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008-1098-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405035 0 GENERAL INFO +ATION (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: Walkk , Jack I Eau Galle Township 008 - 1098 -20 -000 CST BM Elev. I Insp. BM Elev: I BM Description: ( O(o I. ')/O /06 Q• Yb CST * Z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. C ) 1 P Septic (C � / S � Benchmark z � /D /1�s t Dosing Lt f• Alt. BM 3 •� � o Z+ Aeration Bldg. Sewer Holding St/Ht Inlet 13 - ID 6/ - TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y l �8 D _ Dt Bottom (3• S /, / 11+ ��� 6 f Dosing 3z Header /Man. c f 8 -- ' oq.o•i6E Aeration Dist. Pipe t m .6 Holding Bot. System 1640.0 . �'Z. oLR•98 final y ` PUMP /SIPHON INFORMATION w:(,(� Manufacturer ^ Demand i St Cover 6C GPM Model Number /�� � TDH Lift • Friction Loss System Hea TDH Ft A IL d 1.31 �•S° tq•� Forcemain Length I Dia. Dist. to Well q t. I ��r> tt "" I !] SOIL ABSORPTION SYSTEM ,D fEP9REN8I Width Length No. Of T"IIM IL*s PIT DIMENSIONS No. Of Pi side Dia. Liquid Depth IMENSIONS O( C. l )� SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA RING Ma urer: INFORMATION CHAMft O Type Of System: 1 31 /� -�� Model Number: DISTRIBUTION SYSTEM Header /Manifold if Distribution ( x Hole Size I x Hole Spacing + Vent to Air Intake Pipe(s) `0 /) 3 2 ? �---1 Length •� Dia Length Dia Spacing '(J J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ! No Yes I: No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:/ n /1 Inspection #2: • Location: 73 250th Str Baldwin, 154002 (SW 1/4 NW 11/4 Parcel No: 35.28.16.527 /4 35 T28N R16W) NA Lo 1 1.) Alt BM Description 2.) Bldg sewer length = Z 2 ! - amount of cover = 3. Contour= #)6?. 6� ps' ot- /o':'$:�0�) `{ A--16D -- P an revision Required? Yes ( No 0 _ � i� � K U �l Use other side for additional information. _�. — - Date nsepc Signature Cert. No. SBD -6710 (R.3/97) H fe 201 W. Washington Ave., P.O. Box 7162 -7162 - 1 53707 �r- Site _ss Madison, Vi a ii L) e P a r t f n n it G i lk u AI 1 c G u S Pest Application S Permit Number -- — -- — 0-- ; , L nL 1 n -.1 � F-f;- WM� nrW.'--ie , � t _ � - , r-1 , . --w -Guu- m ay be used for see- ses Frivac Law, s! . s pnv� �5 p� State - Plan I.D. Number I. Application Information - Please Print All Information ,/�l in /? r - i A, — W8 14: C T o Property 0-i-.F-zr?s Nam 0 k p ro perty Location C L -5— 1 -A N VIA; S T Lot Number - Nurner Zip Code Phone N r Block State Ziu!)IBVISIOR NaM 1 13 Z - 9 S1 / c u' 6�S'Zvo ` 1 �lP iF2�3 ; -I, -It tart .... llvi LI-f' or 2. Family Dwelling - Number Of Bedrooms R ECEIVED C]Village_____ [ 'l Rrnwnshin E14 2 3 Nearest Road "1- 4 State I V r. I t( 0.r I It ROIX COUNTY • So ID if Pool 1c anp- One no- U11 -,. W, QF0A_Qj it r..irnnlete line B !qie nf 2rm-it- `-- - -- -- Y A. 1 "1. 2 0 ReOlacement System 3 ❑ Replacement 6 ❑ Addition to I" County use System Tank Only 0 E System _J_ B. •C heck if Sanitary Permit Previously 3ssned I W. Tyne of Permit (Check all. that lipply)(numbering scheme is for internal use) 1 44 [J Non -Pressurized In-Ground 2`1F K-Wiuu--uu- 51 ❑ Drip Line 22 [1 P In-Ground 41 El Holding Tank 48 El Single Pass - -- Tl- AO n V-ilr11116119 30 ❑ Other r V. DispersaMPreatment Area Information: Design Flow (gpd) Dispersal Pea l Application perco IIl! System Elevation Final Grade 4rea i Elevation Dispersal Elev Rtcludred Propose &(SM R C1, /0 Manufacturer ' I site Steel Fiber Plastic P re fab ti, Gallons G a ii olrs Ul' ia New I Existing Tanks Tanks K or 1101M-Pt Dos ing C on the attached plans. T- thot d ed 2ssurne restion sibility for i of the POWTS Shown P� Nm-Fr Plumber's Name (Print) Pl r - s Siguawl Plies e— AA,ift�C�-y VN v at==. �X J - q 42 XrITI- C Use Only )Upproved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse !i� --� IX. Condit' f Approval/Reasons f r Disapproval ALL Wps Z�6CVAft"&AZ 04 PJU� ojapt�" A L the r;�;Itt I I Pa U IC & )WaFb Or e PWffi(-to the_Cpwty ons,Y) Q ;i �A�L;C� �(5 A Dow (0FLOM eLAd AD = *Wvr PLOT PLAN Scale 1 "= 30 - Page 3 of - 7 I r7 So L�ZOF'f= uvrv�� Z, s S C)FL-2 Lb Titis 30'0 �.fPVe P Q.pyytpv�Z g . � q R W1 �4' I Bo�M OF 7 t i 1 � � I III I I;I i z6 N LAC �V OF SUUR} Uw • ��''l - �'�'"� - - - �. - 1 -o G'� .7 .' -O►v �z. "`i'Rz..L. t 31 a `�i 14 - I�SB �S1t - - _ tiv� e� I-�- z _ �i. t o6q .y u K � � � � K 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 l0O Sogallon capacity manufactured by t^-'1 fit.- COkj ecL� Ly / A -1$0o Z� B�- F1 L► siZ 4. Bench marks.-_ S uU� 5. Divert surface water around system to prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 V��O��,� www.commerce.state.wi.ustsb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary March 13, 2002 CUST ID No.267341 ATTIC• POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/13/2004 Identification Numbers Transaction ID No. 718125 SITE• Site ID No. 642005 Jack Wallky Please refer to both identification numbers, 250TH St above, in all correspondence with the agency. Town of Eau Galle St Croix County RECEIVED SWIA, NW1 /4, S35, T28N, R16W FOR: Description: Three Bedroom Mound System APR 2 3 200Z Object Type: POWT System Regulated Object ID No.: 832425. ST. CROIX COUNTY The submittal described above has been reviewed for conformance with appli able Vita a Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVE-D. 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: • 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). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c I�h'tivnalI , ROWD • A Sanitary Permit must be obtained from the county where th is project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. C S �hfGS • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the a designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat $Pp NDENCE • Comm 83.22(7) A copy of he 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. ARTHUR L WEGERER Page 2 3/13/02 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Receive 0 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us TITLE SHEET Page 1 of _] BOUND SYSTEM FOR A 3 BEDROO1M RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P C2.;Z g C ca- (z, l4Q� LOCATED IN THE SW 1/4 OF THE AJw 1/4 OF SECTION 3 S , T 2$ N, R ) 6 W, TOWN OF � 6 Pn_L ST_ ° L60 V, ( 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 PU14PING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR 4) . e �� Q U `Pci'sT ew N - zx S Q PREPARED BY W FEE CBS FEE F< ER !S C3 I L. . TEST I NG AND. DES I Gfi+i SE=Ri1 I CE P.O. Box 74 421 N.Main St. agru River Falls, WI 54022 Phone 715- 425- 0165��,� ®' Fax 715- 425 -6864 .i %. � .b \k'PGE:kE. D -915 P ELLSWOR rw GDII +; rs APB G 0MUME1 "N OF b SEE CORRE JOB NO. Mound System Management Plan Page Z of 7 Pursuant to Comm 83.54, Wis. Adm. Code Septic 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. The o 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 ensure ro er o eration. The filter cartridge should not be removed unless provisions are made to retain solids in t e ank that may slough o the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched 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 S «m was ns�auad co ce �rinine 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 pending. 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 [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to kee the system in proper operating condition. p 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 adsor and dispersal media, and related piping, and replacing said components as deemed necessary to bring the s ystem into proper operating condition. .Questions about the operation or maintenance of this system should be directed to The County Zoning-Office at 11S - $ — `16Sr ST- C _?ttLX The system installer at - IS'- 48 -22.66 STAG The tank manufacturer at 00 Z 3.2S 8.LLS ( 1^J1Q . The effluent filter manufacturer at 81) — Z ZI . S Z Z, 3a~t The pump manufacturer at U= Lt e GC)V� -1J S' PLOT PLAN Scale 1 "= 30 - Page 3 of - 7 N 0 3o'dc 4.tinvc c-0-L 1 � - - - - -� fZ- I I ► i rj a.3 L �O tiwT O � I o tz DISTuNz5 nr I z6 C a r °e tea or- SJU" �!►� $ Z • C Ivor fit» t'Z-.� l O U'2..7 . _O►v tz... - t3>� NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation ipes with approved caps. ( 2. required) . 3. Septic tank to be 1110 SO gallon capacity manufactured by 4. Bench marks--- SLR — t3uUE? 5. Divert surface water around system to prevent ponding at the uphill side. Page �i Of 7 Approved Synthetic Covering ASTH C33 Distribution Pipe Medium Sand Topsoil - -� — H _ W _,. a F Elev. 10 • p --� 4b p . 3 E it y - . % Slope Distribution Cell of Force Main Flowed 2" to 2- Aggregate From Pump Layer Ft'. E i. L 3 Ft. CROSS SECTION OF A MOUND SYSTEM F 8 Ft. G o • S Ft. A c l Ft. H 1• V Ft. Linear Loading Rate =Ol.O GPD /LN FT 8 50 Ft. Design Loading Rate= U /SQ FT I 1 Z Ft. J Ft. K Ft. "'y a'� e o ^fin L b b Ft. -e-; - �_ W Ft. j S -Observation Pipe? K •--� -- - ----------- - - - --- ---------- - - = - -- - - - -- e}--- 6 �__ , Force Main W C - - - - -- ---- ------------ t�cc�ss Distribution sow Pipe Cell of 2 to 24 aggregate Observation Pipe (Anch securely) PLATT 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 Iong turn or 45 fitting to a point within six inches of the f naI 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. l -- ;cc`ss sox_ pvc Fvc Svc Lateral Manifold Lateral X x x x x2 w2 x x x x Lateral Lenoth — Lateral Length — p Distribution Line P Pr roc SOX --0 h ri'111 Ff1 � S PVC P yt i 0-- P 2 � Ft. Hole Diameter 11 Inch - S 3 Ft. Lateral I Inches) X Z3 Inches Manifold Z• Inches Force Main " Z Inches of holes /pipe t3 Invert Elevation of Laterals 13 Y- = S_33 Y- 6 = 3�.aP� 6P" Combination Sep,4'c;_Tank and PUMP CHAMBER CUSS SECTIOM AND SPECIFICATIONS ' PAGE OF 1 -NEWT CAP WEATHER, PROOF JuUCTIOW BOX . 'i'cl. VEIJT PIPE APPROVED LOCKIMG 110' FROM DOOR. A)AMOLE COVER !-11V .kIDOW OR FRESH wA(ttJIIJG LP.gEt sp�G101O PIPE p`'lR IUTAKE cac"Duir G V- E ---- - - - - -- Ib'PIIN. ---- - --- -- INLET PROVIDE I — _ •'` AIRTIGHT SEAL I I � tt�t� • I I'' Approved Zmi r-wrft " I Approved joint w/ (� --��p� i III joint w/ pQC p ALARM PVC pipe - a �I II I I 1 Ow c I [LEY 1 PUMP 1 --J OFF 0 COIJCRETE LT1-LV • I cis �L • U O BLOCK - RISER EXIT PERMIT(ED OKJL�! IF TF,S.iC MAl L'FI.CTL Rs +Z HAS SUCH APPROVAL 3'APPR�eC _ BFDDINit SEPTIC f SPECIFICATIOQS DOSE TA, kiKS MAQUFACTUS,ER. COkJ IJUMBER OF DOSES: y.•a PER DA- TAl`JK 7r'* WOO C. s o GALLOAIS DOSE VOLUME L ALARM P%A)JUFACTURCR: qLL S 'i$ IWCLUDMIG 6 ACKFLOW: 1oZ GALLOtJ. MODEL DUMBER: CAPACITIES: A= IS IUCHES OR 3 O GALLOwi SWITCH TAPE: M E)Z 5= Z IUCHES'09 4LLOUS PUMP MAWUFACTURCK: aCUL--A-Z) C: IUCHE5 OR GA LLO WS MODEL WUMBER: �O - S D =_l? WCHES OR GALLOWS SWITCH TYPE: �" i��t Y _ WTI: PUMP AVID ALA AR TO 5E MIWIMUM DISCHARGE RATE 31,°L� GPM INSTALLED CIIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AUO..DISTRIBUTION PIPE.. 1S•Sp FEET + MII.IIMUM NETWORK SUPPLY PRESSURE . ; , , b • SO FLE.T CS •uX + S� FEET OF FORCE MAIN X lq F r100FEFRICTIOLI FACTOR.. 