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HomeMy WebLinkAbout030-2000-10-000 ~ I'' a O 00 p 6n, O N y a) n 0 O r N CL O C4 0 N C CC H I:, a o t~ cO c O. r N -6 E -a 60 CL CL= u1 C c L Y C N V O X X 000 O O .y a L in d f6 (n w O O y 4) (D h U U a) m CL (D 4) C5 0 C\1 0 (D N a Z COO C Z p.(6C, LL C a Cl• L LL C co m a O E 0 0 0 3 c 3 Co ' CU M 3 a) c p a c x v a 0 wig E Q (A (o L Q U M a) Z E 1 O Z C v ` ° m a m (M7 H ~ a I c C1 ' a I a o zv' Ij. c c d Z rn c M H a) c cc 4) d) N N N O O O (D (DI • (n L L L ~p a3 N d n ° U S2 O c a O 2 Q a+ 16 Z C11 Z Z H Z p Z o N z I d r N ~ E a) a7 Tl~ O) 16 > 1 N O d ICI: co C lag d m (O y :g - }V N N a (L ZN>~333 a~ X333 a5 •N a a a o O O o w a a a ~y a' u'o co (D 04 N (A 0 U) 00 co 41) V O rn y rn 0) (n J a o a0o I~ O W N (D O O O V) OO O O U) Is Q LO LO E I- Oa O a) d iA N c LO N a d Q} U) N N Q O A a~. H N O O c m C m y c o V 3 0) o c c E Lo ao v C) 0 O 60) aa) c c t upi w u a a) o 0 0 0 CL WC O N N u> ao o O y 3 N N 0 (O O O 17 N C N V) Z C N yr a~ H F- c aai LO LO N c -pj ' a co y 7 C a0.1 7 L o _ c r p to (O p O W E E R C, m M (n J 0M0 O Z N F- J O Z y U) • ~i ~y O 0 ~ I = I v a~ ~a a d a ~s a ! L a L: a Zl 4) 2 ID t A ciaa~I,',O~ 0 OnU y y'G 3 AS BUILT SANITARY SYSTEM REPORT OWNER A,/e;LC TOWNSHIP SECTION 3 3 T 30 N-R W ~G y s,.- - ADDRESS ST. CROIX COUNTY, WISCONSIN S T, 3 SUBDIVISION LOT z LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D ou orb i Vt INDICATE NORTH ARROW ,F7-- BENCBMARK:Elevation and description: /DO, 0 \ Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. i lov, : ioo /y ' / p p • L S Rings used: Manhole cover elev:9• Final grade elev: 100-o _7 77' /VA Tank inlet elev.: 7T-692- '-Tank outlet elev.: 91~ z 0 ' X >/00, p O No. of feet from nearest road:Front , Side- Rear Ft. > /00 From nearest prop. line:Front S' 111 No. of feet from: Well ;70 ~ , Building: eleP io " (Include this information in the above plot plan) f (2'reference dimensions to septic tank) SEE REVERSE SIDE 7071/ alt- 2 S Ti C- r,-te-~S i v !`N r •/o/~, Qa/ ri r 7 'ts!ro 08 o/ X0:06/9 S~Yo~h~ e oEE :uaak N ssNaoiz gor No x3sKnqa asYo : uo,LoadSHI :_l ov jnueH maul y 7 peo.I gsa.Ieau buTpTTnq aM :uto.Ij -4883 -ON' •~3 .Ieau '-apes 4u0.13:quit •c~o:id ~4saapqu uco.Ij 499J •off :48TuT Jo uoT4enaTa : xue4 MO0 4oq 90 uoT4en9Tg : pasn sbuTa 30 • oN _toedeo : aaan4oejnueH NNVS f)XIQ'IOH 8lS butpTTnq vto.13 qaaj -ON :TTaM uOaj 490J -ON _ 0 l • 4a aeau ! apT s ' 4uo.13 : auT T • doad 4sa.Ieau moaj 49a j • oN 0 Gi 1<1 N 0 E 21- T : adTd jo do4 o4 g4daP TTTa • naTg ape.10 TeuTa pasodOad • naTg apeaD • 4sTxg -4TTng ea.IV _ : sauTZ 40 aaqucnN od g4buea ,r : u4PTM T~~5 : goua.Is I YIISSAS N0Ild1H0SSK 'IIOS S .