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010-1008-90-000
O y ~ ~ ~ ~ ~ ~ 3 M 3 K 3 ~ c ~ oN ~ ~ m y I ~ o p I c ~ ~ `~ rn 2 ~ ~ 7 a I y n O. O 7 I ~ ~ ~ ~ ~ ro ao a °o O Z O ~ m a C W a co ~ ~ ~ N O' O ~ W m' O m fD C N 3 m I y. o v g• y ,. ~ ~~.m co~~x-i D ,~ a I ~ ~ ~ ~ ~ Q~?;~ a I N 7 N' ~ !~ O V A ~ O. 3 ~ .. ~ N S S ~ ~ I •Z~ ~ O~ 3 ~ c° N °-' I ma,?~~~~~'o. o 7. f0 ~- N N I a°1v~~$.o~~ y m ~ cpK M ~~~Nj' n O N O~ 01 N ~(Q I ~ ~.~ Gv0 aSj I ~- f0 N '+ o d CO fD N y ~ ~p ~ ~ I N N N N~ F~ O~ I ~ y ~ 0°1 -d o ~a~ y ~ ~ I 'p O j C~~ ~ W O I ~7' N ~ N2 ~fn~D I Q ~ ~ ~ O ~ y I m ?Nam ~' a 3 I ~ I ~ m I ~ O 0 I o coo o a I I i I I ~ _~ I -` q.. O ~ ~ ~ I N a °' I ~ 3 ~ I I o I ~ CD I C I 3 I ~Dn I I I .y-. I ~ o I o I p 0• I O) ~ I N a I o I I o~ I ~ I W I a I o I -' O~ 7 I I I I V1 tl! d I ~1 ~ y I a°'~ I 01 I -' -~ m ~o~, I V O O ~ N I N N ~ N I SC SS Qo A I '-1 ~1 ~ A N y y ~ I ~ v q o ID ,~' M I d ~. ~ < I 3 oyi ~ I A -' c ~ `D I m 3 I a a o d I c ~ I I A O I W I I I I I W '0 I ID ID c 3 3 (/! Z I W I I I a I I I I I I I I I I I I O N ~ ~ ~ ~ ~ 3 K -~ v 3 0 ~ ~ ~ a fD ~ ~ ~ o ~ o y. Vl ~ y Q O 7 fD O f~D n ~ ~ N , ~ ~ D ~~ N N ~ W a ~ O m N r ^D N ~' N m O m fD G N 3 y _~ ~ _a ~ O~ 3 y OZ n ~ W faD 0 I rn 0 I ~ I °o a N N ~ ~+ C N - a ~'° d N A ooh' N N V U1 ~ ~ ~ ~ ~ D N c ~ '. 3 fD ~ ~_ ~ p p a A M N G ~ of 'O ' 3 ~ °' ~ •~ w ~. D y ~ N 'O N +~+ fD m °' cd C O. W '0 a 3 M y Z W C c 7 a ~ 3 m c d r_ ~ O ~1 ' m ~ ~ A~ K. , ~ n O 3 W ~ ~ • ~ o ~ ~ d ~' p oo~ -'-' ~ n S O O 3 O O ~ ~ - .~ ~ G rid uni o c 3 " c .. n A ~ ~ 'J ~ w la Z O ~ 7 fn -I W m c z m rn J A a ti fi h A O R 4 N 0 0 a° ti ti N ~• N ~• c~cn0! 3~n d [~ o Si ~ ~ c .. c ~ o A -1 ~~ ~~~ I I ,~ 3 :~ ~ ~ • • ~ ~ ... ~ Z+ I r. ~w ~. 3 Zu, Z ~ c K pmw `,, cc ~ °w° ~ ~~ ~ N C W ~ S fD m O _ O a°' -'h ~ ^ ~ o i N n y 3 ~ ~ ~ ', o ~: 00 ~wm c ~ 1 I °o ~ coo o w n m ~ c ~ 0 cn3 _ ~ no ~I 0 3 w H W N o 0 ~' ri"'1 I ~ o ~ D C ~ i - a n°Di m co N ~' ~ d !p ~ fD "' O N I ~ O ? i ~ ~ ~ I Z o ~ J O ~~ 3~ Q ~ I m , OOOcD'', ~ a l ! l o w m f/J fp y c p l I N °: ~ Q ~ v v o~ ~ `' _ ~ n I 61 ~ .t ~ ~ ~ ~ y ~ I fD ~ ~ Ol w i2 . ~ ~ '; "~~~11 = I n ~ Z rt w 'i ~ 0 D D o =+ O I ~ j ~ n !~1 • ~ _ a I ~~~ yyy,, ~ c yyy VVV w m I Z ~ I' A 2 A I ~ N ~ n J ~ •- ~ A ~ ~ ~ I ~ .. ~ ~ w w m O a`° ~ _'Z A G ~ I o ;- ~ 3 y m me < ~ A ~_ w N p~ ~~ 0 y a N 7 ~ n ~ ~ • I d N O a~ p ~ C a~ m m I -+ Z a am env '~ im / ~ V j N 0 7 '.p~ O ~ I O nc rn (n F = y cn ~ o fi m °D ~: ~• ~ o ~ ~ a. I ~tn'~o~ N ~ ~ O d O ~ ~ ~ O fl' O ! . _. 7 O ~ O7 ..~ ~ O t0 I y N 1 fG ~p v ~ ~ ~ O I ax ny I ~ y Q O b N I cD ~ N ~o ti ti o : `~ I . ti ., _, J/1 AS BUILT SANITARY SYSTEM REPORT ":IER ~s`~~ ~2/' _, TOWNSHIP.. ~ ~~ ~SEC.~ T ~~N, R~W -0. ADDRESS - ,., ST. CROIX COUNTY, WISCONSIN. - ?.. '3DIVISION , LOT ~ LOT SIZE- ~/ PLAN VIEW ~ •Distances ~ dimensions to meet requirements of H62.2Q I ~ 4~ ~~ ~~ /~ n ~~ . ~I:~i;i ~} - ~~ ~' TIC TANK{S) MFGR. .CONCRETE STEEL - N0. of rings on cover Depth DRY WELL INCHES N0. of ~~ width ~ length ~~y .area 6 3~ ,) no. of lines width length area .. ' depth. to 'opt Pf pipe ~ ~ ~' .JREGATE / ,,.Z -- . ti{ RATE~~-' ARE REQUIRED~~. - _ AREA AS BUILT ~ciaimer: The inspection of this system by St. Croix County does not imply complete % pliance.with State Administrative Codes. .There are other areas that it is not possible i inspect at this point of construction. St. Croix County assumes no liability for ~ .tem operation. However, if failure is noted the County will make a effort to -ermine cause of failure. 'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST "INSPEC D~ITED L ON JOB NUMBER .~` .~~~" Z --_. _ REPORT OF INSPECTION INDIVIDUAL SEGJAGE SYSTEM ., - 4~ ~~ • San~.~any Pehm~.~tf ~~ F ~ S~a~e SPp~~.c,~ o NAMF~C~-2~ ~/l ~r~c~~ rownah.Lp ~~~=~~~~'~~ S~. Cno~,x Caun~y -_ Loca~~.a~a~ ~C Sec~~.on SEPTIC TANK ~ -- ' <, i S.bze L`~`~C~"~ ga~'.Con~s. Numb en o~ Compan.tmen~b ~ ~_. D.c.a~ance Fnam: GIe.2.C C a ~ r ~~. 12 0 on gnea~en ~a~ape .~~' y ,y- ~~, Bu~..~d,i,ngb~. UJe~.~anda ~~• ~~ H~.ghwa~en ~~. .. fIISPOSAL SYSTEM - D~,.a~ance Enam: we.e..Z ~~~-~ S~. 12~ on gnea~en. b.2ope"""-'-~~. Bu~..~d~.ng- ~f-~--~~. tUe~.~and.a "`-------.-..._ Fz. H-i.ghwa~en ~~. FTELD DIMENSIONS: Gl.id~h as ~nench ~• ~~. ~. ~~ G' Length a ~ each .2~.ne~~~~. Numb eh - a ~ .Z~.n e.a ~. ~'o~a~2 .~eng~h a~ .L~,ne~5~s~. S.Lope o~ ~nench D.c.a fiance b e~cueen .2~.ne~s -~-~- ~~. To~a.2 ab~s onb~~.an area ~~ ~~2 -~ Retu~.ned area ~2 PIT DIMENSIONS: Numb en o ~ p~.~'a Ou~t~.de d.iame n ~ Taxa.~ abd atcb .Lo area Area n INSPECTED By APPRO`UED / /~ ~ G / ,DATE 19 7~. REJECTED ~ ,DATE / 197_ Depxh ab nacfz be.Q.aw ~.L.e.e ~'2._ .in. Depth a~ nacFz aver ~.i.~e ~-- .~n. Depth o~ .t.i.~e be.Q.aw gnade~~~.n. ~~ ~.n pen 100 ~~. Depth ~a bedrock Depth ~o gnaundw -~ -`~ ~~. Type a~ Caven: Pccp2n n S~rcaw Gnave~. around p~.~~s yea na Depth be~aw ~.n.2e~ ~~. 2 ~~ ~~2 TTTLE,~; /`~ //I ~.. ~~. z s m ~I EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ,` DFVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 ~ MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION'/4~'/4, Section ,~.., T~QN, R ~E (or)~Township or Municipality 0 Lot No. ,Block No. County Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence ~.1~- No. of Bedrooms -~ Other EFFLUENT DISPOSAL SYSTEM: NEW t~A ITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS/~ °? SOI L MAP SHEET- ~~ SOI L TYPE ~~LXt'.~,Q~;~ 1~ Y~~~'~~~ 1 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS HOLE WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER P ~ ~7 ~J -~7 ~ ~. Qa r ~ ~ o ~ ~. Y~q. I ~ d / ~ ` ~~ ~ O P- ~ ~ I' '~ ~ l ~ ! ~ ~ lye ~ P~ ~ ~~ `, ~ a 1 ~ 1 ~~ ~% S SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) ~ ~ t~ >~ ~ ~< < G -`~ `~ ~- y ~ ~~ 5' .~ r ,~ 8 , ~~ ~~ S ~~~ PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t;, lar d i ~ - ti - -~ - t~ - ~ `~°~ P L ~ ~~ State and County State Permit # Permit Application County Perm' ~ CJ for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: ® 'J B. LOCATI '/4 '/4, Section ~, T~Q N, R E (or) Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family ~ Duplex No. of Bedrooms „3 No. of Persons_ '~ 1- D. TYPE OF APPLIANCES: Dishwasher ~ YES ~/NO Food Waste Grinder _ YES i~ NO # of Bath?ooms ~ Automatic Washer / YES ~_IVO Other (specify) E. SEPTIC TANK CAPACITY/~tt, d Total gallons No. of tanks _~_ *Holding tank capacity Total gallons No, of tanks / New Installation 1~ Addition _ Replacement _ Prefab Concrete !~ *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area .~ D sq. ft. New V Addition Replacement *Fill System Seepage Trench: No. Lin . Feet '~~3 Width ~_ Depth~_Tile Depth ~_ No. of Trenches Seepage Bed: Length Width- Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the C if~d Soil Tester, ,,Q~Q ~ NAME _~C~~-~;7S~e~ C.S.T. #5s ~~~ and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# ~'~'`)'~ Phone # 6~~?a3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). e\ v ~~ ~,~~ c~tnp~ ~vip 3~op d I c ~»' ~ ' ~ ~ > > ~ 3 ~ ~1 ~ ~ r: r: ~ ~~ I ~- ~ Z o ° N S cn m ~ Z v a, o o a t c` m p p 3 ~• ~ ~• m I ° a ~ v, S n ~^ ~~ ~ m ! s ~ n ~ H ~ ~ w° y ° ~ ~ ~ N~ O O Q O ~ ~~ O ~ C• ~ O a _ ° d~ pOp ~ I _ ° I ~ ~ °° ~ m ~ ~° ~ C ~ ~ ~ c ~ 0 C n ~ ~ ~ ~ N N ~ d ~. O ~ I I ~ cn -C D o~ ~ c ~ I ,~ a n°Di ~ m cn v D ? N ~ ~ D ~ a ~ • ~ m I ~ cn N W m c a sr~ a' c cQ ~ rn o W a ~ C ~ ~ v ~ ~ V ~ ~ O~ o ? n V !