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Home My WebLink About008-2000-90-080.sconsin Department of Commerce PRIVATE SEWAGE SYSTEM safety and Building Division INSPECTION REPORT GENERAL INFORMATIOw~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TANK SETBACK INFORMATION ermit Holder's Name: City Village X Township Fre ine, Evel n Eau Galle, Town of .ST BM Elev: Insp. BM Elev: BM Description: ic,~ ~ " r' C5T 'INK INFnRM~TIAN ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~~~ 3 ~j 3" F~ // /ZJ~O Dosing G~ 7so ~~ Holding TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ Z`J ~ /(~ /V ~^ /~ o / ~ 1 Dosing Z~ / '"1~J ~ ~j ~ ~ ~ Aeration Holding PUMP/SIPHON INFORMATION r !~ Manufacturer Demand ZC~? ~~tti GPM Model Number p t j~U I~~ `Jf-.,y f v / TDH Lift Z~ Frictio~oss System H ad TR.ti~ c~ LL 7) Forcemain Len r Dia. +! Dist. to weir Z SOIL ABSORPTION SYSTEM County: St. CroiX Sanitary Permit No: ~ t 479217 W~ ~-t State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 36.28.16. .~i5 fd 2 . ~~ /OU STATION BS H1 FS ELEV. Benchmark Alt. BM (~ _~ G 1C J ,~ ~ 7S Bldg. Sewer ~ r~ ~ a ~5 StiHt Inlet ~ ~ S ~ $ ~ ~~ StiHt Outlet `,` _~ Dt Inlet ..~~ ~. Dt Bottom L 7C 'C~ ~~ _ /~ S~i~, .5~ " T' Header/Man. Z .55 / .~ Dist. Pipe d 2.SS J~ . ~ Bot. System ~ 3. Z~I r~ ~ ~ Final Grade ~ ~,~ ~~.5 BED/TRENCH Width j Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ DIMENSIONS ~ '\ -_. ~~ ' ~~ SETBACK SYSTF_M TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~ INFORMATION CHAMBER OR Type Of Sy tem: 7C ~ ~7 ~ f ~ ^ Jar N,~4- UNIT Model Number: \ b,., DISTRI6UTION SYSTEM Header/Mani~old /( r~ Length Dia L Distribution CZ~ (' Pipe(s) ~ ~ Length ~ Dia Spacing x Hole Size ~~ G~ / x Hole Spacin~ --7 L Veto Air Intake ~/ ~~ 1~~I SOIL COVER Y Procm~ra Rvs4ame C1nly YY Mnunrl nr At.Grad2 SVStemS Only Depth Over ] Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center , i Z. ~Z Bed/Trench Edges ~y '\ Topsoil y r , Yi"'~ Yes I; N° - ~ No a COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~b / ( / d 5 Inspection #2: / /_ Location: 2628 Boston RGOad Woodville WI 54028 (NE 1/4 NW 1/4 36 T28N R16W) NA Lot 3 2 ~ ~ ~~ Parcel No: 36.28.016. 1.) Alt BM Description = ` -~ ~' ~ ~ ~~^~ ~ y.~ ~- J~C~S ~ ,rte ~ ~)~ ~ ~`~ 2.) Bldg sewer length = ~~ t - amount of cover = ' ~ 7 ~~ -; -,-- , Plan revision Required? , '~I Yes No ~ " ~ I G a~ Use other side for additional information. ~.__ ~_~-J Date SBD-6710 (R.3/97) Cert. No. ~- Safety and Buildings Division County ~.~- ~(' `„ ~ I 201 W W ~ aton Ave., P.O. Box 7162 l` ~ Madiso itary Permit Number (to be filled in by ~cons~n (8>26 ~ E® z ~ ~ ment of Commerce tare P an LD. umber Sanitary Permit Applic tior~ EF ~ `~ 2005 l ~ 7 `fZ 3 t~ ~ roject Address (if differentt thari ~lnat tnl gml g In accord with Comm 83.21, Wis. Adm. ores ~~cy i~~O ,ate( YCCou provi e ~ ~ / - may be used for secondary plop 5Tm)CROIX COUNT ~G FFICE on Information -Please Print All Information ~ ~ ~~-- B arce Lot # e N ' ~e ~ -_ am s Property Owner l ~ . C~,/ ~ ~ property Location ~ property Owner's Mailing Address ~ r • !~/~ Section ~ __`~ ~S ' Zip Code Phone Number rate ~ Ci ~ ~ clrcl one) R • _ E r W ~ .- ty, ~ ~ ~ T N: s~! Yw ~ - -" e of gnilding (check all that apply) Grp ~ J ja,n„ II ~ieA.Alasge CSM Number .~ ge, /q4! _ ~~ . yp Dwelling - Number of Bedrooms r 2 Family U ' / ~ ~ ~ ~x ^vill wnship of~_ ^City sk 7 C be ^ PublicJCommercial - Descn _ X ^ State Owned- Describe Use g ._..~J livable) lete line B i Com A p p . III. Type f Permit: (Check only one box on line Replacement Only T k lding /H ^ Other Modification to Facisdng System o A.. ^ Replacemerrt System ^ Treatment ew System ed su List previous Permit Number and Date Is -` ^ Change of ^ Permit Transfer to New ~ [ ~ T ~ ~ z ~ 7 ~, ~ ~ ~ / ~ uT v"~ T T it Revision Owner g. ^ permit Renewal plumber Before F.xPira-non J ~ ^ IV. T of pOWTS S stem: C eck all that a 1 ble soil ^ Mound < 24 in. of suitable soil i ^ Si a Pass Sand Filter ^ At-~e ~ Sand Filter ^ ~ ta ^ Non -Pressurrud In-Ground ound ? 24 in• of su ^ Peat Filter ^ Aerobic Treatment Unit ^ Reeirc sung J ~ I l 7• r r ldin Tank urized In-Ground ~IiO g Constmcted Wetland ^ ^ Gravel-less Pipe ^ O ^ Drip Line • ther (explain) Chamber Recirculating Synthetic MediaFilter ^ Leaching pis ersal Area Proposed (s System Elevation (` eatrnent Area Information- ersal Area Required (s P i fT r sp D V. Dis ersal Design Flow (gPd) Deli~j Soil Application Ra ~ ~ w G r ~ G-~ Site Steel Fiber PL /, ~~ Manufacutrer Capacity in Total Number ~ F` f Units ~ ~ ' ,/ ~~ fab Consuuctrd crl~ Concrete (,~ VI. Tank Info Creltons Gallons o , New Existing ? Tanks Tanks _ Septic or Holdins Tank ~ ~ Aerobic Treatment Unit i~ Dosirra Cbambu 1 onsibility for installation of the YOWTS shown on the 8 ~ Phone Number the undersigned, me p VII. Responsibility Stateme re Mp/MPRS Nu ~r Plumber's 5 e (Punt) Plumber's ~ ~ ~~ Cr ,State, Zip C 1/ it /I ~1l _ ~~~ A art _. , _,_ .,~ ~< 'v4/ VIII. Coon /De artment use v~^ Sanitary Permit Fee PProved ^ PPro Surcharge Fee) ^ ~ ~ eason for ~ 1 rovaUReasonsforDisa proval IX. Conditions of App p SYSiTEM d ~Isr ~ ~tpalrlent plan provided by f?I ~ ~ nts must be maintaiMd 2. ~ ~lo• _ s.taeh complete plans (to the County only) ~- (dj . oa ~ r~~' ow P~ope.C system an paper sot less than $lry x t 1 i>xhes SBD-6398 (R. U1/03) PROJECT Ev Freaine NE r/a NW 1/4S 36 /T 28 SYSTEM ELEVATION 99.7' PLOT PLAN ADDRESS 911 200th St. Baldwin Wi 54002 N/R 16 w TOwN Eau Galle COUNTY ST. CROIX BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. TOp Of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^BOREHOLE O WELL *H.R.P. Same as Benchmark I dimension was extended a extra 3' due to presence of weak sil in the first 12 inches! Please note: original soil Tank is to be properly bedded and provided with test was not on the lockdown covers with property, once the lot approved warning labels Pro 4 Bedroom lines were staked. House AIt.B.M. is >200' \ from West Lot Line Area 15' below system is to AIt.B.M. is to remain undisturbed p Huffcutt Combo Tank of 1 /2" pipe C~ 100.1' B -1 4% Slope B.M * B-2 98.7' 9 9' B-3 Grading is to be done to divert run-off away from system 400' Well is to meet all setbacks found in Comm. 83 1007' Property Line Boston Rd Scale = 1 /4" = 10' commerce.wi.gov ^ ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyte, Governor Mary P. Burke, Secretary September 20, 2005 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NE W RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXP11tES: 09/20/2007 SITE: Ev Fregine Boston Road Town of Eau Galle St Croix County NE1/4, NWl/4, S36, T28N, R16W Subdivision: CSM No. pending; lot 3 Identification Numbers Transaction ID No. 1197423 Site ID No. 699100 Please refer to both identification numbers,. above, in all corres ondence with the a enc . FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1020225 Revision; Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on 5/26/05 under Transaction ID No. 1141448. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(N01/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)" • 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 POWTS 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. . • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to 1 eaning must be provided per Comm 84 product approval conditions. ~~'~~~~~~ Cn~~c~itionall~ ~R~ilED SHAUN R BIRD Page 2 9/20/2005 • Comm 83 22(7) - A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local ins ectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soi! 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. • 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. 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 code:. 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 9/13/05 Owner:Ev Fregine Location:NE1/4 NW1/4 S36 T28 N,R16 W Lot 3 Boston Rd Eau Galle System type: Mound System (Revision) Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigen plan 9-11. Soil test Shaun Bird Signature License number 226900 D V1StON Of AF Y NG gUILDiNGS r SEE CORRE ONDENCE ~`~cFi S SFP 1 ~~~ qr~.~ ` ~ ~DOs ~ ~U~`o /Nc;~ ~~ No Designer Date f Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric ASTli C-33 S o n d --.~ \, " Topsoil J t E ~'• StoPe Bed Ot ~f~ 2 `'z Drain Rock j?istribufion Pipe ~H Forst NOin From Pump Fiowe d t_Cyer r tp ~. E F ~ J G h > > / Cress Section Of A Mound S sAteoUsin A Bed For The Absorption rf r~ t~ !' ~; t't'/o ~ s g ~ ~ _ Ft. ~ j^~,C~ Ft.- J 7_.~ Ft. ~; K ~~ ft. .._ _.~ _. L ~i Ft• ..--------- L d.~Observotion PiPe'~_~-` K J ~ E ______--- .. _ - _ ..._ -.-- -~` bl ~ q ~1 ~ ~ Force Main -° ~ ---- -------------- --------------------- { From Pump o w t~ ~. ~ .~._.. _.._ _.._ ---- -- -- - . ~ ~ 1 •_ ~" o Distribution Bed t}i /Z Z ? ~ Pipt - Orain RocK I .4 observation Pipe °`f~c~.~~:c.~ Permor~ent Morktr . •/x~ ~/~ ~ ~~~pi pe or Rods Pion Vit»' 0i Mound Ucin A Bcd For The Absorption Areo PAG E,.,._ ~~_-- C%cz Lotate4 ocs 8ois4~• e Equant Baoeeo FitLST tiyOLL liQY.~C re CenMC~~of ~ r. ~ , ~~~' ~ .,~ .~~.. t~}islribution PdQc i.ayovi 1 ~~ S~gneQ: L3Cen5e Number: Oate: i ~ / ~" Ft . ...^.,-- R ~ Ff. X ~/- Inc~+es ~` ~_ ~ inches r Hole Drtameter /~~ Inch ~~ 'fan i fol d 4- Inches Force Main ~ inct-es ~ of ~o~esi~ipe~ Invert £3 ev~tiot~ of i.ate+~al s~`rU~ Z Ft. Pes¢eca!tG asCt petoil ~~ ___._ • MBFR Cr20SS SECT; GN At~O SFECLi ICATIUKS SEPTIC TANK ~ PUMP CtiA ~tEATN£RP1Z~3f ApFROY ED ~t£13T PIPE IZ" t~IN • ABOVE GRADE ~ JO}~CT~DN $OX MpNKt3&E CDi+ER `~ G,, 4dINI30w 4R WITK CONI3LIIT Wf PAALOCIC £ ? °~~` FROM D44R. ~ ~AR~;}IG LABE:. `~ i ~~f ~~ '~ 7 FINS ~"::D GRADE ! L ~ ~' g '~ ~~....-4" MII~ i zY~ , a j a y... ~ •. INLET Gpr,S- t a, "~'_ TIGFd T t tlA~t'~ED iiAT£R 'FIGH'T 5~E"' A ~~~, ; . 30If11`5 wIT~ _ APPR!)1~D PI~£ ~~t?Eft -"""- 8 , ~ pi3 3` 01tt0 ~_ _ StR.St? SOIL ApP~Y~ C s i c)F1' S~.IO D SAIL p1#MP t3FF ELF - ___-- . 3;: APPRt3VED BEDDING UNDER '~A~;C l/ j~CQN~~ETE PAD ~1 SPYrIFiCATZQtFS DOSES ?~ DA`f = ~----- Ntli'iBER SEPTIC f DOSE C/ _^--~ GAL- TANK I$ANt1I'AC~URER' I3{35E vo~~E INC~,,UDII+IG GAi . F yaylgAC IC : ~ " SEPTIC ~~_,._ ~__`~-- GAL • _ .~~.[..=,--~'GAL- TA1iK g;ZE5 = fl£?S£ ~--- - ~~ ;NCHES ~.,, , ` CAFf4EITZ~S= A `•-~---- S' 7 GAL. `~ ~~ n-„ A1+ARM MpNttFRC1S3R£R,= . , .-,-~-" MODEL I~UtfSER = ~.~.~~~z`,C~~~.-- C _ ~ INCf1ES = /1---~L ~~~ D _ ~ INCI~iES PUl'SP 24Ai~3FAC'TCJRRR = •,~, ' ~' ~ ~, ,,~r'~ (~ I L~'iR 15.23 WAC KoD~~ NUr~$ER ~ - ~ ~zR~r~c As DER ~;TCii T'i*1sE~ ~ . ~ G4r4 PtItSP 5 ALAR /L,l FEET 331SCIiARGT RATE ~__.- ~~-~~pt1 FSF£ ~.G---° FEET REQDIIL£13 fi BE~EEN PUMP OFF •ANB }~ISTR - ~ • ~ ~~--~-- FEET • '~~~~~F£ET VpZ~'yCA3. DIFF£R~NC ~-T1IQQ F'T- FRICTION FACTOR _ ~ €3PF'LY PRESSURE pYN~``IC $~ ~ MIHII4i3l~ F££T4FORCF~AIN X ~ ~ ' T£~TAL / r ~,£rtG'i'N ,~- ~i pUM? TAr~K= LIQUID ~ FN'T£RNAL DIMENgIDt~~ 4~ i.fCENS£ 1~L1I4$Eg- SIGt~E1~= D~AT £ = _, zf&8 TOTAL DYNAMi% HEAD!CAPACITY P_R t~41NUTE EFF W ENT :-.ND DEwATERING 1: 0 s C 0 ~- V '. FLOW P£R MINUTE ~ MOCEL I 1~ ' t5 3 Feet t Meters Ga ~ Uiers Gal. Liters 5 1,5 69 I 201 77 291 70 3.? ~ I 61 231 70 i 265 . 4.S I 15 53 201 61 231 20 •~ 6.1 ~ 4a ~ 16? ~ 52 197 L~ 7.6 S4 129 42 t59 30 9.t ~ 23 87 33 ~ 1G~ 10 7 -- I -~ 22 t 8~ . ~~ 40 12.2 I -- - - ~- 1 1 ~ ~ 2 ; ipck Votve: 38.0 F'. - {tt6m) i44.0 Ft. {13.4m) 654508 0 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ~` " l,~ with .Electrical alternators, for duplex systems, are available and supp an alarm. . Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°CJ special quotation required. 1521153 Series s2 i2 t ~~~' i I I ~ t? t/$ r"r i y I ~ J - t -~ sKZOe4 SELECTION GUIDE a caunorl Ali installation of conVOls, protection devites and wiring sAOUId be done Uy a qualified recent NationalElectricCode(NEC)andth Oc~cupationalSafetylandHealthAct(OSHA)~~ 1. S;ngie piggyback variable level float switch of double piggyback variable level float switch. Refier to FM0477. 2. See FPA0712 for correct model of Electrical Anenlator E-Pak du lex 3 3. Variable level control switch 10-0225 used as a control activator, specify p ( ) or (4) float system. RESERVE POV~ERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. • bfA1L T0: P.O. BOX f 6347 l.ouisviUe. KY 40256-0347 Manufach~ersof • • ~, SH1P T4: 3049 Cane Run Road ~ ® Louisville, KY 40211-1961 Q~rrP~os ~~rc~ /939 ~/,~~ r~,~, (E~p2f 7?8-2731 • t (800) 928•PUMP l/ t IJ. FAX (602) 774-3624 }mP;/M•wwxoelfer.com ©Copyright 2000 Zoeller Co. All rights reserved. Pi.AN R'S iypNUAL- 8~ MANAGE GEC c ~oNs Q011Y'1 S 01t111''1E SYSTEM SPE Septic?artlc CaPa~ .