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008-1038-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 191 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Albrightson, Craig W. & Kelly Eau Galle, Town of 008-1038-80-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 13.28.16.197 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ,---1, \- Alt. BM Aeration Bldg.Sewer q•71 /65 , /z Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing t 4_,. k.' 5 �t „c....... Header/Man. Aeration - Dist. Pipe Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover Ze //q 3 Model Number 6:ir tL.i \� (r)7 Z.3 n.-7 9 /, 7 1Lift TDH Friction Loss System Head i TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION E` CHAMBER OR Type Of System: ,s,r 5 UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution /� /V x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) (J//x Length Dia Length Dia cing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Ea Yes El No 0 COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 2680 County Road N Woodville,WI 54028(NE 1/4 SE 1/4 13 T28N R16W) 40 acres Lot Parcel No: 13.28.16.197 1.)Alt BM Description= I 4-3 t.ue-N4, /60 2.)Bldg sewer length= /I__ -amount of cover= / C, v� �; �.5 G.O C-ikS v,°��S S 6 c.�X_Q Plan revision Required? n Yes j No / / -7 / 1 3 X34 s Use other side for additional information. I I u`' I+ ../ ____ SBD-6710(R.3/97) Date Insepctor's ,gnatu/ Cert.No. p,rj X4,11II.A-5 ree- County Sanitary Permit Application ST. CROIX CO WISCONSIN Gp,~O 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 ri [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 STL 1. Application Information - Please Print all Information Location: 4_&450 (_4v k~t JAJ Property Owner Name Ree E )I, N L 1/4 S~1/4, ec 13 t a; ✓ : ~5~ oEaaF Z$ N, R 1 E (or Pr perty Owner's Mailing Addrew 1 PRGo 6 G l Lot Number d Block Number 1, A 61W - - - - Zb D Govr~" GY141~ 9 IV City, State FoR e Phone Numer Subdivision Name or CSM Number W o~ :11'Z A \ s1 .1R# 15yoZC6 1 S - 6°1$ - 399e it T f Building: (check one) amity ❑Village Town of 1 or 2 Family Dwelling - No. of Bedrooms: ji ( ❑ Public/Commercial (describe use); A q,) a 9- 0 State-owned Nearest Road It. Type of Permit: (Check only o le-tax on line A. Check box on fine B if applicable) 9,a N Parcel Tax Number(s) ' q-7/ 1Repair 21 Reconnection .❑Non-plumbing 4. ❑ Rejuvenation ` 1 A) Sanitation O 13 o o p B) Permit Number Date Iss ed /State Sanitary Permit was previously issued R J V Q 2 ZDD IV. Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground Mound z 24 in. suitable soil ❑ Mound < 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information 1~ _n Ai CW__ 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area . Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required AjJ- Proposed (Gals./day/sq. it (Min.finc ) 5~ Elevation t o o v 1603 I 3 `940 o.s A o qy. 3 VI. Tank Information Capai ty in Gallons Tot # of Ma ufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks 1e ❑ ❑ ❑ ❑ p IF' ❑ ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnenction/rejuvenationAnstallation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the instpliation of non- mbing sanitation system. Plumber's Nam (print) Plumber's ignature (no to MP/MPRS No. Business Phone Numb L 11 ~ 2 _7(S CY-11 3 Lf 7S _&5 ~o 7' ri! Plum , V0 Addr ea,, Street, City, tate, Zip Cod J) Vill. County Use Only Disapproved Sanitary Permit Fee Date Issued I uing Agent Si na e s ps) Approved Owner Given Initial Adverse ZZ S. /Q~ 0/20 Determination IX. Conditions of Approval/Reasons for Disapproval: SYSTEM OWNER; /C~(//f~ CS h h 1. Septic tank, effluent filter and 12- 4ae dispersal cell must be serviced! maintained Jv~ as per management plan provided by plumber. V /C~IX Qh~ _ / /r 2. All setback requirements must be maintained -~"~v~'►~- r v~ as per applicable code/ordinances. & 0,,, q;~ - inT4Ae__ 7f-- be, &K a ,40 0 _ O C co~ z z ~ m mm O m r x ~ O Cl) a m m Cl) 0 z 17~ m D -n r r ~o m p O -I C7 0 m p m m z O Z ~ o m ;um Cl) c p *mews C/) C) o