~ I o ctO o c CDO ~ I vfD, m N N E N ° ~ ~ ~ ~' ,. ,. _ 3 Q I < N C • ~' ~ I ~ o. °~' • Z I OOOo l Z OOOA ~ o ~ ~ m ~ o =-o ~ ~ ~ I ~ W ~ t ~ N ~ m ~ ~ ~ 3 I ~ d ~ I v+ Q 'o v 0 ~ r. ~ m Q ~ o 0 o ' n o ~ o ~ ~ ~ H a '' ~ ~ ~ ~ o m 7 l o ~o y ~ ~ ' ~ 'o m ~ I m ~ _ ~ ~ I ~ ~ D ~ _ ~ ~ 3 d (T i ? O 3 d C N I z ~ W N z 7 `° <D fD ~ I ~ N ° ' Z z~ ~ ~ D D o d O I ~ D D o I '" o I `° `° I c c w w m w m Z ~ ~ Z = J A Z .~ I ~ ~ ~ ~ v ~ I =. ~. .. I fD -1 w oo~ ~ ao~ mw I co eo I ° W ~ a ~ Z . ~ 3 a I o r: c r: t~ ~ rn m N I y < G ~ I ~ ~ A w~ w ~ Q ` O N Q ~ ~ ~ j• 7. 0~1 ~ fC ~ O_ X• S Q I G 'O fl- N 7 ' O fD ^~ . cc 7 G t0 O- C~ ~ O ~ N a fD 7 (D N '~ Q t0 ~ r' ~ N p 01 7 O ~ ~ O O. • 0 N ~ 7 - N O C '~ G)N J J ~_ ~ ~ fD fD C N n ~ C D_ ~ ~ Z o fl:o ~a a ~ Z ~• ~ ~~~ m~ y a o d d ~ O 01 p 7 ,,~ ~ 7 _ N~ O~ 7 .~. N N ~ O d C ~~ O I ~ 7 N~ •CJ'17 d J~ 7 ~ N O n ~ ~. -I N a~ < (nom ~ N ~ O q/ ~ O ~ O. f0 ~ N O v Uf C ~ •O .0 Q~ cpN Nm NO A , CD ~ ~ ~ ~ O . •~p O .•. n cC S~~ n N CD O ~ ~ V 7 N ~{ ( 3 o N 0 N~ I ax a~ I ! f D t ~ 1 ~ Jti m o t ~~ ~ O N ~' I U7 ~ ~•Aa`~ ~ _ ~ O Nn N '~ ~ ~ OfD tin N O ~ y 3 _? ~ N a N ~ ~ y ~. ~ A O O :d m m op o0 Efl ~ i Efl Q A ti ~ I O ~ O ~ ~ ~ ~ ° ~ ° ~ Parcel #: 010-1008-90-000 10!21!2005 09:09 AM PAGE 1 OF 2 Alt. Parcel #: 3.30.16.50 010 -TOWN OF EMERALD Current ~X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O - PJ OF HUDSON & ASSOC INC PJ OF HUDSON & ASSOC INC 326 KRATTLEY LA HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description " 2482 170TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N!A-NOT AVAILABLE SEC 3 T30N R16W 40A SE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07!02/2002 683328 1921/522 WD 08/29/1997 1261 /097 WD 08/29/1997 1261 /096 WD 07/23/1997 1192/005 LC more... 7nD~ SI IMMORY Bill #: Fair Market Vatue: Assessed with: Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 25.000 4,500 0 4,500 NO PRODUCTIVEFORSTLANC G6 11.000 11,000 0 11,000 NO OTHER G7 4.000 18,500 177,400 195,900 NO Totals for 2005: Generai Property 40.000 34,000 177,400 211,400 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 34,000 177,400 211,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Department of Commerce PRIVATE SEWAGE SYSTEM 3uilding Division ,i INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township PJ of Hudson and Associates, Inc. Emerald Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~ ~~/ f ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic / / / (/ Q~~ Dosing / ~~ ! l/ Aeration W Holding TANK SETBACK INFORMATION TANK TO e P~ ~ WELL BLDG. Vent to Air Intake , ROAD Septic ~ ~~ ~ ~ ~ ~ Dosing ~ / V Z ~^' r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number / ~Z/ ~'~ ~,(7 TDH Li ~ 3 ~ Fricti~~Lgs ~ System He~ ~~- ~ Ft ~~ ~ For main Le / Dia. /~ Dist. to well f j'~0 Z iti1 SOIL ABSORPTION SYSTEM c°~nty: St. Croix Sanitary Permit No: 420446 0 State Plan ID No: l / ems! Parcel Tax No: 010-1008-90-000 STATI N L~S~.r BS Z, •Z HI •~ FS ELEV. ,G ' Benchmark ~~ ~ ~ ~ N o~• i ~- d Alt. BM / '1 5-1 / Q 2 ~ ~ . ~ Bld .Sewer N~ . ~.- - ~.9 9'/ 13 UHt Inle ~ ~ ~jni - dd {` SUHt Outlet ,~ Dt Inlet ~ ,`J Dt Bottom ea er and ~ ds ~. Dist. Pipe- o 10 ~ ~~ z~ ~9.3~ Bot. System 3 ,~ ~ q p , ~ 1 Final Grade -~d~`~' ~Z ~e.S - /~~~ St Cov ~ I°r-t G` ' Say. .~ ~~..r•.~ 5 ~n T ~ q~ BED/TRENCH Width ~ Length ~ No. Of Trenches PIT DIME ONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~~ SETBACK SYSTEM TO P/L ' ' LDG W L ~ LAKElSTREAM CHI Manufacturer: INFORMATION CH OR Type,~f Sys temN~ ~~ / ~ `) ~ ~ UNI Model Number: DISTRIBUTION SYSTEM / /-1Z'f'~SS 14./S1/ D.tl ~V Header/Manifold ? ~ ~ ~ Distribution f Pipe(s) ~J ~ .~ !~ / ~ x Hol e x Hole Spacing /~ ~/ 2 ~ Vent to Air Intake ~ ~.~ Length 3 Dia_ Length (i ' Dia Spacing / SOIL COVER x Pressure Svstems Onlv Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center "~' ~ Bed/Trench Edges Topsoil Yes [~ No ~,-, i'i Yes ] No COMMENTS: (Include c de discrepencies, persons present, etc.) Inspection #1: ~ / (~ ! U Inspection #2: /~~ Location: 2484 170th Avenue Emerald, WI 54013 (SE 1/4 SE 1/4~30N R16 ) NA Lot ~~ K P~`? ~• .ST ~CAYt~- v ~{~~ f~ SG7/~ Ql~ Y/~xd r ~UILC~" ~'' ~ha.~ 1.) Alt BM Description = ~. 2.) Bldg sewer length = 3([] + ~.t[.~[„ N'-\! ~~~ ~~I •1NCtt~' Q"L ~ /.SPA -amount of/c~over = ~~ ~ D 1~.P1G~~~ ~2~ 3.) Contour = '{ ~ gb' - i ,, - - 1 1 -. ~._~- -i _ /' ~ - ~~ q ~- Plan revision Re uired~ Yes No Z J _ ~'~!YY+•r _ s Use other side for additional information. ~ ~ i r d - -- ~' _ ___ ~- '~ , ~~--- Date Insepctor's Si azure Cert. No. SBD-6710 (R.3/97) / fits xx Mound Or At-Grade Systems Only Safety and BuildiaSa Divisiatt 201 W. WashiaQaa Ava., P.O. Boz 7162 ST . CROIX /~~O~S,'~ ,Madison. WI 33707 - 71tiZ oe Address ~ ~' ~' fGYO De artment of Commerce 0-'y -0 Z- ~ ~ ~~~ ., Sanitary Permit Application _ ~'" ~`~~ In accord with Comm 83.21. Wi:. Adm. Code. personal inf ou rovide ^ Check if Revision . ma ba used for seeo see Priva Law 15. I. Application Information -Please Print All Intornnation .State Plan I.D. Number SIT)I ID#65051 1' " ~ Y 10• 7882 RANS . ID# property tTvnar'a Name 5 E P 2 5 2 0 0 2 Patter Number 010-1008-90=000 PJ OF HUDSON AND ASSOCIATES INC. Property Owner's Marling Address Z 0 N I N G O F F I CE Property Locadou "' ' 326 KRATTLEY LANE ~SE ~ SE ~•S 3 T 30 p g''1bW~ City. State Zip Code Phone Number .. Lot Number 81ock Nutober N A N A HUDSON, WI 54016-7101. 715/386-6345 Subdivision Name CSMNtttt~tat +:°~ A N/ ~v ~~r~eS II. Type of Bttildi~E (checlt all that aPPly) ~ ~~_~jl,~~,,.,,~, tiQ~,,,~,s,.,(,a..`~ ^Ciry 1 ^ 1 or 2 Family Dwelling -Number of Bedrooms 3 ^Village S o~. K° C~Townslri EMERALD ~ ^ public/Commer ' Describe Use _ ~~~ ^ State Owned ~~ ~~ ~~ ~ju.S Nearest Road ~ .. u l '~ nn r 170TH AVENUE XIS 'M ~ D = •~Z ~23 •~l '~" ( . III. Type of Permit: (Check only one box on line A (numbering scheme for terns! use). Complete line B it appIIcable) A. For County use ' 1 ~ New 2 ^ ltepiaceareru System 3 ^ Replacement of ti ^ Addition to stem Tank Ohl Existin S stem Dau Issued Permit Number B. ^ Check if Sanitary Permit Previously Issued 1V. Type of Permit: (Check ell that apply)(numbertng scheme is for internal use)~~,~ ~4--(0~ _ , 44 ^ Non -Pressurized In-Ground 21~ Monad 47 ^ Sand Filter SO ^ Constructed Worland 22 ^ Pressurized In-(',round 41 ^ Holdin; Tank 48 ^ Sinyle Pass S1 ^ Drip Lice 45 ^ At-Grade 46 ^ Aerobic Tteamunt Unit 49 ^ Recircula ' 30 ^ Other V. Dis ersal/T7reatment Area Informat Design Flow (gpd) Dispersal Area ion: ~ ' Dispersal Area Soil Application Percolation Rate System Blavatioa Final Grads : . Required Proposed Rate(Gals./Days/Sq.Ft.). (Min./inch) Bievstion - 45U 450 450 1 N/A 98.7 100.54.x' VI. Tank Info Capacity in .Total Number Manufacturer Prefab ~~~ Sits Constructer Steel Fiber Gh~i Plastic Gallons Gallons of Tanks New Ezistint , Tanks Tanks septic or Holdicta rank 1000 - 1000 1 WIESER CONCRETE X Dosing chamber W E VII. R onsibilit Statement- I, the undersigned, n~,.R.. respoatibillty for Lrstallatlon of the POWT3 shown on We attached Plumber': Name (Prior) P s Signature MP/NJPRS Number Business Pltoae Nuttlber " ~ BENNIE HELGESON 20292 715/772-3278 - ;t, ~~~ Plumber's Address (Street. City. State. Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Conn /De artment Use Ohl Approved ^ Disapproved Sanitary' Permit Fee (includes Groundwater Data Issued lssuinR AReat SigaaWm (No - z;~ ~, , ~) S~ ^ Owner Given Initial Adverse • CR[' ?,~,5 ~- © ~ 0 ~.' Zak Determination •.1-I I7C. Conditions of ApprovaUReas~on~s~pf~or~ Disapproval ~ ~ ~ ~~ ~ ~ ~ _ ..~ _ ~ - ` t Y~ $p'Q G(. aK.$" ~ Attach tomputa plans (t0 tiN t:ooot7 0017) [Ot tW s7ste0r 00 paper OOt urs wait oL~ s as aaicaas ra ass . _ ~ y.:, ~~-~~SBD•b398 (R. 05!01) :: - r I / ~/ -~ ,~~` ` ~~' i '~ ~ - t"~O t~ ~~~~ ,~ P I oF8 Omer: 1~~ of 4-~uc~_seh + ~;a~~ ~ hr ff~~~ ~ { ,.. _ 7t f _ 51u~ ~~~ Y7. ~ ,~ a. ~ $~ ~- B. M- loa. oU ~- ~P G -1 I~JC P~~ t i ~5 io~~6©0 ~z.,/ 5e/fic ~~Gaf~ ~zn~ ~~ ~kcep~ s Strow~ f~ i 1 r ~v v ? ~0 i 3~~ QJ V F_I~~_ 9/cti-~ gyp` 4"P~ ~f G ~c~Sc3 ~ . ~~°' ~` ~ D~.~ R.I~~,~~, ~r i~l ~i6v' t <---~ i Ews~ Ho~.~ ~~ 1 1 4~Pro ~r I a00 ~ 1"rc w. Ho~e..s ~f ~-~ 17 V ~ ~, . A ~ ~ . v ~~ ~~ ~ ~ 9y ~' ~s l 7b ~~ ~.UP .'~ ~ ~ , isconsin Qepartment of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce. state.wi. uslsb vaww.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary September 19, 2002 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/19/2004 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: P J of Hudson & Associates 170th Avenue Town of Emerald St Croix County SE1/4, SE1/4, S3, T30N, R16W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 870766 Identification Numbers ransaction ID No. 788210 Site ID No. 650511 Please refer Eo both identification numbers, above, in all corres ondence with the a ene The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. Stets. • 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. Stets. • 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 inspectors. Owner Responsibilities: • 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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. P.O.{l1J.T.S. Conditio~rally BEM~IIE W HELGESON Page 2 9/19/02 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions azise 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 $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 ' ~ ~ INDEX SHEET PROPERTY OWNER: PJ OF HUDSON AND ASSOCIATES INC 326 KRATTLEY LANE HUDSON, WI 54016 PROJECT NAME: PJ OF HUDSON AND ASSOCIATES INC PROJECT LOCATION: SE 1/4, SE 1/4 , S 3, T 30 N, R 16 W MUNICIPALITY: TOWN OF EMERALD COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Page 2: RECElVE~ page 3: ~<<l~ ~ a ~.00~ Page 4: SAFETI(& BLDGS D1V.Page 5 Plot Plan Cross Section and Plan View of Mound Distribution Pipe Layout Septic Tank & Pump Chamber Cross Section & Specifications WLP1000/600-MR Zable Tank Specifications Page 6 Pump Specifications Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signe Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: August 28, 2002 DEPARTMENT Of COP~IJ~ERCE QIVISiON Of SAFETY AND BOILD1Nf,S ---------- 5EE CORRE:SP DE=NCE • ~ ~~O I~ t"~CL~ Pg ~ oF8 ' Oj ~~ n~F'Y'' I~~ ~f N~bh ~ can -~a~".~ lnc . ~~' ._.,, .M~n~ '~F 9C. g c 1 '`- -.~ a- B.M- Boa. o~ ~ ~~- ~~~ ~ ~p-G -- ~ ~~c p~~ OvTS . R, ~ boy. 9y ~ ~ •r ~v t J ~~ v V ~ ~ ~L F_i~~_ 9I•cti-~~ y" Pic- }7ra~bScg --~ r~ a ~ / l . ~ io~~6o0 ~,~./ 5e~ f• ~ % ~Dc~s E= ran ~ I `~ ~ 1 5~.~ I G_ I - 4_ {~ ~1cc~~-~' ~s S~~ow~. /~J~r~S~ ~ro~r_~ ~rn`z ~s 17d ~~ ~P ~~ ~ c O' R. ~p ~j o ~~ Tv~ ~ ~J• i y D ~ ~ Kok ~ Ic~.~ ~- Tv~-~ ~~, -, 0 ~~~' ~ws~ ~--lo~.s (.,~1 ~ 1 ~'~PrGk I o~~0 ~ ~ro vv. _ , Synthetic Covering ,~srM c 3.3 Medium Sand -~ Topsol{ Slope !Ji ~ -}~ 3 J~` C C Lli. O f i ~- Z Z Aggregate -' Cross Section Of A Mound Signed: License Number: Date: L_ Page ~ Of8 •Distribution Pipe /~,sy !-~G F ,~ . 71 o Cc5-1~a,w- Eke . `r~ . ~ Force Main From Pump A Cc~ F '~ •~ F K ~ Ft. L , ,~ Ft. ~ X,~7 Ft. T ~~ Ft. W ~ ;,7 Ft. Plowed Loyer D 4`9~ Ft. E a.~~ Ft. F . ~~ Ft. G . ,S Ft H / U Ft. Observation Pipe J ~ K I p A i ~ ~ g _ ~ -- -------------~-------!_-_._..~ ~ w ~~ - _ -7----._._-- - u ~ u Distribution ~~l.L Of 2 - 2'2 Pipe Aggregate Observation Pipe ~ 357 ~ ~ 6ms4 ~~.,-ems Plan View Of Mound C~ep.ino~ -G~CS~ ' ' (ecwa-~-~ Perloroled Plp• Oaioll J / ~J end vl~>r P.•/ereled ~~ 3oF8 Holes Located on Bottom are Equally Spaced io i~ ~ex~ -~o ~d~: ~01~0 ~ I~~ Distribution Pipe Layout ---- - p ,.1 ~l 5 1 /l R S ~ I x ~ 3 ~ •~ _ ~ fl Y ~ 3~ Inch Hole Diameter Signed: License Number: Dace: P~v~ Lateral ~ Incn (es) Manifold " _ a Inches I~'orce Main " a Inches -~o)ps ~r I-a~-e~) = 3 k rwo ~~~Q ~-~ ~ _ ~~ ~-b,ps n 9`- R SSyG J 0.-~-e~ Ii.~c F ~ ~d S ~ ' l Page y Of 8 . . o < ~ nPr • -,c TANK l; PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS SEPTIC 4" .PVC..VENT PIPE 12" MIN. ABOVE GRADE 6 NEATHERPROOF JUNCTION BOX APPROVED > 2S' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E ~ WARNING LABEL FINISHED GRADE 9,00 „ ~/e~. a.- ~4" MIN. ~ ri~n. " ~ iy y~~PU~ UbSERVnTiorJ S•D• u le" IN• PIPE '~; 18 en-N. ,, INLET I , WATER TIGHT SEALS ~" GAS- ~ TIGHT ~ ~~ /APPROVED - A SEAL ~ JOINTS WITH - F1E7ER J; ; ALM APPROYED PIPE ~~ B~.L , APPROVED •_ B ' ON 3' ONTO „ . , a . ~ ( ~~ PIPE 3 ~ ~ SOLID SOIL ONTO SOLID SOIL PUMP OFF ELEV . ,.OFT. C -~-- I ' OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS C--ASEPTIC / DOSE /3;3`/ X '~ =~ ~`~`~• TANK MANUFACTURER: ~~/~S~/ -' TANK SIZES: SEPTIC /GAO GAL. DOSE VOLUME FLOWBACKG S ~ /•/.~ GAL. • DOSE UFACTURER: ~ ~_ GAL. • ~a CSPACITIES: A = ~F~ <T ~~t~~~z ` ~ S~- INCHES = .3x[,68 GAL• ALARM MAN ~- MODEL NUMBER: , - j e g = 2 INCHES = ~.S-? GAL. SWITCH TYPE: M..r.f1 ~-, ~/oa.f" 1 C = ( INCHES = /p~~GAL. PUMP MANUFACTURER: MODEL NUMBER : ~~~z1~r/ i ~ D = /~ INCHES = //GAL. F ~ SWITCH TYPE: ~ PUMP E ALARM WIRING AS PER. I LHR 16.23. WAC RGE RATE I, I ~ GPM REQUIRED DISCHA ,,~_ V ERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~~ FEET • + MINIMUM NETWORK SUPPLY PRESSURE FEET FORCEMAIN X ~ FTI100 F CAHEAD I ~Q FEET 7 FEET ~_ -~ ' + ~ DYNAMI TOTAL . (3~ INTERNAL DIMENSIONS WIDTH OF PUMP TANK: LENGTH -- ~~ Y r, DIAMETER - ^ ~n~ LIQUID ••~ I `./ ,y (/ (p . 7 / ~jrc ~. r"['V'. ~h c ~.~ ~/Pa S ~ s~ ~e / ° ~ K ..S,~eC ..fit a •e. '! LICENSE NUMBER: DA-E: SIGNED: 1/88 ~0 ` Cl, O O U Z W J Q ~ Y ~ Z ~ ~ w .-. J O O F~ _ "a ~ ~ o ~ a~ Wo o ~ Q o ~~ ~~ vv ~ V ~m ~Q ZZ ~ o ~ aJ J U tii¢ J J ¢a Q _ O U ~ m ~~ o ~o~ Z O W , o o _ N~° M Q ~n ¢w ~~ n~ o = OO~~ ~ H ~WW N~ ~~//~~ M N U ~ ~ O ~J~~ZW.- ~ ~W ~Vl C9 ~ Q o~~~`'Z~zo°a,~ QooQww w_~ z°ma a~c~ ZNO Q~~. ~ o Z3mU~2J~0]-~ 0 Z J Q Q ~ Q J Z Z J O N H Z W > J ..ZiT e!' Z ~I y" 0 ~n ~ ~~ w, >~ O J t"_ U N G H s ~' „~8 a ~ ~ d -_ ~ ~Nf '~ J ~ m U ~ °o ~ CD Q ~ N p. o ~ 00 ~ 2 ~:i ~ a ~ (~'~acv , ,, O cv y ~ L~J ~ m W Q ~ ~~ ~ ~ Z ~ ~ w w N ~ N ~J F W o „6~ „9S ,fin ter.; ~.~ d ~- l~ kd 5 ~~-- ~ A 55~ c i ~f~s s~ ~ . HEAD CAPACITY CURVE MODEL 152/153 W ~~ 53 12 4U 1 x ~_ 30 8 0 ~ 20 0 4 10 0 20 40 60 80 100 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 10 3:1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) GALLONS I LITERS p 80 1 0 2 0 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • 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 float switches are available for variable level bng and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 15?