~`~ . . lt.P INi=C>Ii1K~nOP[ ~- ,`~,,~„_/ $eQticTank Manufa~rer ` ~ Effluent Filter Marut~~rer Nu ~ of Bedt~~'s ------ err~ Units Number of Comm. _. Eslrtrtated f ~ {~°~`~ eted x ~ -~) tin tivw (peak), (gym Ra'~. Sog aRP~dOr' trtfluettt/Eftlr~t Quality Fats. Oi18 Grease (FOG) an Demand (BODE BioctlE: ~i ~ndexl Solids ([SS) Pretreated E~uent QuaCrtY ~ D t+lA t O en Demand (BODs) B•locheTotal S pertded Solids ~~~ fecal Cotifom"- (Geometric M~drrtum Eftluern particle Size lwn ""' ~ Event Servi tnsped cpnd'rfion of tank(s) Pump oUt Contents of tank(s) Inspect d-sPersal Cetl(s) Clean Bfflueni filter ~ afartn mP• P+~P controls {nspe~ tw assure test 1=1ush Iate~ and p aaUda~.. la_ tt~da ~rs:= Monthly average. X30 rn9n- Q24 m9n- M trion h/ average" ~0 mgn 530 m9n- 510` cful__~~ ye inchdiametieC Etfl~---- ~ p~r Pump~Tank Pa pump TanK M~u~~urer . Pu M ~ Pump Model F,~~-p~ttr-eni Ucsi~~~ ra+r~ p MSa~ nicat Aera~n p Disinfection Manu~~rer DisPa~ Cett(s) p 1n~Jround (gravity) Q gt.~rade Page of _ 1] NA Gc~ ^ NA I ~'`llz7 ~ 1VA ~ at >7 WA ~~~C~-L ~ ~,~,~1 ~~ 1J [9A p peat Fliter p Wetland p piper. p -ground (prsssuri¢ed) iynd D Other ^ Ori lne rd~ wastawe~ r+d Values tyPi~ f or d°"~~ ~no~+~"~'~ waste+K+~- s~ ~~1c~ tar tm~~ .+ Values tyP Service PreQuencY ,~~Aat(s) p months 1~--` (Nfazimum 3 yrs.1 of tank volume At feast once every a and scorn eQuals one-third (~) 3 rsJ llfiazimum Y ludg VYhen combined s ~s) p months ( At least once every r(s) p manths qt mast once every • ~s) 5 p months O NA pt teast once every r s) ~ p months p ~ At least once every ~ p months fl Years) O NH qt least once eve? p months II Year(s) ^ NA At feast >,nce every o~ licenses or ova of t3ia foitowtn9 e TRt1CTlONS li be made by an individual cacryin9 clot: PO1~l'rs ~Aaintainer, ~ men S inspe missing MAIi-['fENAN~ INS aad disPa~i setts spa Restrioted Sewe chet~ for any back of tanks star Plumber r ~ of the tanks? to tderltifY any t levels tom: Master Plumber t'~a ns must lndude a tinsual inspecti ed sludge and scum and c~edc the eMuen Setvidrt9 ~~ ~~k mspe~O measure the volume of combrn ~SUatiy insPec~ ponding of effluent on the. pads, or leaks, -rne dispersati cell(s) shall be autttoritY round surface- ndirt9 of effluent on tfie ground surface• ~ of effluent on the g for any Po lion of the local re9uta~ofume, the i and to cttt'~ d requires the irnmedtate noti t~ ~~ or more Of the tan in tfi-e obser+ratsx- P P~ failing condition ~ lc oafs one-itt- of in aaxtrdanoe with d'• NR tnund ~~ ~y indrea~ a m in any tan eq 9 mutation of sludge and scu ~ $ c~rvicing OPerabor and disPa~ yin the combined a~ shalt t,e mmoved by a Sep g vents, and any entire contents of the tan vents. PreVeat+Frnent c~rnPo S Maintainef- 113, V~ pdministrav1fe Code• meted by a ~ POWr' mechanical or pfessulized pOYYT'S compo cent filters. of ~mpletion of any serwce event The aefvit~ng of ~ r moaRaring at internals of 12 months or less shall be Qz othermatntenanoe o ~ the local feguiatocy authority,~}tin 1Q d~ A sett report shell be prorrded ttn9 products or Other dte ~nt'~ Of ~ D OPtaRAT10N eatment tank(s~ for P trations ~ START UP AN the PODS check tr, ets~ cell{s). tf high cono~ n, ~~ to use o~ rooms ancuor damage the ritspo tQr Pdor to use' FOr Qt',VY OOt>sbv~ , e the treatment P b a septa9e servicing ~ cherniCdls that may ~P ~ of the tank(s) removed Y deteaed have the ~rtte i , "~~ '' th infitrative surface_ Page of stagy uP ~a11 rmt occur vetien sa; conditions are frozen at a is restored the excess System fiI( shove nom highwater levels. '~ ~ th cep(s) and may result in the ~~ pump tanks may ceti(s~ in one large dose. overtoa 9 ~¢ tank removed by a ~} t. To ayoia this sifuatfon have the contents of e P Duriing ~r m the disPe~ ~ a p1un~ ~ POYiiT'S Maintainer to ti,ras;~ Pr be ais~-~~ tP ~ ~~~ disd~ar9e of ~~~ er tQ the effluent pump ar coma prior.tD tPSflDtin4 !~' um tank- s~9e S~`~9 pperator tite pump ~ontrnts to restore normal levels within the p . P to manually operatrng Do not drive or park over, ar othetwtse disbutti or compact. a~ vehicles over tanks and dispersal veils- . po ~ drive or park mound or at-grade soil absorption atea_ ~~~ and p~4 the fife the oleo wither 15 feet down slope of any clove the pe fr~orn the yrasterirater stream may imp dental ttoss: diapetsti Reduction or-etiminat~ of the fDito+t~r[g ~ butts: condoms, cotton .swabs; degre2tsers; yyater, fruit and vegetahfe peelings; ~asof"rne, grease: herbicides; meal of the PC?WTS: ant<fo`b n draln~(sumPdP ~~ ns: grid water softe-ier brine. d ~ ns; pi(; I13(flt3nQ Qn~dirc~s: pesf~ddes; sanitary napkins; Campo _ ~c~y taken out of serxice the foltowlnJ steps sl>au ~ taken do insure that the pBpN00[~M~T #aUs $ndtot is perm in Adrntrstsfsative Code y~/hert ffie POVYI-S d safes ed in compliance with ch_ Comm 83.33, Y~-srrons ~ ~ AroP~y abandon ings seal~- ~ $ha{l be disconnected and the abandoned PlPe oi~n d;sposed of by a Septa9e $ervictng Operator. A(t ptping to tanks and p' - - Tz,econtents of alt tanks and P~ sha(I be removed and property shalt be excavated and removed or their covers removed and the void space After pumping• alt tantcs and Pits filled with soft, gruel oranother'rnert solid rnaterial_ to rovide a code CONTINGENCY PLAN the fo![owing measures have been, ar must betaken. P If the POWTS falls ent system. repau~d compfsant reptacem has been evaluated and may be utilized for the location of a rep[acem nendt sbouf6 not p A suitable re~ernenCarea absorptron system- The replacement area should be protected sect structure, Ialines and welts- Failure to be infringed upon b}r r~ecluired setbacks from existing and prvpo tact the replacement area wrll r,~suit in the need for a new soft and site °eval at that tfrn tablish a su~tab e Pro Re }acement systems must caomptY tinntfi the rotes in effect advances in POWTS replacement area- P , LJ A suitable replacement area ~ not avaitabte due to setback and/or soil [imitations- Sarrrng technglogy a holding tank may be installed as a fast resort to replace the failed POWI~S- a suitable replacement area- Upon failure of the POWTS a sol.and / site has not been evaluated t0 identtfy lgcernettt area is avaifabte a. ~`" SRQ evdtctatlOn must !7e pe~'~ th }ovate a suitable replacement area- if no rep otd'ing tank may be ~rrstalted as a last resort to reptafle the fated P01~'-rl~S_ at rode soil absorPtlan Systems may be reconstructed in Pty tfietir~~gn effect at that fime~ at Mound and -g ~uctfons of such systems must comply th " fittrative surface. Recon ~,cyfrARNJN©~ TANKS NIAY CONTAIN LETHAL GASSY AN1310R INSUFFICIENT OXYGEN. TMENT TANK UAJOER ANY GIRCIJMSTANCES. DFJ~ITH MAY SEPTIC, PUktP AND O~'HER TRF-ATMENT DO NOT ENTER A St~'TIC, PUMP tJR OTHF-R TRt:A RES(ILT_ ,RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR iltl(POSSIB gpOITIONAL COMMENTS . POtAt?'S JNSTAU.ER Name ~,~~z-~ ~.-/ e` r- .- J--~ Phase ~ ~~'-'~~~ POVYI'S MAINTAINER tame ~~rcr~~-'~/`~!_~ Phone 'mil ,,---02~~'~" ~ ~~ ~ tr.tacA!_ ~GUTATaRY I~UTNORfTY SEPTAGE S~RViCING OPERATOR PUMPS r /I Agency ~ ~ ~r-' '` Name ~~' / ~ ~ `'`~'~ phone ~ 1 ~ ~'~ C~ Phone % J J':-- o~- `~ '" ~ ~ and sanltatiatt ~- ~-~ eocument tha staffs of the tteen take. MarQu®tfe and Waushara County Zoning ~~ Use of ft+is dower does not This ctowmentwasdratted try t and 83_S6(i}, {2) 8 (3), yy~cpnsin AcSminlsfraa+ra ~yy tvp1t the minimum regvi[+eti7er~ts of dt Comm $3_~~71 }(d)ddfl gvaraniee the performance of the P(7YYTS. Wisconsin Department of Commerce SOIL EVALUATIO Page of Division of Safety and Buildings `~' m accvraanc;e wnn ~.ornm o , vvis. ~ya~y ~ in ~ ~~ ~7 er not less than 8 1/2 x 11 inches i Attach com lete site lan on a size 'Plan must p p p p . i d indude, but not limited to: vertical and horizontal reference point (B re n ), d • ~ Parcel D. ~ t i e~ r~dr, ( percent slope, scale or dimensions, north arrow, and location and d tance , _. B Please print ell information. ~ "Revie ed by Date Personal information you provide may be used for secondary purposes (Pri acy L.aw~O ~~9 ~C)1!J>\( ~; ~ Z3 Property Owner ~~ ~ Q ~ . Q~ ro 22 {~1/4 SJ Lot ~~~ 1/~ll Govt ~ N R ~ E ( ) W ~ ~ r `, , . Property Owners Mailing Address Lot # Block # Subd. Name or CSM# c~d ~ ~ `~ City State Zip Code Phone Number ^ City ^ Village Town rest Road Ne a ew Construction Use: idential / Number of bedrooms Code derived design flow rate ~ ~ GPD ^ Replacement ^ Pub' coLnmerdal -Describe: ________ __ ___________ __- Parent material , ~ Flood Plain elevation if applicable /~/~ ft. General conxnerrts ~,~,~,~ s ' ( ~~,, ~ ~ S and recommendations: ~~~, ~ J ~, ~ O{', ~ i a ~ doL- - c ~~ ~~~~~~ lad- wod nv~- ors ~~'~ U ~F~ j~~ Ca 1~ ~~ # Boring Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil icatitm Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP DIfP in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 ~~ ~~~ 3 ~ir~ , ,~ -- ~- -- ~--- ~--- e«~~ # p Boring ~, pit Ground surface elev. _~ ft. Depth to limiting factor ~ ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. unsell M Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ~/ 1 /~ Z -- !3 D- , I ~- ; ` ~ ,~ ~ .~ l ~ ~ ~ ~ r.>~ ~ ~- .5! C ~.rr'~~ 6/; ~ ~ ..;yam N i~ ~ ~- • 3 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L `Effluent #2 = BOD < :SU mg/L and t ~ < :iU mg/t_ CST Nafrls (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ ~'~ .-~~ 715-246-4516 Property Owner _ Parcel ID # Page of ^ BOring r `~ t/ BOring # pit Ground surface elev. ~ " ft. Depth to limiting factor ~~ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ©-,~ I 0 ,- 3 ~~ r---~ s, ~ ,r ~ ~-~ ~~- , -y ~ ~; ~. a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= 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 ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL 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.6N0) Property Owner Parcel ID # Page of © ~~ # ^ BOnng r -~ Pit Ground surface elev. L `" ft. Depth to limiting factor ~_ in. ~I ~~ ate Horizon Depth Dominant Odor Redox Description Texture Structrxe Consistence Boundary Roots GP O/fg in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •E1f#2 Boring # ~ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. SoU ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Sure Consistence. Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz Sh. •Eft#1 •Eff#2 • Effluent #f = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L • Eflluer>F #2 = GODS < 30 mg/L and TSS < 30 trrglL 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. seaesw tte.6,oo~ Soil Test Plot Plan Project Name Ev Fregine Address g11 200th St. Baldwin Wi 54002 Lot 3 Subdivision NE 1/4 N W 1/4S 36 T 28 N/R16 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. Township Eau Galle County ST. CROIX Top of 1 /2" pipe System Elevation 99.7 *HRPSameasBenchmark Please note: original soil test was not on the property, once the lot lines were staked. Scale is 1" = 40' unless otherwise noted AIt.B.M. is >200' from West Lot Line AIt.B.M. is top of 1 /2" pipe `~ 100.1' 98 B.M.* 9 9:.~_ B-3 Boston Rd 2 C #226900 Date 9/13/05 1007' Property Line 400' Scale = 1 /4" = 10' .~ ~' APR I 12005 ~ 4, ~~ _.,._,.,_,,~.R .~ .. Si ~` €' ""...a~,~. `~~ ~n ~~ 77Es~ 1 2 VOL 19 PAGE 4853 KATALTiEA H. its'-'~"' REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR ~?ECORD 10/0S/20A~! 11:00AM .CERTIFIED SURVEY tlAP CERTIFIED SURVEY M~GEZ 3.00 LOCATED IN PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 36, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. OWNER: WEST LINE OF THE NORTHWEST 1/4 PAUL & JANIS NELSON = N O x'20 ~57" W 2646.40"_ ~ 2626 BOSTON ROAD ~~-~ ~ a' - _ _ _ _ _ WOOD MLLE, WI 54028 ._ , - - ""C"•- • L6 - ~ ~ 0 7b 18o JOO -j ~ ~ L7 T ~--91.29' c,. LINE TABLE: EC/3scoR ~`; ~ ~--~7-- - - - NUMBER BEARING DISTANCE L1 N 89'50'07" W 105.38' L2 N 89'50'07" W 139.62' L3 N 89'50'07" W 55.30' L4 N 89'50'07" W 22.97' L5 S 89'46'51" E 33.02' L6 N 01'31'21" W 302.49' L7 N 03'17'21" W 358.55' L8 N 76'06'50" E 75.69' L9 N 89'48'10" W 375.10' L10 N 18'18'37" E 183,23' L11 N 18'18'37" E 42.73' L12 N 18'18'37" E 140.50' L13 N 26'09'20" E 44.68' L14 N 54'41'02" E 55.49' L15 N 89'48'10" W 297.75' L16 N 89'48'10" W 329.88' L17 N 89'48'10" W 112.89' Li 8 N 89'48'1 O" W 236.60' L19 N 56'19'12" E 219.85' L20 N 18'08' 20" E 156.73' L21 N 65'49'23" W 184.05' L22 N 78'24.38" W 206.40' L23 N 89'46'51" W 174.72' L24 N 57'41'57" E 381.22' L25 N 74'18'51" W 359.19' L26 N 63'06'50" E 213.85' L27 N 13'04'44" E 252.74' L28 N 74'55'35" W 232.19' FOUND 3" ` ALUM MON ; ~~,<i~1 ~ _ I I 1 ~~ <~o C27 •_.~ rnl I } 1~,~CZp a V I 1 N ~.~ ~~ c1i1 <~~ 1~ I~ so I I i I ~~s•~~ LOT /~ o ~ 67 N~ y I~ I C7p ~~ I '~ ~ I'~ C 2 O I I ~' 1 I I I w ~ I~ I I I ~ I `R ~I I Col i a Z ~I 11 0 s ~ 11 I z; I m I I I ~ v I I~ ~ I I Iv' i w ~ I GI 66' `~' I N ~ I ~ I~ i ~ rn N I~I C ~ N< ~~ ' ~~ j w qn ~ ~ ~ LEGEND: • SET 3/4" BY 18" IRON DRIVEWAY NOTE: ! PIN WT. 1.50 LBS./FT. JOINT DRIVE TO SERVE L0T5 3 & 4 _ COUNTY SECTION MONUMENT `-°. (FOUND AS NOTED) a - 100' BUILDING SETBACK UNE FROM .ROW ~ 75' 6UILDING SETBACK LINE FROM °~iWlMkeea:aQo • n ""-'"""'- 66' JOINT DRIVEWAY EASEME °~ 4~l~,4'~..~~v -'""-""""- DRAINAGE EASEMENT & ~'•••• 10o YR FLOODPLAIN ~}£' ROGER LYNN ~~':~ -~- PROPOSED DRIVEWAY ~ ~ MPHR S-2188 - - - SOUTHERN ORDINARY HIGH ~• WATER MARK (OHWM) _4%. 1L LBO = LOWEST BUILDING OPENING '> ~~ ~- .~5.