1. FEET TOTAL DyUAM1C HEAD = Z3 •l0 - --_ FEET As per manufacturer 1 - 1.0 gal /in. Liquid depth 3g� Goulds pp 7 oi= 7 ` Submersible Effluent Pump M5 3871 EPO4 EP05 APPLICATIONS Fasteners: 300 series • Full submerged in high ■ Motor Housing: Cast iron Y 9 9 9 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 far automatic and • Farms 'and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. 115 or 230 V, 60 Hz,1550 models include Mechanical • Water transfer Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • automatic reset. preset at the factory, rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. • Solids handling capability: automatic reset. ■ EPO4 Impeller. Thermo- s plastic Semi -open design /a maximum. Power cord: l0 foot AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: up to 24 feet. with three mechanical seal protection. SP- Canadian Standards Association prong grounding • Discharge size: 1 1 /2" NPT. plug. Optional 20 foot Im EP0 rove 5 d performance. er: Thermo- numbers Impeller: (CSA listed model • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in " to or " del - rotary/ceramic - stationary, three prong grounding plug i m p roved BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 components. Pump: EP05 8- Solids handling capability: 0 25 maximum. �, 7 Z • Capacities: up to 60 GP 6 20 i • Total heads: up to 31 fe . 1• • Discharge size: 1 N z 5 • Mechanical seal: carbon - rotary/ceramic - stationary, 15 BUNA -N elastomers. lw 8 4 3t q� • Temperature 3 io f 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 EP � Oa —. 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m °/h CAPACITY ®1995 Goulds Pumps, Inc. Effective May, 1995 83871 r Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings . , in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, F distan to ne arest road. Parcel I.D. % �'p 1 rJ G ce Please print all i O IVED R iewed by Date Personal information you provide may be used for se ndvacy Law, s. 15. (1) (m)). ` 23 Property owner Prop Location Pre SC S113 1/4 j'Qt0 /4 S -3 T N R 1 b E (or W L CR Property Owner's Mailing Address ZONING OFFICE Lot Block # Subd. Name or CSM# 11 O Q V�►vT CF)UV� SDv City State Zip Code Phone Number ❑ City ❑ Village W Town Nearest Road � > MN (6sI) X136 _$-9 2,1 tt'J Gfv ZSO `I)1- S New Construction Use: a Residential / Number of bedrooms Z Code derived design flow rate Ll S C1 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L{'C� 1 1�'l, 'l LL Flood Plain elevation if applicable 1V 1� ft, General comments and recommendations:�� r — SJp FL t.1L. Cju R- e1 - E Boring # ❑ Boring Pit Ground surface elev. b S � 0 ft. Depth to limiting factor 3 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 I 'Eff#2 0— 1 w-trL l S i z'Fs 6 Iz ►�` - �g _ . s cm tz 316 -3 K) 3 31 — �S O Yv� Y►2`Fl �S ,� •1 ,� 33� LO�RY� �t� 1 •3 t -I R- N T a Boring # ❑ Boring v ® pit Ground surface elev. 10 ft. Depth to limiting factor 3 `� 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 I 'Eff#2 O - L�`-),tZ 3 L S 1 2.`�S b it WL ° - . S • f3 Z 8 -Z 1 Lb4 fL 316 -93 Z.( -3 $ - Z. S'/"I Y - 1 9 O ti-t h'1 'FI_ IN — • S • 7 3$ -�L �•S`2►Z3d �� Z•SLtR Sol 16 m'�L. - • Z - • 3 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) igna re CST Number Arthur L. Wegerer 0 46 ' . C) I _q 220254 Address W �T e g e r e r Soil Testing &, Design S e r v i c e Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, FBI 54022 715 425 - 0165 ww Property Owner IA.) V -LVL��Y Parcel ID # _ �D1W G Page Z of 3 F-�] 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 p� g io-m -3 Lz - SL� Z`�sb� 1 i1' - �S •S .£� SO z +S6h yyl - 0--L. - � s •� 3 �� - (� � - � IZ3ly - 1 s cry► -� tin.' e s �. S ,. z..6 � Z 1,0 �2Y�6 — S1C Zm.s b YnF�, �.>,� -- • � - � S 32-39 7-Sy23 / + sc 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F -1 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eff#2 i • Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg /L and TSS 130 mg/- 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 (86100) PLOT PLAN Page 3 of 3 r Scale • l I tYowl 0 Lj ZIC LUT � i 13 o�'Yp ►� OF 0-�..L Z � - - -- � t 1 �- , •n� rwT r�r- ►arc -r r C iv aw'l � _�:�lD �:_7 O►v. �z w ' Tltt- 1...t- �1g "�1_� --�t 1'� - -- C J C/I�NIt,�- 3 -S_�Z - 715 - 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. Tod 688L 980 STL:I^OHA 01 oc:ST ZO -ZZ -to T cw AND ��Srxi�i�x� �.c�rv� ..� ,�, ,� +� � ► s� i n - ra 5 �, S (10 W � h jblo�� Add=S& .� rlSlaoRt f MW Gdsr�3l�+ixrDtY�Xi�„_,_r,,,.,.� .,'�— _..... �'a icadolf. rcquimd i �'�YAtatriit \ 08' r 109' �� - °c° /1 ' ItCA� � ` ^98 lei -R % v', Tow" of � �%, N /4� iA, sec. 3 _ � - . , G 0 'volume � ?Age �.� ` v arcs' ,f Deets '9 9 �catazsa� f h ©urn C yes ,. �a L ., a,,,, tds 7tf bl YOS 0 no t do spx0m. leg 11 izt a Pitt. ~t�uza ��b�utitiara �� �� loft yo � �o � .:ystcsrs r;Q ySt5 a pa�uag w 111c saptk tan's: every y ears or �� 4�Ai y1yfCm. a�ee Tnr& aas t huu=,L -, ,gc to isr tic .YEt�u�C ��+ t Ct k cxiota ct shb fi tho aewf2crr aad by a � gtod s}s4xL:dt t� St �aix Za , �J ' "nx a ce�tif"ira4iusu €c> , 9 i Le" by ater diS'X) I LI Sysiath �'il'CLR'J?G %f. p'KtC1.,Y' Cr VCtitP,J 1q d121 E f 71 the (Zlin6itr � "".' "^' xsaastex rluxxbexo, x�'�ix�xabc� x ecra e+i z bG� n}�a "•cc Tras�s rr a L=k is i than des €istl of stud ±;c - caxacJt�.arz a�dt x M f: �Spectccroxe assd ��1��ra the . xs xa� pxcreLtitt�ab with the stasadsrct � gy� to �� �� �Li�£a�s sa*t�a�7e e�ZS�r[rsaa syx8am Ccati�teatieYL tires Ce xee tti a the D mc)2t a#' N'dtas "R"Qtac4s, State a! � stt��az offi rvit�Zin 36 sit arf12, y i' u : set by the feel =ct retum&A to nc� fi¢, for � coanCy 7�va ita� s� �a.g Zit �,� stac�sg^�tt: Btals'heat�n mai�i+:redrn�8st'bd �o»aPlo cry, of the do � e;cp" (ion dst 1, D,+ITE C' A� pj -JCAN , Ft F this f 4s:;3 ++z� (air) t� fl��titl�} sr, x (4J scriify that p SYatr ' ert Obn : ate �a to t�;c: host host of xn,y' (�U") 's..:.nwtlf: �,�"- t ,/ 7 tta r�Yro ,ei'� esck aba o e o ,era auxy ciccd recrsrded ; af�ist�c o€ �earSs C9 tin. ! Z, DAM /5 VP lwf, 3..11 '• yMO itAW d •iAi�aY. C s%f YY mit �a�sz revwk..d by tha ve ©ails oepa =rmt. * 4a y mtxlsn t33 iS tzt'Psa sudmY a c 9pt�clafdc �F t Maas sq �tiCAti : a xtampn(l vtan=ty dead tram the tzagistcr Of :tad" office ctafficd sa rve.