/153 MODELS ConVol Selection Model Votts•Ph Mode Am s Sim lex Du lex N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Induded 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Induded 2or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Induded 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Induded 2 or 3 O CAUTION All installation of controls, protec8on devices and wiring should be done by a qualified dunsed electrician. All elecUlcal and safety codes should be followed including the most recent National Electric Code tNEC) and the Occupational Safety and Health Act (OSHA). 3 27 I I 1z 1/6 5 1/ SELECTION GUIDE 32 s2 8 ~5 ~ a ~ ~ sK2oe~ 1. Single piggyback variab-e level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of ElecUical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4}float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Mai ro: P o. eox 16347 ` Louisvile, KY 40256.0347 Manufacturers of. . SHIP TO: 3649 Cane Run Road ~~ Louisville, KY 40211.1961 p Z o ,, - ~ { # m Q!/dL,TYPU.f/PB SNCE ~9i~d htfp:/hvww.zoellelcom PUMP !O. (502) 778.2731.1(800) 928-PUMP . FAX (502) 774-3624 ® Copyright 2001 Zoeller Co. All rights reserved. ' ~ ~ POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN Page_~of v ru_E INFORMATION Owner ~,~ rJ~ ~DSOi`i ~~ E,SSOCIATES INC Permit # DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Commercial Units ®NA Estimated flow (average) 300 aUda Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate 0.5 aUda /ftz Influent/Effluent Quality Monthly average' Fats, Oii 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODb) 6220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ~ ^ NA Monthly average•* Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) S30 mg/L Fecal Coliform (geometric mean) s10' cfu/100m1 Maximum Effluent Particle Size Y inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity 1000 al ^ NA Septic Tank Manufacturer IESER CONCRETE ^ NA Effluent Filter Manufacture r A-100 12" x20" ^ NA Effluent Filter Model ABEE ^ NA Pump Tank Capacity 600 al ^ NA Pump Tank Manufacturer IESER CONCRETE ^ NA .Pump Manufacturer ZOELLER ^ NA Pump Model 152 ^ NA Pretreatment Unit ®NA ^ Sand/C~ravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection D Other. Manufacturer Dispersal CeH(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ®Mound ^ Dri -line ^ Other: • Values typtcal for domestic (non-commerclan wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every 2 ^ months ®year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months . ®year(s) Inspect pump, pump controls & alarm At least once every 1 ^ months !~ year(s) O NA Flush laterals and pressure test At least once every 3 ^ months ~ year(s) ^ NA ~1ec At least once every ^ months ^ year(s) ^ NA other. At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspedaons 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 Servidng Operator. Tank inspections must include a visual inspection of the tank(s) 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 (Y) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components; and any other maintenance or monitoring at intervals of 12 months or less 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. STARTUP 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ~- OtidNER: PJ OF HUDSON AND ASSOCIATES INC START UP AND OPERATION Page 8 of 8 For new coistrucison, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s-. If high concentrations are detected have the contents of the tankls) 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 cell(s) 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 evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available 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 last 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 HELGESORT EXCAVATION ' Phone 715/772-3278 POWTS MAINTAINER Name Phone 715 273-5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST. CROI r Phone 715/273-5811 Phone 71 - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code qty ~( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizor-tal reference point (BM), direction and Parcel I.D.' peroent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~j l G - /GCS- 90,E Please print all Information. ~~"~ by Personal information you provide may be used for -- { ~•. ~ ~~, s. 15 (1) (m)). Q~,,~,,,,,, „~~/`A,. p Location Page _L- of Date ~Z Property Owner II ' ~'~' b -~, fl i.iGl fit; tr) `Pr A S -~~; ,. Go Lot ~ G 1/4 5E 1/4 S 3 T 3 C~ N R ~ t'o E ( W Property Owner's M fling Add ess " ~-' Lot Block # Subd. Name or CSM# a r~ e ~-a ~~ .. Cirrty~~ tState Zi Code hone ` ` !; , _ ^ ity ^ Village own Nearest Road ['t~.Cdv. I~,~ri ~~©/!;I ( ) ~:,' ~Prd/c.~ ~ ~t11 V2 New Construction Use: esidential / Number of bedrooms ~_ Code derived design flow rate ~~~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material si~~ Q~xv ~;%( / Flood Plain elevation Napppcable R General comments {'-'t lh . ~ 3 " ~4,~ ~ CCr-p`t'r c.~l(J er Ed?~ e. ~~ ~ C~ (~ Q N C oa.-~OU r- 9G . g and recommendations: a ~' / a~ ±rs U Boring Boring # ,-.,/ q 7• ~! g• Depth to limitin factor ~~ in• l~ pit Ground surtace elev: g Sop lion Rate ~ure St Consistence Boundary Roots Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture nx Gr. Sz. Sh. ~E~1 ~~ • 1b ~ ~ -~' ~ tv ~ S , - a ~~ a- a ~ 3 vY. s J ~ l J Boring # ring pit Ground surtace efev: ft. Depth to Smiting tailor ~-~• Sop icatlon Rate t T Structure Consistence Boundary Roots GP D/l! ~ -` Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. •Eff#1 'Etf#Z ~ a 3 -Ib - ~ 0 ~ o Kai f o ~ .- ~. ~ n ~ '~ ~ ~ • 1<r r h1-~t- C~ ~J to ~~~ u k ~ ~ S ~ ` , , ~ • Eftluen[ rFl =lieu > 3U ~ ZCU mg/L arw ~.~ +ou: iav n~y~. •......,......- --- . -- ---~- - - - - CST (Please Print) ~ Sign CST Number . v` v~ I -e e ~s o ~-- ~~ o~ r~ A~~ Date Eval Coftdut~ed Telephone Ntunber Property Owner ~~rr ~~S~r, 9-r^1SSc)G.-(-^+~" Parcel ID # ~~~" ~~~ $- Sa o c~ d Page ~ of ~ ~ d /~ Sa ~ Bonng - ,.. _. y~ ~ Boring # 3 it Ground surface elev. --~- ft• Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color - - a Depth to Iimitir3g favor Texture SWdtue Consistence Gr: Sz. Sh. s ~ ~s -~ ~' Boundary Roots [ v Soil ication Rate GPD/ftr - 'Eff#1 ~ 'Eff#2.. ~ ~! ~ s- -- ~ ' ~ V v ~ I LJ Boring Boring # Depth to limitin factor In. ^ Pit Ground surface elev. fl• g Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E~GPD/ffE~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring # U Bonng Ground surface elev. ft. Depth to limiting factor in• ^ Pit Soil ication Rate Roots GPD/fP Horizon Depth Dominant Color Redox Description Texture Structure ~~~ Y •Eff#1 'Efi#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BODb > 30 _< 220 mglL and TSS >30 < 150 mgll 'Effluent f)'•2 =BODE _< 30 mglL and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services oC need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S8D-8330 (R.6I00) y i ~rJr 3 oF3 ~~ O I ~t ltv~ _, - - _ ~t ` ~o~oa ~T ...._~_._._:v__~c~.__._e_~ e rsov~ - 9a _ _* 63x Fc,~ ~ e i ~._ ~,, f'f. , n_o ~1° o~rp l{{A 'a~JY~. R.lJ~ t 4 f -- • r~`'~ 8 ~ - - _ 9S.' S P~.~.~. V 9y,~ _- a ~l ~G~ou~~. ~le~. 9i,n~ v~ j~r-o o~se~ 3 ~Q o ~~ e t o ~v~-e, ~. . . `~, B. M . 