• '• "~O O u f EAST" THIS INSTRUMENT DRAFTED BY KEVIN SAMUEL HUMPHREY ENGINEERING Vol 19 Pag 4853 \~y'p ' ~ F~~~ 'dr 'L < f ,s~F~~4o 1a~~~~ Z f ~ v <~~ ~ o s,~~ ~ ~ Off. HOUSE O )~ LOT 2 a ,o~~ METAL Do i- BUILDING B r- 8~96'32.64. ~~ ti LOT 3 s,,. x~ !0 ~?. ~~, ~~~ ~j ~ 6 "mss. LOT 4 Q 66.09' - S 02'55'09" E 658.73' OF THE NORTHWEST 1/4 w N m NW COR SEC 36 SET PK NAIL FROM TIES OF RECORD ~,M. TOP OF P.K. NAIL ELEVATION = 1080.63 ~ ~ ~ 2 ~ m N w ~ ' ~ .~._ - ,, m m F ~ O O w N ~ A NOTE: BEARINGS ARE REFERENCED TO THE WEST LINE OF THE NORTHWEST 1/4 OF ~ SECTION 36, ASSUMED 70 ~ BEAR N03'20'S7"W. 1/4 COR I FOUND 2" ~ IRON PIPE SHEET 1 OF 2 1 N oa 6' r Safety and Buildings Division County~~ ~ ~~ i 201 W. Washington Ave., P.O. Box 7162 ` ~ m Madison, WI 707 - 7I 62 Sanitary Permit Number (to be filled in by Co.) «cons~n (bog, I ~ ~ 2 ~ ~ Department of Commerce State PlanI.D.N ber ~ ` Permit Applicatio ~G ~l _ S . ~o Sanitar , y i Tn accord with Comm 83.21, Wis. Adm. Code, personal information yo ro~ pro ~ A (if different than mailing address) may be used for secondary Purposes Privacy law, s15.04(1)(m) Q l I. Application Information -Please Print All Information ~ ~~5 ~~ N ~ , OU cel Lot # Block # Property Owner's-Name ZONING OFF E 3 ~~^• Catlon Property Owner's '!vn dyes /~ /y~~~° ~ ~~ ~ ~ ~i, SeetlOn ~I /Y, ~ f,r / ~4, City, State t Zip Code Phone Number (ctrc one ~O T ~~ N; ~~ E r W . L2. .. IL pe of Building (check ail that a ly) ~ M Number L~9/3 f B d ~ ' (vQ ~ P r - ~S / ~ ~ . e ., Family Dwelling -Number o ^ Public/Commercial -Describe IJse ^City-^Village wnship of r ^ State Owned -Describe LJ se ~ ' III. Type of Permit: (Check only one box on line Complete line B if applicable) A' ew System ^ Replacement System ^ tment/Holding 1!~artk Replacement Only ^ Other Modification to Existing System ~ List Previous Permit Number and Date Issued ~ ', ^ Permit Transfer to New B. ^ Permit Renewal ^ Permit Revision ^ Chang f q~ '~~ ~ Owner Plumber ~ Before Expiration '"' ~` t 1 IV. T e of POWTS S stem: (C ck all that a 1) ~''.- ^ Mo < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ and ? 24 in. of suitable soi ^ Non-Pressurizedln-Groan ^ Peat Ft ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ldin H g o Constructed Wetland ^ Pre surized Tn-Ground / achin Chamber ~ Drip Line ^ Gr 1-less Pipe ^ Other (explain) ^ L • e Recirculating Synthetic Media Filter g V. Dis ersal/freatment Area Information: Dis errs! Area proposed (sf) System Elevation Design Flow (gpd) Design Soil Application Rate(gpds - Dispersal Area Required ( P / ~ ~ 7 ~ ~ ~a CJ v C /aci in Total -Lp Number Manufacturer Prefab Site Steel Fiber Plastic VI. Tank Info ~' ~' ~ l~ P ~ ~, _~ap oncrete Constructed Glass ' of Uni • W ll o rG4b /~ / /_ ,_ Gallons Ga ~jIT~ E i i ng (i. x st New Tanks Tanks Septic or Holding Tank S~ Aerobic Treatment Unit ~' Dosing Chamber T VII. Responsibility Statement- I, t 'undersign some responsibility for installation of the POWTS shown the ~~ nessPhone Number / Plumber' afore MP/MPRS Nwnber / ~ (/o Plumb Name (Print) ~ L/~ ~ ~~ ~/~ ~~1~ ~~ Plumber's Address (Street, City, S ,Zip e W / C / VIII. Coon /De artment se Onl Sanitary Permit Fee (i lades Groundwater Date Issued Issuing A t Signature Stamps) Approved ^ Di ed Suroharge Fee) [/~r~ ~ (}z ^ Own Given Real for Denial T J A. Conditions of ov 1 SYSTEM O ER: 1 Septic t nk, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 8111 x 11 inches in sivc SBD-6398 (R. 01!03} PLOT PLAN PROJECT Ev~ Freaine ~ ADDRESS 911 200th St. Baldwin Wi 54002 NE 1/4 N1N 1/4S 36 /T 28 N/R 16 W TOWN EauGalle COUNTY ST.CROIX SYSTEM ELEVATION 97.1 BEDROOM 4 BOREHOLE 0 WELL *H.R.P.SameasBenchmark MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK \R.P. Topo f Spike in Oak Tree ASSUME ELEVATION 100' Fi1~Zabe1 A-100 Pro 4 Bedroom House Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels 741' Property Line Well is to meet all I setbacks found in * Comm. 83 ~B-1 4% Slope Grading is to be done to divert run-off away from system ~ -3 V ^ B-2 96.1' B.M. @ 98.6' Area 15' below system is to remain undisturbed 96.6' 94.6' Top of 1.5" pipe Contour under cell is straight and curves on the end slopes 1007' Property Line Rd 400' To Boston Rd coP~ ~- commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com me rce. wi. g ov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 26, 2005 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/26/2007 SITE: Ev Fregine ~c-1 ~n-- Boston Road Town of Eau Galle St Croix County NE1/4, NW1/4, S36, T28N, R16W Subdivision: CSM No. pending -lot 3 ..Identification Numbers Transaction ID No. 1141448 Site ID No. 699100 Please refertoboth identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1020225 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. ~ ~, 'g' ~. C~nr~ftioftal~y D EPARTMENT nr nom.-_ ® ~. SHAiJN R BIRD Page 2 5/26/2005 • Comm 83 22(7) - A coQv of the approved Mans specifications and this letter shall be on-site duri~ construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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. 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. 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, ~~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:1 S pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 T code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Cover Page RECEIVE MAY 2 3 2005 SAFE~,~ ~~~~~, ~. CGS Date: 5/20/05 Owner: Ev Fregine ~~~~ ~ Location:NE1/4 NW1/4 S36 T28 N,R16W Lot 3 Boston RD Eau Galle System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 1 Ol Shaun Bird ~~ Signature License nu r 226900 _.,,,~t.,~:-~cE ~,, „SUN ~ SAFETY AND BUILDINGS .SEE GORRES ONDENCE PLOT PLAN PROJECT Ev~ Freaine ~ ADDRESS 911 200th St. Baldwin Wi 54002 NE i / 4 NW i /4S 36 /T 28 N/R 16 W TOWN Eau Galle COUNTY ST. CROIX SYSTEM ELEVATION 97.1 4 BEDROOM BOREHOLE O WELL *H.R.P.Same as Benchmark MOUND )OOC SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Topo f Spike in Oak Tree ASSUME ELEVATION 100' Filter Zabel A-100 Pro 4 Bedroom 741' House Property Line Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert run-off away from system B-3 B.M. ~6-1 V B-~ 96.1' B.M. @ 98.6' Well is to meet all setbacks found in Comm. 83 4% Slope Area 15' below system is to remain undisturbed 96.6' -94.6' Top of 1.5" pipe Contour under cell is straight and curves on the end slopes 1007' Property Line 400' To Boston Rd Rd Designer_ Date ,, " Topsolf 4" Observation Pipe Perforated Below Filter Fabric AS72i G-33 S o n d--~ 7. Slope ~ ,~ /k r .n, r~t~ f S f NO !-1 r Non-Woven Filter Fabric ~Distribuf ion Pi~+c J ^ R' FOrGt Moin fie d Ot ;!~-' 2 'z From Pump Dr+~in Rock fifotxe d f.. a y`e ~, ~~ 1 ~ E ~_. F _ i~~- G ~- ~ ~ ~~ Cress Section Of A iM~ound S stem UsFn A Bed For The Absorption Arta ~' p Ft. g ~~Fi. _ I ~ ~ ~Ft.~ 3 '~ Ft. K Ft. - k~~Ft. J ____ _.__ ~E-__------~---- °' A ~ ~ Forst Moin cn (° _.~._.__.._..__..-------------~_~`+r~ From Pump r ~ Distribution Bed Of /2~- ~ t ~ Pipe ~ Oroin Rock 7 4~~pbf-ervotion ~ipe~~-.?C~~~ Permonent Morktr ~S~-r' i /~ ~ ~ s~a,~-~ l~c,'~'~~,~~.~" ~ p e or Rod s Plon View Ot Mound 1}cfn A Bed For The Absorption Aree L 4-JObservotion PiPe-~ ~~~ i.•' ~-- ~n~ -~ r- i rte. _ `~ PAG E_ ~F~.--- Pestcsa'eG Dips: flet0it c tatated 4n 8ottonn. a ~Ruatty SQOaea Cl>rq FIRST MOLL t~Ifi.KY TO C~MC}~Cr ,/ ~ ~ Signed: License Number: t}a to I ~ ~ o~ ~t . __.,_- ~ ~. ~t. X ~/ inGttes ~ ~~ : aches Hole Diameter~~~ ~nch ~ate~al ." ~ ~ Inch(es~ Man i foi d Z_ Inches r Force Main '~ inches ~ of holesi~iRe Invert elevation of later~a~s~ ~~ ~~'t... '~i41ri~2cttiprl ~ipt t.OYattt ~~.. F~,gTIt~hS ' T ~ ANB SF£~=~i F Cx~.OSS 5£~T`G. SEPTIC TA~iK ~ z~3!~P C~.kM$.,g u~~~~pR4t3F Apg~QV ED ,. ~ZTi- gBDV£ BRADS ~ Jij~CTiCi~ $flx rsAxxo~.~ car ~~ - io -VENT PIPE ~Z W~TK CflhflEtlT WI PA$L~K ~ ~ ~~ ` ~`Rp!'S D4QR. ~dlN~a~ 4 ~tARKI~iG ~A$E~ 9 ~~ e~R ;NTAiCE r^~ ~~~~ HZ1~- r - FKE~7I~ R1°tB L ~, ~~ ,, o, ~ s, e. t8~ «~~~- =~ ~ . ~ "~ SMART ~ `, ,3t3Iti'~5 it17H i,,;AT~ 'MI6 H'~' SEA ~ L app~~ pIFE giLT£R $ s QI~ ~jB 54IL App~V~ C t i 4FF s -~- P 54LtD OFF ELE~ -~_.:--- T- O SAIL Pi32~~ __--~ ~~._ IC eORCg£TE PAD APi,RpV~ BEDDI2~C UI~D~ '~.A3+i/~ r SPrCZFICAiZ{3N5 `~ ~ ~" - Dc35S5 ?£R DAY = J....-----'-' /~ 1+it3i'iBER SEC f IIQSE ER + ~t..L7`.~' ~~t~~~"'" ~£ v ~s i..x1 ME I NCO gDp~CNG ,r~ GAL • , L - ?ANR ~„;A~~-~,C'I7JR '~ ,~-'~~'' ra,~'-i - ~ ~ „~`_ ;J CyA TAIiK 512ES = SEpTZC ~ ~ ~ 6AL - g ~~~ ,f"I~,CiiES ° n~ t~ DOSE ~ ~¢~,~,,~} CAPACI'II~" _ . ~ Y3~HES = <.d~--^_'GAL- FAC'~3RFA;= S ` ~Z'tC ~ ~ I~I;ES ~ i~1AC ~~~ RODEL ~~E£? ,, ,rrs L,s ~' ~Rlh WIRING +H pCiri~' 8 A _~~- f~' FEET ~;~ TE -~'`~^ ~~~ #F f.NB '{?IS'~RI~Ti~ gIPE.~~ ~-~-FEET RE~Z~tF.D D;SCIiAR~E ~' I - - - _ ~. ~--~'"~ FE£? PtJI''~P fl _ _ ~~~~ FEET PRESSUz"tE - Pg;C'TIaR 'FAC~`4R vER'!'ICAL 8~~~~~KCSt~PPLYEEri ~ 3 £T/1Q~ F'Ffl`~I~L flYN~~C M~ •~ £R + ~v's ~ pE£`~ f ORC£T'1~IN X .~----- 111, ,~ ~ D~~~---"...- L~~~3I ~1TER~~ ~1MEp~1~t~~ ~~ p~M I 4AT£ ~,, ~ C EIS ~ ~~ ~'~~ ' -```._-------' ^j$& I~EAD~ .CAPACITY C~JRVE NI MODEL 152/153 ~ Ili' 1"' 153 40 12 15~ o ,' - s 30 U . .__ $ z 0 20 r 0 4 V\ I 1 10 I 1~ - TOTAL DYNAMIC HEADJCAPACITY PER MINUTE EFFLUENT AND DEWATERING Z O~~ _0 4 ii0 80 100 -LITERS ~ 80 160. 240 320 FLOW PER -MINUTE CONSULT FACTORY FOR, SPECIAL APPLICATI~N;S • Timed dosing panels available. ~° " Electrical alternators, for duplex systems, are available and supplied with an alarm. . Variable level control switches are available for controlling single phase systems. • Double piggyback variable level #loat switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F.,.(54':C.) special quotation required. 157!153 Series MOD EL t 5 2 15 ., Feet Meters Gal. Liters Gol. Liiets 5 1.5 65 ~ 261 77 291 } 0 3.1 61 231 i 70^T 2E:5 15" 4.6 53 201 6t I 231 20 6.} 44 167 52 197 25 7.6 34 129 42 154 30 9.1 23 i37 33 t?5 35 1UJ ~ -- I -_ 22 ~ c5 40 12.2 -- -- 11 42 -- Lock Valve: 38.0 Ft_ (tt.6m) 44.0 Ft. (134m) 014506 - 3 ~7/ ;z :2 I ,2 t/8 r,i ~_~___ ~~ f 1 a sa2o64 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. n cnunolu 2. See FM0712 for correct model of Electticat Attemator E-Pak du lex 3 3. Variable level control switch 10-0225 used as a control activator specify p ( ) All Installation of controls, protection devices and wrong should be done by a Qualified lkensed electriium. All electrical and safety codes should be foNowed inctuding the most of (4) float system. recent National Electric Code {NEC} and the OccupationaLSafety and Health Ad{OSHA}. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MALI. ro: a.D. sox 16347 Louisvile, KY 40256-0347 Manutacturersof. ~~ ~ SHIP 70: 3649 Cane Run Road _LLLf...p' ® Louisville, KY 402f1-1961 ffvaurrP°Mas svcf /933 ,,. (502J 77B-2731.1(800) 928-PUMP p~/NJp CLT. FAX (502) 774-3624 hftp://www.zoelle~ com © Copyright 2000 Zoeller Co. All rights reserved. • •g MANUAL & MANAGEMENT PLAN Qp~-t-g py~NER gySTEM SPECtP{CATtONS Septic Tank CaPa~ RMA L ,/ ~" zT ` $epbic Tank Martufa Effluent Fitter Manufac{urer Number of Bedt~s Number ~ ~~efctat Units - Fs6mated ~ (ave~~) aced x t _5) peslgn flow {p~~lc), (Esbm Soa gpp~n Rate tnfluentlEfRuentQoality Fats. Oil $ Grease gOO~ Biochemical Oxygeri~ SoGds({T ) Total Suspe ~ Pmtreated ~tfuertt Quality - en Oemand (BODs} Blochefn~l OxY9 nded Solids {TSS) Total Suspe metric mean) Fecal CoGforrn (g Maximum Efnuent Partide Size '•"" el,r, Effluent Fitter Mod a NA ~ _ Pump-Tank Cale ---~' ~~~ allda Pump Tank Manufacturer at/d "• .Pump Manufacturer ~' ~~ / ~ ~.._.~~-a~da ~ Pump Nloctet ~eafxnent Unit Monthly average' pre D SartdlGravel Filter 53o mglL p M~hanicat Aeration ~Q mgll_ ^ Disinfection p months ^ nom^ nom ths r ^ month- s ^ m thou s Monthly average'"` Oispecsa[ Ceti{s) - p In-ground (pressurized) ^ In~~nd (gr'avity) ~Aound ~i0 m9n- ^ Afgrade p Other s3o m9n- D Ori ine Si 0' cfu11 o0ml ~~ for darestic (nom ~stetirater end Y inchdiameter v~eftgUent Valurs LYP~ for pretreated wastewater- - SCHEDULE Service Event inspect condition of tank(s) Pump out contents of tank(s) Inspect dlspersaJ cd1(5) Clean ~Ciuent fitter Inspect pump, pump controls 8~ alarm Rush laterals and pressure test Service Fre4uency '' D rnonths~ ea' At Least once every ua s one-Ihi~ When combined sludge and scum eq_ At Least once every At least once every At least once every ,ot Least once every At least once every At least once every Page of .~ gat DIVA r~; NA -~`rl~ o NA 7 ~_-•- ~ C1 NA .