-7 n'/1 i buTPTTng a// 119M :ucoa3 a0ue4sTQ pTg --4UOld :auTT •doad gsaaeau ucoaj a0ue4STG 14a A_V" uoT4eooZ adds u04TMS _ J~7 : • UUN : uc.IeTK p~ :aT0A0/suoTTe0 :•AaTa 3jo dmna O h ~:•naTa uo dmna c~z"~6 , uoT4en918 xue4 90 M04409 Q :4aTut Jo uoT4enaTg C~ .S Gd d T~ azTs duLna / Z : •4oejnuey4 uoudTS/duina G :TapoW duina : A4Toedeo ptnbTZ :.Iaangovjnuvx (2 (2 ap 7-5- 71 uag VHO dldnd 1h l? N ~ 1n ~ ~ ~ d d o. ~ ~ CA, z n N 4 ~ y ~ ~ ~ o~ o o x ~ ~ ~ Tl ~n 0 ~A Vj IE3 V o I ,h I , ~ of ;11~77q ~ 00 ~ ~ ,0~ ~n - 1h l I N , I K 1 x I I ~ ~ I n ~ ~ ~ ~ I 1 I , i I 1i ~ ~ , C ~ I I l i ' i 1 'mil JO I I I, li 1 ~1 ova o I ~ 'I 1 1 I 111 O ~ a -Its I 3 !,'c J ~ r Tt, H 2 7 335 ~M, zm r r F kA CD my aom~ m „ o m V r t r m r} -o N ~ ~ w Z C~]7i_y~ ° M Z = Q Q 4~v ~A CnZ \ C r O ^ 3 3 p 3p o m ~ LOCATION: ST. JOSEPH 33.30.19.359C,SE,NE, 60TH ST. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and ¢uiidfigs Division (ATTACH TO PERMIT) Sanitary Permit No.: NERAL INFORMATION 171 42R Permit Holder's Name: ❑ City ❑ Village X9 Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~ do A. TANK INFORMATION ELEVATION DATA A920o192 5 .7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1AQ 7' 07~ Dosing q Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/A Outlet ' 9931' TANK TO P/ L WELL BLDG. Ai Intake ROAD D3 Inlet T Z ~ 7,,2 Septic 7~ ~d NA Dt Bottom- ~ UK . X/ Dosing Na >140 S >2s- NA Header / Man. Q q NA Dist. Pipe Bot. System Holding I (Q) PUMP/ SIPHON INFORMATION Final Grade Manufacturer & Demand ~ af' S ~ Model Number ~t r2~ GPM 9 -7 Of TDH Lift.tD Friction` System TDH6,4SFt ,3Q~ 93.77 Forcemain Length 25' Dia. 2f' Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 7 Length,,,, I No. O:9 enches PIT No. Of Pits Inside Di;. Liquid Depth DIMENSIONS ~ d9 DIMENSIONS LEACHING Manufacturer: SETBACK SYSTE TO P/L BLDG WELL LAKE/STREAM INFORMATION Type CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold N Distribution Pipe(s)' ~z ! x Hole Size x Hole Spacing Vent To Air Intake 3 Length 0- Dia. Length -77 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~r a Depth Over h , xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges 24 _WTopsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. 7~__~~ 1,ay _ 1r,2 Al 'I'a 7,95' aZt<_0 Plan revisi n required? ❑ Yes 2 0 Use other side for additional information. 7 SBD-6710 (R 05/91) Date Inspector's Signa ure Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' 7-77w h~ /0, 6,s3 ~ G.?D~ 1.12 G: g(` 8,36` n o2` 5-5' 9 8'G' 7, ~7 3~~j x.33 eix ~ R6R SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 I ill 8% x 11 inches in size. ch I revision to pre sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 11(14- PROPERTY OWNER PROPERTY LOCATION 1_111 r Z-01VA91 /u 5 A % lify., s 3 3 T)©, N, R /F E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # Z BLOCK # 116 60M 5"7-. 