9~, ~ ` ~' ~ /~~~ ~~a~ h ay ~ ~ p~~ ek e lc~t~e f--Trees ~~ ~~o~ ;~-~ _. _ . _ __ ._ _ _..._ We ~ I ~'r pw. H a,~g ¢.. +O ~ 7(:~ ~ ~5~~ I.~ i `' = y~' ~XC e~p T ~tS ~~ b~-~ ~-~ ~C'ct.~res~ ~'rc~•er l V 2 vJGN TC. t`7O ~'~. ~Qa Q_ ~`~ S ~ SEP-18-02 09:42 AM ST CROIX C4UN'I`1' SEPTIC TANK MAINTENANCE AGREEMENT AND QWNERSHIP CERTIFICATION FORIv1 OwnerlBisyor ? ~ ~_~ ~ tx ds ~ N ~.J~ ~Ss oe~ ~-Pf's ~ ..~ e, Mailing Address Property Address 3~ 6 eft k T t c.rr v L,~.~ ~~-.~,.. ~ y 8'~~ 17b "~~ -~s~ ('Verification rcyuircd from Planning Department for new CitylState _ r i.~.t~.c.4 t ~ ~ W ?' I?arcel ldentiftcation Number d ~~ ' oa 8 " v '- Ovo LEGAL DF,~C$IPTION 1'roperiy Lvcativn SG %., _~ '/., Sec. ~,~, T~ d N-R I ~D W, Tawn of ~ !'-Q ~'R/~ ~C Subdivision /~ LOt# ~' ~. Certified Survey Map # M. /~ /~ ` , Volurtte /V ~ ,page # ~~ Warranty Decd # l~ g~ ~.~ ~ ,Volume / 9a2L___-., Page # ~~~ Spec house D yes ~" no Lot Iinas identifiable CSI yes D no SYSTEM ~~TENANCF . L^rproper use and ma:ctrr.~ticc oC yvur septic system could result in its premature failure to ltandte wastes. Proper maioteszsnCQ consists of pumping out the septic tank every three years or sooner, if needed by a licease:d pumper. What you put into dta system can affect the ttmetioa of the septic Rtnk as a treatment stage an the waste disposal system. The property owner agrees tv submit to St. Croix Zosurtg Department a ccrtii"icativn foutt, signed by the: owner and by a master plumber. journeyman pturttber, restricted pluraber or a licensed pumper verifying that (i) the: on-site wastcwatcrdisposalsyslem ~s to proper operating condition and/or {2) after inspection and pumping {if necessary), the septic tank is less than i/3 tldl of sludge. Uwe, the tiadersigaed have read the at~ove reyuiremeats and >,grCC tv rusultaitl dot private scwagt: disposal systcrri wi$1 the standards set forth, hrrairr, as set by the Depac~rnent of Commerce end the beparttnent of Nattual Rcsottrccs, State of Wisconsin. Ccrt3Ciceeioa v~ating :hat your septic system has been maintained nwst bC completed and returned to the S!. Croix Cuuc~ty Zo~ting Office within 30 dQy of the three y ar e~pirstivn date. / , ~ '<' ~ ~ ~ ~ ~ ~ a ~ / ~~' /~a'O L 51GNA'I'UR.L O CANT UAI't3 `'~ A .r. •a 1 is ~ cPr+- s ~~/ ~ P A6s , d ck r ~ S a~ !1 wd s ~w ~.,.. „ A s s o c~~ar~sy .~ c . S?~_'LYER CERTIFICATION I (we) certify that ail xcafein~nts on this fom~ arc true to the best of my {our) knowledge. I (we) ar=e (are) tlic owner{s} of e!~ pr petty descri a e, by virtue of a warranty decd recorded iu Register of Deeds Office. p ;~ 7 J / $ /~ c~ n St4NATVR~ 01= C N1' UA'I'E ~~.~~.~ i ~as~~~ pis;lwNt- '****` Any information that is mis-ltpte3t;uled may result in the sanitary permit bciug revoked by the Zvning Dcpartrucnt. "••"• P ,) v .~- ~'~~ S u.~ a.... d~ S o e~,n-f6s r ~C "• Include with this application: a statnped warranty deed from the Register of Deeds office a copy of the certified stuvey map if reCCrcnCe is trade in the warr~ttty dead P. 01 w~s~, w s sydlG-?l 01 d - ~ 1921r 522 " ~1'ATE BAR OF WISCONSIN FORM 2 -1999 6 8 3 3 2 8 WARRANTY DEED KATHLEEN H. NALSH Document Number REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between Rose 117. Henkel, RECEIVED FOR RECORD . 07-02-2002 11:00 AI! Grantor, and PJ of Hudson and Associates, Inc. EXQPT ii ~ REC FEE: 11.0@ TRANS FEE: 690.00 COPY FEE: Grantee. CENT COPY FEE: Grantor, for a valuable considerati PAGES: 1 on, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Ares SE '/. of SE %. of Section 3, Township 30 North, Range lti West, St. Croix Name and Retum Address County, Wisconsin. .`~/ olo-LOOS-9o Parcel Identification Number (PIN) This is homestead property (is) (siX00 Exceptions to warranties: Easements, restrictions an drights-of--way of record, if any. Dated this ~ S ~ day of July 2002 ` • Rose M. Henkel Signature(s) AUTHENTICATION authenticated this day of ACKNOWLEDGMENT STATE OF WISCONSIN ) /~ ) ss. . C, t~~ County ) Personally came before me this i S ~ day of July , 2002 the about named Rose M. Ha I, ~p- r1$ T[TLE: MEMBER STATE BAR ~ S IN ([f not, me k to be the person(s) t e ted the authorized b instru rnt d acknowle a me. y ~ 705.06, Wis s. ~~~+y` THIS INSTRUMENT WA~p ~' B .7'.+ + drn.2o~i .C/p/!cs-- ~`- ~' Notary Public, StatebfWisconsin Hudson, W 15401 • Janunuta`~ My Commission is permanent. (If not, state expi ation date: (Signatures may be authenticated or acknowledged. Both are not necessary.) J~~ .) • Names of persons signing in any capacity must be typed or printed below thew signature. Inromgtimvrorasro~ra ca„Puy, Fang au tae, Nn STATE 11AR OF WISCONSIN eooass'zo2t WARRANTY DEED FORM No. 2. 1999 ;i . ~~oz sTC - ioa AS IIUILT SANITARY SYSTEM REPORT OWNER ~~ ~~ ~ '~ ~ ~Z~~.~~t ADDRESS_ ~~~~ / 7G1 ~~ ~1 % ~, p ,,, t ~~~ i ~ j`- SUBDIVISION / CSM~ IAT ~ SECTION '' ', •- _- ~ T.~f~ N-R~W, Town of C ~~~r..~~~~ i7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~~~ ', ~,. , .~, rn . \\\ ~•~ ~, ~~, , .1 ~ ~, (tO" ~` 1 ~, ', `L ~~ f~~ r ,~a ~~~ ~~~~ '""_'..~ A r /~3j_ ~ ~, i ~., ~_ /~Q-'3 1 .___..-.-~ .~ { !~4~~ -- i~N°~~I ~~' ~'~ C~ z:2. ~_ / ~ 1 \'~~ \~`~ ~~ INDICATE NORTH ARROW f p-~k `< Provide setback and elev tion information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. !. IIENCIiMARR: ~ ~ ~ , ' ' ~~~ ALTERNATE IIM; SEPTIC TANK / PUMP CHAMIIER / HOLDING TANK INFORMATION Manufacturer: - -' ,~,, ~ .r,~-~,~ ,~, :~:-,,Liquid Capacity: ~''~~~:,~~~7 Setback from; Well 13 ~ _ House ~o j Other ~ /7D'~~' `~D r Pump: Manufacturer C'=c~csc r~s Modell G'~"C > Size_ ~2 t-b° Float seperation ~'~z Gallons/cycle:_,/~? f, ~ Alarm Location ;,- >~a-~;~=7,~~~~L~ T-. SOIL ABSORPTION SYSTEM width: Length 5 Number of trenches ~`>~=" ~' Distance & Direction to nearest prop. line: `c ` Setback from: well: $/ House /3 ~ Other /LDA.T~ /7U' ~`l7~ c ELEVATIONS Building Sewer '~' ST Inlet: != ,,~; ST outlet: ,/~`'~`, j'.~' PC inlet _ PC bottom_ ,c,1/', ~~ Pump Off Header/Manifold ~~ - Bottom of system jc,"~" Existing Grade Final grade DATE OF INSTALLATION : _ ' ~"' ~-- ,.~_ ~' ~ <j~ PLUMBER ON JOB: ~,1~-~~ /~?%r~i; ~,s ,' LICENSE NUMBER: j?' ~~'~' ,~~~ INSPECTOR: ~__ __ ~...,./.__._- . ~ ~ ,~,~ /,~,,L~ ,~'' ;~, c~ 3/93:jt Wischnsin Depprtment of Industry, ~ Labor and Human Relations • .Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) County: ST. CROIX Sanitary Permit No.: 299116 State Plan ID No.: Parcel Tax No.: 010-1008-90-000 Permit Holder's Name: ^ City ^ Village Town o HANKEL, ROSE M. EMERALD CST BM 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 Airlntake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction Syetem TDH Ft Forcemain Length Dia. Fii Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mo a Num er: System: OR UNIT IIISTRIRl1T1AN SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 3.30.16.50,SE,SE 2482 170TH AVENUE • r • • ~ T • A ~ • f ~ ~ T ~ «~vr+rw~~ vr+r.