- ~ C7 t~A D Peat Fltter ^ Wetland p Other. ,) (Maximum 3 yrs.) (y~) of tank volume ;~ (Maximum 3 yrs•} p NA ^ !YA O m th p year(s) O NA ^ months ^ year(s) O NA ----- licenses or Mpi~NpNCE INSTRUCTIONS n one of the following twiner, Septage of tanks and drspersal cells shalt be made try an ind'rvid~~s inst~e~r pO~s Marv lnsped~ Restricted Sewer; on of the tank(s) to ,dentlfy any rnrssrng or broken Ce~tlons:. Master Plumber; Master Plumt~er m and ~ cthedc for any back up tor. Tank insped`-ons must indude a visual Inspecti to dtedc the effluent Levers Sentidn9 Opera Leaks measure the volume of combined sludge and scu of effluent on the hardware, kien'~ ~r cracks or ~ The dispersal cell{s) shalt be v<suatiy inspedQd riding or ponding of effluent on the ground surface- riding of effluent on t?.le ground surface- The p° oratory authority" in the observation P-P~ and to chectc for any t~ uires the Immediate notification of the local reg ground surface may ind-cate a fatting condition and req k owls one-third (X) or more of the tank volume. thNR moved by a Septage Servicing Operator and disposed of in accordance ~t ~- 1Nhen the combined wow shalbe fesludge and scum in any tan eQ entire contents of the tan ~ retreat#ment camPonents• and any 113, Wisconsin Administrative Code. ~ POWT•S ~mponents, p a mortified pOWTS M~~,iner. The senriang of effluent fitters, m~ttanicai or pressurized rformed by service event other maintenance or mondonng at intervals of 12 months of Tess. shah be ~ of aomptetion of any . shalflae provided to the local regulatory authority within 10 days A senr"1Qe report eructs or other START EIP ANO OPERATION for the presence of painting p ersa[ cell(s). if high concentrations are For new ooctstrudion, Prior to use of the POWTS check treatment tanks rm a the treatment process and/or damae servte c 9 oPe~`t°r prior to use" chemicals that may ' pact s removed by a septag detected have the contents of the tank( ? Page of /^ ' conditions are frozen at the infitfraave su is ~~ ~ excess ' when soft gystem start up shall noUoccur ~ hwtrter levels. V1(hen outages pump tanks may ~ above nottt~ cg During t?~r ed m the d'sspe~ cell(s) in one large Gale, o,rerioading the cep) ink ro~~t-byna e ~~~ yn-if tie d'tsd~~9e of effluent To avoid this situation have the concontact a P- mbec or pOVYTS Maintainer to backup ~ surface disc*~9 print-to Ong pawet tQ the effluent pump or um tank. image Servicing ~ ~ pump Controls to restore normal fevels within the p . P assist in manually oPerah and dispersal cells. Do not dme or park over, or othen~tse disturb or ~~~ po not drive or park vet-tctes over tam - thearea within 15 feet down slope of any mound or at-grade sotl absorption atea- from the tnrdstewater stnJam may improve the performance and proforig the frfe of the foltawing condoms; t~tton swabs; degreasers: dental fuss: diapers; Reduction or-efunirtatton dg~~ butts: of the POWTS: antibkrtics: ~Y wipes: amp} water, fruit and vegetable peer'n95 gasoline; grease; herbicides; meat d-~~~t,; {~ foundation drain {sump t? ~~; sanitary napkins; tampons: and water softener brine. ; medt~tions: ori; painting products: peS -- gt3AN00NMMENT taken nut of service the foltowln9 steps shaft I~ taken to Insure that the When the t'O~S falls andlor is permanently 1-ance with ch_ Comm 83.33. Wisconsin Administrative Code: and safely abandoned in come - i ntngs seated. system is propedy ~ shall be disconnected and the abandoned P Pe o~ . Alt piping to tanks and p' - disposed of by a Septa9e Servicing Operator. The contents of a[[ tanks and pits shall be removed and property • ~ shalt ~ excavated and removed or weir covers removed and the void space After pumping. a[t tanks and P fitted with soli, gravel or another inert solid material. rovide a code CONTINGENCY PLAN ~ the following measures have been, or must be taken, to p If the pOWTS fails and cannot be repay compGantreplacement system. en evaluated and may tie utilized far the location of a replacement soil p A suitable repiaCerttent area has ~ . n system. -rne roptacement area should be protected sro~ sere ~~t~ d ~ d~~s n a are ~o t not absorPt+o aired setbacks from existing and propo be infringed upon by ~ vriil result in the need for a new soil and site evaluation to establish a surtab e protect the replacement area i ~~-, the rules in effect at that time. replacement area- Replacement systems must comp Y bte re lacement area is not available due to set ~~ o r Piace'the failed POWTSn9 advances in POVYT O A surta . P be installed as a last res technology a holding tank may n failure of the P01NTS a sol and Tile site has not been evaluated ~ tdentrfY a suitable replacement area. Upo site evaluation must be perfoRn~ ~ locate a suitable replacement area. If no replacement area is avaitaWe a trig tank may be installed as a last resort to replace the failed PONY~S removal of the biomat at stems may be reconstructed r ~ Pik ~e~~sn effect at that time~ ound and at-grade soil absorP~~ns of such systems must comp Y the rnfiftrative surface- Recon «'Y{fARNING» TM,gN'(' TANKS MAY CONTAIN LETHAL CSC RC MOSTANCES~ D TH MpYGEN. SEPTIC, PUMP AND OTHER Tl~F-A DO NOT F_N'rER A SEPT'[C, PUMP OR OTHER TREATMENT TANK UNDER RESULT. , RESCUE OI= A PERSON !`ROM THE tNTERtOR OP A TANK MAY 13E pIPPICULT OR IMPOSSIBLE. AQOmoNAL coMMEN'rs . - - POWTS MAINTAINER / POWTS INSTALLER Narne ~ cam,-rL~`•' * °~ Name .. tZ.~..~'t./ ~' Phone ''' ,,,~_j.-~~ - -° ~ ''~ Phone ~~ ;.% ="" ~,~~'_' ~..`~ . LOCAL REGULATORY AUTHORi1Y •--~ SEPTAGE SERVICING OPERATOR PU PER ,~ ~~ ~1~~~ ~ ~ Agency ~/ Name Phone ~j.1 ,•-~ ~' - ° ~ ^ Phone ~~ ~_- ~ ~ ..~ ~~ This docrrmeni meets the staffs of the Given t,aice, Matqueife and Waushara County Zoning and Sanitation agencies- merit does not This document was dratted by t ~ ar~d 83.54(1). (2j 8. (3). W~stbnstn ACminrsVadva Code- Uso of this doer me r„irumum pOQuioertlents of dL Comm t33.22(Z)(b){ )(~ (~ ~ G~ ty0t i guarantee the perfoananoe of the p()YYTS- Yvisron~n Department of Commerce Division oF3aiery and Buildings SOIL EVALUATION REPOR' Page ,~ of m acooraance wnn i.vmrn cs~, vvu. room. wun Plan must 11 inch s in size t l th 8 1l2 l it l County ,t , x . e Attach wmp e p an on paper no ess an ete s inrJude. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locatlon and distance to nearest road. Prease print al! information. Reviewed by Date Personal information you provide may De used for secondary purposes (Privacy Law, s. 15.oa (1) (m)). %'rr~perty Owner Property Location ~'~ w j t t ( O ~ Govt. Lot ~ 1/4/~; lJ~l 1/4 S 3 ~, T ~ b' N R ~ ~ E (or W Property Owner's Mailing Addr ss p ~~ ~ Lo # ~ Block # Subd. -(Narita or CSM# ~ J b .J ~,._ ~ O'er O r~ f ~C~c , ~ .a a 1; t'. v~ 1, umber Phone N Zip ode ~~it! S t ate C illage own Nearest Road ^ City (] ~) I ' r / / / ~ ~~ ~dM'~ J r ~ (~ W,1 ~ 1 V a~+l rS (~ / ~ ~ G ~ ~~~~ _ ~ V l ~Gt.~.~' TcIJ ~ t/ ~~C~ r~. 1` Gtf~ ~~ New Construction Use: t.~ riesidential !Number of bedrooms _?_ Code derived design flow rate ? GPD (::) Replacement ^ Public or commercial -Describe: Parent material L, o~='~~ z~ ' )C u" rt ~~~ r J Flood Plain elevation if applicable fL General comments (_ p~', , and recommendations: ~wT ` ~~ 2v- ~c1G J ~ ~ ~ t_~. J ~ dr.~ ~ b v~c vt.{ ~~ z)6, / i !~ Rrrinn f! ~ Bering n ~. , .. ~- L._~ ~ _ L+~PIt Ground surface elev. 7,J - _~ ft. ueptn to nmiung ractor a ~ ur. Soil A lication Rate ~ i t C l D tion Redox Descri Texture Structure Consistence Boundary Roots GP DIft: i-iurizon Depth in. or om nan o MunseN p Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Effil2 l ~---- ~---- ~ -- ~ (O`I ~. ~ L ~ „ ~' ~ YH •~ V _._ i ~ --- ~--- . ~---- I ~-~ ~,~,:~~ „ ^ Boring L`_~ ~ (_.}~p)t Ground surface elev. "/'~ , ~~ ft. Depth to limiting factor c~1 7 ~n• Soil A lication Rate ~-I riz n De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfg c: o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ 'Eff#1 'Eff#2 ~ - --- i I Ir---- l~_._ ' Effluent #1 =GODS > 30 _< 220 mg/L and TSS >30 < 150 mgfL 'Effluent #2 = BOD _< 30 mglL and TSS < 30 mglL - CST Number CST Name Please Print) ` , ! ~ ,~' nature v (~ ~ C~a s:' /l f'1 ! ~ p rl--f~ ~' Address Date nation Conducted Telephone Number t Property Owner l~c'L~. ~ ~~ (S tic .. Parcel ID # Page c~ of _3 i -~ Boring # U Boring [l~. pit Ground surface elev. y~o - ~ ft. Depth to limiting factor ~~ in• Soil A licaiion Rate t T Structure Consistence Boundary Roots GP D/ff Horizon i 3 Depth in. -,~ ~3 Dominant Color Munsell oy ~ ~ to r~ ~ ~ a y Redox Description Qu. Sz. Cont. Color ure ex L s~ ~-- Gr. Sz. Sh. ~' b ~..,~ ~~• ,, ~ ~~r c w ,; c `"~ t t~ `Eff#1 ~ v ~ ° ~ ~ 'Eff#2 ~ ~ ~y ~ ~ \ . / f /v ~. , ~_ T~ _ n Boring oui n iy rr ^ Pit Ground surface elev. ft. Depth to limiting factor in• Soil A lication Rate t T Structure Consistence Boundary Roots GPD/fg Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. `Eff#1 `Eff#2 I I -I ~1 Borinc ~ °"""y * Ground surface elev. ft. Depth to umiung rac~or ~~ ~. ^ pit Soil A lication Rate cture Str Consistence Boundary Roots GPD/fP Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture u Gr. Sz. Sh. 'Eff#1 'Eff#2 I C it "Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS <_ 30 mg/L and TSS _< 30 mg1L 'flte 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. >;i,n., ~ ~u rk ovoo~ c~ - 5. ~~._ .. ___ ~ _ `1~,~~ ~ ---8.' ,~ ~. ,~~ . -. 3...~t, ~I~'~~ Tip ~~~4 I~>'' .~~c_ ~~~~ ~~':r~t ~, bb£~~~ ,. av~ ~ Inc ~~ j l c ~~ ~~~~ / i .' !~ '~ / ~; , yyc~.t `~ 1;~ ~ ~ 4~. ~ i~ ~ ~ 9~ Sri ~ ~.. , r '' ~; G~' G` .k. ~7'r~ is ,~v ~~ =~ ~( l~ L`~ --~ -~--1--.__._. ~`f:CeYJ~ /~Tsy ~~t~CL;vL Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ~ of - In aCCOrOance wan ~.ornrn oo, vv+s. r~un+. ~.WC ust Pl 11 i h i i - County , f.. an m nc es n s ze. Attach complete site plan on paper not less than 8 1/2 x 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. Please print in~""° -_W~_w_ ~ ~ ~ Re 'wed by Date nt~ ~ `~'~ Personal information you provide may be used f r secondary purposes (Privacy Law, .75.04 (1) (m)). '~ J 11~.~ VZ Property Owner x s ~ •~ ~ ~ ~ O ~ .J ~ 1 I_ ~ i ! Q a ~ <... Rroperty Location / ci govt. Lot ~ 1 /4/U ~ , /4 S 3 ~ T a d N R ((.o E (or W Property Owner's Mailing Addr ss ,p ~ I ; ; ~ ~,~, ~, ~,: ~ ~# Block # Subd. Name or CSM# Ciry State Zip Code Phone Number 1~Vo«~ V ~ I ~ e-~ ld)..C Date (~ -s) 69 ~ ~~ y3 ^ C;ty ^ Village own Nearest Road ~a-4- C~~I I ~ s~o ~. ~d~ New Construction Use: t~ Kesidential / Number of bedrooms ? _ Code derived design flow rate ~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material _ ~.. dCSS O OCtr" ~~-~ ( Flood Plain elevation if applicable ~~ ft. General comments (~ `,,~ nn r and recommendations: ~k,T -T102ir' ~cu5 ¢ ©`T ~'e-'' d~` eo~~~k~ 9b~~ ~ ~ (f~ i ~" 5~ K ~- ~~~.~- ccl l ~ o(,~tr, 5 s tt,,,~ E ~e ~~~ 97. t ^ Boring Boring # Q p Ground surface elev. "/.~ ,3 ft. Depth to limiting factor o'~ ~ Soil lication Rate l n i ti D R d Texture Structure Consistence Boundary Roots GP D/fF Horizon Depth in. or Dominant Co Munsell escr p o e ox Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 0-~ roy~ -- L ~~ b w,~-- c w ~ ,`~ ~~ 3 " T jj ~~~ ~o r r 1. L t t~ C K ~1 E' J~ ~ ea~ r ~ ~~ `a Boring # I~~I~Boring °" Lam' Pit Ground surface elev. ~. ~ ft. Depth to limiting factor Soil A ication Rate D th lor i t C D tion Redox Descri Texture Structure Consistence Boundary Roots GPD/f~ Horizon ep in. nan om o Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 0 _ ~ ~ ~ b t ( ~ ~ f f (c - Yf2 .s t2 '~ Ci! ~ 3 - -- - - Effluent ~i =taw > 3U < 1'LU mg/L ana +~~ ~3u ~ +ou rnyrt CIIIUGIR RG - uvV ~ n,y« w... •.. ~ . •-•s- CST Name lease Print) ~ ~,,,( 'nature CST Number Address , / Date uation Conducted Telephone Number Property Owner J G~l~ ~ ~tL~$dv~ Parcel ID # Page o~ of ® Boring # ^ Boring C~PIt Ground surface elev. 9~0 • (a ft. Depth to limiting factor ~ ~ in. . ,,..__--+ Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 f oY ~ L .~ ~~ c ~ ' ~~ ~ ~ ~ ~' -`` 'c~ -3 SL b ~r (o ~~ .~ ~~ ro n~ ~ ~~ .< <~ ~~ ~0 4 o.M -~~ ~ ~o s. ~. a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP 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 A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 1 SO mg/L 'Effluent #2 = BODE a 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. SI3D-8330 (R.07/00) r~~>>~,~r, I~~~1 ~,1~~,~Iso~ =;~------~ ~ qY. g, .M ~oo`ov ~cSQos~ to-~' 3 ~,o~~~ ~` 9g'~' ~~~~ R~bbr a ~~o~ dos 1~.~, . ~ -~1 1 ~~ - f ~ ~ ~ _ - f `~F9` 5/0~~ i' l ~ (~ v s ,+ 1 •~ ~ ~ ~ Q~ t] ~ Q~~e 3 e~ 3 SP,k~ ra pa.k °r"r~e~. ~~~ `~ ~o ,~ , ~,~ / ~'1 CpUN'r'~ E1ViEN'T- ~~ ~ 7 t s ~ R 6 - ~ a~ ~T coo ~Np~CE A~~ , SEPTIC ~ ~'~AIl~`~prtD ~ ~ FORM - " OWNE~~P CERTIFICATION l - ~~ ~ n~ pwnerlBuyer zooms 5~ .. r ~ ti ;~.. . Mailing Address ~ _ . ~ - ~ DeP~ent for new constr Property Address ~yerification required from ~~~ Parcel Identification Number city/State DESCgIpTION ~ ~ T ~N-R ~~ W, LEGAL... prope~Y Subdivision .._-------~-- SurveY Map # ~ c~ ~, page # ~S~ ~ Volume (~ 2~~ Page # .~----- Cert~ied ~ I ~©g Volume Deed # Lot ~~ id$ntifiable O yes C1 no Warrant'' ~ Q IIo wastes. Propermsiattaamce SpciC house D Y its coma ~ ilure to ~t You gut into the sys~ ~~ tic system could result in ~ by ed pumPcz. sCF or soo sf ne tem. a ~ _.