• r zr;`crCtC�G. s=kda La tucc yo C d RE E1VE APR ' 2 3 2002 ST. CROIX COUNTY ZONING OFFICE zea LO/ LO 90) "ON L5�= L F0, FF /90 6922 98 ALL Jt,)0ll%fm 1b3H313W r 676907 U_ 18 7 6 P 2 7 9 KATHLEEN H. NALSH REGISTER OF DEEDS ` ST. CROIX Co., NI RECEIVED FOR RECORD WARRANTY DEED e4-22 -2002 2:08 PH WARRANTY DEED Document Number Document Title EXEMPT 1 Y��) �nn_ REC FEE: 11.80 -�OC TRANSFFEE: 75.00 COPY This Deed, made between ' dwood View, Inc., as CERT COPY FEE Grantor, and Jack Walkky and Brenda Walkky, husband and wife, as survivorship marital property, Grantees, Witnesseth That the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to RETURN TO: Grantees the following described real estate in St. Croix County, State of Bank o f Spring Valley Wisconsin: P.O. Box 159 Spring Valley, Wl. 5476 7 P.I.N.: U DC- /09�-.z0 -ODO LEGAL DESCRIPTION: Lot 0;b Of Certified Survey Map recorded in V ne_.J 6, p age 427 3, document number 675200 on April 2, 2002 being a part of the Southwest RECEIVED Quarter (S /4) o the Northwest Quarter (NW' /4) of Section 35, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin rese .ng' A P R 2 3 2002 h ri ht to heirs, exec tors administrators and assigns, e However, to the grantor, his u g , t Use a right of way over the West fifty (50) feet of Lot 1 of Certified Survey M p ST. CROIX COUNTY recorded in Volume 16, page 4273, document number 675200 for the purpose ZONING OFFICE gaining access to property currently owned by the Grantor. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging, And grantor warrants that the title is goog indefeasible in fee simple and free and clear of encumbrances except easements of record, if any and will warrant and defend the same. i Dated Friday, April 19, 2002. r(� (s FAL) -1 ��GZej�v (SE *Gerald Falde. President - Wi e *Laurel Falde, Vice President /� /� / /e cc� ?mot c_ ( SEAL) (SE AL) AUTHENTICATION ATION ACKNOWLEDGMENT Signatures of STATE OF WISCONSIN ) authenticated on April 19, 2002. rn,intir of �3- ' 3� r=1 - 7 VOL 16 PAGE 4273 XATHLEEH H. WALSH REGISTER OF DEEDS ST. CROIX CO., Ml ' ppp ' OVE 15 RECEIVED FOR RECORD n, » ST• CRO ; '" 04 -02 -2002 2:30 PM -' Planninn 0 0 2002 prr N CERTIFIED SURVEY MAP o 0(b � pPR 0 2 O COPY FEE: 3.0@ D W 't - C I © 0 PAGES 2 ' not recer r 3. If dad O , e aVPfO ai shall be ;,a o O z H aPPtO and void o y p , n N N N to Q ' A N� 11 to Q 1 t(O� C W OfY_N C- O N A C z C SS On N O »- C ° z 3 o B n x S -� 3 5£ o4 ;So ° avi�jsaM spUD� ° N p O 35 4jOSZ 1 0° rt ££ CA M'0'21 Avelsam as'oss – A01►8£ M „L1p,0£.10N — — — — ;£sTs M „Li 0 0 @ M..Ltr.O£.ION w ry c a GO ,00'48£ M „L4,0£.IONr aW 'is 4t09Z 1 C) ££ t o o 1 M•0•a Ciaa)sc3 . - r0 S _— _ ou'`7ooglo5 6 PPii ;9 � 'C7 N O n '► R ®O67 x N I� O (l1 C ( T �• A ' 00Ll y '1 in IT p� '0 m D `� t rn 'o I .p rt W 3 c o I r� rt� v m v `� m �7 a 00 w rt o _ -< rn rt ? m W IC rt CA � D c Q c0 .h m 0 n y X _ � 0 a N n N �° O 00 a EIVED ° ” D�� F (/) RE {n ° ,o w`° N d y 0 y o a ID Li C/): �j n =Ce zi -,"li !O 2. Lb 0£. t0S n y ,00 SF 3.. • € ' I m - n v Rnu � E 1111 o�"�i ” spu - 1 pad }oau(� t Vol.16 Page 4273 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of -J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ County ST e i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must � � include, but not limited to: vertical and horizontal refer ijirlTp�hy„ direction and Parcel I.D. percent slope, scale or dimensions, north arrow, a lecation and distbriCa to nearest road. �� G Please print all P 4D lti+f ation,* , Reviewed by Date Personal information you provide may be used fo:ol�dary pu� Law, s. 15.1,4 (1) (m)). Property Owner Propefty Location Sh0r_ IAJf tt' ,lu i I 1 � (;oot S )Q 1/4 MW 1/4 S - �,5 T Z$ N R ! Ej E (or W Property Owner's Mailing Address ST C 1, .# Block # Subd. Name or CSM# 110 C`�v'r T- �vtz -T '' F ICE _ 0-SY-'l PN1vDlN 6 City State Zip Code - one_Number City ❑ Village ® Town Nearest Road L'P fzZLpoW 1'`')N SSO43 G#°rt L -.SO T11 ST. a New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate S GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G Lftt -I. Y"L D(1 TW" Flood Plain elevation if applicable ft. General comments and recommendations: M M e�JQ Pte_ 0�t� SLIST&I IJ 1 X 9 p' N A l>vwty S�ppE QT- `Ttvfa �ls`T1ZLBv"Slt l�l Pe �U�v`2 � Z� - �f� . � � — 1ST P L P� Ls t-�1 • `'2 � • 5 / F1 Boring # ❑poring Pit Ground surface elev. ��• 3 ft. Depth to limiting factor 3� 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 Z b -l� )o�lz 3l6 — S bk rn`fl- �S lug -S -5 3 11, - 38 �. S 7tZ31 — 6r � s 1.eS b 1'z vr)'v'Q1•• L,S • � t. o q - y Z.sy2S Gl - • o ,o �w M Boring # ❑ Boring b ® pit Ground surface elev. 0 14 l ft. Depth to limiting factor 7 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 O�� 1� �4�Z 31 Z _ S 1 Z`�S bFZ hl fy L°_S 1� -'s •5 G�-I-q eS l/ 39 - S'J 7•S YR31yc �l�' �1.SypS /8 G� 1s C��+, �O •D w CEM ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) ignature CST Number Arthur L. Wegerer ` —�$ 220254 Address W e g e r e r Soil Testing & Design ' S e r v i c e Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 S ,�Z_d� 715 -425 -0165 I.v R LLkt,Y Property Awa®r Parcel ID # - P)E�KJ`�1N 6 Page Z of 3 Boring # ❑ Boring ® Pit Ground surface elev. S -� ft. Depth to limiting factor _ 39_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a -8 1o�rL3lz — si 1 Z`Fsbk wl��- cS l� •S .g Y) e S l v� - s • 8 V 39 -3 T y231y Li 9 - 5�8 G>• is �� - v o �- ►J Izl_N Cwt ❑ 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 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 -26478777. SBD -8330 (R6/00) PLOT PLAN Page 3 of 3 Scale 1 =3O' � Uzi o� IB I4- 2. e B• 0 / o� s D L 1QU`Rp►�1 PIPE ff1v . 