcel. This onsite revealed suitable soil for onsite sewage disposal to a depth of 17" while meeting the requirments of the A + 4" rule. This site should be suitable for new construction using a mound septic system having 19" of sand fill. Should you have any questions, please feel free to contact this office. rely, mes Thompson Assistant Zoning Administrator cc: file S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County v OWNER/, (21n J411 ~ ~~f~► GP,Y' ADDRESS Z o) FIRE NUMBER CITY/STATE S-1 wi'o 1/~ s ZIp_ tj `f D y PROPERTY LOCATION: k_W1/4,&W_1/4, SECTION, TILN-RL~_W TOWN OF_ St. Croix County, SUBDIVISION , 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 a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix county residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1), the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. f SIGNED: DATE : 10 __q l St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-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 pormit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), thenla second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -----------------1- Owner of property 0~h L, c~1 ~y Location of property- A/9/1/4 1/4, Section Township /Gi ✓ (D~! ~f Mailing address 47 ~ Address of site ! _7y subdivision name Lot no.-. other homes on property? yes _No Previous owner of property _LC) ~✓f CL e~ ey Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes LNO Volume C I and. Page Number WO 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 & 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 i the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site or 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 county Register of deeds as Document No. ~f Ss~S155 w;. "ture of applican C applicant t3- Signature Date of Signature . 0 CA c o 0 00 190 o:e 'o C, A II !i~` T CD T ~n F r ~ ? d O 3 0 O v j JU O O co F0 ° N C d m 3 3 (NO O cn CD O . { N fD CO = (D 7 C t0 -I S' C N ° ctrl CL a) I CO PD N 0 0 O O O y W (~D N c A N fZD N y W O d° "*r rn P CD m 3 m m y v=i N N N a v O. O O CD 0 0 5 U) CD w co -V CD CO v y ° U) (A C) to (a O d N 1 p C p N O j y W a ° Cn z D - a zmi- O W (n -4 1 3 a C flIw 10 1~ N O 3 O V jL N e W O N 00 000 Wco O c 1 00 OD fT Q °z 0 000 a O n C vi CO) N N n C col co ca III CD ~f oN uCf r 03. T O G » cc Q -0 G G 0) O .O► N 'O O O ' w S'1 'y0 N Qp co = eo m A _ g N CD Ol N 3 7 7 a a ! m , Z Z D D o D o m O O > a s a =r s m CD • CA cn !mi l m c CD CD c N i W fD co O. a 3 a 3 CD 7 o v, o A z ~o 0 m a A z 7 0 W CD CCD ONo CL a 0 Z c 3 c A ;u 0 7 z 0) 3 y N z CD CD I W ~ W 1 0 a C V S y 7 01 a ;:w x A j CO .y. 7 d N S C CVT_1 O c 01 ~CD Oz a ~~am? oz ' D cn A =r CD y N 0) Cl) (D (n C O S C CCDD O. u! S N CD F ` 60C. CD 0 CD 0 t, R Cl p `yC 3 5. 0 0)~ b ON BCD co ~ n CO ~ o ~ ) n m= I 0.. 0 O; (D ur ul N ED =r 0 'a 0 CD 0 ;L CD CD CD U) 0 CZ5 CL O a 0 :3 o b A CD < aro o o 0 0 o ° i Parcel 008-1082-90-080 12/21/2006 04:46 PM PAGE 1 OF 2 Alt. Parcel 29.28.16.439A-06 008 - TOWN OF EAU GALLE Current k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/25/2005 00 0 Tax Address' Owner(s): O = Current Owner, C = Current Co-Owner O - DULLINGER, DANIEL A DANIEL A DULLINGER 170 222ND ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 170 222ND ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R1 6W PT SW NW EXC CSM Block/Condo Bldg: 16/4270 & EXC AS DESC IN 2473/413 & EXC CSM 20-5067 & EXC CSM 20-5073 & EXC AS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DESC 2928-493 29-28N-16W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 11/15/2005 812142 2928/495 WD 11/15/2005 812141 2928/493 WD 08/25/2005 804550 2875/169 LC 08/25/2005 804549 2875/167 moQC 2006 SUMMARY Bill Fair Market Value: Assessed with: 171390 166,000 Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 14,700 85,500 100,200 NO 05 UNDEVELOPED G5 