1444- CITY , STATE ZIP CODE PHONE NUMBER SUBDIVISION NA OR CSM NUMBER V.1,17 iaS~~A~ Cvr • SyoBz 5y 6& Cs,-1 Yr 3 CS-! . 'F2- 0 II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLLLAGE : 5 F .TUSK Ct N~ REST RQAD sT ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX NUMBER(S) (OCJ III. BUILDING USE: (If building type is public, check all that apply) d30-X000- /0 3s / Ci 1 ❑ Apt/Condo 2 El Assembly Hall 6 1:1 Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 ❑ Campground 70 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. [4 Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure r 43 ❑ Vault Privy 14 ❑ System-In-Fill .3 Eti f EAC4 5- _J9 0 VI. ABSORPTION SYSTEM INFORMATION: f7, 0 /01,0 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6 SYSTEM ELEV. 7. FINAL GRADE 600 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ¢7. ~ITION /2QU l2{~E7 . r A/ 9810 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons T ks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks (,(~/i=5~/Q structed Septic Tank or Holdin Tank ~OUQ .v Lift Pump Tank/Si hon Chamber 00 Q Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamp MP/MPRSW No.: Business Phone Number: ~DroT 33,c> -715- 3ev Plumber's Address (Street, City, State,.Zip Code ASS ®`~v~--i/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved saffl't y Permit Fee (Includes Groundwater Date Issued Issuing ent Signa re (No Sta s) 17 Approved F-1 Owner Given Initial Surcharge Fee) (J Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber { INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed- pumper ' whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application. must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system into be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% x 11 inches must be submitted to the county. The ~ plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) `or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GKOUNOWAM SORCHARGE 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, ground- water contamination investigations and establishment of standarifis. - SBD-6398 (R.11/88) b W O ~J ~ O v i `9 yl Q° N o ~ ~ rt ~ o ~ / to U 60 I 4 f, ~ l i 0 ~ l I ~ I~ tJ l l~ ~ ~ I Q I vl ~ ~ ~ I T T i I I I , ~ ~ 't p t I_ 3 I I I I ~ I ~ ~ Gil 1 I dig; I , 1 , 1 I ~ i 41 , c-f- a, 1 1 i l C51 I , 41 ~ I ' k l 1 ~ ~ ly = I I H ~ N i r~ CL CL C5 I ~ vi c> I -7 C) Zw V O 141 -J ~I z O '0" vS~ww v)crLnL '~(1: ~C o z LU Q Q c Q~S rn fi~yiSEf y l~iP 7/" tl~ O coo et-A /0/0 2y ~ovim ) 1AW 0 ek) 1411 3 v Fresh Air Inlets And Observation Pipe a 0 J p .------Approved Vent Cap Minimum 12" Above Final Grade /•U~Sf~~ _ 4" Cast Iron Above Pipe Vent `Pipe' Zo Final Grade r Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System 7,0 /aw 74 SEPTIC TANK PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS i 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 !'WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE. WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK 6 WARNING LABEL 6" MIN. ABOVE GRADE ► 4" MIN. . 