98,s / I _ C3_�ti - � - LZ- LUU.�` orv= _ ""T�p�.(,,� 31Y`�iJ1�• (PVC PIPE "i - - - - -- _ - - -- - 'off :. HT25']` - -- 5 -120J 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. 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 C than 8 1/2 x 11 inches in size. Plan must Attach complete site plan on paper not less include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ����1Y�1 G Pfe print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location IQIAZ Z- - S k 1 V'JQiL„Lk 1 Y Gto -� S )) 1/4 MW 1/4 S -1 ,5 T Z $ N R E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 110 QvN'�r arwrzT S . \ _ cs P e�,bw G City State Zip Code Phone Number ❑ City []Village ® Town Nearest Road 1 -PvfL� .NKA' -> I MN L SSO4 3 1 (bsl) 41� -BS11 L TV Gr l 'Z SO T11 ST, New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate U S d GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L L Prl - QU Tk1 fIrg 14 Flood Plain elevation if applicable ft. General comments and recommendations: �.p y,,� O p _ Gw'tE SL ST ►� l �' X q p' SOR- P S�I111J zA l�vwty Su�pE or— `lam � l' Pe . � ��.0�_ 1ST PIPPZ L�eJ `3 - © Boring # ❑ Boring Pit Ground surface elev. q4- J ft. Depth to limiting factor 3a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 sb�L Z b -tb io�lz � l6 — s 3 1� - 3g � • S 7tZ31 — G� � s 1,e.s b 1z vrt'v'f'1� C,S • � L. O w` Boring # ❑ Boring O ® pit Ground surface eiev. C l'?- 9 ft Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM 'Eff#2 O -7 % -mZ 3 L z S i t Z`{ b�_ r+ -(• - C°._S `p • S - y lye 316 si l Z b1z m`f�- �s l u; • S 8 3 �� - �•S�Q�t cy-is l esbk Xv(V 0S - •� t. z 31 S1 7 -S YR-3JY `F 14 ypS /'3 1 .0 - WE t- CZ" 'rem Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) ", i , ?!nare tu _ CST Number .,., . Arthur L.' Wegerer 220254 Address Wegerer Soil T e s t i n g & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, WI 54022 S. 12._d 715 -425 -0165 � y R �.Lkz.`f Property ©wfler 1 Parcel ID # Page Z of 3 Boring # ❑ Boring ® Pit Ground surface elev. S -0 ft. Depth to limiting factor 3�_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -8 l0Ll t1- 3lz s" Z` Z3b1Z m -P�- eS 1� •S _f3 z $ - tip 1 d'�rL 3 16 s i l ZTS b rn `P►- M v f�- y 39 -s �.Sy23Jy LIP, 518 G�- 00 ❑ 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 /f1 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 /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BOD > 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 (R.6W) PLOT PLAN Paae 3 of 3 Scale 1' ='30 o� � o ho DtS�- 1�3v`n.prJ PIPE �1.�V - X28 , g / a I (� ~_s s "Ta" -i 64 - 4d , S -120 715 425 - 0165 220254 C�1 -QS CST Signature Date Telephone Ito. CST No. Job N0. Parcel #: 008 - 1098 -20 -100 12/11/2006 03:19 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.16.527A -10 008 - TOWN OF EAU GALLE Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JACK & BRENDA WALKKY O - WALKKY, JACK & BRENDA 73 250TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 73 250TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: 4273 -CSM 16/4273 008/02 SEC 35 T28N R16W PT SW NW BEING CSM Block/Condo Bldg: LOT 01 16/4273 LOT 1 10.000AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 35- 28N -16W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 04/02/2002 675200 16/4273 CSM 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 171537 392,500 Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 25,900 227,800 253,700 NO UNDEVELOPED G5 5.500 2,500 0 2,500 NO PRODUCTIVE FORST LANDS G6 2.000 2,700 0 2,700 NO Totals for 2006: General Property 10.000 31,100 227,800 258,900 Woodland 0.000 0 0 Totals for 2005: General Property 10.000 31,100 227,800 258,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 0411712001 Batch #: 561 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 Parcel #: 008 - 1098 -20 -050 12106/2006 04:38 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.16.527A 008 - TOWN OF EAU GALLE Current ,_X_'; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WILDWOOD VIEW INC WILDWOOD VIEW INC PO BOX 1764 TOMBSTONE AZ 85638 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 30.000 Plat: N/A -NOT AVAILABLE SEC 35 T28N R16 SW NW XC CSM 16/4273 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 35- 28N -16W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill M Fair Market Value: Assessed with: 171536 Use Value Assessment Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.000 200 0 200 NO UNDEVELOPED G5 15.000 6,800 0 6,800 NO AGRICULTURAL FOREST G5M 13.000 8,700 0 8,700 NO Totals for 2006: General Property 30.000 15,700 0 15,700 Woodland 0.000 0 0 Totals for 2005: General Property 30.000 15,700 0 15,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 , n■ of s V 0 tv \Tn /¢2 ¢ M■ �2E Ir e x z E z o a[ m 8 & £ CD @ ° ° Q $ _ m , , a 0 E 7 C) CD m - 2 / 2 \/ / Ch SD Ln CD X o CD E E d� 3 § e Ui a g E e v E £a E 2� -0 f \ C a z w§ E A / 2 /§ f 2 E E f . § ■ r \ M 2[ 0 0 0 2 ; . M \ / 1 -3 CO) CO) % �I (� § \ 97 7 § $ G ; 0 C N k � ■ � 2 j CL z > > o ? k M ° z 7 _ ■ � o � � � ■ k m w ■ T m ° � § E 2 7 z CA) % / 40 0nn± 22 J2$% § 2 200CD0 C. 7 %E£E� z % CL CD CL 0) m CL 7 §4 (7 * 03 & i 33- r ƒ 2 § \0_� / CL ®(D J\ ® GE CD , - _ Z � 2_ % ��� � �H #ems 2 i� ;R ON f� 0 # _ e 2 / \ _ o , � 3' 6752rD0 d VOL 16 PAGE 4273 Jug 2 � KATHLEEN H. NALSH REGISTER OF DEEDS T. CRC C )rr ST. CROIX CO., NI RECEIVED FOR RECORD '+ ST. CRU1XGOl!i1TY' ^> 04 -02 -2002 2:30 PM planninf, 7nn;.' n I CERTIFIED SURVEY MAP N z L4* � APR 0 �? 