15.893 7,200 0 7,200 NO 05 PRODUCTIVE FORST LANDS G6 2.000 2,100 0 2,100 NO 05 Totals for 2006: General Property 20.893 24,000 85,500 109,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 192.00 Special Assessments Special Charges Delinquent Charges Total 192.00 0.00 0.00 2 2 OF 2 Parcel 008-1082-90-080 12/21/2006 PAGE E 04:46 PM F 2 Parcel History: cont. 08/02/2005 802044 2855/420 LC 12/12/2003 749002 2473/413 WD 07/23/1997 967/410 I 1 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER f ,e tA4e-4 1TOWNSHIP S a SEC. Ct T 2_LN-R W ADDRESS ST. CROIX COUNTY, WISCONSIN k4 y 124 l SUBDIVISION LOT ( LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 QC /06 2 T o / SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~70 ZLZYIy fT t~ ~J ~ EI J plot V QA a INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used _~h ~flP Gj? 41 Elevation of vertical reference point: G U Proposed slope at site: ~f. SEPTIC TANK: Manufacturer: "V L I It Liquid Capacity: O V Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front , Side, O Rear, O 40 feet .From nearest property line Front,0 Side Q Rear, O S'UO feet Number of feet from: well building: l 3 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 PUMP CHAMBER + Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / Bed: Trench: y Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: y Number of feet from nearest property line: Front, (9 Side, O Rear,0 Ft--sSy Number of feet from well: G O Number of feet from building: 2 ~~U (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: • 1 License Number: 3/84:mj 8 QEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING. LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑IIIIIIIILTERNATIVE State Plan I.D. Number. N(U%, W4, 29,T28, 16W ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound . Town o j Eau. GcfUe N M ADDRESS OF PERMIT HOLDER: INSPECTION DAT RobeAt KachetmeyeA RR. 1, Box 150,Ba.2doin, WI 54002 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV_ Name of Plumber'. MP/MPRSW No.'. County: Sanitary Permit Number: Joe Stan GG4G ckoix 112773, SEPTIC TANK/HOLDING TANK: b✓ MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: T WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED. / / 2:: ~ VYES ❑NO ❑YES NO BEDDING: IVENT Dlq.. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. JBUILDING. (VENT TO FRESH Y/ ALARM. LINE'. AIR INLET FEET FROM ?e ? V ❑YES NO ❑YES NO NEAREST D K •JVD DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCwys MATE ~ PIT DEPTH DIMENSIONS J GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. D STR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEyV. INLET ELI~j END • PIPES LINz AI INLET e FEET NEARESTO S~ G .~G 3.5~ SL 721 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OliSEHVATION WE LLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODOEO SEEDED IMU'CHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL IND DISTH JD~STRPIPE DISTRIBUTION PIPE MATE HIAL & MARKIN(~ ELEVATION AND ELEVELEV.DIAELEV.PIPES DA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: 00 PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPS TV WELL: BUILDING. FEET FROM LINE I / Ut/ ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Re in in county fi e for audit. Reverse Side. SIGNATURE ITLE DILHR SBD 6710 (R. 01/82) Zonin A SANITARY PERMIT APPLICATION cou T 17-b""ILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT# 3 -Attach complete plans (to the county copy only) for the system, on paper not less than s T PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO PROPERTY OWN/ER PROPERTY LOCATION /96 br' I< G~r= ell V11, tjL/'/4,S2 TN,R / (or)CWD PROPERTY OWNER'S MAILING ADDRE S LOT NUMBER BLOCK AMBER SUB IVISIION NAME fl. I /30 /go a I 0//7- rv 4 CITY, STATE ZIP CODE PHONE NUMBER CITY NEARryES/T~ ROAD, LAKE OR LANDMARK L74 !i~ k/ $ ~UCXJ O VILLAGE; II. TYPE OF BUILDING OR USE SERVED: 'PAIMM Ij7 ' OCR5 O Number of Bedrooms if 1 or 2 Family ORE] Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ❑ New b. 9 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OOFSYSTEM: (Check only one in ##1 and only one in ##2) 1. a. ykonventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. E:1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ See a e Bed b. Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): N114 5-0 'N, 2 ' 94 7 Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. Con- INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank ~UUU ee- ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber 1 El I El VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb 's Signature: ( Stamps) MFrMPRSW No.: Business Phone Number: oe. Sta. GG ?Is- Gf~ 2GG Plumber's Address (Street, ity, State, Zip Code Name of Designer: uG k/"&,w prt W ",'~/C k/, 5-y4, ~2 ~r t 2 1-✓ z VIII. SOIL TEST INFORMATION C7e-tA- ied Soil Tester (CST) Name CST # e e 3 7 L CST's ADDRESS (Street, City, St e, Zip Code) Phone Number: C 0?U Z-/)-r L.lp R7 I',/, s -wo 1 I lS C I V~ L 47/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) FJ1 Approved ❑ OwapnerGiven Initial D SurcharFee ;2 ~=2~ Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: pj WYLO Plumber SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION y TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. . Private sewage systems must be properly maintained: The septic tank(s) should be pumped by a licensed pumper` whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimenta approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bili Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure x_ is used in your building is returned to the groundwater through your soil absorption t o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t~ water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) 1- r ~i ~r 9 a p f. i { -F' a.a.. _ '.I Y ~ r f4 acid tb* ;Southe"t Quwter of ~~t` a~; - !Miwt° ~iittbi~st Qwster o! ~ Wit.'. ~3-• feint ~ ! ~ ~ ~ +lt fir. t fi 41 y h` ~y~ iyN ' 4f t ie { i'• '1 IT ~ S K_. 'Yr n r h .~C r at - v~ eD x l a - 1 x ~.w. sA' r................. 06 n MM.._. .(..,f~ - W 4!knowlw e - ~ . ~ r R fi~oi~ 4~n 7F ~D tl .iY.. ~Fw~a, r-wd" t1 d''~•y'-~`t ~h~C. At. Niwi, ►~wci~.;rntyy~.1 ..r-yttM.d D~k,v t►eir **Ut.ns, •,r n t ~ F• z ST C- 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d 9 t / I/ / / H OWNER/BUYER 1 6 , t et ect r- Gt e- 1 rvi G c~ 2 0 X 1 5 U Fire Number ROUTE/BOX NUMBER /C /20)(, CITY/STATE 86 4t", S 7.IP j L~GU 2. PROPERTY LOCATION: 11`4/14, Section, T N, R~W, Town of /`G Lt Oyu Ile St. Croix County, Subdivision N, fY Lot numberd-LI9 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into lI the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE L St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPT-,H TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS `INUi,'cTR°:, - DIVISION LAM°R AND PERCOLATION TESTS (115) MADISP.O. BOX 769 ON WI 537 .HUM 07 RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: ~TOWNSHI'UNICI PALITY : LOT NO.:BLK_ NO.: SUBDIVjSION NAME: sw 1/4 u~'/ z9 /Tz$N/RG1tL.~E - - (COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS: S 6--e 1r KA C- V-1 el-M G Y E 2 _ Q w j w t S V o o Z USE _ DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER LA ION TEST w E New Replace g 3u . IP p ~j , N Residence _ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) IS DU ®S DU~ $ DU ❑ S ®U D S WU Z.'t 7vCti _ tst~c.N s'x s 'cur., DESIGN RATE: If Percolation Tests are NOT required If any port on of the tested area is in the ?V under s. ILHR 83.09(5)(b), indicate: Gl.l`CS S Z Floodplain, indicate Floodplain elevation. PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IBS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPPTH NUMBER DEPTH)X. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) o. SN 73; _Z 8n Si l; L/•6'Bn B 1 •S qj,l-O~ > S, )IS -'.)Z'CS o -mow wtAlrcL- ~e-~ tai in n I o.7 • Gy l~n si 1 Ts B ►vprv~ > ~•S. 6• J Ch S ►~~`~S 19 h.,p m ~ S 'L.•'Kert S t=o.v B 3 3' 9 6.5' f.~oYv E 3 o. 6' ott 6 An 5 S 1 w SUQ17- Gl - S.9' 3n 1S K+~•~S Raw M S L.x`fERS A i B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 'PERIOD 2 PERT PER INCH P- P PQ 1fTILL -CTZ c S 3b " _f-~IFTP 5kT X~wN NA L CMGE. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical eievation reference points and show their location on the plot plan. Show the surface elevatioon at all borings and the direction and percent icnd slope. cj l i ~Nf,\M a Z .7 ' SYSTEM ELEV TION Cl 1•-1 S <IPIZ= r~~ gruel _ ~O. LvJ SPlt~C ~►~8ou~ G2~v~DD 1N DoUBL~ t~yD)p. DRwEwA`T Sj`T~ LU~hT~D, 4SOLZ. $ 30o w, OF 11 ~ `n t E ~E ~-oY..t.~ ~ OF T}tE Sw ~iy- ~w~~y z5P_ LpCATfON St<ETC zoo B ►'I q `1O 1 OQ X ~ --15.3 SITE 5 N - ♦ 30o - i{ - N__ - } hue 4 10 s c Pc~L = 6 o r e~x e.;~T Rs 3 t-towN St''c' z4 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. .NAME (print): TESTS WERE COMPLETED ON: L&3 G:-G '~DDRESS: 14 $uK ZZ (o CERTIFICATION NUMBER: PHONE NUMBER(optional): S-)b -))S- yZS-aby L CSTSIGNA L)ISTRIBUTION: Onginal and one copy to Local Authority, Property Owner ad Soil Tester. DILHR-SBD-6395 (R. 10(63) -OVER - Ru, e , Abu ®rl 71 9y i U v~rJL l~ verx IF J 0 84, n 00? wtl ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 July 11, 1988 Mr. Bob Kachlemyer Route 1, Box 150 Baldwin, WI 54002 Dear Mr. Kachlemyer: Enclosed is the violation on your failing septic system. Grant monies are available through the Wisconsin Fund to assist you in payment of the new system. I have also enclosed an application form, should you wish to apply. There is an income limitation for qualifying for funding, that being no more than $48,250 in the year 1987. You may check this from your 1987 Wisconsin tax returns. If you used Form 1, the totals of line 5 is your guideline, and on Form 1A, line 7 and on Form WI-Z, line 1. Should you wish to apply, please fill out the front page of the application completely, making sure to include the tax parcel number (from your property tax statements), and the Register of Deeds Document No. (from your warranty deed). Return the application, along with a copy of your 1987 WISCONSIN tax returns, and the application fee of $150 to the Zoning Office, and application may be made as soon as the permit has been issued for your new system. Should you have any questions, please feel free to contact this office. Sincerely, ~W, hvL N Ot";kA Roxann M. Croes, Secretary St. Croix County Zoning Office Enclosures o APPLICATION FOR SANITARY PERMIT STC - 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 U h e- f 1<Ct C~ l rh c. r~ Location of Property S k/ W Section , T N-R~ W r Township ~4 Nailing Address Z, C, p3 k It/,' S S ~!G G Z Address of Site .S AA.-, Subdivision Name (J Lot Number { Previous Owner of Property M e r"~ c ~"C r f t 1.4 kl..r y Total Size of Parcel lelo Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume -Cg2 and Page Number S M 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cen.ti.6y that aU s.tatement6 on thi.6 6onm are tAue to the but 06 my (our) hnowtedge; that 1 (we) am (are) the owner (s) o6 the pnopen ty des cA i.bed in this .in6ovnati,on 6onm, by viAtue 06 a waAAanty deed neconded in the 066.ice o6 the County RegiAten o6 Deeds as Document No. and that 1 (We) phesen,tey awn the pnopo.ded Aite bon the sewage d"pos system (oh I (we) have obtained an easement, to hun with the above deachibed pnoperrty, bon the conbtAucti.on o6 6a.i.d system, and the same has been duty neconded in the 066.ice o6 the County Reg.is,ten o6 Veedb, ab Vocament No. o(I `l y~ 1. SIGNATURE Op OWNER r SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED V o n y~ PA G e f G