-. Ay/UU434 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/ Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade Plan revision required? ^ Yes ^ No (~ Use other side for additional information. I SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. Wisconsin Department of Industry, Labor and Human Relations • Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^ Town o CST BM Elev.: ~ Insp. BM Elev.: ~ BM Description: ~G~, GC) /C~-Gtr ~ cue as ~~ ~-- TANK INFORMATION ~~Rn \~' `~u TYPE MANUFACTUR E R CAPACITY Septic / ~ - ut°S {er F Ye S'~ c~ +r!'' Dosing ~rn ~~~~~~Gh d~ A Hol ' __ TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic (l~~ ~A NA Dosing i/ NA Aerati ----- NA Holdin PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction Systema SQ TDH Ft Forcemain Length Dia. H~ ~' Dist. To Well /Cf111 OR~[1RPTI(1N CYSTFM ~. d~~r .,,~ ,1 . ELEVATION DATA County: Sanitary Permit No.: State Plan ID No.: Parcel Tax No.: ~~; ca - / 0/2/ri 7 STATION BS HI FS ELEV. Benchmark a? ~ ~ 0 ~ Qd , ~ Bldg. Sewer St/ Ht Inlet ~~% , ~~ ~ St / Ht Outlet Dt Inlet '~ Dt Bottom ~~.fl~ 9/, 1..z ~ Headed: 5 ~3' l"7 ~~ Dist. Pipe 5,75 ~ Bot. System ~, ~~ ~ G, ~7 ~ Final Grade BED /TRENCH Width Length , YNo. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMN1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACH n urer: r" SETBACK INFORMATION Type O CHAMB Mo a Num er: System: ~ O T nICTRIRIITIAN SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discr anti s) person present, e?tc.) ~ ~ l~ 96.90 ~~ ~,,) ~ a.r~~l4 r , Q,sy..a ~ ~~ 6~-01 = ~~ ~'~i ;~ f~,/~ - /• 7(1, (~/'-' !/d) J r~~"^ G` lJ {~ cry , / ~ ~ ~ Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ~. SANITARY PERMIT APPLICATION 201 E w SBnilg'~onnADie sion . `~seonSin In i h ILH Wis. A m. Code P.O. Box 7969 Department of Commerce accord w t R 83 05, d Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county ~. than 8 v2 x 11 inches in size. ~.~=t ~--: r ~ ~ ?~ • See reverse side for insfiruttions for completing this application state sanitary Permit Number { <_~~~ The information you provide maybe used by other government agency programs ^ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLI ATION INFORMATION -PLEASE PRINT ALL INF RMATION `~~ ' ~ ~' = ~~~' Pro ert O ner Na p Y ..,- , ~ ', ~ ''" ' ~. ~ropert cation ~ `` R' E (off ~I S ~ T N v4 ~ 1la L' Q , !~ ~.' , , , ? n ~ ,,..7 .1 Property Owner' Mailing Address ~~ ,. Lot Nu4nb~er Block Nu er / City, State ~ Zip Co a r -^ , Phone Number ._..,.. Subdivision Name or CSM Number II. TYPE F B LDING: (check one) ^ State Owned _ ., °^ vla e Nearest Ro~ ,/ Public 1 or 2 Famil Dwellin - No. of bedrooms ~ own of ~- r` ' ~ ? ~~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment /Condo ~- /!~ - r'<: ~ ~' j ~' ~ r'c ,~l 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar/ Dining 4 ^ .Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office/ Factory T3 ^ Other: specify IV. TYPE OF PERMIT:. (Ch a box line A. Check box online B, if applicable) A) ~ . ^ New Replacement 3, ^ Replacement of 4. ^ Reconnection of 5- ^ Repair of an -_____System ^___ ___System________ ____ Tank Only__~___________ Existing System ________ Existing5ystem B) ^ A Sanitary Per 'was previously i ued. Pe Number Date Issued V. TYPE OF SYSTEM: (Check only on Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ~ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure 42 ^Pit Privy 13-^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Elevation Required (sq. ft.) Proposed (sq. ft.) (Gals/day/ . ft.) (Min./inch) ~ , 6 ~ ~ ...1~ ...~ ~ .~ ~....-. { ~- ..~-~- Feet 'j : Feet \ VII. TANK INFORMATION Capactt in allons g Total # Of r Manufacturer s Name Prefab. Site Con- Steel Fiber- Plastic Exper. N E i i Gallons Tanks concrete glass App ew x st n strutted Tanks Tanks Septic Tank or Holding Tank t1 - - /~ ~ _ x ;~ ,~ ! '~ ~ ;, ~' , ^ ^ ^ ^ ^ Uft Pump Tank/Siphon Chamber ~`~ - ,'~ ~""~> !~'J :~ " ( -~~ T" ~;rc { ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT ], the undersigned, assume responsib[lity for installation of the onsite sevyage system shown on the attached plans. Plumber's ame: (Print) ,~ Plumber's Sig ture: ( o Stam~s) :. M_ lMPRSW No.: - Business Phone Number. n, Plum er's Ac dress (Stree#, City, tate, Zi Co de).:..- ,-^ a ~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved. Sanitary Permit Fee ('"dudes Groundwater ate slue ~\ Issuing A ent Sig " ture ( tamp Approved ^ Owner Given Initial Surcharge Fee) ~` ~; ,, cL/ `''~ ~ ~~ '~' ~ ~~ , , ~ ` <' ~'' ~~ ` ~ '~ `' ~ ~-- Adverse Determination > - !1 ~ - ' ~ ~ X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD-6388 (fl.t 1/96). DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit invalid for two (2) years. 2. 'Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septit tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. I.V. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vli. "l"ank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and ;manufacturer's name, indicate prefab or site constructed and tank material.. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions; location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution hexes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and cor:trols; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY AND BUILDINGS DIVISION 15837 USH 63 ~~~~ Hayward, WI 54843 De~'i~C~rnf%nt Of IrOlYlt'1'IE'I'CG' Tommy G. Thompson, Governor 01-Oct-97 William J. McCoshen, Secretary Gustum Septic Tom Gustum N 13450 937 St New Auburn WI 54757 Arlin Axell Plan ID 9710340 SE,SE,3,30,16W Municipality of Emerald Inspector: , Leroy G. Jansky County of St Croix (715) 726-2544 Private Sewage plans including the following element(s): MOUND 450 gpd The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The ovyner, as,~efined ,in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with'; all?cQde"r~q~;irgpi~j~~. This plan action is subject to no additional conditions. 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. All permits required by the state or local municipality shall be obtained prior to commencement of construction/installation/operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector ~t„the number listed. The inspector for this project is listed above. ~,~ , , Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. ' i I'1 s r ~. ~ . , . Sincere , ;I r . ~~.._.. ~ ~ ~„ Tho as Brau Plan Reviewer ' (715) 634-3026 ~' }'~ ' ' ., ,. is . , . l .. ' f~li' ~. RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project Three Bedroom Mound Owner Arlin Axell Address 2482 170th Ave Emerald WI P.O.W.T.S. Legal Description SE SE SEC3 T30N R16W 1tlOllQjly Township Emerald WI 54012 County ST CROIX OVE D Subdivision Name na Lot No. na DE TMENT OF COMMERCE E?Y YULLDIM~ Parcel ID Number s2G " ~„` n ID Number SEE COR SPONDENCE OF ~~ ~/ r• INDEX SHEET PAGE ONE ~Q'~ `:2 ~ THOMAS D. :N MOUND CALCULATIONS PAGE TWO GUSTUM Z MOUND DRAWINGS PAGE THREE 1201 PRES. DIST. CALCS. 8~ LATERALS PAGE FOUR PUMP TANK DRAWINGS PAGE FIVE o~~i3f~ Q.