~~ of y~ acs aer, oral sys S~~op~ ~ o~ a septic tank every ~~nt stage in the R'aste disp ~, by the owner ~ bym. consists o the ~~tion.of the septic tank ~ >; Zoasag Dep~emeat a cezt ~~{~~ ~~ ~stewaterdisPosal syst~ can affeet to St. Croix verifying tic tank is less than 1!3 fish of sludSe• r erty oar agrees to ~ ~ lumbar or a licensedP~nscessaiy?t ~o sCP umP The P o ourneYm~-Plumber. ~~ ~~ctioa and F sag (. ~ system with the s~~ masterplumb~~J d/or {2) after fain the Private sewage d3spo cation ~~ condition an ~tesouze of Wisconsin- Ces~ - is in Propel oP eats and agree to main atur~ es, SCount?' Zoaiug Of ~u ~~ 30 mmerce and the DeP~acnt of K St. Croix d have read the above leted and retained to the Uwe, the uz~s ~ sct by the 1?epar~t °.f ~ ~ must be comp ~ q, set forth. hie tic system has ~eII ~~ ~ ~ j-~----~ stating that your sep~ eXp~tion date. DATE days of the thre Y OF AP LICANT am (tee) the owper(s) of Si ~ • ]niowledge. I (we) ER ICA ~ ~~n on this fozm are true to the bes~teo~ter of Deeds Office. C~EI (we) Cep' that ~ of s warcaaty decd recorded in B ~ f /~ ,~ ~ ~ gropert5' described above, by viztue DATE ' DeP~ent. #~.~«. ATURE ~ APpLi a sanitary Pennlt being revoked by the Zoaiug SIGN v result in th #*.~~t. ~,y infosmadoathat is misrepresenud~- office d from the Register of Deeds deed de in the warranty G~~~~ Town of . d yya~nty dee if reference ss tna ss Include with this application: a copy of X30 cethfied survey map U ?.??5 P ].7 ~ Document Number STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED ~''3 1 rLi iZr 6 (( KATHLEEN Is. MALSH REGISTER CtF DEEDS ST. CROIX CO.. 411 REC.EIV.ED FOR RECORD 03/;il/2005 02:15PM MARRAN'fY DEED REC FEE: 11.00 TRANS FEE: 14.70 COPY FEE: CC FEE: PAGES: 1 THIS DEED, made between Paul R. Nelson and Janis R. Nelson, husband and wife, Grantor, and Evelyn Fregine, a single person, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: of of Certified Survey Map file January 18, 2005 in Volume 19 of Certified Survey Map, ap ge 4913 as Document No. 785194 located in part of the Northwest '/4 of the Northwest ' . an to part o the NE '/. of the NW '/. of Section 36, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. Recording Area Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Aletro Legal Services EDIRET 459763 A 44S33U t1~ 35u753 Dated is 17th day of March, 2005. * Paul R. Nelson AUTHENTICATION Signature(s) authenticated this 17th day of March, 2005 * TITLE: MEMBER STATE BA O ~( iC (If not, nsin authorized by § 706.06, Wi TNIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed or printed below their signature RETllRN T0: ~ 5 METRO LEGAL SERVICES, INC. 330 SOUTH 1N0 AVENUE, SUITE I50 MINNEAPOLIS, MN 55401-2217 008-2001-20-000..... 008-2000-90-000 Parcel Identification Number (PIN) This is not homestead property. c r'' * Janis R. Ne son ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this March 17, 2005 the above named Paul R. Nelson and Janis R. Nelson, husband and wife to me Irnown to be the person(s) who executed the foregoing ins en~and ackn wl ged a same. A n ~, /Y 1 *J a VanHouten No ry Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 7/27/2008 ) WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ,' - ~1 t~ M 7ei~ 1 ~.~4 VOL 19 PAGE 4913 KATHLEEN H. fVTGSR---- REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 01/18/2005 11:15A![ r----- ~+ -~~°~C E R T I F I E D S U R ~2 3A P LOCATED IN PART OF THE NORTHWEST 1/4 OF THE NORTHWEST 1/4 AND IN p0(~ERL~IN PART OF THE NORTHEAST 1 /4 OF THE NORTHWEST 1 /4 OF SECTION 36, K TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX 4ANpP COUNTY, WISCONSIN. •. Mo su LINE NUMBER BEARING L1 N 89'50'07" W L2 N 89'50'07" W 139.62' L3 N 89'50'07" W 55.30' L4 N 89'50'07" W 22.97' L5 S 89'46'51" E 33.02' L6 N 01'31'21" W 302.49' L7 N 03'17'21" W 358.55' L8 N 76'06'50" E 75.69' L9 N 89'48'10" W 375.10' L10 N 18'18'37" E 183.23' L11 N 18'18'37" E 42.73' L12 N 18'18'37" E 140.50' L7 3 S 89'48'10" E 487.38' L14 s oo-11'so" w 6s.oo' L15 S 00'11'50" W 40.33' L16 N 00'11'50" E 40.30' L17 N 00'11'50" E 33.00' L78 N 89'48'10" W 329.88' L79 N 89'48'10" W 454.24' L20 N 56'19'12" E 219.85' L21 N 18'08'20" E 156.73' L22 N 65'49'23" W 184.05' L23 N 78'24'38" W 206.40' L24 N 89'46'51" W 174.72' L25 N 57'41'57" E 381.22' L26 N 74'18'51" W 359.19' L27 N 63'06'50" E 213.85' L28 N 13'04'44" E 252.74' L29 N 74'55'35" W 232.19' LEGEND: O SET 3/4" BY 18" IRON PIN WT. 1.50 LBS./FT. • FOUND 3/4" IRON PIN COUNTY SECTION MONUMENT (FOUND AS NOTED) I 1 ~ ., o ------- I I I ~ \I Imo L28 -•-~...•\ ~I I I cr ''i ~o <<''~: cnl I ~ ~ ~ \ III ~~5.~~ LOT 1 i' ~ .} 3~. I ~O,p ~+ W Q -76 6 N: 9i1~ ~ /v / N I I ~,,. <^ 2 ~ , m x1 ~ I O I I I I I I z I ~~ I ~,1 on o I ~ I I ~ I ~ I I f I i ~/~ ~' - 100' BUILDING SETBACK LINE FROM ROW 75' BUILDING SETBACK LINE FROM OHWM ---------- EASEMENT OWNER: PAUL do JANIS NE~_SON -""'-""'- DRAINAGE EASEMENT & 2626 BOSTON ROAD 100 YR FLOODPLAIN WOODVILLE, WI 54028 - - PROPOSED DRIVE WAY - - - - SOUTHERN ORDINARY HIGH .~ 11 ca tiF ~ i ;I s~ t- ,po4o j, nl N ~ ~Tjeo~ti .~ ~ Ir .,,~ ~ s sr.~.. ~"' ~ r N C F v ~\ O~ I ~ fT10 ,r\ as '\ ~ -X -~ ; (~' oar. \' ~ •. j'I i -q_+ HOU1 SE Z ~ ~L ~~ A JOINT lg ~`9p 96~ I f ,l LOT 2 ~ ~ , ~?`;•' F i ' a,I METAL o0 nl BUILDING J' I ~ h N cn N ~e~2n. N ~ / V JOIN T DRIVEWAY EASEMENT /y 0 U '- i LOT p , '~. Off` co F o v_ ~$ ~+ sue. LOT 4 ACCESS EASEMENT N W COR SEC 36 SET PK NAIL FROM TIES OF RECORD B.M. TOP OF P.K. NAIL ELEVATION = 1080.63 NOTE: THIS CSM CANCELS AND SUPERCEDES CSM VOL. 19 PAGE 4853 Z rn C loo m -' m-- m N Z on ~ NOTE: BEARINGS ARE REFERENCED TO THE WEST LINE OF THE NORTHWEST 1/4 OF SECTION 36, ASSUMED TO BEAR N03'20' S7"W. .09' WATER MARK (OH WM) - ~ - - _ - - - - ~'-S 02'5509" E 658.73' LBO = LOWEST BUILDING OPENING EAST UNE OF THE 1yORT}IWEST 1/a THIS INSTRUMENT DRAFTED BY KEVIN SAMUEL HUMPHREY ENGINEERING WEST LINE OF THE NORTHWEST 1/4 - N 03'20'57" W 2646.40" - ~ r --'-- a+~'- SCALE: 1' ~ 300' ~ .p - O 75 150 300 \ ' W L7 `-91.29' ~ - W 1 /4 COR ~ / ~r w DISTANCE SEC 36 1 1 `~`°! FOUND 3" 1 i' 105.38' ALUM MON I ~~ ~.-~ ~ N 1 /4 COR I FOUND 2" I IRON PIPE I SHEET 1 OF 2 Vol 19 Page 4913 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes {Privacy Law, s.15.04 (1 }(m)J. Permit Holder's Name: City Village X Township Fre ine, Evel n Eau Galle, Town of CST BM Elev: Insp. BM Elev: BM Description: ~~ 8 rn I cs~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Z /~ ~,~~_ ~- /tom Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,7 x , /Q„~ ~3 ~ 31~ t Dosing Aeration Holding PUMP/SIPHON INFORMATION Demand GPM Number Loss to S[lll ARRARPTIAN SYSTF_M ELEVATION DATA County: St. CrOiX Sanitary Permit No: 479217 0 State Plan ID No: Parcel Tax No: Sectionrrown/Range/Map No: 36.28.16. STATION BS HI FS ELEV. Benchmark ~ ~ Z /b9~ L 1 DD Alt. BM Bldg. Sewer ~ , / t ~ + ~ ~~ . SUHt Inlet ~ ~ ' 1~ ~~ ' St/Ht Outlet ~ ~ `~ A Dt Inlet ` ` Dt Bottom ` ~~ Header/Man. $',~ ~Oa/~/~J Dist. Pipe ~a 15.b /O~~ 9,Z Bot. System Final Grade ~ (or `{~ ~bZ •8 St Cover ~ Z J ~ ~ ' ` ~b7 ~ --n ~ .05 /~. IS -t-Z //. a 98'. Z BED/TRENCH Width ~ Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS ~ $7 ~ r5 ~ ~~ 1`,_ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. r INFORMATION CHAMBER OR I Q t Type Of System: ((~~ 7ZSt ~~, v ~ A / /V UNIT Model Number: Ov~C+~K.r ! l 7 ,.~i 9 DISTRIBUTION SYSTEM /'I~Y`/~f~.:/,2~ d'7~~'wa.~L~ Header/Manifold J ' / Distribution \ Pipe(s x Hole Size ~~ x Hole Spacing Vent to Air take 9 Di t ~ th Di S acin L ) ~ ~ ~~ Leng h a p g eng a Snll_ COVER v Drecm~ro Rvc40mc Anly YY Mnnnd Ar Ot-Grade $VStem3 Only Depth Over ~ ~ Depth Over xx Depth of xx Seeded/Sodded xx Mul hed Bed/Trench Centers/! ~.. ZY ~ Bed/Trench Edges \ Topsoil ~ Yes 0 No Yes (~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 2628 Boston Road W dville, Wf 54028 (NE 1!4 NW 1/4 36 T28N R16W) NA Lot 3 /r ~ 1.) Alt BM Description = l.t.. ~~ G~,tE~ d'-' i 2.) Bldg sewer length = ~,/,~, e -amount of cover = ~) G l-.a~.+~l'S I /l ~' Plan revision Required? 'Yes No i l d ~ ,~ ~ S Use other side for additional informa on. L_ ]-i ___ Date Insepcto s ignature SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 36.28.16. C71~,, n /~-~" S _~ 3 ~ Cert. No. `"' j a ' t ~~ ' W ~ County ~ ~ ~ ~ ~ ~ 1 ~ 716 eh . = ashin " 201 . ~ M icon, WI 53707 - / ] 62 ~ Sanitary Permit Number (to be filled in by Co.} J~ (608)26b-3151.: _ ~S~O~S ' ~.q D Department of Commerce ~ State Plan I.D. Number ~ Sanitary Per a - ~ ~~-°ti, ' Tn accord with Comm 83.21, Wis. Adm. Co e, maybe used for secondary pu ses Privacy , s - ~.A~ { r,,,_ ~= .______j Protect Address (ifdiffereni than mailing address) I. Application Information -Please Print All Information ~- X91 SD ~v~• ,I~t4--\ n ~. Block # Property Owner'sName ~ •~ ~ (/~/d5C ' / ` ~ Property Owner's Mai ~ g Addre ~/ / ~ ~ ~ ~ Property Location / ~ ~'~ . J ~ P(, 1 p l~ ~ /d(.%~ .. /., Section ~/,,/ V/ City, S e r~j~ ~ ~ ~ / ,/ ~ ~g Zip CCo~de / Phone Number s~"" K.(/v~' ~° V / ~ / ~ L ~ T ~ ~N> ~ ~cEc one II. ype of Building (check all that apply) ~ ~p~- 1 or 2 Family Dwelling -Number of Bedrooms / . ~ t ,l.e~ b`~ 1 ^ Public/Commercial -Describe Use ^City ^Villa ownship o /'/- ^ State Owned -Describe Use III. Type f Permit: (Check only one box on line A. Complete line B if applicable) ~ 2 ' GDBZ ^ ~ - O D A' ew System ^ eplacement System ^ TreatmentllTolding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal it Revision ^ Change of ^ Pennit Transfer to New ~~ , t, / ~ 5 ~_ 0 Z ~ 2~ S ~"~(~ Before Expiration Plumber Owner rv e of POW TS S stem: Check all that a 1 } ~. 1c '~ 2' ~ ~ Non Pressurized ln-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recircul~ ing Sandr _ / n ~ AC'i~i G Recirculating Synthetic Media Fi] Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~7 V. Dis ersal/I'reatment Area form 'on; Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S tem Elevati VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S 1 Fiber Plastic Gallons Gallons of Units W-l~.~x~ F1' ~l~ oncrete Constructed Glass New Existing ~ (•}tr-• Tanks Tanks Septic or Holding Tank ~ ~' Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersig ssume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumbe ' gnature MP/MPRS user Business PhoneN~` r ./ l J ~~ ~ f ~ ( - ~ ~~ l / / / ' J~Q-u-n~ J ~ '~G Plumber's Address (Street, City, State, Zip ~/ ~; ~~ ~1 ^ (,~ ~ ~~;~ ~/`Lt-•~1 ` t l VIII. Coun /De artment Use Onl Sanitary Permit Fee i dudes Groundwater Date Issued Lssuing Agent Signattve (No Stamps) Approved ^ ~ approve F / ~ Surcharge ee) I 1 en Reason for enia! IX. Conditions o Appr a -~` ~ ~, Q 3 ~ '~w ~ S a• : -~ r, als ~''F' e'^ -' 7r-~ SYSTEM OWNER: ~-_~ 1 Septic tank, effluent filter and o~.. ~ -G ~~ '~~ ~d~w.Q , aintained d / m dispersal cell must all be service as per management plan provided by plumber. ~ (~ ~ ~~ ~~ ~ ~ ~ r ~~~~/P,Q,ut.,~ irements must be maintained dC ~'t ~ (~ c ~ 2. All setback requ ,~ep.-~C O. Q~ / ~~~ ~X ble cndelordmar~ces. ~ l ~ ^ ~ ica as per app r Attach complete plans (to the County only) for the system on paper not ltss than 8TI2 x l I inci-es in a ~ ~ S~ SBD-6398 (R. 01!03} ~ ~ ~-1...~~. Si~-l . PLOT PLAN PROJECT Euaene Klien ~ ADDRESS ;~ NE ~1/4 NE 1/4S 30 /'r 29 N/R 18 ,~r MPRS Shaun Bird 226900 CONVENTIONAL X~OC IN-GROUND PRES Industrial St. #6 Hudson Wi 54016 Warren 10/4/05 DATE CONVENTIONAL LIFT COUNTY ST. CROIX BEDROOM 4 HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top of Lath ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.0/96.2 5' below grade upper setbacks required by Plans Designed Using side of Cell WDNR Conventional Powts _ Property Line Manual Version 2.0 _ Scale is 1" = 40' unless otherwise noted 2-3' X 88' Cells with >3' s B-1 Ve is ~-, 20' ST 25' Vent >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Long 100' „ , „ Grade at System Elevation 15% Slope B-3 25 Pro 4 Bedroom House G~PY PROJECT Euaene Klien NE 1/4 NE 1/4S 30 /T 29 PLOT PLAN _ ADDRESS 1 N/R 18 ;J~~ Industrial St. #6 Hudson Wi 54016 Warren MPRS Shaun Bird 226900 DATE 10/4/05 BEDROOM 4 CONVENTIONAL XXXX IN-GROUND PRESS CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top of Lath ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.0/96.2 5' below grade upper setbacks required by Plans Designed Using side of Cell WDNR Conventional Powts Pro ert Line Manual Version 2.0 Scale is 1" = 40' vent unless otherwise >(,°° Standard Biodiffuser of Cover Leaching Chamber noted with 31.1 ft2 of Area 11" Long Grade stem Elevation 100' 34" 2-3' X 88' Cells with 15% Slope B.M. >3' spacing 10' Vents 90' ~- 75' 20' 20' B-3 ~5' ST 25 , 25' COUNTY ST. CROIX Pro 4 Bedroom House 4 ~ , Wiscowsin Department of Commerce SOIL EV Division of Safety and Buildings in accordance wkh Comm 85, Attach complete site plan on paper not less than 8 1/2 x 11 inches in s indude, but not limited to: vertical and horizontal reference point (BM), percent slope, scale or dimensions, north arrow, and location and dista Please print all information. Personal iMorrnadon you provide may be used for secondary purposes (Privacy Property Owner~,~, Property Owners ing Addre ~~ ~y /~~ ~~ #~ City~~~~ State Zip Code Phone Number fl`/.G~Ltir.~ l~> I ~~yA/~I c ~ :. Adm. Code ~ County Plan must ~' ~~ lion and parcel LD. to nearest road. .. , ~,~ ); ~. L~ ,. 'wed by `i - Property Location Govt. Lot ~G 1 /4 ~1 /4 S ~ T Lot Block # Subd. Flame or CSM# ^ City ^ ViUage Town G,/u,-~e..~.