6" MAX. 49LET 0, Fl WATER TIGHT SEALS GAS- T TIGHT i V 4" BAFFLE A SEAL i APPROVED CI PIPE ' ALM JOINTS W/ CI 3' ONTO B I ON PIPE 3' ONTO SOLID 'SOLID SOIL SOIL C PUMP OFF ELEV. 13'I FT. OFF RISER EXIT /~.Si/fg~V/o.•. D PERMITTED ONLY q~ •So IF TANK MANUFACTURER ' 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE W/Esew ca~cale- TANK MANUFACTURER: Cd.• NUMBER DOSES PER DAY: /oa TANK SIZES: SEPTIC Ida GAL.. DOSE VOLUME INCLUDING DOSE 600 GAL. FLOWBACK: ~a3 GAL. ALARM MANUFACTURER: GFV&[- 9G /`9 CAPACITIES: A = Co • INCHES = GAL. MODEL NUMBER: AV,/ w%SWITCH TYPE: MST B = 2 INCHES, = / GAL. PUMP. 'tMANUFACTURER: C = / 3 INCHES. GAL. MODEL NUMBER : f7 Vi t" 115 001-T- j SWITCH TYPE: M~7PGdRV 4f2r -~uifSy,Q~cl~ D = w• INCHES = 7 GAL. REQUIRED DISCHARGE RATE 30 GPM PUMP C ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . 0'- FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . o FEET + 2~O FEET FORCEMAIN X 1,Sy FT/100 FT. FRICTION FACTOR . 31 FEET dV?rL 5 HfipED TOTAL DYNAMIC HEAD = 7, FEET INTERNAL.DIMENSIONS OF PUMP TANK: LENGTH IBS WIDTH ~2 ; DIAMETER LIQUID DEPTH •Sy SIGNED: l t L' L,ICENSE NUMBER : #-s~3 DATE: lez`i ~ ~~i•v~' SP~~S 1/88 t 4 C~ s V 1.) F ~ ~ :-E j W A f 115 ' A CITY 32 110 M QA 32 -105- 30 100 - rU V 95 28 90 26 85 EFFLUENT 24 Bo MODEL and as 75 MODEL 109 DEWATER/NG X 70 165 V 20 ~ 85 a z 18 a 55 _ J a 18 ODEL } O 14 50 163 MODEL ` 1 45 168 12 40- 35 10 MODEL 137, 139 , . MOD EL SEWAGE and 6 25 DE EIJtjG 6 20 r MODEL 15 MODEL _ 161 4 7 10 i~ a J 2 MODEL 5 $3.55, - II 57.59 0 GALLONS 10 20 30 40 50 60 70 Bp 90 100 Y1p Y. 2f LITERS 0 80 160 240 329 400 FLOW PER MINUTE 2? w.: O 1 MODEL 295 MODEL 'I . _ N 284 i Q 4 19 MjODEL F 10. 293 MODEL 8 204 MODEL - - 1 6, 1 262 - - 10 ~ I f~ 4111490 L r1 p' 32$0 010 Afftm Lane i GALLON 10 9011 30 40 50 60 70 80. 90 100 110 120 130 140 y15P 160 1y0 180 190 P.O. BOX 1$347. , Loulavift, Kenifua ky 40216. y i LITERS 0 ~ 160 240 ~ 320 400 480 560 640 720 MR) ~~~~i 1 i FLOW PER MINUTE 771, ..r 'V.7" QjS1 Jforr Safii&z" CAPACITY MEAD UNITS/MIN • Automatic or Non-Autoloatie. Feet Maters Gal. Ltrs. 5 1.52 57 216 • 'ia H.P., 1 Ph., 115V or 230V. 10 3.05 51 193 ' - • Non-clogging vortex impeller design. 15 4.57 43 163 • Passes 112" solids (sphere). 20 6.10 27 104 • 1'112" NPT discharge. Lock valve: 24.5• ' I • Float operated, submersible (NEMA 6) 2 pole mechanical switch. 