• • PUMP CURVE PAGE SIX S~GNE PLOT PLAN PAGE SEVEN Designer Thomas D. Gustum License Number Signature ,,L~ ~6Glia~~ Phone No. Date 9/13/97 D1201 715-658-1344 Notice: Tampering with this file by unauthorized persons is prohibited. i7eliberate modiflcatlon will result in disciplinary action under s. 145.10, Wis. Stets. SBD-10462-E (8.04/97) Page 1 of 7 RESIDENTIAL MOUND DESIGN Eight Bedroom maxrmum information in red framed boxes as necessary. (y or n) n Is the system over creviced bedrock? Slone 7 Number of bedrooms 3 Wastewater flow rate 450 Depth to limiting factor 18 In situ soil infiltration rate (code) pd 1703.3 Lpd i 45.7 cm 0.5 and/ft2 20.4 Um2 Contour line below the upslope edge of absorption cell 95.2 ft 29.02 m Use standard fill depths? U OR Designer speed depth 18 in 45.7 cm Place X In box to use standard depths (1~ 24, A+4 inclusive) OR specify des _ /gn fill depth. Center or end manifold (° °~ el Estimated hole space 3 ft IYor a noel calculation. Lateral spacing 3 ft ~ Minimum dose >= 10 times void volume Use a 0 lateral spacing for trenches. Pump tank elevation 88 ft Outside bottom of tank Number of laterals 2 Force main diameter 2 in Force main length 67 ft Force main actual die. 2.067 in SYSTEM SOLUTIONS Inch-pounds Metric Cell media "x" one only. Estimated daily flow 450 gpd 1703 Lpd x Aggregate and pipe Chamber and pipe Absorption cell Design load rate & area 1.2 gpdittz 375.0 ft2 34.84 m2 Linear load rate 8.3 gpd/ft 102.9 Lpd/m Design width (A) 7 ft 2.13 m Cell length (B) 54.0 ft 16.46 m Depth of cell (F) 9.9 in 25.1 cm Sand filter Upslope fill depth (D) 18.0 in 45.7 cm Downslope fill depth (E) 23.9 in 60.7 cm Basal area required (gpd/infiltration rate) 900 ft2 83.61 mZ Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.4 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 12.2 ft 3.72 m Upslope toe length (J) 8.2 ft 2.50 m Downslope toe length (I) 14.5 ft 4.42 m Total mound length (L) 78.4 ft 23.90 m Total mound width (W) 29.7 ft 9.05 m Project: Three Bedroom Mound Plan I.D. Page 2 of 7 MOUND PLAN VIEW observation Pipes (typical) J W_ 29.7ft A= 7.Oft 2.13m 9.05 m - ~ A~ B = 54 ft 16.46 m B ~ -K J= 8.2ft 2.50m I I = 14.5ft 4.42m K = 1 .2 ft 3.72 m 78.4 ft _ L = 23.9 m typ. obs. pipe A X B refers to absorption cell width and length (ancnored securely) J = upslope width I = downslope width K =end slope dimension ms° (t5o mm> I MOUND CROSS SECTION ~ D = 18.0 in 45.7 cm subsoil cap E = 23.9 in 60.7 cm lateral topsoil G H invert 97 2 ft F = 9.9 in 25.1 cm elev. 29.63 m see note ~F G = 12.0 in 30.4 cm ~ H = 18.0 in 45.6 cm / D E ASTM C33 Sand Fill sys. 96.7 ft elev. 29.47 m 95.2 ft contour 7 % _~ 29.02 m slope %~ G/ Note: Absorption cell rt~dfa will D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or teaching chambers and pipe F =absorption cell depth as specified ex Aggregate G =subsoil + topsoil depth at cell wall at right. Chamber H =subsoil + topsoil depth at cell center Designer notes: If aggregate is used, it is covered with code compliant material. Project: Three Bedroom Mound Plan I.D. Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch- ounds Metric Width (A) 7 ft 2.13 m Length (B) 54.0 ft 16.46 m Lateral specifications Number laterals 2 Holesllateral 18 holes Lateral length 51.0 ft 15.5 m Pertoration dia. 0.25 in 6.4 mm Lat. dis. rate 20.97 gpm 1.3 Us Sys. dis. rate 41.94 gpm 2.6 Us Hole spacing 36 in 91.4 cm Lateral diameter Pipe diameter Design options Design choice Designer must '~C" one choice from the options provided. Manifold diameter Designer must '~C" one choice from the options provided. 1 iN25 mm 1 1/4iN32 mm 1 1/2iN40 mm X X 2iN50 mm X 3iN75 mm X Pipe dlemeter Design options Design choice 1 irr/25 mm 1 1/4in/32 mm 1 1/2iN40 mm X 2iN50 mm X X 3irU75 mm X 4iN100 mm X Place X in red box of chosen diameter. Place X in red box of chosen diameter Distribution system contains 2 lateral(s). LATERAL DIAGRAM -END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram info this area. Laterals centered over the A & B dimension Last hole drilled next to end cap enalcap P i All laterals are identical IF ~~I Hales drilled on the bottom of the lateral equally spaced ~ '~' i • Force main connection via tee or cross to manifold at any point. Laterals & force main of PVC Sch 40 • =permanent end marker [per COMM Table $4.30-5) Lateral length (P) Lateral spacing (S) Manifold length Hole diameter Lateral diameter Number of holes per pipe Invert elevation of laterals Project: Three Bedroom Mound Plan I.D. - ounds Metric 51.0 ft 15.54 m 3 ft 0.91 m 3 ft 0.91 m 0.25 in 6.35 mm 1.5 in 40 mm 18 97.2 ft 29.53 m Page 4 of 7 Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 8.40 ft 2.56 m Are laterals the highest point in the Friction loss = 1.93 ft 0.59 m system? Yes "x' Here. G~ Total dynamic head = ~ 13.58 ft 4.14 m If no, what is the highest elevation Dose Volume downstream of pump? Lateral void volume = 10.8 gal 40.9 L Force main drain Minimum dose = 112.5 gal 425.9 L back to tank? ("x" one) Drain back = 11.7 gal 44.3 L x Yes Dose volume = 124.2 gal 470.1 L No Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhde cover weather proof n w/waming label and padlock grade levels junction box grade levels quick disconect 4" veM pipe ~ I electric as per NEC 300 and Comm 16.28 WAC wall of pump chamber or corrtbination tank I pump off elev 3 " (75 mm) of Tank specifications: Pump tank = Pump tank volume = A alarm on pump on B 88.8 ft C 27.1 m D C adding under tank and anchor tank as Pump manufacturer: Barnes Pump model number: SE411 alternate outlet location 18" (46 cm) min. ~ aPPr~ ~ outlet joint ~ ~a" weep Grade levels hole 8S pump tank manhole = 4"min. above finished grade necessary pump tank man. =100 mm min above finished grade vent = 12"min. above finished grade ~ vent = 300 mm min. above finished grade 88.0 ft Pump tank elevation 26.8 m bottom of tank Capacities: Inches Gallons A= 6= C= D= 22.9 389.8 2 34.0 7.3 124.2 6 102.0 Project: Three Bedroom Mound Plan I.D. Page 5 of 7 PPLICATION: , lln normal pressure sewer systems the ellluent pump is in- stalled in a basin on the discharge side of the septic lank. In new home construction, the septic tank contains a pump insert section which allows the pump to be installed in the tank ~tsull. Usually a home has its own pumping unit, but it is feasi- ble to discharge two homes into a simplex system or several homes into a duplex system. Design layout of the pressure system would depend on location and topography 01 the indwidual lots. INSTALLATION: Barnes Effluent Pumps can be installed by one of three methods (1) the stationary system, for areas having shallow troll lines; (2) the rail system, or (3) the flex hose system, where deeper frost lines exist (refer to drawings below). All can be furnished in a duplex arrangement. Fiberglass basins can be furnished in almost any size (con- tact Barnes for detailed information). A control panel can be installed at the pump basin or in- side the dwelling, as can a visual or audio high water alarm. Power costs to operate Barnes Effluent Pumps are much Tess than for any mayor appliance normally found in the home SERVICE AND MAINTENANCE: It is recommended That, in most cases, a pressure sewer system be owned, operated and serviced by the local sewer authority. A sewer district should be formed it none exists in the area. Maintenance personnel would receive training to repair and rebuild pumps locally. Spare pumps would be kept on hand to replace pumps needing servicing. The home owner would receive a monthly sewer charge to cover COSt Of operating and maintaining the system. BASIN INSTALLATION SYSTEMS Union Connection System Rail System Flex Hose System ` At left, a cutaway view of a 1000-gal. fiberglass lntercep- to- tank fitted with a Barnes ellluent pump. If illustrates use o/ the flex hose system, utilizing an S. T.E.P. series pump. Recommended for most new residential lnstalla- dons (see picture on back of this flap). r ,l ~~ • ~ 9.S'q'~o nl~OUr • 9S. 