~ I Page of Date ~ 0~' tO r N R I ~ E (or~W ~'Ne~Construdion l7s . Residential / Number of bedrooms ~ Code derived design flow rate GPD ^ Replacement ~ ~.L _ ^ Public or commerdal -Describe: ________ ___ __- Parent material 0 Lut1w nt~~ _ Flood Plain elevation if applicable N ~ ~ ft. General corrvneMs r and recommendations: ~~~,'~ ~( ~-tJ~tn'o...~ ~ S . D~ ~ ~ ti ~ "~,~5 S ~~ •~ v~ '~ G..,.Q. 20 r ® C~1 l` ~ ~' ~k W ~Q! i ~' ~ r Boring /~J~~ - v C~I~vrcSu:~co~o•~ r~/~1+~,5. l ~~ # pit Ground surface elev. /~'~ " ~ft. Depth to limiting fador ~ 2' y in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 (f' ~ /~ ~V ' ~ °~~ ii ~ J ~ /~' YY'1 ~ ~./ C b"11~ ~ Sr ~ N~ir'T 1~~~' ~ 1. ~~ # Boring / l Pit Ground surface ele4. ~~ ~ ft. Depth to limiting fador `~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 T~ y~ Z ..-,..-.--~,.. j /~ V'~ ~ s ,~ --,~ -rz ~ ------- s rn 1 I ~ r/1~} ~ ~ 1. 4~ ~- qs n • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 'Effluent #2 = BOD < 3Q mg/L and TSS < ;~ mg/L CST Name (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 --. D ~ 715-246-4516 .. Property Owner Parcel ID # Page of 3 ~~ # ^ Boring .pit Ground surface elev~~~~ ~ Depth to IimiGng factor ~ 1 ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIif in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0- ~ a I 3, L ~---'----' S ~ m ~,r. ~ . ~ 3 ~j.-ice ~~-~ t~ ~ .~rrl n"~ //l~ . '~1 n Boring # ~ Boring U U Plt vrounasunatxeiCV. n. vaNunvunumiyiauvi m. Soil lication 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 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Descxiption. Texture Structure Consistence. Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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. seo•s3~o pr.aroo) Soil Test Plot Plan Project Name Eugene Klien Shau Address _ 1815 Industrial St. #6 Hudson Wi 54016 Lot 3 Subdivision -------- Da i~ #226900 10/5/05 NE 1/4 NE 1/4S 30 T 29 N/R18 W T h' Warren ~] Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. owns ip County ST. CROIX Top of Lath System Elevation 95.0/96.2 *HRpSameasBenchmark S~ u~ n~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # ~~9 0 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units Nq Estimated flow (average) al/da Design flow (peak), (Estimated x 1.5) 0'D gal/day Soil Application Rate Q - ~' gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) _<150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (HODS) 530 mg/L Total Suspended Solids (TSS) _<30 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity Z al ^ NA Septic Tank Manufacturer ~ -I-"['- ^ NA Effluent Filter Manufacturer ~~, ^ NA Effluent Filter Model ~._ ~Vp ^ NA Pump Tank Capacity al NA Pump Tank Manufacturer NA Pump Manufacturer ~[ NA Pump Model Lg'_NA Pretreatment Unit C~NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cellls) ^ NA ~In-Ground (gravity) O In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: 3 ~ month(s) (Maximum 3 years) ear(s) ^ NA -Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ monthls- yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthls) ^ year(s) NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) A Other: At least once every: O monthls) ^yearls) A Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event GMW 14/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells). If high concentrations are detected have the contents of the tank(s- removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump- water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site eval lion to establish a suitable replacement area. Replacement sys~~te~~ff,,,,s must / comply with the rules in effect at that time. e~~,p~~- S /-T~ f S ~E~L'~2~5 ~ ~r"""~ S~~I ^ A suitable replacement area is not avails due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a fast resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~j ~ Phone '~ 2C.f POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S'"C-. CP-~f trl(.M l `t' ~~J/1~1 Phone ~~ ~ ,~~ This document was drafted in compliance with chapter Comm 83.221211b)(t)(d)&If) and 83.54111, (2) & (3), Wisconsin Administrative Code. ArcIMS Viewer Page 1 of 1 http://72.21.230.178/website/LRPortal/ARCIMS/MapFrame.asp?PIN= 10/10/2005 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Build Divisldn; INSPECTION REPORT GENERAL INFORMATION { (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Klein, Eu ene City Village X Township Warren, Town of CSTBM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well Sf111 ORS(~RPTI[~N SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 479440 0 State Plan ID No: Parcel Tax No: 042-1082-40-000 Section/Town/Range/Map No: 30.29.18.460D STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet St/Ht Outlet Dtlnlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover 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 CHAMBER OR Type Of System: UNIT Model Number. r11STRIRIITIAN SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Snll_ ~nVER Y Proccnro Cvc4omc Only YY Mnund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Ed es g To soil p ® Yes No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 991 80th Avenue Roberts, W1 54023 (NE 114 NE 1/4 30 T29N R18W) NA Lot 3 Parcel No: 30.29.18.460D 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? [] Yes ~] No ~ ~ Use other side for additional information. ___ _ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~ J ~~~~ ~ I ./~ ` ,~CO~~,~ Madison, WI 53707 - 7162 (608) 26 - Sanitary Permit Number (to b filled in by Co.) ~~ ~~ Department of Commerce ~~~ R ~ LD.Number catio Sanita Per rY ide a ~ f atio you prox d ers Wi Ad C 83 21 i //g~-39~ X m. o , s. . , In accord w th Comm may be used for secondary purposes Priva )(m) H ~~~ ~ ~ ?n Projec Address (if different than mailing address) C tJ ~ J_ ~ 'l I. Application Information -Please Print All Information S1. CROI Z X CCU ~ q q ~ I / M! ~ ~/~ Property Owner's Name FILE Par 1 # t~ Block # / ~ ~ (~- ~ Property Owner' ailing Address ~ ~ - ~' Property Locati v s ~ ~ ~ y!, ~~ ~,., Section City, tale ~ ~ Zi Code ~ Phone Number trcl ne) T ~N; R~E r W ~ ~ '^'''r II. pe of Building (check all that apply) O j ~ Subdivision Name CSM Number LAS . or 2 Family Dwelling - Number of Bedrooms ^ Pu lic/Commercial -Describe Use ^City ^Villa wn ip of ^ State Owned -Describe Use Q. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 2. -~ O~Z - - ~~ O A' System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other ModiScation to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of List Previous Permit Number and Date Issued ^ Permit Transfer to New Before Expiration - Plumber Owner IV. T e of POWTS S stem: Check all that a l ti7 X ~ t' ss Sand Filter ^ P l ^ Si e a ng ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil Mound < 24 in. of suitable soil At-Grade Constmcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) DispersaS Area Required (sf) Dispersal Area Proposed (sf1 System Elevatioi VI. Tank Info Capacity in Total Number Manufacturer ~~ Prefab Site Steel Fiber Plastic Gallons Gallons of Units ~ ~~Gp C f+-C , Concrete Constructed Glass / "~~ (~• New Existing Tanks Tanks Septic or Holding Tank Z ~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility tatement- I, the undersig ssume responsibility for installation of the POWTS shown on the attached plans. ss Phone Number Bus n Plumbe/r's Name (Print) Plumber' MP/MPRS Number / /~ / r ~ c5/l-u-c~ ~ ~ ~ ~v® ! ~ j ~ fj~ ZJ l Plumber's Address Street, City, Stat , ip de) ~, ~ Dl ~ VIII. Coun /De artment Use Onl Sanitary Permit Fee dudes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ^ Di ed Surcharge Fee) (~ ~- ~ - 2J r 02 , ,~ rven Reason ial 1 ~ IX.Condition pprov 3~ `~~S a~t:e~ ~S C.tM.S~ ~ SYSTE W N ER: 1 Septic tank, effluent filter and ~~ (~ o r2 ctu~ ~) '1' _ d .'_ ~ cQ-~~ dispersal cell must all ~gxArvioed /maintained ~~ Q as per management plan provided by plumber. ~ ~o Y'^-h0~~~- /~_ "~` ~'~(~ . must be maintained t p Q ~ ~ ~q (' s 2. All setback requiremen ,.,~ _S ~ ~~Q is ~~,t~ ~ 1 ~ as per applicable code/ordinances. ... ~-.. •6 e.. Al n . 11 :n..hea in Rile A[raCa eOmp~em puns (cu mr a.uu..q v..q~ ,......~..~~ ...... .... ......_. _.__ ____ _- __ _. ~~, ~-~ ~ - SBD-6398 (R. 01/03) PROJECT fuaene Klein PLOT PLAN ADDRESS 1815 Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1/4S 30 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 100.8' BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none ,BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE • WELL * H. R. P. Same as Benchmark ~ ~0' Property Line Scale = 1 /4" = 10' 325' Property Line Ta is to be properly bedded and p vided with lockdown covers approved warning labels B.M.#2 Top o " Tall 3/4" PVC B-3 ~ Huffcutt Combo y B.M.* B-1 ~~ ^ 3% Slope Area 15' below system is to remain undisturbed ~6rading is to l done to divert run-off away from system \ 101' 100.8' B-2 100' Pro 4 Bedroom House ~ 8otn Av • ~~ Well is to meet all setbacks found in Comm. 83 Copy 9 9' t s. commer~e.wi.gov isconsin Department of Commerce August 23, 2005 CUST ID No. 226900 SHAUN R BIRD ' ~ZO~1 BIRD PLUMBING, INC ST CR 1008 '192 ND AVE 1101 ~ NEW RICHMOND WI 54017 >~ HUDS CONDITIONAL APPROVAL 1 PLAN APPROVAL EXPIRES: 08/23/2007 SITE: Eu ene Klein 8 ve Town o en St Croix Coun NE1/4, NE1/4, S3 9N, R18W Lot: 3, / FOR: Description: Four Bedroom At~ , ade System Object Type: POWTS Componeri ~ anual Regulated Object Maintenance required; 600 GPD Flo .ate; 71 in Soil minim System: At-grade Component Manual, -10570-P (R.6/9 The submittal described above has been reviewed confon and Wisconsin Statutes. The submittal has been CO TI chapter 101.01(10), Wisconsin Statutes, is responsible fo No person may engage in or work at plumbing in the sta 'un stats. r The following conditions shall be met during constry~tion or prior to occupancy or use: • This system is to be constructed and located ' accordance with the approve ans, and with publication SBD- C0~2 10570-P (R. 6/99) "At-grade Component ual Using a Pressure Distribution tem for Private Onsite Wastewater Systems". • The pressure network is to be constructe in accordance with the sizing methods of pubh n "SSWMP EEC R7MI Publication 9.6 Design of Pressure Dis ~bution Networks for ST-SAS (01/81)". ~ N OF ~. • Per manual cited above, limited acti ties are allowed in the area 15 feet down slope of the component SEE COF Soil compaction, excavation, vehi ar traffic and other similar activities that impact the treatment and dispe are prohibited. L. • The well must be a minimum25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must obtained from the county where this project is located in accordance with the requirements of Sec. 14 .135 and 145.19, Wis. Stats. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m m e rce . w i. g o v/s b/ www.wisconsin.gov • Jim Doyle, Governor Mary P. Burke, Secretary 1 POWTS Inspector • fG OFFIC ~I~C TY SPIA A> EL ~N 540 r1+ Identi aton Num Tr saction I o. 1187396 9~fe ID No. 3288 Please re r to both identifcation numbegs,~ above, ' all correspondence with the agency. II No.: 1034922 depth to limiting factor from original grade; Biofilter :e with applicable Wisconsin Administrative Codes ,LY APPROVED. The owner, as defined in ance with all code requirements. licensed to do so by the Department per s.145.06, • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 8/23/2005 • Comm 83 22(71 A copy of the approved plans specifications and this letter shall be on-site during construction and omen to inspection by authorized representatives of the D~artment which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@c ommerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~~® AUG 1 5 2005 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 8/10/05 Owner:Eugene Klein Location:NE1/4 NE1/4 S30 T29 N,R18W Lot 3 80th Ave Warren System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maint 9-11. Soil Shaun Biri Signature License n~ ~y l~ 0 a ~. {gin; ~: ~.~ ., " ~~,,, 3.fi cC't,~a,~ER,~E `~~ b ~ GS -~-P<OtVDENCE~~~~ • ~ ~ - PLOT PLAN PROJECT ~Euaene Klein ADDRESS 1815 Industrial St. #6 Hudson Wi 54016 NE 1/4 NE 1/4S 30 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX SYSTEM ELEVATION 100.8' CONVENTIONAL AT-GRADE XXXX CONVENTIONAL LIFT $EDROOM 4 HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none ,BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^$OREHOLE WELL *H.R.P. Same as Benchmark ~0` Prooerty Line Scale = 1 /4" = 10' Tc Tank is to be properly bedded 325' and provided with lockdown Property covers with approved warning Line labels B.M.#2 Top of 9" Tall 3/4" PVC B-3 Huffcutt Combo Tank B • M • * g _ ~ Grading is to be ^ done to divert run-off away from system 3% Slope Area 15' below system is to remain undisturbed `~] 100.8' B - ~\ 100' 101' Pro 4 Bedroom House Well is to meet all setbacks found in Comm. 83 99` > 5` _ B >5 PYC FOE~E.E.MA1 ~t ~,~ 2r ~ rJ ~ ~ - ~...:TURt1- U Pc u W # ~ L ncsrrti si.iTecrT ts-r~RA~ --f A, ( ~srnet~: ~~~ a$.