X ~ `C z o O O - .4 CC z 1A z~ mm mT EQ vv~ ~ mn~ -I m v ~v CD a`v I'D = p DQ w (D S (D (D CD Q n 3 S S 0=1 S m C a y (D C= f!J D7 31 O _11 m y ? m N m 3 ai o a _ o (D N N (D O y m m ~3 =m o =3B 5 TTY (D (D c? T N 7 N X y d VJ m N N X S n Q a < 7 CO) =r 0 3 3 = (D m m o m a o N= N, Q' Q 3 p N w '0 CD CD cc (C y m c (D (STD a v v m o v < '0 m 0 a a 3 a v o 3 CD M o n, ca z CD_ = o m m ' 0= r-~ 3 y?m CD 03 C: m zr Z o (D o S o m Z C I71 o (D m o 0 o C7 m cr -4 -0 =ID CD I:R a (D o T (D v; rL O O Z O D CD CD Z Z G) Z 57 3 v o m m t7 c CD =Wr 0 o ❑ ❑ ❑ _ _ CD 0. f x ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This i to certify that ave inspected the septic tank presently serving the .ie.! ~z~s'oyc residence located at: N 1/4, 1/4, Section , Town 2. C N, Range__J_~_W, Town of G'me- , 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 Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: zoo Construction: Prefab Concrete A~ Steel Other Manufacturer (if known): Li~~ ~ - -1-Age of Tank (if known): /Z V,e - 5r&!S7r -L L,6b 2 00 1 (Lice sed Plumber Signatur4 (Print Name) C)1-/ham Wl-'-9 fz-? s9 (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) aff ea!S rUA,C~ya.1 J (o e( , 8 1 8 8 1 6 8 Tx : 4156!)32 Document Number Document Title 987456 St. Croix County BETH PABST REGISTER OF DEEDS Occupancy Affidavit ST. CROIX CO., WI RECEIVED FOR RECORD 10/11/2013 2:23 PM GCq~ ~s° EXEMPT Name-- (Owner) Ty ed or printed REC FEE: 30.00 being duly sworn, states, under oath, that: PAGES: 1 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 11 Page y 460 Document Number ~9 St. Croix County Register of Deeds Office: Recording Area Name and Return Address A parcel of land loc ted in thee of they t of Section C q.9 M b r ~ b o r, T 2 $ N - R 1 W, Town of `c-11, 6.11\),Z- ,St. Croix 26 Zxy R ~ t l County, Wisconsin, being duly described as follows (include lot no. and W o~dJ ~11~ SyoZ `a subdivision/CSM or detailed legal description): F SI I f Sec, 13 N- M6~ 666-~a3 - o -o o Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a bedroom home, or a design flow of 6oo g pd- The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently occupants living in this residence; `6 occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of 0 G~'ob~ 7-o)2> G.o 1 6 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenttcated this day of St. Croix County. ) P rsonally came before me this day of aAt- PM a above nam 1 * ~.J~ r-1 %F ••%t~2 0% TITLE: MEMBER STATE BAR OF WISCONSIN N 113 me known to the person(s) who exetxrt the foregoing not. (authorized by § 706.1)6, Wis. Stats.) Z astrument a wtedge the same. O . THIS IN TRUMENT W DRAFTED 15Y Pv~ f~C~ Notary Public, State of sconsln (Signatures may be authenticated or acknowledged. Both are not My Commi on is pe anent. If not, state expiration date: l'/~' necessary) Date; "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" 7bls intimation must be completed by subml(ier document title. name 6 return address. and 'SIN rd regtdned). Other intimation such as the granting pauses, ieagal description, etc. may be placed on this fast papa of the document or may be placed on admiorw pages of the doaxnent Note: Use of this crnrerpage adds one page to your document and ,$2 to the recordina fee. Wisconsin Statutes, 59.517. 1 of 1 5 au~m H®m& C/o l f C/o Q) 1 D w~Tj L 4a `lo • ~ ~ ~ 8t1 2 - k ZS o~ Ao. °\0 o o r»r east PA eY 468 +3 STATE BAR OF WISCONSIN FORM I - 1999 664979 i:ATi•ii.EGt~ H. WALSH Document Number WARRANTY DEED i~ c:TER OF DEEDS S-%'- CROI X CO., WI This Deed, made between John E. Zignego, Joyce M. Langer, RECEIVED FOR RECORD Ronald J. Zignego, Richard D. Zignego and Linda A. ideen 12-1-7-2001 8:25 AM _ _ _ vupF:FAb1:TY DEED Grantor, and Craig W. Albrightson and Kelly M. Albrightson, H husband and wile, as survivorship marital property ~GY FEE: Y FEE! isSFEn FEE: 495.00 - - ''t CRDIt1G FEE: 13.