2002 , n 0 o cn y o COPY FEE: 3.00 ^' D o v+ -� © PAGES: 2 r O N= N r? 1 Z m j, It not rernfr,'ad wt't , shall be o ' o ,o approval date amf c" 5 o Co g p ' O -+ rn nu4 kind o: cC M "' rn cA a , o vco rn 3 c Ln n = o y z �► — Z--m — ip j; m 0 c o Nom Il 3 \ro Z c o o �►° G N m o c y ro o 3 c N p o °, ° c t z N m N B 0 n ° o — o o :r o o N o c 3 o cu �° ?o oa o 0 ti 9£ a4 } So auij }seM O SpUD`J p8 }�ql un • }S 4109Z Jo o O ,££ � •M•d•a Ilae }saM � Z 00 - rn M„ 0,MLON -' `- ' _ ,86'069 - =r =r C °c M„ L X - ION }S c ' ,00'b8£ M „Lt,,O£JON w 4 }09Z ;0 0 0 n o a ££ 0 0 i o M'0'2i �Ci�a }sD3 u:) el m 00 v QUll1 ODq}aS 6ulp11 8 ..► �, — y � O 0 r N Q Ln O(11 o — " o (� I D 0 ca rn G- 0 I� N p - 0 0 O� O rn o (n -+, cfl to N Z o OD VJ V C O M r- o W c S M W o 4 0 -� o a I'ri I C 4 00 r _ I �-► I D. o o. 0 O o N 0, � n to C N ..... n''' CL �• a I�0 0. • a 1 a AS 11U1L "1' LiAN1'1'A1tY 5Y61'1:M Itlilutt•1' UWNL1t ' �,rCl /Gf �C1(° - '1'UWNsllll' /QU- 1�;C711e 51.-1:3_'5",v29ii- It�low AlJUIt1:5S r� e / ,_ ST C RU1X C:UUNTY , W ISCUNS l lv SU DDI VIS LUN Lu'r - -� _ > u"1 51ZL _ _— P LAN v I LW naiona CO u►ac rc uir�u►4r ►LS ut H63 Ui� tancee and c�ip� �t j;;U THiNG WITHIN 1UU 1�1::�'1' Ul' SY5 '1'LM O a ep .C- Q - �v Dp�GJesfi fri - -- - -- _ • r CM aX. I di a e 40 th Arrow I So u� s a s s SC .L �i�NCNMAt�K: (Peruwnant ruttrance. P U+:acr lbc " t"P /iq Ave, 6 � glevacion of vsrticajrateranca pulnL : ZQ_O _ -- ---- _Slupc aL y1Lc : SEPTIC TANK: Manufacturar: S LiLluld C:apaclLy Nuu►bar of rings on cover J - Tank .111Al►1ku1e cover cicvatiuu Tank Inlet Elevation; _ Tai►k Uu L1cL EIcVa _ -� PUMP CHAMUL:K Manufac curer; _ _ NuuIbci 01 �yd 1 1 Ul1a Number of gal • purllp kld - C Or r� — cy�I _ bul 111JUS , Lul Lil _ Cap"' i L y of did tribution 1 inea ba l lull d i zc of Pump I►��►�1 gallon per minuto huraapuwtx brat►d name of pump and modal nu"#Ar - Type of wwruing r N+ULUING TANK: Manufacturer_ _ Ntu,►bc, ul 6allun:, of marnhnlu !•/l IIIdY DEPAFITYI.ENT OF INDUSTRY INSPECTION REPORT FOR r SAFETY & BUILDINGS LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS ' 1�—g�. DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ?[7�CONVENTIONAL El ALTERNATIVE State Plan l.D.Numbec (If assigned) ❑ Holding Tank ❑ In- Ground Pressure El Mound NAME OF PERMIT HOLDER: AD OF PEFIlJT HOLDER: INSPECTION DATE: K7 BENCH MARK (Permanent reference Pomtl DESCRIBE IF DIFFERENT FROM PLAN: t REF. PT. ELEV.: CST REF, PT. ELEV. l :_' A i_ - Name of Plum ber: MP /MPRSIN N. County Sanitary Permit Number: SEPTIC TANK /HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1 P O Z ING PROVIDED YES FIND DYES 1:1 NO JEDNG: VENT DIA.: VENT MATL HIGH WATER ROA PROPERT WELL. BUILD NG: VENT LE FRESH t ALARM � LI AIR INLET: YES ❑NO El NO DOSING CHAMBER: MANUFACTURER BE DUING. LIQUID C APACI TY 'PUMP MODEL PU ^ryP /S H¢P MANUFACTURER. WARNING LABEL LOCKING COVER u....._,.- _..,_...�. ... -___. _...� -- PROVIDED: PROVIDED: - ❑YES ❑NO [:]YES ONO OYES ONO GALLONS PER CYCLE: P P AND NTROL PERATI NAL r PROPERTY WELL ] BUILDING JVENTTOFRES H _. __. (DIFFERENCE BETWEEN "`� — ---' -- �' ESN " ""` - --� -_. ._ Ala INLET PUMP ON AND OFF) S O SOIL ABSORPTION SYSTEM_ Check the soil p6istureat th depth of plowin "'�w �� LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a w e, construction shall cease un II the soil is dry enough to continue.) 1 CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE SS�CING. COVER ' # , a INSIDE DIA. H. =PITS LIQUID TRENCHES MATERIAL: T DEPT FILL DEP DISTR TH DISTR. PIPF . PIPE DISTR. PIPF. MATERIAL NO. DISTR E F PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER EI EV. INLFr ELEV. END PIPES �`�¢ AIR I ? �-T >C K MOUND SYSTEM: Mound site plowed perpendicular to slope Check the e ,of't e fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound s ems, fo kk�- "certain that it ON REVERSE SIDE. SHOW ELEVA- meets tye criteria for edium sand. TIONS MEASURED. DYES ❑NO SOIL COVER TE Y,TURE f PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER THE NCH BED DEPTH OVER TErENCH BEV DEPTH OF OPSOIL SODDED SEEDED MULCHED. CENTER EDGES � � ❑YES ❑NO DYES ON O DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: NO. OF LATENALSP, S ING. GRAVEL DEP '$ELO P FILL DEPTH ABOVE COVER. TRENCHES. MANIFOLD PUMP MANIFOLD D TFf PIPE MANIFO MATk IAL. DISTR. DISTR. PIPE DISTRIBU 710N PIPE MATERIAL &MARKING ELEV_ ELEV_ DIA. EL E1f.. PES. DIA.: �/ f f { E® HOLE SIZE HOLE SPACING DRILLED CORRE¢'TLV OVER ATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED r ^ PLANS ❑Y S NO ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERV TION WEL PROPERTY WELL: BUILDING: •'' "`t 9 LINE: 82- ❑YES �NO 01 S ❑NO 0 Z r � , F Ze Sketch System on f In in 660 y #+fie or audit. Reverse Side. / JJ i DILHR SBD 6710 (R. 01 /82) - DEPARTMENT OF APPLICATION SAFETY &BUILDINGS IND USTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 i HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Matter Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: Property Location: City, Village or Township: County: � .56) Y4 �U TO N/R A� # W (or .CCIU �Q (° .