97 Serlas • Automatic reset thermal overload protection. ~L listed SC-2225 • Stainless steel screws, guard, handle and arm and seal assembly. • Watertight neoprene "O•' ring between motorand ' Canadian Standards pump housing. SP Assoc. Approval available N97, non-automatic, available packegud with a piggyback mercury float switch. i yZ Sc C Z Wisconsin Department of Industry, SOIL DESLrdPTION REPORT P. O. SafetByyo6 z Buiiu~ngs Division Labor and Human Relations 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 7/5` 5-4if -CvC, 3 ~ Page ! of 3 Ifustomer Name i w uauon Date Current tan Use or Vegetative Cover ParentMaterials yIi/~E GU.vf~/mot/ ai- ~F_ IFF1 G~9w.v- ~f'~ISs~s ustomer Addicts Estimated Shallowest roun water flood Plain Elevation 12!Py lid 5i 5r JosCPN 1,01S. S / ax arce No. ystem Loading hate in Gallons Per Sq. Ft. Per Day °ST G,Q 0 !'X T~v t, o~ ST .J 0,f f tat pe Lot legs Description ystem Geometry an Depth o and e~ ct ~ESTE/~Ly 5E /V 33 r_3 A-j, e I? W . /0 Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores H and other GPD/ft.2 S L- 2 F 5 /Ca 11 °F FiY/ OUErP Al 6-1q /o yR 412- f sh& 7^R z f C-57 - G l3 , /y-32 /0 ye S7/L/ f Sh t n~ f /4+1 C S 611 osGf TY e~ 3 Z_ /6 4 2 n ~ ~ ~ 13 Sbk f H/ ~A c ors z yG YR ~ cos G-~G -7, s 4/4 ~,f g n'^ F f l C w S L rEti T )ti • S 16 0 Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores pH. and other GPD ft.2 0-7 /o y3/3 5,y 1,shk "W fe 2f cs 61 - z2 /o y4 4 3 - s/ .7 9,e 411 7',e 37- ~z-yZ I'sy/P4 SR ']AvfP_ cw - - S - s _ W C y1-90 75 yR 412 s/ f, 5k /W f/ - w 10/3r 7- a ffo.pi 20~ Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots -Boundary ores H and other GPD/ft.2 ,4 /0 yR 4/4 . lGs}M ~ f,sbx troe Zuf C S 5 yn c w • ,Y) 2-32- ~s yA _F/~ C 2- -90 ~5 y/p 4~4 s/ v of fie ccv , S 0 13 Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 r1a A-) Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 1 If Vl r . ~iV ✓C/TE v~,E'i~C~9T /oN w ~ 7 f'~- ~ ' SEP'IE ~'LUEi181NG CO. t1 i M TtiO~-+ PSE•v /ASST, Z ONi^J ►k PO IityFSSON, WIS. 54016 / vtt 1i R081t'Rf ABRIGHT c s r y~z ffi DM . O C / , r1~r'STi-WiWM8tR LIC. NO.3307 M.P.R.& kLI:'f & DESIGNER LIC. NO.OD6Ii3c 1 / / 9 Additional Remarks: SiV S~Ar~E /P Shy// ~y ~SE` T~CNGy s A T 3 : ' if r 3~ ,0/FF,PEic7 T ~'/E' ~~1 T~o-v 5 Gt~id X20 3o x hiss ter. o,~,,, w r p.~SiU.t. /o~o~;vy ~P~T~ of -S~ f~ . Z ~ . st ~ • s -rGt~ ~u 2 rt~ - - _ ~ECotiry~~D~I TioAv 6~( 2D~ic~~ o~~~E 7~i~T DoSiv (J S a~~v o~cv,e Z/Si;y P U M it M (3 E i2 s ~,r/ Li~tio R~~Fs To xpos~ ti~~ S/ -T&Y7vQF-7 p-eAs. C OF 51Df11S 7~P.cacGt. DT( DM , /2" aF /Pock, ~s ~Pca~•ti-Uo~~ Other Site Features: 715 3,4-Ve5 LYE Z c ~ Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST SOD-8330(N 01190) lfi'G'l~,~ST Tpi ~ti - 9~ TeEue-k- 97,o 03 z o`r nM zm r- G D n 11 m zmo rn 3: -1 M D3 c C: es ~ ~CinC~ 'v C\ I Ln~Or' i V In w w N c N N~ c I ~t ~i 1 w ^ i `C o , 1 I ~ , I i Q ' F ',n 1 I _ ~ C I • ."'l 7p _I A w 0 y ~ I' REPT131 ST.JOSEPH ST. CROIX COUNTY ZONING PAGE 1 05/26;/92 13:56 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/26/92 