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): The Northeast Quarter of the Southeast Quarter (NE-1/4 of SE-1 /4) of Recording Area Section 13, Township 28 North, Range 16 West. Name and Return Address AND Craig & Kelly Albrightson Part of the Northwest Quarter of the Southeast Quarter (NW-1 /4 of SE-1/4) 738 Oriole Lane of Section 13, Township 28 North, Range 16 West described as follows: Hudson, WI 54016 s Commencing at the Southeast corner of the Northwest Quarter of the Southeast Quarter (NW-1 /4 of SE-1/4) of Section 13; thence North along the 40 line 29 rods; thence West to center of highway; thence Southeasterly along center of highway to place of beginning, all in Section 13, Township 28 008-1038-80 and 008-1038-90 North, Range 16 West. (PIN #008-1038-80 and 008-1038-90). Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (4s.) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this '-l day of November 2001 * * o h n E. Zi n o i. ~ * * SEE ATTACHED EXH'A' FOR ADD'L SIGNATURES AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF IJ/,tj,(/~e~~ ) - ) ss. - - ~CAH~y County ) authenticated this day of _ T// Personally came before me this _ day o1' November 2001 the above named * John E. Zi ego v SABERG TITLE: MEMBER STATE BAR OF WISCONSIN - - to me kno to b i why exec`,tcd he po (1 f not. G~)' - „ _ eras Jan 31, g instrume d ac pA t. + .,vs137n~...::,,.~,,na~:..~.'VWWV ■ authorized by § 704.06, Wis. Stats.) THIS INSTRIJME;NT WAS DRAF'T'ED BY Timothy J. Scott _ Notary Pub ic, State Bakke Norman, S.C. - New-Richmond" WI 54017 - My Commission is permanent. not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) JA.v!A 3/ _ _,o~ * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Company. Fond du Lac, wi STATE BAR OF WISCONSIN e00-655-2021 WARRANTY DEED FORM No. 1 - 1999 YO!. 118SPA(;F 469 EXHIBIT 'A' (Signature page for Warranty Deed from Zignego et al to Craig W. and Kelly M. Albrightson) Jo a Lan er IV I ACKNOWLEDGEMENT STATE OF lrlcnat..>G~v t.)LCOCOUNTY Personally came before me this __6!t day of November, 2001, the above named Joyce M. Langer, to me known to be the person who ex cute t~e foregoing instrument an doe.Ativ,se 1. ~o~'ru n cy KRISTY '_XF KROENING Notary P lic , My Commission Expires: a n.!~ 3%,cn5' 'Ij' ''c bYtJ~SOTA .pVC(vf,,; - rIwm Jr. 31,1006 Ronald J. Z an o!<V ACKNOWLEDGEMENT STATE OF A ~ZGfJ/¢ COUNTY Personally came before me thi day of v ber, 2001, the above named Ronald J. Zignego to me known to be the perso who execu I oregoin Inst ment and acknowledge the same. -("(G~Ly' _(jc nG OFFICIAL SEAL CINIDI Notary Public NOTARYP BLHIC- RZOpAD My Commission Expires: 5 , 009 PINAL COUNTY M Comm. Exprrts 'qqy U, ZQ3 X aft Lc~• ~i Richard D. Zignego, ACKNOWLEDGEMENT STATE OF ~ZrrLrz~ptw. /L, ti COUNTY Personally came before me this /01(lk day of November, 2001, the above named Richard D. Zignego to me known to be the person who executed the foregoing instrument an 7KRJ-8T`Y!'-EE KROENING F'U; IC - MINWSOTA Notar blic Y s•:s, ~.,.r,.,<~.w ~Krm jar 31. My Commission Expires:% kza 31, -Ro05 sw+~~ Ve Linda A. Videen / ACKNOWLEDGEMENT STATE OF `77Gc~2+u~o'fiC: 4dz.ah"'7q ~c7 COUNTY c Personally came before me this (vim day of November, 2001, the above named Linda A. Videen to me known to be the person who executed the foregoing instrument and acknowledge the same. GO2tw~--t MAPw.r•. ,..-•v 1nNvvv,ryl Not rP lic KROE NING Y M y Commission Expires: 3P;;"-,. NNESOTA =ttxran. 31i2006 nnMVyyy 10/07/20 E I OF A 1 Parcel 008-1038-80-000 PA3 09:50 P 1 GE Alt. Parcel M 13.28.16.197 008 - TOWN OF EAU GALLE Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ALBRIGHTSON, CRAIG W & KELLY M CRAIG W & KELLY M ALBRIGHTSON 2680 CTY RD N WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 2680 CTY RD N SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 13 T28N R1 6W 40A NE SE Block/Condo Bldg: (EZ-U-1111/046) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-16W I Notes: Parcel History: Date Doc # Vol/Page Type 12/13/2001 664979 1788/468 WD 07/23/1997 886/420 07/23/1997 756/355 2013 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/06/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.500 24,800 165,100 189,900 NO AGRICULTURAL G4 37.500 4,700 0 4,700 NO UNDEVELOPED G5 1.000 50 0 50 NO Totals for 2013: General Property 40.000 29,550 165,100 194,650 Woodland 0.000 0 0 Totals for 2012: General Property 40.000 29,550 165,100 194,650 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399501 ' GENERAL INFORMATION (ATTACH TO PERMIT) "aa ~Ptlan ID No/: Personawnformatigrryou provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. (s~7 tP Permit Holder's Name: City Village X Township Parcel Tax No: Zi ne o, John Eau Gallo Township 008-1038-80-000 CST BM Elev: Insp. BM Elev: BM Description: o..