� /• o/� Lot Number: Blk No.: Subdivision Name: Nearest Road Lake Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑ Public ❑ Variance* ❑ Other (specify) Bedrooms: JX 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): J Z New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): JZ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for in tion of the private sewage system shown on the attached plans. Name o lumber: Si e: MP /MPRSW No.: Phone Number: Plu r s. ddress: Name of Designer: COUNTY /DEPARTMENT USE ONLY Sign ture of Issuing Agent: Fee: �G Date APPROVED Sanitary Permit Number: ��„ ❑ LLli t�U ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White - County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod- Plumber DILHR -SBD -6398 (R.07/81) r Qfi FkAr rnr N F C fr .EPOK ON SOIL. 8011 GS AN SAFETY sU ►LQIN43 Y, Qlvls► A46 /� 1 Fi E I AI SONS L �T � X11 P.O. BO 39� 1H6 Ghaptlar;'1�'a�?4 MADISON, WI S 7 .t ��. . • Q _ ,.' OWNSHIP`� PA -1 NO.. A NI�i � NO.: SUBDf VISION NA E. k6 _71 zw DA f ATIONS MADE 0 ME S tP Ri�' 1 E O TES A� ',> �lRr3�cter►ce • ; .New , ©Rsrplace y � ^ . �/ - r � /. BAITING; 1 *1' S= Site 1Rwe for sy stem Li= Site 40 for'OV06m r '* n ' ONA i ND:. - I LDi f,, TANK, CC) F,IVf1ED SYSTEM:Ipptionaty' i .. �' Kf p1aQiation•T C?t.reuir .. r Ca11i 4 4t , l portiant tha@sted ei�ee is in the k a s W6 3 It ,'ine�ieate: F ix '• r: "" _ . ; r• larodpiaidio oodpl,�in elevation; �r4a�� a q i 4` PROFILE i�£SGRIP!T�tNYS: 1 ,Nil TA G L ' VAT ON t S ChYA i R O !T KNE OOi E, A'ND DEP N _591 5 H 4, TIP 8 K IS 4 RU, ON BACK.1 f Y r 4 fl L P ` '/ J 4 IV q . p (^ r I l ?i >. 3:A {±R, ( -f,'S / :7''J" % '�' '' ar' 2 �. xa { $ V, POIttOLATION TESTS ©RTH ATE i ,_. `W � Tf*&3' 1 ; �, . � - � iiA MI NUT *. R. A F TEPLS 1 ,: ER;:INCH g , "• f .... ri 27 r n e - � 1 flT PLAN: Show 1"tlons of pereotpt ►4h tests, soil 4wrings and the dimensions of suitable sd4i aree;. India ',Acaie or distances. Describe whaC are the hQ ` gotttal and vertical, elevation r�terence ybiITti .and shgw their location b the, plzrt plan;` $hS�+N' kirface elevtlti`pKi'St all borings and the tlrect►on and per •` 0666 siope. _ fl # j { [ $} ( }{ ^�i'i"',. ....^y.'..y. _ } ! I{ t I I ol , .I �qcR 1 f i - P R , fi r. 7 x y A S_.. �r x� y^' , .„3 « .j - as P^ f s.,�„... ,..,. r< _ < e ✓�.. I .4,..�. $ .a H ,. c 1 s W �.. rV v` 0 P 6�k � W �• � -� ^rte a 40 F F T 1 W DEPA OF REPORT ON SOIL BORINGS AND S AFETY & BUILDINGS INDUSTR HUMAN RE C 7 7 DIVISION DLATIONS PERCOLATION TESTS (115) MADISON WI 30 T p (H63.09(1) & Chapter 145.045) .S 1 4 # � .�� 126 N R �� ielor * TOWNSH IP/MUNICIPALITY• LOTNO.:BLK.NO.: SUBDIVISIONNAME: / -emu COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: .S'f" C,ro iz Ge Zvi USE DATES OBSERVATIONS MADE [ NOBEDRMS.: COMMERCIAL DESCRIPTION: rpr PROFILE DE CR PTIONS: R LATIO TESTS: Residence ZNew ❑Replace Y _ 3 ,2 �O O RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN -GRO INDPRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) x S ou 0S ou o S ❑u a S ❑u a S ❑u co,, ,., �,e, fo 7al If Percolation Tests are NOT required re DESIGN RATE: q I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: F ind icate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i B- I " 99,,E A >� /s 2 * .5 s 7" 5 .zs" B -3 1 99 . 7 r 39 s B- ZI 72 99 -Z B - 72- 9 (?.3 9 815 /d 5 5 s - r 3,2 s 2, B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER . AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- P -_ P � -� P- 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 elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELE 97 — �- I r te . e . vz l w 0 I By gi ; i a INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must induce.. 1. Complete legal description; 2. The use section Must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planners; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASEL} ON SOIL CONDITIONS; 6, PLEASE use the abbe aviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIES} SOIL TESTERS Soil Separates and Textures Other Symbols st — Storer: (over 10 ") BR Bedrock colt — CoL6?e (3 - 10 ") SS Sandstone gr — Gravel (under 3 ") LS — Limestone *s — Sand HG ,' %i — Hicrh Groundwater Cs .._ Coarse Sand Prerc Percolation Rate rneed s — Modium Sand lA'l Well fs -- Fin-, Sand Bldg _ Building Is Loarny Sand > — Greater Than sl - Sandy Loarn < -- Less Than *l Loarn Bn -- Brown sil - Silt Loam Bl Black si — Silt Gy — Cray *cl Clay Loam Y — Yellow sc.l Sandy Clay Loarn R Eked sicl — Silty Clay Loam niot - Mottles se, — Sandy Clay vv r' -- with sic — Silty Clay fff few, line, faint c -Clay c;c -- camnicm, coarse pt feat: rnrn - Many medium m - MU'Ak d — distinct p — prolr=inent HWL - High water level, Six general soil textures surface water for liquid waste disposal A BM Bench Mark VRP - Vertical Reference Point i i ST. CROI X COUNTY p WI SC NSI N ZONING OFFICE 386 -5581 Ex. 49 &56 COURTHOUSE HUDSON 54016 October 27, 1982 Mr. Gerald Falde Route 1 Baldwin, WI 54002 RE: Rejection of Sanitary Permit 428179 for the sewer system for the residence of Gerald Falde, located in the SW4 NW4, Section 35, T28N -R16W, Eau Galle Township. Dear Mr. Falde: The inspection conducted on September 17, 1982, for the sewer system for the residence located in the SW