'Con ~yµr '~ ~&~ ~;s ~~°~ ~~&/o~/ fib''" '1~° 83 1"0 6 (/n~;'s~~~d~ Po1~ S~~ / `~~ ~bQ~ .~ bbd" ~~,~ I'~~n $~. 3~~C ~ ) ~-_ ~-a ~ooo_~rd ~ ~orn6v ?~a~k 9 3.5'cc,r~ok r A~ %~ ~x~ ~~ FIp f ~.~ ~8~ y X,2-9, 7 /~ovnJ /4/o n~ ~C ~C~ ~ ~., Cey~~oUtr sd, h, ~,., sti~d ~~ ~ NRP ~ SOi' ya-*in~s ~11~C~crieG 3B~ Roe,, d fleck o~~l°V" ~~n~~ ~~ s3 a3(27 Gq r~ J~ We I I N~ ~r ~; n i4xe/~ p/d~ ~/a r) a y 8a ~ 7a ~ ~4-ac . Eme~'a lc~. w.2' syvla. ~me~ald Tawnsl~; ~ ~-~ ~.' /''0/ X Cpu R s~ << ~: y6 2~ ~.~ y~i3~9~ ¢~ / 20 / ~o ~ ~~ ~ ~, ~~ ~~~ '9. c~sconsin Department of Commerce SOIL AND SITE EVALUATION Page ~ of 3 Division of Safety and Buikfings 'Bureau of Integrated Services in acxo nce with s. ILHR 83.09, Wis. Adm. Code 8 Attach r~mplete site plan on paper not less 1 inches ~ j' e% ~ "'~ must County ~• ~ ' include, but not limited to: vertical and horizo rerw oir+~BM), d and J+ ~ ( 0 t ~( percent slope, scale or dimensions, north a ~~ loca ~@nce' est road. Parcel I.D. # '~~` ~~ ~ SID -• Od ~ - O °- Ooh APPLICANT INFORMATION - P/ pr ~l ftbfj3r-Ifwtion. Reviewed by oats Personal information you provide may tie used for ry pugrris~i~y law, s. 'b4 .1) (m)). Property Owner I I ,, ZONlNCpp~/~~ ' "' ~+ / roperty Locatlon Lot ~~ 1/4S~ 1/4 Govt S 3 N R ~(p ,f!(or~ T~Q J X{. ~'t"r j , . , . , , Property Owners Mailing Address ~ ~ Z Lot # Block# Subd. Name or CSM# ~y ~ a t ~ ~u~x ,._....., nJ A- ~ R ~ A City State Zip Code Phone Number ^ City ^ Village Town Nearest Road ,m~,~a UV .L ~ HDI~ ( ) ~ era ~7 ~' ~~~. ^ New Construction Use: Residential /Number of bedrooms 3 Addition to existing buikliriy [~ Replacerrier~t ~i Fiibiic or corm-iiercia - Deso~itre: Code derived daily flow ~~ gpd Recommended design loading rate ~• $ bed, gpdHt2 Q' ~ trench, gpd/ft2 Absorption area required bed, ft2 ~ trench, ft2 ~ Maarximum design loading rateQ~bed, gpd/fi~ Q• ~P trench, gpd/ft2 Recommended infiltration surface elevation(s)~'i~OY~i gJ`~oZ Ga ilfiou r ft (as referred to site plan benchmark) Additlonal desigNsite considerations /1~ /~ Parent material Flood plain elevation, if applicable d/ /it ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in FlII Holding Tank U = Unsuitable for system ^ s ®u ®s ^ u ^ s ®u ^ s ®u ^ s ®u ^ s ~ u Boring # Ground ~S ft. Depth to ii~~oi~iny factor ~in. Boling # Ground ~~fL Depth to limiting factor l ~ in. SOIL DESCRIPTION REPORT Horizon Depth Dominant Cobr Mottles T Structure i C t nda B Roots GPD/ft2 in. Munsell Du. Sz. Cont. Color exture Gr. Sz. Sh. ons ence s ry ou Bed ,Trench ioY~ 3 r nrm.e ;1 a w-cr mv'-~- s l o. ~a~ a. -t3 0 si l a•rt sbk m Cw 1 ~ oS '0-~ 3 13-t~ ?•srf24 ~ n.c sr I bk C~J '- •S ~ o~~ ~ 1 ,~.'f 7VS`f2 5f (y -3c1 ?~s~,e sib' b~ - O~s' 4~(v Remarks: ~ .7 t1a m y Q S 3~~ p S ' vCP ~ i~an.t? a m .~. e.w arK loo o •5 . e. C~ a ,.sr~.sra~ . sc bk - a y ; o.s Remarks: CST Name (Please Print) Signature Telephone No. Tho a 17. ' u S~u rn _.e~'~ti.~~ '715-10'8= 13'~ Address Date CST Number N-~y50 q37~` S~e~ IJt?u; cn WI 5475'7 R- f0~q~ 7(p t8' PROPERTY OWNER ~~ ~ ~ n h~>< e I ( SOIL DESCRIPTION REPORT PARCEL I.D.ff Boring # `3 Ground ev. 3 Sft. Depth to limitlng factor, _~in. Boring # __.. Ground elev. ft. Depth to limiting factor in. Boing # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. tt. Depth to limiting factor .v- Page .a ~ 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Q-~ /UyiZ florae ail cr mv-~t' S 3~~M 0.5 'a~~ a S- ~3 !© 2 yl3 Ylan.e ; a~•abk a+~~- cw In Iw os ; o~~ 3 ~3- 1 `7~SYK~1 f'la 5 t I a-m5bk n•~~ Ccv ~- 0•S ~ D•(o y 'T~s~r sal bk -~ era - o~ ~a•co S ~-Yo R ti r•• s~( - NP ;n-P Remarks: Remarks: Horizon Depth Dominant Color Mottles Texture Stn~cture Consistence Bourxla Roots in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. ry Bed ,Trench Remarks: '"' Remarks: saaaa~o (R. o~~s~ ;. a ~S S ~Co n~ur g$~ra rConl~dur / \ , PPp\ LLB n f Pole S~ ~ \5 P` $-a ~ 3• S co~u r Ar ;~ ~xt ~f ~o f ~,~ m ate- ~< <~~ ,~-~~ of j ~,c~r n m-n S'licd /~fsa ~+e ~~P A sJ~!' ~eN'~Y1cj.s ~lk~aCrC,~oG ~a c~h~~ ~q f~ J~ 1 w~ ~ ~ ~~ ~r r% n i9x~e~/ ~/d~ ~/a r~ ~y ~a i70~ A-Nc. ~-~nera Id. w? s y~ 1~.. ~ t , 5 ~, Sic , 3 ?: 3 oN. Rl~ u/ ~'m~~lild Tvwnsh,Q~ 5~-, C roi`x Cpu- n~/ ~~1~ ~- y6 c~ ~z~~~ P.~Jc 3o F.~ ~j rG ~ay'$z. STC-105 OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS CITY/STATE ..~' PROPERTY LOCATION S~ 1/4, Sce~ 1/4, Section ~_, T ~ --N-R~~W TOWN OF ~i-i7c~~/n ST. CROIX COUNTY, WI SUBDIVISION /'y / i4 LOT NUMBER /~ ~l CERTIFIIED SURVEY MAP ,VOLUME ,PAGE ,LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standazds set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex ,' ion date. SIGNED: . ~ . St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County rizn (location of septic system) Please obtain from the Planning Dept. DATE: fi ©` ~ ~` ~ ? - 11/93 L ` S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will. only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property ~ ~ ~~T1~-~`~~ `~~~L-` Location of property~l/4~_l/4, Section ~~,T~~N-R~_W Township _ ,~-y,~ ~', Mailing address o7 ymg~Z /'7r~ ~ ~,/Cr r ~ - ~~ - - Address of site o7 y~J„z / 7D Subdivision name _ irJ/,a Lot no. _~~- other homes on property? Yes_ ~ No Previous owner of property _ ~~„~ /"r7ot%-zt- Total size of property _ Total size of parcel - Date parcel was created Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house)? Yes ~c No Volume 1~ / and Page Number Q ~ ~ as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLIIDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ~ !~o e~`7 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in t~he-~ o~f~fice of the County Register of Deeds as Document No. ..~-1 °-T- L? ~T-~-- ~ ' ~, C~ Signature of Applicant Co-Applicant ~~`~ ~1~7 Date of Signature Date of Signature YJ~ ~ ~F1 Pp~E(~~ / . ~ 5~'~V~ • STATE BAR OF WISCONSIN FJIW ? - 1y82 WARRANTY DEED DOCUMENT NO. com~eys and warrants to G ROSe M Hankei , a Slagle plerSOn, also known as Rose K. Hankel the following described real estue in S t. C r o i X C O u n t y County, State of Wisrnnsin: SE ]/4 of SE lj9 of Section 3, Township 30 North, Range 16 West, St. Croix County, " Wisconsin. 010-1008-90 PARCEL IDENTIFICATION NUI118ER ., s T ~r: ~~~ This iS n0t homestead property. 7LIIt (is na) Excepriontowartanties~ Easements, restrictions and rights-of-way of record, if any. Dated this 28th d„y of August ~ ~ , A.D., 19~Z_. (SEAL) ~i~L'~I',.ltr.-~ ~ .~2..[~-~ (SEAL) • Arlin A. Axell Signature(s) AUTHENTICATION (SEAL) authenticated this day of , 19_ TITLE MEMBER STATE BAR OF WIS ~ U IXSOn (lr n«, otary Public I~ authorized by §706.06, Wis. 5tats.b'tat@ Of Wisconsin THIS INSTFiU~AENT WAS DRAFTED 8Y ~i~,. - REGISTER'S OFFICE ST. CROIX CO.. WI la.~~ ~ Ibeea AUG 2 9 1991 12:as P M p.d.+.. d D«d. THIS SPACE REaERVED FOR RECORDING DATA !j--___~.___. _ -- _. ~, ~ NAME AND RETURN AOORESS ~~ _ ACKNOWLEDGMENT (SEAL) State of Wiscon~tn, ss. St. Croix Countz. I'~sortally came before the this 28t" day of AUgUSt _ 19 ,the above named Ariin A Axell, a single person. ao >r kne~wn to be the persor. who executed the fore ;ring ta~rsr~ent and acknowledge r sa ,