( L •af S oQr- CS'(- P"",* TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ,O 1vS;~ t lTO 0, ope Z aa/gb Dosing L% Alt. BM Aeration Bldg. Sewer Holding J St/Ht Inlet ~t 3S St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S7C) I } I t r Dt Bottom I 88-Z)3 / Dosing r t 1 p -ti Header/Man. g3 ~.o.w. la 3 S I~' Aeration Dist. Pipe S t Holding Bot. System Final Grade PUMP/SIPHON INFORMATION EIE e. Manufacturer Demand St Cover b 3 f Model Number G~3 Sb \ , TDH Lift~•i~ Friction Loss System H S TDH ~~Ft Ho Forcemain 1 Length 1 Dia. tt Dist. to well 30 z I tso SOIL ABSORPTION SYSTEM ~(o o f 3 7- BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Die. Liquid Depth DIMENSIONS I r / _ 1 f I lG "T a. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anufacturer: INFORMATION CHAMBE Type Of System: i UN Model Num J 1 DISTRIBUTION SYSTEM C) 3.90 Header/Manifold Distribution _I t x Hole Size x Hole Spacing Vent to Air Intake f „ tt ZH Pipe(s) .31. SC~r'` 0 3 •D 3 1 /a 3 6 t' iLengthlo, Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S ❑ Yes JOB No rim] Yes [1-11 No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: I- / Ni/ G Inspection #2: i - t-- Location: 2680 County N Woodville, WI 54028 (NE 1/4 SE 1/413 T28N R16W) NA Lo NA "'~i CL Parcel No: 13.28.16.197 n 12,04- Sc:cavef 1.)Alt BM Description = 1ft6"-c*Q- "r*v"°"A C 5) 2.) Bldg sewer length V,,12.r • + O° ` - amount of cover = 5 W Q t 3.) Contour =13.aot~ l[• 10' o K~ - /°S•0 - an revision Required? ❑ Yes No Use other side for additional information.' 2 Z I SBD-6710 (R.3197) Date Insepctor's Signature Cert. No. Safety and Buildings Division Coca 201 W. Washington Ave., P.O. Box 7162 7e , li, o " ✓ SIN ~ Madison. WI s37 Site Address NN J' cnsi De a tment of Commerce 2 ~L N jy Permit Number . , Sanitary Permit APPlie 319 51D I in accord with Comm 83.21, Wis. Adm. Code. Personal inf you R"tl V~ Check if Revision may be used for Law. 1 m 2001 Plan I.D. Number . 1. Application Information -Please Print All Information DC T 29 Property Owner's Name Nummber • Z '0 U Property own er's Mailing Address Property Location 3 C~ f N. LPL L (r Z G z. L- I i v x' r 56 S I3 T -2k N. R 1 G E City, State Zip Code Phone Number Lot Number Bloch Number i ttattta► Subdivision Name CSM Number U. Type of Building (check all that apply) 13Ch3' ~l 1 or 2 FamrTy Dwelling -Number of Bedrooms []Village e • 0 N owttshmp t t 4 I 0 Public/Commamial - bey Use 0 State Owned e t uR r O / u 1kA Road X(v~' cam. b III. Type of Permit' Check only one box on line A (numbering scheme for internal use). Complete line B V applicable) A 0 Addition to For County use 10 New 2 ~ System 3 ❑ Replacement of 6 stem Tank S stem Permit Number - Date Issued B. 0 Check if Sanitary permit previously Issued IV. Type of Permit: (Check all that apply)(mhmbering scheme is for internal use) ^ I-" . 47 0 sad Filter 5o 0 Constructed Wetland 44 ❑ Non Press►mrized hi-Ground 21[~ Mound 22 0 pressurized In-Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line Recirculating 30 ❑ Other 45 0 At-Grade 46 0 Aerobic Treatment Unit 4911 V. D' tment Area Information: Percolation Rate system Elevation Final Grade Design plow (gpd) Dispersal Area Dispersal Area . Sod Application Elevation Required Proposed Raoe(Gats./Days/Sq.Ft.) (Mitt.Mch) e3 in Total Number Mamrfactrer Prefab Site Steel Fmber Plastic Vi. Tank Info Capacity Concrete Constructed Glass Gallons Galion of Tanks New Exisft Talcs Talcs v Septic or Hol nL Tank b U i/. G