~?.YwT~srs VJBti. a ~a ?5` '~ I/~ B ~ -~----~ A = ~ ~ F#. _ s = fit. Ft . 3 I/68 ~il2 B CELL. of li'" Z%Z AC=GKEGaTE ~~QRovEa SYUTt~~t Fobr€o ~ Dis~ribuYion La~eral 5T~8t~i~~,~ t~bserva#i~3n---~ ~ ~t ~, ~- Soil Cover ~ j f~ ~C~~ ~ ~ ~2~~ ` ~~ '~~ f i. ~tYER ~f.ev~tED > ~' A ~ 2 ` ~ > 5' .--~-. SIoP~ Plan Vi.aw and Cross Section of tJisconsin At-grade Unit with a Single Absargtian Area on a Sloping Site S1fat~SA7u 1~~ : 1.tC£~lSE. #~ Page Df [3istribvtiea Pipe i}etail for Lateral Network '~ Last Hole Should $e Next To ..TuRt~t -uP" €tt.eR~o~r~ PYC Farce Nair ;'"t ~'1 Z- t~YC !?istribution Pipe •,~ P Ace rr ~~~ ~~ ~~ ~ Inch P _.d_. u..~ fit. idle Diameter X ~'~" inches Lateral Diameter ~ Inch{esj Y ~ l Inches force Main Diameter ~--~ Inches ~ 4f Nol eslPiPe ~.1..~G._.... Invert E'i evation Df Lateral s % ~ ~~ ~ fit. Signed; Lfcense fiber; t3ate: • ~- ;. ~,RMS..R Aht"3 SF£CI~ FCATZONS SEPTIC TANK ~ P~MS C ~ r Cx2t}SS S£CTi4:~ ~t£ATHE"~tp~4ilf wn G~ ~E13T PIPE ~:Z" i~TN, ABDV£ GRADE ~ Ji1NCTIflN $DX APPROVED > ~~~` FRflli D44R, ~d;NI3aS~ 4it ~i~T~ CJNI3EIIT iKANHQLP COvER ~- , ~, ;INTAKE' W/ PADI.UCK 5 t FREai; . IR ~~~~rn ,~,, ~ ~tAR~iI~IG LA$E.. 3~" ~N~_ ~ r....~: I ~~ i~ r___~_---- TI6~' SEALS ~3LT~R to J1PPAaV~ii PI?E 3` C~ D~1~ `~,~~ I~~FT. SOIL PU~'FP 4FF ELE~I - B ~- C. f B ~~ Mira. .t. o- ~ u a T s • GA,S- ~ TIGHTT ^ VAPPIt~YED • ~E~i-*' 3E)IiiTS 1itT1i T j ALl'[ PIPE ltP s ON tiNTO ~.F4 SOII : + 3 ~ AP~'RpY ED BEDDII+~~ UNDF.:R "~,A2+€~C CONC3tE'TL' PAfl S PEC x F ICATI t3PI5 BER B+DSES PER DP~Y = ___,~ _-- SEPTIC f DOSE ~~ rItI3'i Tp,,1~iK I~AN;IFACT~fRER: ~.--- ~flSE VC~~E ;1~iCLUU'I~ t'oc ~ ~``cwL- :~ .~ CAi . _ ~' SAC K : `_.-----r'~~/ TANK SIZES = DUS£IC ~ CAL. - . G(~' INCHES = ° ,~~~s'~~"~AL- ~~~J~tr~-~' ~°.~- CAFACITI#'S = A _ -='~~6AL_ ~ nANUr'ac~vxrrR;. . e._. ~/ a = ~ ~ ~~x~s rsonEL xuxs~R ~ _ ~,~,-~ _ ._..." ` ~~ ~ -~`~~xL. S1~ZTCH TYPE: 1~ C = ~' ~ ;FICHES ...._.r.~--- p[rKF ifAi~ItJFAC"1~R£R= ~~~~~ ~ ;RCI~iES = f~~ G_AL- ~1J,~_.~,_ I3 rS{3DEL NtTt'iBER : ~~ ~ _~~~~ 15.23 ytAC S'~iI3Ci~i T~tPE= p+( i~IIRZi3G AS P'£R ILHR ~ ~ a ~' F'T-#!SP E A L~.R Rg#}~iIRSD DISCHARGE RATE .':'_--r- G" ~ ~~ FEET . ' yr ~ -~-~-FE£T vEgT2CAL DiFFEgENCE HETytEEN pv~PEOFF .AFdB'F?ISTKI8i3TIUN pTOR - ~ .~ fE£'P + MINIT"I'JN kI;TNORK S€JPPLY XR~_S! ~--F'~/IQSI ~PT- FRIC'TIQi3 F14C ,, ® FEET F©RC£i3AIN '~ T~3TAL DY~~C ~~AD ~ S;___._. ~£~r J ~ D ZAri ETER .,_._.,-- ~iIDTHIJ~ AI~ flF guM? TA.it3C: LEND ~ ~ `.~ ~~- Fp7~iNAL DIMENSID I.,IQc3 Q'A :-F I.ICENS~ ~JI''4BL'R = S;GptED: _ :f~F TOTAL CYhAMIC HEAD/CAPACITY PER MitJJTE EFFLUEtvT fNC CEPIATERING 0 S U Q z O Q O CONSULT FACTORY FOR SPECIAL APPLICATIONS s • Timed dosing panels available. ~` " • ElecVical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and ShoR cyce controls. • Sealed Qwik-Box available foroutdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 15?l153 Series Model 152H53 Volts-Ph MOQ Mode Am k:OntrO Sim lez Selection ~ Ou !e: N152 115 1 Non 8.5 1 2 or 3 BN752 tt5 1 Auto 8.5 Induded E152 230 1 Nan 4.3 1 2or3 BEt52 230 t Auto 4.3 Induded 2 or 3 N153 175 1 Non 10.5 1 2 or 3 BN153 t15 1 Auto 10.5 Included 2 E153 230 1 Non 5.3 1 or 3 BE153 230 1 Auto 5.3 Induded 2 ar3 O CAUTION AU installatlen of controls, protection devices and wiring should be done by a qualified licensed eleci<ICian. All dectrial and safety codes should be foAowed lncludIng the most. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA}. MOCE~ I j Feet i Meters ! g t_5 t52 Goi. Liters 69 I 261 Gol. 77 153 ~ Liters 29? 10 15 3.? , 4.6 61 53 231 201 70 1 61 265 231 2~ ~6.1 ~ 44 i57 52 197 25 7.6 34 129 42 ?59 30 9. t 23 87 33 I 125 i 40 ~ t2.2 I _- r __ tt i T2 Lock Vowe: 38.0 Ft. (11.6m) ~44.0 Ft. (t3.4m)I 3 27 32 S2 I ~ I i i , i2 ~,/s ~ . 1 i i' ~~ I 5 t/i j i - I SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct mode! of Electrical Alternator E-Pak 3. Variable level control switch 10-0225 used as a control activator, speafy duplex (3) or (4}float system. RESERVE POV~ERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AlA)L 70: P.O. $OX 16347 Louisville, KY 40256-0347 Manuersof. . ~ SHIP T0: 3649 Cane Run Rcad O Louisville, KY 40211-1961 Q~Ty p~yos Sircf /939 .~. Q /~ et (502) 778-2731.1(800) 928-PUMP /mpy/www.z0e~lercom ~~~` ~•O FAX (502)774-3624 ® Copyright 2000 Zoeller Co. All rights reserved. FL01N PER MINUTE • Page ____ of ... • • • OV-lNER'S MANUAL 8~ MANAGEME~ C Tto s . P~~S SYSTEM gpECI r~ ~~ ai ^ NA '" e > ~ .- Septic Tank Ca1~a~Y Ftt~ iNFOt~MAnOK ~ ~~ J optic Tank Manuf~~r 1 O t~tA Owner Pem>k~~ Effluent Titer iNan~~T~ ~-- a NA ^ NA DESIGN P/1RNMETE~ •~ p Effluent Fiitel' Model [borne Pump-Tank Capacity ~' ;`~'~ at O NA Hutn6er of Bed - iVA Units ~ PutnP TartK Manufacturer Number ~ Corntnen~l ~ ~,.•`~-'~ aifda -~ ~~t/ 0 NA- Esri~ pow ~'~ X ,~] ~ G' alld °~ .Pump Mar~u'~ ~ ~--~ ^ peslQn ttOw {pea[c}, { - a!<da Pump Mode( Sod ~~~, ~~ ' preis,eatrnent Unit MonthfiY average' O ~nd/Gravel Filtef p Wetland influx QuafltY S30 mg/L. p Mechanical Aera~n Fg~.0i18~ Grease {FOG) ~O mg ^ Other. Ozyg~ pemand {BODs} n- ^ Disinfection Bfocttetn&~I dad Somas {TSS) s't 50 m /L Mancrfactitrer Tots[ Suspen average" Dispersal Cet1(s) . Pretreated E~'~nt QuatitY hlA MonthtY ~ ..ground (gravficY) ^L7 Mo tnd nd (pressur¢ed) en Demand (BO s) 53Q mgt .grade Btochem~ C)xY9 530 mg/l.. ine ^ Other_ Total suspended solids ~ rss) ~~ ~, ~~~~ OOmt ° Fecal t;,otifotm (9eOmetric mean) try for domestic tnoRC~'~'+~"d'n'"`stO""`ser and Y lnchdiameter vatues~aiituern. Maximum EftlueM Pariide Size -.,. ya~iu cu trv~ ror vrc~'cod +wasmwatcr. MAii+lTEN~CE gCHEDULE Service Frequency Servfiu Event p months rfs) (Maxtmurn 3 yrs.) At least once every ~ oats ane-third (Xs) of tank volume Inspect condition of tank(s) iNhen combined sludge and scorn eq ~'~ ^ month r(s) (Maximum 3 yts.1 Pump out contents of tank(s) At least once every . dts real Dell(s) ~ ^ months . r{s) [rasped Pg ,qt least once every ^ months s) O tdA C[esn tstflueni fitter lkt [east once every controls & alarm ^ months s) [] NA [rasped P~mP• Pip qt [east once every Rush laterals and Pressure test p months fl year(s) ^ NA At least once every ^ ~ oa-e~ ^ months ^ year(s) At least Once every one of ttte following licenses or MptN~NgNCE INSTRUCTIONS c~or• POYVTS Maintamer• Septage lnspe~ of tanks and ~persal Darts snail be made by an ind'NJd~~nYfinnst~ or broken atlons: Master Plumber: Master Plumber Restricted Sevve s ~ iden~Y arty ~n9 _ 3e~9 Operator, Tank inst~ons must include a visual inspedian of tfis tank{ } crsacks or leaks, measure the volume of combined sludge and scum and ~ ~e effluent: teti-ets nardware` Ide~r~Y any round surface- The dispersal cell(s) shoo be visually ~+sP ~ ~~~g of effluent on the or pondin9 Of eftiuent on the 9 for any ponding of effluent on the ground surface- a„fl,or;ty. in the observation PlP~ and to check d'tion and requires the -Immediate notification of the local regulatory grotmd surface may indicate a fatTing con or more Of the tank votum ~ NR e and scum in any tank equals ene-~+t~ {~ of fin accordance w-th When the combined 8ccurrtulation of sludg a Septage Setvidng Operator and CisPosed entire Contents of the tank shaA be removed by - ~ ant p~mponents; and any 113, Wisconsin AdmirtistratNe Cade. - onents, pre~~` ~Ttte servicing a testified POWTS Maintainer. of effluent . mechan~als of 2smo ~S ooess sh i be ~rformed by o#hermaintenanoe or monitoring at ~ e tarsi regulatory autnariiy within 1Q days of oDmpteiion of any service event. q Setvlge report shaft'be provided to th U roducts or other START UP ANO OPERATION reSence Of pain n9 P For new oocis6ruction, pr'i~ ~ use of the POYYTS check treatment tank(sy for ~ X11 s If high conoen>ra~~ are crn a the treatment process and/or damage [fie di5persa< ~ nor to use. d ~ the (~Oti ~ of the tank(s) removed by a septage servicing operator p ~~ Page of ~i ~ 1 not occur wtien'sos~~~ndiflons are frozen at the infiltrative surface- is restDred tfle excess Sysbem staff up staaf ~y fill above nomtai highwaier wets. When Pow • Durirs9 poor des Pump ~! ~ ~~~ ~t(s3 in ere large close. overloading the oeE(s} and may resuit;n the ewater wslt be dtscl's~9ed L To avoid this sif<ration have the contents of the pump lank removed by a ~p or s~irface else of ettlcien ~ the effluent pump or contact a Plumber or POVYTS Malntafner to O 1~~ tes~af[rtg P~'~ ~ ~op~hn9 ~ pcrrttp caontrr~is to restore nomtal Jewels within the pump tank-• drive or rk vehicles over faltits and disp~sai taells. i3o not drive or patfc over, or otherwise dstttrb or compact, the ar+~a wifhfn ~ feet down sbPe of anY mound or at-grade soil absorption area- Redudion oc eI'urlTnation of the fo!lo~tril'tg from the wastet~rater stream may impmv~ the~~mtanoe ~P.% ~ dgarette butts; condoms; cotton swabs; e9 hertbcxdes; meat of the pC?WI'S= antibiot~s; •babY!+~P~ i+~ater, fruit and vegetable peefiitgs gasoline; gtease;~ d~nfectrants; fat: tiottndafon draTtt {sump ~Fl scups; medications; 011; meting Products; pesfiades; sanitary napkins; tampons; •and wafer softener brine. ABANDO[tI~MENT taken out of service the follawing steps sftatJ fie taken to Insure that the when the POWT`' fails andlar is permanently system is ptoPeriy and safely abandoned in oompTance with ch_ Comm 83.33, y/lsconsi~ Adm~Inh~traUve Code: • AI[ Pfpfng to tanks and pfis chaff •be dssconnected and the abandoned pipe ope g . The contents of aft tanks and P~ shall b+e removed and property disposed of by a Septage Servicing Operator. pftet pumping, al[ tanks and pits shat[ be excavated and removed or their oov~ers removed •and the vow space filled r~ttft soli, grav+et or another inert solid rrtaferia[. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the f°ffowsng measures have been, or must be talren. do Provide a code compliant replacement system: ant soil D A suitable r,epfaoerrtenCacea has been evacuated and may be utilized for the location of a replacem absorpfion system- The replacement area should tie protected from disturbance and compas~iort and should not tae infringed upon by required setbacks from existing and proposed structure. lot tines and vvells_ Failure to protect Etta replacement area will t3esult in the need for a new soil end site °evafuatiort to establish a suitable replacement area_ Replacement systems must comply vritft the noes in effect at that time. D A suitable replacement area is not available due to setback and/or soiE limitations_ Barring advances in POVYTS #echrtotogy a holding taniG rrtay be insxalted as a last resort to replace the failed POWTS_ The site has not been evafuat~ed to identify a suitable replacement area Upon failure of the POVirTS a soil and s vation must be performed to locate a suitable replacement area_ ff no replacement area is available a ofdutg tank maybe installed as a fast resort to replace the failed POWTS_ Dune and at~grade soil absorption systems may be reconstructed in place following r:rmovaf of the bicunat at the ttr3tive surface. ReaonsGuc~ans of such systems must comply wfih the rules in effect at that time_ ccYf(ARNING» St=PtfC. PUMP AN!? OTHER TREATMENT T~1KS ~Y CONTAIN LETHAL GASSES ANDIOR INSUFFfCt1=1VT OXYGEN. 00 NOT EKTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UN(~t:~2 ANY CIRCUMSTANCES. DFJ~TH MAY RESULT. RE5CUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE QIFFICULT OR IMPOSSIBLE. ADQRIONAt_ COMMENTS POWTS JNSTALLER ,- Marne ~-~ .~~' ,//r . Phone ~lv 2-~" `~~° POWTS MAINTAINER Name ~ ~u era..~~ 1,r Phflne ~ /' J -~'~~~ ~ - ~y-•r SEPTAGE SERVICING OPERATOR PUMP LOCAL R1:GULATORYAUTNORfiY ntame Agency ~''`. ~~ /~. ~ B~C~'Z >~,~^~ , ~~,.~~--'' ~ Phone ~ y ~ ~"` ,~'~ f l/ Phone ~l ~ ~ . -~"'" ~~' This duaxrsgtt was dialled trY the staffs of the Cxnan take. Marclustfe and Waushara Coc;nty Zssning attd SanRation . This dOWment sneers the musimsun roquirements of cl+~ Casnm 83-22f2}(6XtXd)&{t) arse 93.5x(1). f23 & (3). Wisconsin .4dmintstrati+~e Code_ Use of [Ills document does not guarantee the performansx of the POVYTS_ C,tAwl~tl Wisconsin Department of Division of Safety and Bui " OIL EVALUATION REPORT ~~ in accordance wi Comm 85, Vdis. Adm. Code Page ` of 3 County ~-- Attach complete site plan n pap~t l~s~jh~2 x 1 inches in size. Plan must ~ 1 C-~y~ include, but not limited to: erti h z ntal reference Dint (BM), direction and Parcel I.D. percent slope, scale or di ensions, north ~ocati nand distance to nearest road. ~ ~. - ~ ~~ ~~t _'J t - ~}O C~ $T. CROI~.~~U~ ~ f `' eds+?®rm6~7 Reviewed by • Date Personal information you prowused for secondary purposes (Privacy Law, s. 15.04 (t) {m)). 1 Property Owner l~,J~JLL ~ G ` ~`~ ~~ Property Location \~ `} ~"~-~~ '- -~ L-.~ ~ ~. 7'~.~ ~ ~ L. L 1 ~~ av~:-f=et ~ ~ 1 /4 ~ t`-"", 114 S 3 Q • T ~..~ N R ~ E (o Property Owner's Mailing Address Lot # Biock # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ~`~t~~Ux~`~ Lvt s~c,~S ~ Est}~~6-~1~3 ~,~~Z~L., ~ By ~+ ~~ ~ new construction Use: psJ Residential / Number of bedrooms S Code derived design flow rate ~ S ~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material _ LCI~.S OU ~z. ~ 1 1,,,,,~,. Fiood Plain elevation if applicable ~U_~ ft General comments and reco~„mendatians: ~~ ~ ~ ~ .., - n ~ ~Zl~ i ~ C~ r~jv ~Z S `°i ~ ~.