AREA: JT -'Activity: A9200192 5/26/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 33.30.19.359C,SE,NE, 60TH ST. Parcel: 030-2000-10-000 Occ: Use: Description: 171428 Applicant: LUNDIN, MICHAEL B & EILEEN H Phone: Owner: LUNDIN, MICHAEL B & EILEEN H Phone: Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: BOB ULBRICHT Phone: Req Time: 13:05 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 05/26,V92 13:55 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/26/92 AREA: JT * * * * INSPECTION REQUEST SUMMARY Address Time Activity Type ST. JOSEPH 33.30.19.359C,SE,NE, 60TH ST. 13:05 A9200192 CONVSEP Item: 00012 FINAL INSPECTION • ' •G y2 sC C Z Safetdo". Buitu,ngs Division Wisconsin Dapartmentof Industry, SOIL DESUdPTION REPORT p.p, 7969 labor and,Human Relations Separate, Signed Sheet) Madison. WI $3707 (Attach Soil Profile cation Map -To Scale - On A page of 3 7/ -54%-(~G3 Zust -lee Name i va station Date stain, tan Use or Vegetative over patent matena s u water P am . evauon ust at rlid sGmate aow nt ro L • ! T, JoSPh` Co/s. S d 7 r Q.ft.Per ay atem a nsPe stem toa m9 R ount~, ex ar uNo. y G,P D !'X Tq~i,,., a~ ST J oSc System eometryand Dept n~ Ct ~ESTERLj~ iotle Descnpuon a~• 1 o 0 5E , ivy SSG . 3 3 7"'3 f Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading ! ores~F/d/ tE~ .2 In. Munsell u. Sz. Cont. Color Texture Gr. U. Sh. Co y-3 Consistence Roots Bounda GPD/ft Q-/& 2f 16-If /o yR 4la- S~/ , f ShK fie 2 f cS (y c S s~~ r c~,gr.S 3 / l3 , 2 %e S/ I,f Sb t P 4ti ~i Z yG /AYR 416 - rv/ 2~r» Sbk nv1 pesos 11!!r! C4,4 Y S Yo e 41, s~ 1,f 5 2 nr'f C ~N rE,u 7- AN 11A -13 Structure ~ Remarks: clayskins Loading Horizon Depth Dominant Color Mottles In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores Hand other G~ ft.2 1 s6K fe /YA ,q 0.7 /o YR .3/3 sty Y4 4 3 S/ .7 9,p 141 7' ie ~ ~ cs S S Y,f 4121 s/ tM, 7R 1~htlfp C Gv - u V2-9o 75 Yk f, 5le M^, fI' Gv A10/s7- ~ f/o~i zo,,J ^ ? 6 Structure-. Remarks: clayskins Loading; Horizon Depth Dominant Color Mottles In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 /0 yR f/¢ 16441 f, sb X As, r k Z VF C S , 5 7S yX - s~ ~ , w e Ak YR _ s~ ~'w' 9/2 f'R c w • S C 2-90 7, S ye 4/c~ s/ of f R c::: V,4 Ilk J~ Structure ~ Remarks: clayskins Loading Horizon Depth Dominant Color Mottles In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPDII,0 r10 A_J Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 ri ~iU ✓/TE v .f'lFi~t1 %/ON w HOMESITE SEPTIC PLUIMING CO. NI TA6m PS'c„v 145177, Z 0A,1j, 0 6-- 05 O'NEIL RD., HUDSON, WIS.6QI6-r r Y ~Z ROBERT ULiIjRiGHT /t UM . 0C r, / I / 9 9/ AS, MASTER PLUMBER LIC. NO. 3307 M.l}.f & :.!N. 1r2TALLEI & DESIGNER LIC. NO. 00663 I. Z (06/10 N)O[[B-OOS 15~ 'ON ouo4da(al pau6!S aiva ainieu6iS 1ST :41daa/siopel 6uniwil :sajnteai 015 J8410 o -~v/a✓.