S c' y Dosing C6arttber ~ U ~ ~ VII. Responsibility Statement- 1, the , assume resP ' for installation of the POWTS shown on the attached Plans. SS ignature MpMIPRS Number Business Phone Number plumber' s Name (Print) PluCmber's/Address (Street/. ity, State, ) J G Ltd, l [ . ra 61L,-1, tic- 4/ 1 S - cr G 'L VIII. Coon ent Use Od Si (No stamps) Sanitary Permit Fee (includes Groundwater Dace Issued Lssuitig Aget Snatrmre XAPproved 0 Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse 325" Determination / G .44 approval IX. Conditions of ApprovaMeasons for Dis SYS ~a.,t~s►r is t fix. _ -U 11 inches in sde / PLOT PLAN ✓ Scale 1"= Page 3of Uo C" czKy-%Vjz:~ gyp t# Z- fit.. q'1.p' 0)J `MP OF WM > FeQCE ROZT, .C~lb Nth. DOS- 1038 _~p _ _ - k 92 f3M 1{-'L or- yk ZS of S t~-n 0- y `tp 43~ fM ~ ONO Z 1~3 P~2 ~1DN , / / ~i 2 ccy.ho`~Z tz. a V, p' S' `mss. 80','Mm OF CZLL LTL Ojq. S ao 1M•O. W . UN r)UT'F'pt -L 00 vvOT L°0~'1Pflt~T ~ ZS O 1'U ovz- tl. 19T1~Zi3 z O T14 Sr. Q e-f1~ ~y NOTES: - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be ZZ.~U/gp0 gallon capacity manufactured by W LL5e1Z COrv C\- Z-eT-J:~- L-J/ 4. Bench marks ; S ~ Pc~3ove S. Divert surface canto,- a Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD (608) 264-8777 f scons n www.commerce.state.wi.us/sb www.wiscon isconsin.gov Department of Commerce Scott Mccallu overnpr Philip Edw. Albert, Acttng,,Secretiary October 23, 2001 CUST ID No.691727 ATT: POWTS INSPECTOR ST. CROIX COUNTY SPIAj ~Y ARTHUR L WEGERER 1101 CARMICHAEL RD. Zs_ WEGERER SOIL TESTING & DESIGN SERVICE HUDSON, WI. 54016 NJ PO BOX 74 RIVER FALLS, WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/23/2003 Idcntificat' s Transaction ID .6834 6 SITE: Site ID No. 6379 Craig & Kelly Albrightson - 2680 County Hwy N Please refer to both identification numbers, Town of Eau a e~T , St. Croix County above, in all correspondence with the agency. NEIA, SETA, S13, T28N, R16W FOR: Description: FJj Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 816515 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01101). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Owner Responsibilities: • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. ARTHUR L WEGERER Page 2 10/23/01 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Craig Albrightson r Safety and Buildings > 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD (608) 264-8777 r. www.commerce.state.wi.us/sb Visconsin , a' www.vAsconsin.gov Department of Commerce R r ~ : Scott Mccallum, Governor t Philip Edw. Albert, Acting Secretary 4 ss Cper October 23, 2001 C 60 • -100* CUST ID No.691727 POWTS INSPECTOR ST. CROIX COUNTY SPIA ARTHUR L WEGERER 1101 CARMICHAEL RD. WEGERER SOIL TESTING & DESIGN SERVICE HUDSON, WI. 54016 PO BOX 74 RIVER FALLS, WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/23/2003 Identification Numbers Transaction ID No. 683456 SITE: Site ID No. 637999 Craig & Kelly Albrightson - 2680 County Hwy N Please refer to both identification numbers, Town of Eau Galle, St. Croix County above, in all correspondence with the agency. NEIA, SETA, S13, T28N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 816515 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01101). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145-19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Owner Responsibilities: • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. ARTHUR L WEGERER Page 2 10/23101 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Craig Albrightson Y a TITLE SHEET Page 1 of 7 FOUND SYSTEM FOR A L4 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD-10691-P and the Pressure Distribution Manual SBD-10706-P (N.01101) (N.01101) LOCATED IN THE kl~ 1/4 OF THE SE 1/4 OF SECTION 13 IT Z6 N,R )6 W, TOWN OF E~tv G1ruL~_z S'T^. QXZU 1X COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR GIzS'rL6 ~1vb=vi'--~~~35 acv PREPARED BY ' WEGEf~ER Sa I L . TSST = !V G AND. - DES = Gfit SERV S CE P.O. Box 74 421 N.Main St. River Falls WI 54022 Phone 715-425-0165 :dF~ Fax 715-425-6864 A