~~ ~~ , t?t~eL~t ~ p' ~''t 5 ~ Cc1u G , i S r i`-r ~' ~:r--3z.T ~•LV _ f~ T ~ p SL.U p~ e~zL ~. ~Z ~ t f~J - 8 ' a Boring # ^ Boring ® Pit Ground surface elev. a~ - ~ ft, Depth fo limiting factor 7 ~ ~ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPDtft2 in. Munsell Qu. Sz. Cont. Color tic Sz. Sh. 'Eff#1 'Eff#2 j ~-~ ~ 1D'~'ty ~ ~ -- `; E~ ~ 2~~-~'r h'tv`~L- ~-S ~~~` . S . ~ %~ ~ _3~ ~~~tt~3Lb - ~`t~l 2~'S~k rn~-- ~ ~~ ~~ ~ ~ ~ ~ e ((~~ / ~ Boring # ^ Boring Pit Ground surface elev ~ uU • ~ w n,,..a .,. ~:....:.:.,_ :.._.__ 7 -7 Horizon Depth i Dominant Cotcr Redox Description Texture Structure Consistence Boundary Roofs Soii Application Rate GPD/ft= n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 J u -S 10 `-~ 1't 31 ~ - s~~ 1 2`f`q 1- 1~U `~b^ CS ~ ~~'., , ~ . ~ Z. ~ ~ -ZS ~_~t~ )~yR 31•~ !~~-~~Ib - - S~)1 sit 2.`FSbk 1e.sb~c. vrl`tY' b1.s~ CLJ cu, ~ ~ - .`Z .~ (, ~ ~ i -~ sy r~ ~~6 - `-~ ~ vim, - ~, • rm_.__ . ~j - w - u.~ ,w}~,. anu , oo ~av ~ ,ou mgit. - tmuent tFL =BUDS < 30 mg/L and TSS < 30 mg/L CST Name {Please Print} - ~ Sign re CST Number Arthur L. Wegener '~ ;3 `Zv~ 220254 Address [,j t? g +? r e r S o i l T e s t i n g & D e S i g n S e r v i c e pate Evaluation Conducted Telephone Number 421 x~. iiain St. ~.iver r'a11s, tJI 54022 1 1 ~.Z~J- ~3 715-425-OIb5 ~- ST CROIX COY.Th1'I'Y . SEPTIC TANK MAINTENANCE AGREEMENT AND pWNERSHIP CERTIFICATION FORM ~ ~' ~ 11(~ Address ~ ~ ~ S ~ ``` ~ r Mailing Address ~ ~ ( ~ ~ ~ ~ Property (Verification required from Planning Deparnnent for new construction) City/State ~r'~.p ~~5 ~ ~ Parcel Identification Number i E~'AL DESCRIP'T'ION -7 ~ ~ W, Town of ~ O,r re~~ lion l- `/~, Iy ~= '/4, Sec. ~ T~N-~ Property Lora ~.._._ Lot # ~ ~• Subdivision - ,Volume ~- .Page # Certified Survey Map # -fiQ us Deed #D ~`~g ~~ ~ .Volume 2 ~~3--~ Page # ~ Lot lines identifiable. y~ ^ no Spec house ^ yes no ~VS'I'EM MAINTENA-N-~E tic em could result in its premature failure to handle wastes. Proper maintenance Improper use and mamtenanceof your sep syst b a licensed P~P~• What you put into the system consists of pumping out the septic tank Query throe years or sooaer, if needed Y can aSed the function of the septic tank as a treatment stage in the waste disposal sy~m ent a certification fota-, signed by the owner alns b em The property owner agrees to submit to St. Croix Zoning verifying that (1) the on-site wastewater dispose yst mastcrplumber, jotrracyrnanPlt~r- restnctodplumbcror a licensed )~ ~ septic tank is less than 1/3 full of sludge. is is proper operating condition and/or (2) after inspoetion and pturrping (• rivate sewage dispose syste is and agree to maintain the p 1 m with the standards ~~ ~ undersigned have read the above requiremen ent of Natural Resources, State of Wisconsin- Certification set forth, herein, as set by the Department of Commerce and the Departm Office within 30 Ming that your septic system has been maintained must be completed and returned to the St Cmix County Zoning days of the three year expiration date. i l lQ DATE SIGN OF AP LICANT OVER CER'rIFICATTON our knowledge. I (we) am (are) the owner(s) ot` I (we) certify that all statements on this form are true to the best of my ( ) the property described above, by virtue of a warranty deed recorded rn R°S~er of Deeds Office. LL ~ / / ~.7 DATE SIGMA OF APP ICANT .««+•~ Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. •sass• •• Include `rith this application: a clamped warranty deed from the Register of Deeds office a copy of the certified survey map if refereace is made in the warranty decd y ~ ~ U 2y73P '~07 ~. I STATE BAR OF WISCONSIN FORM 7 - 2000 Document Number TRUSTEE'S DEED Lowell J. Gillette and Leticia H. Gillette as Trustee of the Leticia H. Gillette Trust dated October 6, 2001 for a valuable consideration conveys, without warranty to Eugene B. Kleln and Meredith Klein, husband and wife Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): See attached Addendum 748'9'98 KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROI}I CO.. MI RECEIVED FDR RECORD 12/12/2003 i1:i5A?f TRUSTEES DEED EXEtSF'T 1E REC FEE: 13.00 TRANS FEE: '292.20 COPY FEE: CC FEE: PAGES: 2 RecoMing Area Name and Return Title, k` econ~.Stsee~'~uite 115 W154016 ZZ / ~~l-~SZ 042-1082-40-000 Parcel Identification Number {PIN) This homestead property. (is) (is not) i+ r Dated this ~ daffy f ~_~,~~'-J ,~ + ~ ~ ~ ~: ' L we J. Gillette + Leticia. .Gillette T tee Trµsfee AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF scd tARRIEU ([f not, J~{p authorized by § 706.06, Wis. St .} tats of Wisconsin THIS INSTRUMENT WAS DRAFTED BY Brent R, Johnson-Locomen Nelson Law Firm Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ~,~ 1 1! County ) -~ Personally came before me this ~ ( day of ~,)s~ ~~ ~~ ; ~'~ the above named Lowell J. Gillette and Leticia H. Gillette, trustees of the Leticia H. Gillette Trust dated October 2, 2001. to me kn to be the person(s) who executed the foregoing insgtiment an knowledged the~ame. V Notary Public, S ate of WISCONSIN My Commission 's permane i i (If not, state expiration date: ,•). ~3 * Names of persons signing in any capacity must be typed or printed below their signature. TRUSTEE'S DEED STATE BAR OF WISCONSIN INFO-PRO (800 55-2021 www.inf forms.com FORM No. 7 - 2000 ~ °~° U 2473P yfl8 ADDENDUM TO TRUSTEE'S DEED PIN 042-1082-40-000 PROPERTY DESCRIPTION A parcel of land referred to as Parcel 3 in the NE 1/4 of the NE 1/4 of Section 30, Township 29 North, Range 18 West located in and forming a part of the Town of Warren, St. Croix County, Wisconsin more particularly described as follows: Commencing at the NE comer of said Section 30; thence S00 ° 31'00"E, 525.4 feet; thence N89 ° 12'00"W, 875.41 feet to the point of beginning; thence N89 ° 12'00"W, 441.44 feet to a point on the West line of the NE lJ4 of the NE 1/4 of said Section 30; thence N00°21'00"W, 495.00 feet along the West line of the NE 1/4 of the NE 1/4 of said Section 30; thence S89° 12'00"E, 440.00 feet; thence S00°31'00"E, 495.00 feet to the point of beginning, subject to Town Road Easement described as follows: Commencing at the NE corner of the above described parcel, the point of beginning; thence S00°31'00"E, 50.00 feet along the East line of said parcel; thence NWIy along a curved line, concave NEIy, having a radius of 50.00 feet and long chord bearing N44 ° 51'30"W, an arc distance of 79.69 feet to a point on the North line of said parcel; thence S89 ° 12'00"E, 50.00 feet along the North line of said parcel to the point of beginning. For the purposes of these descriptions the North line of the NE 1/4 of said Section 30 is assumed to bear West. Together With anon-exclusive easement for an access road and for the installation of utility lines over and across a parcel of land in the SE 1/4 of SE 1/4 of Section 19 and in the NE 1/4 of NE 1/4 of Section 30, all in Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin being further described as follows: Commencing at the SE corner of said Section 19; thence S00°31'00"E along the Section line 28.28 feet; thence NWIy along a curved line, concave NEIy, having a radius of 881.47 feet and long chord bearing N63 °47'55"W an arc distance of 294.20 feet; thence N54° 14'14"W 426.64 feet; thence S33 °52'50"W, 33.02 feet to the SWIy line of the existing Town Road, being also the point of beginning; thence S54° 14'14"E along said Town Road, 33.02 feet; thence S33 °52'52"W, 405.74 feet; thence 242.08 feet along the arc of a 50.00 foot radius curve which is concave to the NE and whose long chord bears N56°07'10"W, 66.00 feet; thence N33 °52'50"E, 407.90 feet to the SWIy line of the existing Town Road; thence S54° 14'14"E, 33.02 feet to the point of beginning, Except any of the above described land which may lie between the true West line of the NE 1/4 of the NE 1/4, Section 30, Township 29 North, Range 18 West as established by survey and the old fence line located along and near, but not exactly on said West line. WARREN. ~Q~l ~~~) T.29N.-R.18W. ~' E _ _ _ SEE PAGE 43 Cjame U /.:c, fed .Pa 12'i- ~ { HRf-~ U/(ES~1~ ~ ~ ~ ~ C/a~e.'ceP ~a'''`~~ • L~n ~~ ,QiOh~( . / • Gera/d L. sConnie ~' E • /l'en ~~ iJ rf: y , Fo~/ns, ~ ~ . ~ ~ ~ t e 7~ Ij ,vat ~ / ~ ,Pobcrl 63 L Mue/%l' h • Ir'r. 76 Club Inc. / Snc1 .i' ~ , ~ ""- - ` ~. --r ~~'~ • G ~ ~~ n o~ 4 CZ ~Jerrick. z7ss ~ r% C. Micke/son sR ae a _ . /sz.45~f ~ s ~ sb. ~ ~~~ ~ so F ' d; - • z Lau s £ ~ l W h tl 0 ~ ~ ~ ~ F~ /s4 9 ~~ a~ °oe s ~ ~i•h tcT 4i h ~7enn Lee ~ ~ 3 p ~ N / ~~Y //errzors i`% ~ ~ ~ ~ ~ ~ 2roo.2 '. 7 Nanc : ~~ _ /bfn. - urp y, efa/ f p y~ ~ 0 su3yon eyne,~ a' p Wes. ~ rUe/son ~ ~ ~ Pa ~ ~~ z7~~ 4a /40 V °n ~ T/io/naS 0 ~ Mar'Y 3/7 " '39 : / en ~ R ao ~ ~ Freder.c zao Peter ,sy p S .9 ~ 6/ .~ ` . en¢y ~ . / M ' ~ F Fink W4 s:;, ~. a/es ~ 8 a one~ • • W ~ /5 2rB ~ ~" • 40.4 a ZB74 ~! 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RICHMOND PAGE 48 E Clarence & 8 O1 GameUnltd\ FIRES ~tY , um.a+wsi Connie Inc 78 ~ ~^ H~ Club Inc ~~ < vn 1ulutin 4o s.c _ m 85 Mueller O I 158 y j5 a ~ AVEh ~ ~ B Maloney Derrick N / 09 .ar ~ ~ tib X67 c a c58 ~ 275 Midtelson Vernon C+t • A . a e£ Loins 114th x ~ n+sol.et df o Nelson ~~~y z~ ~ Rolenny AVE ~ Thomu ,~~ m s mn~F° V 120 t~ 3s Mal°ney O^ Ne p'°a!°a, "gv ``°'''a~maya GreenRdd a"te"' ~~~ ~qqa tr c~39 e8 _~Brt"`4o _ 216 z 6 39 ~ 180 ~ ~~~ 154 318 240 F 3y. _ ~g 33aaa. $ Fnixis 110t VE ~ ~ ~ g 3Jeff & Kenneth ~ J Dale & 110th AVE cN to t Iac ' u~c 78 tom" $ 3 °~ g °~on Pamela ' Ronald Virdnia~ 80 N 93 z 107th AVE ~ ~ 60 Herlnk z ~ Meyer Dank) a WeBley A Farms Im a ~ tiro ., o s Q Dua':da° om~ ~~ c°v a '.3e+~ F7rederick ~ ~ Inc I~ ~~ ~ ~ ` s.e3 u °~ m 9 67 54 °` xx eta 160 IR36y 40 ~ 310 120 S 1 8 105th ° Rusmu e AVE Raymond Bc Thomas. ' Farms I 104th as ,~ ( Patrida Nora rn TruesdBl Iac AVE a 9 . 3 Seliski Sullwold r~ P o 142 .s ~ 5 4 ~ ~ _145 pis 138 z a s 200 r.ns to 150 160 160 470 160 f ~ ., I J 15 ~ a 9 ° es d avid gt R a {~yalter 100th AVE g~ J I St Curia Vly x DO M -~ ore a 60 Kenneth Nechv8le VanBeek Gh-1 h ST 15 „ ~ ~~a Prederidc r n 80 80 5 rat m 13ma.3 I Scouts to Map 96t "^ tr Henry i "' Bloom AV °• aar Nechvllle Eu~ena 8t ~ 195 232 I~ tl ~ 1 °u 168 ~ Vio-la F 8c_ 13 ~ r Fmntler c° a Trust z SthUlte Farms w David & ~ Land lennif~ °~~ ~x ai Diane ] Corp M Trust Inc ~°}~ ^ Hola dme ~ _I~ Leverltt McKenna 9 q u Is 6 ueRer J p m 3 Trust '- Jac '!~ ~ ~ " D a 29 240 6 t s s tr' <'^"~ 148 "" i ^ 80 119 t 78 a 5 344 ~ M..B.r r~ 50 ~ 160 12 ~ ts`a ~ ~ z 1P r a.,: _ "'"a 4"3 e~arb~.~ - ° `« 7A~ a ~ ~!a` n o ^ G a. s 30 3s,m3. Rohl 3 D 3 e~....e ai"~} °' 37 ~ Waker a GRBs ~ ~ e 1/1 Dan Farms ~~ ~~ PladdLan~d~jj~~ g ne3vet& Berglx JR 5 aF ov, o G`vG°0e Iac ~ GH ~ CompaaY x'~~ 158 i 79 1~6thy 148 5 ~ ~ 11 s ~ ~ \ _ " 139 160 O -~ 3 a 78 c3~ _ ~ nnenta ~ !Earl n `~ $ ~ 8 3. 3i tr Fmly Gardiner do ~ 3r 116 Pecht®a9z ~a . ~hAV~w ~,"~°' o ` a a A tE Ltd Violet " e °8 9~ u GUBs wa $ Pch9r Graham -tl Mark to ~ Farms 67 m a s 5~ I Grice& 3uT ~' ~ ~~ ~ 122 ~ Y~~yy u1~ ~~ ~~.,~ .~rs~G '~ Inc Cs~ 8 ~ ~ •~ t o tr X163 I1~13 ]OS 154 3 ] Z TT ~~zy o a: s ~ x ~ e c it x ~a~ma~en dt 5 9 99th a F~g ~ os Z- Flla W e & orris '°"' ~a I pP~illipQc ST .?3~ '¢$,•~ r6y +s ~! George OConnell 1 I 8g~gy Mary 3 34 D~ .. I £ • &y ~ e w z Bloom °o"•° Trust w.,' Dkms S~texenrt ~I~ t ~~0 s "~"' \ u 80 x rt~er 4o R ~~90 _ 3 6 E Mazk ~` m M 239 593 Donald 8r 2 '~ ~ tr 7a 307 HamBa n 160 1 ~e Q; gg a BOA lode 3 Anderson tr ~ z ,': 4 ~ b iai~ Eui 9g ara ° ~ 2 Q1 ~ IF[udsoa •t ~ Elbert 61 40 164 ~° TWIN ~ 5 g SmitL Pechuman Gl a ~ hem o q~g110 ~ Z °~ W I taro ea.son RB:S et LAKES ~A ~~ ' ~ ~ Z tr z Reed s ~ BoBmar 85 ••~ 160 143 revs to 70th AVE 3 187 80 9 65 , •~ BD °'~ 99 I ~ -7 ` a 1 g & Lenlrtr a~a 'three M°° f i°r a r 3 ark R 7S SS~NSG Farms 4 9~0° as rrtln.ta as dC 87 -Sonatatag Clain c / Fs Si~me ~HNS 40 94 ] Family Peskaz e! Inc z ALEX Richazd it ~ 3nb°` e.s 1 ~ o s• G Ltd 7Yust LN Janet 132 St a to sera ea ~ ~ Wlea ~ ° 115 ~ 223 h' 110 40 03 9 64t t S CJttT• Fravdv! ~ n "13 0 ~ I yy tr 2 160 F A t'i°d ~~° maktc ~ ~ Roberta 'STAR Andrew 8: ~ / Dean 8r ° R o ~ n rn ~ came 3tfx,3a 3 ~ eeraadk3e 88 B `~A LN ~ Rose ~ Glrnda S . hi a co yt h. a Brenda tevea ~ Beskw ECKER 7 amen RudesBl a Hansen 30 ~~ ~ a F a3.ro. Bray nan3m & ~ pr ~ LN tr ~ o >~- a Aurae a,9® I.eaertr ~ o~ a~t.9. * Butler ~ °' ~~ ~ taasa. ~a ~ ~@ eskaz 92 ~ ~~ 194 ~ tr 4 0 z~> 50 a- .-07 176 ra 50e xs tr btu 126 v eaao. 60th AVE RINNICKINMC PAGE 18 856Axvt~.65 ROBER~S GROCERY P.O. Box 14 Roberts, WI 54023 phone 715-749-1718 MEATS • GROCERY • PRODUCE Fax 715-749-1719 HOURS: Northland Surveying, Inc. Monday-Saturday 7:30 a.m. to 9:00 p.m. Sunday 9:00 a.m. to 6:00 p.m. Boundary ~veys • Certified Survey Maps • Major Subdivisions • Topography Surveys Edwin Fianum Michael Brickson (716) 749-3$40 R.L.S. No. 2487 R.L.S. No. 2592 ilOBERT$a WISCONSIN