NW4, Section 35, T28N -R16W, Eau Galle Township, revealed that the system was installed at an improper depth. The depth tested by the soil tester was 97', and the install- ation was 95.56'; therefore, this system has been rejected. It was my impression at the time of the inspection that the plumber was gbing to retest the site at the new depth. This has not been done. To continue occupying the residence on this property would be in direct violation of our Sanitary Ordinance. For this situation to be corrected, the plumber MUST redo the percolation test and obtain new permits from this office. If you have any questions on this matter, please feel free to contact this office. Sincerely, THOMAS ( NELSON Assistant Zoning Administrator r wjo rr: St:_tt f Wi:;con,:in. 13(Ire'A'l Plumb -i11g Lero latj,,k 01; ;�_i I is I i St EveieI BoIdt DEPART OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 El CONVENTIONAL 1:1 ALTERNATIVE State Plan I.D. Number: (If assigned) ❑ Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: 7D ESS OF PERMIT HOLD INSPECTION DATE: Ge r a - W, 1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP /MPRSW No.: Io u nty: Sanitary Permit Number i III LA t SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO BEDDING: VENT DIA.: VENT MATL. HIGH WATER '€ ROAD: - PR OP ERTV WELL: I BUILDING: IVENT TO FRESH ALARM: LINE: AIR INLET: ❑YES FIND ❑YES FIND DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO I OYES ❑NO IE]YES ONO GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET: PUMP ON AND OFF) ❑YES 0 N r J DIAMf LENGTH. TER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing, or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) b , CONVENTIONAL SYSTEM: WIDTH. LENGTH. N DISTR_ PIPE SPACING: COVER"' INSIDE DIA.- #PITS. LIQUID TRENCHES. MATERIAL: DEPTH: A � RAV L DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR �� PR ERTY WELL: BUILDING: E T NLOF RESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END: PIPES: a a. MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ONO SOIL COVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ONO ❑YES 1:1 NO DEPTH OVER TRENCHJBED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. I MULCHE EIYEs D. CENTER EDGES DYES FIND DYES ONO El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. TRENCHES: ." MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV. CIA_ ELEV. PIPES. DIA.: SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES E1 NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: EM PROPERTY WELL: BUILDING: LINE: 1:1 YES 1:1 NO ❑YES ED NO al 3 7/. f 2- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710 (R. 01/82) P LB 6 State and County State Per # Permit Ap lication County ermit # Application for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: ,. Ge �a\d Ga\6 Uj 'i rti 1 3. B. LOCATION: Y L %, Section , T VS N, R Ur, IK (or) OW Lot# City Subdivision Name, nearest road, Lake or landmark Blk# Village 00006 /7 Qd Towns 721 U C. TYPE OF OCCUPANCY: Commercial U *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms 2 No. of Persons D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks OYIG HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured -in -Place Steel Fiberglass Other (specify) New Installation x Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New x Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X Length Width Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private ® Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other tha pr esent owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME T OTC" C.S.T. # and other information obtained from 0 (owner /builder). pn Plumber's Signature MP /MPRSW# MP y�0'1 Phone # (8q — 33°18 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. .1., 4- ....�_..z_.. a� _ n .�. _. t i a °G 4., e t 2 � 7 E �..h m....m 3 t E i m, m E F F E � DEPARTMENT OF REPORT OIL SOIL BORINGS AND SAFETY &BUILDINGS INDUS}�RY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(7) &'Chapter 145.045) SECTIO 3 A 1 �f� /4 35 /T28N /R 1btlor TOW NSHIP/ ICI�P On NO.iB NO d SUBOIVIS N N AME: COUNTY: OWNER MAILING ADDRESS: r e c \ \ A e, 't u e. \ �3 USE DATES OBSERVATI NS MADE I ND. WD—RMS.: COM RCIA D RIP ION: PROFILE TI NS: A O TESTS: [XResidence ` 4j l� � � ®New ❑Replace � 8 — 31 _. 9 i o 2 _ 32 RATING: S= Site suitable for system U= Site unsuitable for system L-1 ONVENTI NAL: MOUND: IN -GROUN E: SYST M -1N -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT re uired DESIGN RATE: Q If any portion of the tested area is in the under s,H63.09l51(b), indicate: (Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL P R UNDWATER- INCHES CHARACTER OF OIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OgS VED S T. HI HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) tee " 8 C3�5 12 s +l sl- o p 21" ys 25„ B. 2 12 q8. i " QIS ' It ► I g - 2 ,, S Jr B- 3 72 qa.7 q „ ups q 01 sal s` r 38" /s I I'' B- �2 .2 „ g,, a Is \2" i s r 2c` Vs 2(0 B -, �2 q.3 „ 8" t31s 10" X11 s - 32" Ys 22 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES ` RATE MINUTES NUMBER I FTERSWELLING INTERVAL -MIN. PERIOD t PE RIOD Y PER INCH 0 P 2 2 !� P 2 P 3. 2, P- - Z 144 Ijq It 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 elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION g 5 5 _. i f�l�f I # r # g5 t Q Q2 3 '~ M � . Pt rev., 1001.0 r ' tN ! I a E F fro _ �rer M^�ec4 n � r >_ k 1 . ' 7 F w CA � u I-+- rb ,-- J n z Q Li a y- 10- v b� J -45 C4w LV IN 1 rb h p y iJ 1 PO Csi r ittr r , r , .,� aa,as.ra 1� W Aw