I,' ro, R'ELLatI ';',rYt. j N,'fJ. I P 0 .T.S. t r diti°nat Y I C' N" C°~ P R01ED ym C0M W1~EN ` ~va~~~~l pEPARTMEWt OF ` % e ~►10 i~ -1`7 -01 pNiS10" of - ES • PENCE R SEE COR JOB NO. 0) _ Z67 Mound System Management Plan Page Z of 7 Pursuant to Comm 83.54, Wis. Adm. Code Seotic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. T erating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessary to nsure ro eration. The filter cartridge should not be removed unless provisions are made to retain so i sin a ank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tanks If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pum° Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual {S$6-}9672 P (f -~}gg)}and local or state rules pertaining to system maintenance and maintenance reporting. -S %1b -1)b ° l - P CNo 1/0 6 No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at j - 3 ZJ - L1 6 a0 SY . C°_ lX The system installer at -1 l0 - °l - Z,Z 6 ST`t~cyv6 The tank manufacturer at 1,71 3ZS- i5 LIS Ly t t?s~2 The effluent filter manufacturer at ~C~O - Z21~ 57 Z gyp`-L~~ The pump manufacturer at y g QU L~S G PLOT PLAN ✓ Tage 3of Scale 1"= qC) ✓BwI w-z cri& pyU `mp of wmD. F j CF- P(1a-r; C IO i130, _00 8- 1038 -$o - k we-~ ~ Hal M1 t, PM 4E'Z yk 7-S' ,tpolk ~ tW ptt3~Dc)N~ dy r 2 echo~2 L-L. q U. o' S Ct.b.w. uNk~- oQ1 rvOT C°Ow1 PPr2.Y ZS p' ll o~Z D IS'CUr Nis ~ z-lo r1+ Sr. NOTES: - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be \Z12 ~-0o gallon capacity manufactured by 4. Bench marks S P~3~v~ 5. Divert surface water around system to prevent ponding at the uphill side. Page L4 Of 7 Approved Synthetic Covering ASTX C33 Distribution Pipe Medium Sand Topsoil Ia = F E? ev. q S E a 3 - b 9. % Slope Distribution Cell of Force Main Plowed 2" to 2-2 " Aggregate From Pump Layer p p_SoFi. E 1-S1 Ft. CROSS SECTION OF A MOUND SYSTEM F Oa Ft. G O- S Ft. A _9 Ft. H 1- O Ft. Linear Loading Rate=?.95 GPD/LN FT B 67 Ft. Design Loading Rate=6,T=,GPD/SQ FT I 1 1 Ft. J S Ft. K Ft. Position of , L g S Ft. Force Main W 2 S Ft. -Observation Pipe O-r - A a------~6$---- yy 0-- -----------------------I--0 Distribution 1 „ Pipe Cell of ~ to 21-2 aggregate Observation Pipe (Anchbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page S of 7 Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 450 fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug, T `-t P 1 C' L \~S S S?~~lp 1~j PVC FV~ PVC illll Lateral Manirold Lateral x x x x x2 x2 x x x x Lateral Length - Lateral Length - p Distribution Line LAN N\EW • P ~ r~cc;~s six S V c-- ~'V C ~=aAC riR7N P 3t.SFt. Hole Diameter 31]6Inch S 3 Ft, Lateral I Inch(es) X = Inches Manifold Z Inches Force Main " Z Indies l of holes/pipe ti I Invert Elevation of-Laterals 0-15-0 Ft. 2,6) 6 - Ll 3- S6 cPrl Combination Sep,ac;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE OF 7 • NEWT CAP WEATHER PROOF JUIJCTIOIJ BOX . '1'C.1. VENT PIPC APPROVED LOCK I?JG 10' FROM OOOR, 11,kWHOLE COVER P,71 V -kDOW OR FRESH t,uA(tIJltJG LP.6EL.. w std a.np A!R IIJTAKE { coratwtT . ' rj FtNis"jm> .tel. q1 f ( `f AIM. G Zpso E I - 18' /"1111. 18~P11IJ. 1JLET i" PROVIDE ( - • AIRTIGHT SEAL I I I ~ I I~ I Approved Z~- ~wT~z I III Approved joint jJ/_~p~ I I ( joint w/ PVC pipe o if ALARM PVC pipe ( I ( ou C I i CLEY.M%3FT PUMP ~ --J OFF D COMCKETE eLocK RISER EXIT PERMITTED OIJLti IF TAWK MAUUFACTURI`R HAS SUCH APPROVAL Bt=DOI tv 3NDD.NQ SEPTIC f SPEC.IFICATIOKJS .DOSE TAIJKS MA►JUFACTURER: jJUMBER OF DOSES: S• O • 2~C~ / PER DA.. TAIJK 51ZL : V z_(80 SOL GALLOIJS DOSE VOLUME r ALARM MAMUFACTURCR: S•T 9JQ=FIZQ S`i3 &1S I.NCLUDING BACKFLOW: 1Z-3'~O CALLOW. MODEL ►JUMBER: CAPACITIES: A= INCHES OR L4 LZ.O GALLOt,I s SWITCH TtIPE: - 8 = IAJCHES'OR G~.LL04J$ PUMP MAMUFACTURER: GQ U`_b C: IULHES OR "-S' ' GALLOIJ5 MODEL kiUMBER: p= zcG- O INCHES OR GALLOAJS SWITCH TYPE: r" Jt'~1ZCC1RJy MOTE: PUMP AMD ALARM JN TO 6E1-$ MINIMUM DISCHARGE RATE Ll 3• S(~, GPM INSTALLED OM 5EPARATE CIRCUITS VERTICAL DIFFEIZEMCE DETWEEIJ PUMP OFF AIJO..DISTRIBUTIOU PIPE.. FEET + MIIJIMUM METWORK SUPPLY PRESSURE FCET r_ S yt t,3) ZS FEET OF FORCE M IM X 3 ag F 00 -F Fr.FRICTIOU FACTOR- 0• a~ FEET TOTAL [MJAMIC. HEAD = ~__`•y FEET As per manufacturer Z0. (~Q gal /in. Liquid depth 3$ ~ Y"lP P~.~~rvt~C~ ~URV ?>~`sE ~ o r ~ Goulds r submersible Effluent Pump s 3871 EP04 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and • Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewaterin9 RPM, built in overload with preset at the factory. rated oil and water resistant. - automatic reset. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. ■ EP04 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi-open design - 3/4" maximum. • Power cord: 10 foot AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for ctal heads: up to 24 feet. with three prong grounding mechanical seal protection. SA- Canadian Standards Association Discharge size:11/2" NPT. plug. Optional 20 foot EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 1040F (400C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running + dry without damage to s 30 5 GPM i components.'- Pump: EP05 a • Solids handling capability: c 25 I maximum. w • Capacities: up to 60 GPM. 6 20 j • Total heads: up to 31 feet. • Discharge size: 11/2' NPT. Z 5 • Mechanical seal: carbon- c 15 rotary/ceramic-stationary, -1 BUNA-N elastomers. 4 EP05' • Temperature:': 10 'C 1040F (400C) continuous \p " 140°F (600C) intermi 2 E 04 5 r 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY ©1995 Goulds Pumps, Inc. Fffacti o Ida ao Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST , L°, ~Lp Attachcomplete site plan on paper not less than 8 112 x 11 inches in size. Plan must ~X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. OD U - l b3 - ~p Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). '/zA D Property Owner Property Location I 0_1~t-f' tC, ~~1J7 r~-~.Y RL$-gC, H-T-S 61') r t Let Nita 1/4SE 1/4 S 1 3 T ?Z N R )6 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~3a 01-Z-WLIE LRQ a - - City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road SWQ ~v1 5~(tJl(~ (Z IS) -1 S~ Z7 ) 6PSLL~ C ' N LI ❑ New Construction Use: ® Residential / Number of bedrooms- Code derived design flow rate GPD ® Replacement ❑ Public or commercial - Describe: Parent material ~O g OVI~ ' 1 L1- Flood Plain elevation if applicable N ~ku r General comments and recommendations: ) A wK)Z) lo-J/ q r X- 6-2 is-F1Zl aU -n 6 Y'j , Y~ L►V o-1 U W! b " Q1=- S fi~v~ t-=s L.C . ST C,,~ wur .r ❑ Boring a Boring # q. S . O Pit Ground surface elev. ft. Depth to limiting factor Sn n c ; Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I e - %-t l23 lz - S L I -L ►n'F1-- es Z U 'S . t3 Z g -3~ l0 2 3~ 6 ~ S') t 3 ~-s ~lr vy), cw - - S • ~ 3 3~i-~Z z. SK~Z3cy _ s 1 1 ~S b tn~-- eg _ b -2 S~C~L-y& - L owe m U zfort-s- %-I S so-6o S~cz~1y ~l~'~s~c2sl~ s i c>>-,, cim 7q Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor 3 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-9 lD`12.~1z - slJ Z`~-sbk cS Z v'~ . s -e ~ 3Z-S~ ~S`Z23 ~ Z,S`22S~~ (jl-SCI p wL'`Pr1z.L~ - .l~ • D ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Arthur L. Wegerer OI-~ 67 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Ilain St. River Falls, HI 54022 lC~-IS-OJ 715-425-0165 t Property Owner -BZ~6~SOt~ Parcel ID # 00 Page of 3 Boring # E] Boring ® pit Ground surface elev. ft. Depth to limiting factor -3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 C)--7 lo`-i t - 25L Z s 11 Z`f 3 blz `f~- cg z v~F - s Z -7 -2Z 10812 31L - sil 3-Ps))•r w✓ - CS . s _ y 3 Zz-33 -1 SVc2-3ly - s l Z~nshk M f4- - 's -9 Y -33 s8 [,~I-Z.sLirZS18 e~SeJ - o ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8:6100) PLOT PLAN Page 3 of 3 i Scale 1' =4o R;K *'Z- - Iz-l. c ,-I- ' OnJ `MP OF W MD FQ0 C.E PoaT; D G s~~-n 0\0 (V / a •z i r 2 cc~r~ AZ ~L . a V. p' s, `mss, i ao ~ol'rpM Or- c LrL c tq. 5, o o nor eon PA-~.r ZS 1 U orZ D ~s~,os z O T)4 57_. _ _ _ ~ eT1~ ly 715-425-0165 220254 Ol- Z(~7 CST Signature Date Telephone No. CST No. Job No. ST CROIX COUNTY v'(D~ SEPTIC TANK ANCF- AGREEMENT 6S I - -7 AND t OWNERSHIP CERTWICAT++ IOI` FORME A N2 C1 n C)-wmer[Buyer Mailing Address Property Address PIA- (Verification required from Planning Department for uew construction) City, State Q I ,..!~1 I Parcel Identification Number 0 pv - v a 0 LEGAL DESCRIPTIQI' \ '0 ay f t W, Town of ~ G U ~ ~ ~ ~ . Property Location L'/, Y{, Sec. , T N-R Subdivision Lot # _ 1 • ° Certified Survey Map # Volume Page f# J` Warranty Deed #r Page it Spec house 0 yes Q'no Lot lines identifiable Gltrs 0 no SYSTTM MA E~t.~-~~ Improper use and mainteameeof your septic system could result in its pre-matiure raiiure to handie wastes. Pmper maintenance consists of pumping out chic septic tank: every three years or sooner, if ueedadby a licensed ptw:tser. Zv ha-t you put into the s}=stem can affe4t the function of the septic tank- as a treatment stage in the waste disposal system. certification form, signed by the owner and by a The property t3Yr'22Cr t3$2Cts to stilarriit to Si, Croix Zonutg Department a niasterplumber, journeymanplummber, restzictedpiumber or a licensed pumper verifying that ( %he on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and purnping (if necee-sa_-y), the septic tank is less thzn 1/3 full of sludge. yssystem with i5r-o~~ the llwe, tfie undersigned have read the above requirements said agree to maintain the private sewage disposal o- set forth:, herein, as set by the Department of Commerce and the Department of Natural Resources, State of staSan that your septic system has been maintained must be completed and. returned to the St. Croix County Zoning Office within 30 g djyf of the three year expiration date. -7 ; DATE IGNATURE ' F ,ICANT OWNER CERTIFICA'i'ION in best of r my (our) of Deed edge I arr (are) the owner(s) « I (we) certify that all statements on this form- ate true. d nee.o ded the propeity= described above, by virtue of a warranty d~ / DATE SIGMATURE 0 ~ NT •v~+# Any information that is ruts-represent-wd may result iu Cac sanitary hermit being revok- d by the Zoning Department Include tiAtb this application: a copyof the certified surveyor mthe ap ifercferc ce is made iuc the wat-anty dead DOCUMENT NO. STATE BAR OF WISCONSIN FORM 8-IM TNIe NAC[ R[ssev[o IOR R[CORo'ne awT[ Qu/RCLAIM ( DEED i - I 1 X4256 I~i~i1tR'i ONCE ~ Luzxa~..l~ ~~:'d fa Rfeerd NOV19 I ..quit-claims toJ ..L°a..Z18Dego...JoY~e..M._.Langer::Rci[181a:J....... ~ 8:30 ~W %86 i Linda A. the following described real estate in .-.SL.-.Croix County, State of Wisconsin: R[TU1114 TO The Northeast Quarter of the Southeast Quarter of Section 13, Township 28, Range 16, and - That part of the Northwest Quarter of the Southeast Tax Pared No: Quarter of Section 13 described as follows: Commencing at the Southeast corner of the Northwest Quarter of the Southeast Quarter of Section 13; thence North along the 40 line 29 rods; thence West to center of highway; thence Southeasterly along center of highway to place of beginning, all in Section 13, Township 28, Range 16. The purpose of this Quit Claim Deed is to terminate the life estate reserved by the grantor in that certain deed dated October 2, 1986. Recorded in the office of the St. Croix County Register of Deeds on October 9, 1986 in Volume 756 of page 355 as docket number 417966. E This is homestead property. (is) (inapt) 90 Dated this day of .......October . _ . . . - . _ . . . _ . . . . . , 19._ 0--------------(SEAL) _._......................------...................................(SEAL) ii Lorraine M. Zi net f ~ • j; ..----•----•----••-----••-•-----------•-•----------------•---.---•---(SEAL) --•--------..........(SEAL) i • AUTHENTICATION ACSI jWLEDGMZNT Signature(s) STATE OF WISCONSIN St. Croix County- anther ' this .11 ...day of - , i9~~?_ Personally came before mew ________________day of f October the above na n - Zi o -`'G""L * Lorraine M. eg 1 --------------------------------'0. d4!!!1¢at..... ..A CS I` ' ! it TITLE: MEMBI!:$ STATE BAR OF WISCONSIN (If not, authorised by; 706.08. Wis. Stats.) to me known to be the person who executed the ` foregoing instrument and acknowledge the same.