~t,~S ~ro~~, r1//n.~~d'>~j "S~ad 3a'nl~- /S ~~~N "rye. ~SOdx~ of S.~a'~~ o~~y cr~r~~ar~~5 ri~~?d'~~/~ys s/~~rr~o•~s w~' wed " - W.117 W. r.•o.~1 ~ f/ %~/_i S.rQ A o& r o ff r) 7 1 (1,o / Gf~ ~ 1 ls!. re7 r z S~>N~c~1. 7 nO ~~NyS C~'~f (~LS~1'l :s>tntwa)Jjevon!ppv G 2 Z o` - ,b-~ _mm • M O r m II 3D m o m z 5~- z m --4 Go ~O \ t cf) 1 E5~coccnM I n m~C)zC j z? I~ b N w N Q i i I • --W f r' ~ c 'All I 1 I ~ ~ ~ 30. o ♦w I cil I p I i J I ' ' Q ' I I ~ ~ c. V1 i ' • C 1 ' O I vl~ 7p y / z - 140 a^g o G ~ N y+.n i t Form - S T C - 104 r . AS BUILT SANITARY SYSTEM REPORT ~.Gl /V OWNER 4TOWNSHIP S"` m SEC. 33 T SON-R /'/'W ADDRESS Rr2 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ P •1 J I \ •.V I INDICATE NO~TH ARROW } BENCHMARK: Describe the vertical reference point used T~ Elevation of vertical reference point: i~tn Proposed slope at site: SEPTIC TANK: Manufacturer: v Liquid Capacity: Number of rings 'used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from near"t Road: Front 10 Side,Q Rear, O feet From nearest property lItne Front,O Side,O Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE } 1 f • T PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: A Trench Width: IF Length: Number of Lines: -~7 Area Built: Fill depth to top of pipe: -3'v? ° Number of feet from nearest property line: Front, O Side, 0 Rear,0 Ft.;3 d Number of feet from well: Number of feet from building: 7 ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil ,absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: 0 Dated: gam-~ Plumber on job: f~-Y-"--✓~`° l - - License Number: Z-1"2. 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. B09 7969 # BUREAU OF PLUMBING AAADISON„ 1F41 53707 XaCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: E] Holding Tank E] In-Ground Pressure ❑ Mound I (If NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Michael Lundin Rt. 2, Hudson, WI 54016 Q- BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. SE NE, Section 33, T30N-R19W, Town of St. Joseph, Lot#2 Name of Plumber MP/MPRSW No Cnunty. Sanitary Permit Number: William Schumaker 6382 St. Croix 83782 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER //PROV DID: PROVIDED v V -cc~ YES ❑NO ❑YES NO BEDDING: VENT DIR.: VENT MATI HIGH WATER NUMBER OF ROAD. PROPERTY WELL- BUILDING: VENT TO FRESH . Z_ ALARM I AIR INLET s" ❑YES NO FEET FROM ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY JPUMP MODEI jPU11P,1l11ION MANUf ACTUHER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST -0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ,I 1"I'Al"IFTEIf [ATE HIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continua.) CONVENTIONAL SYSTEM: I ,?0TH y r LENGTH INO OF TSTH PIPE SPACI Nt, COVER INSIDE DIA -PITS LIQUID BED/TRENCH THENCHES M. RIAL PIT DEPTH DIMENSIONS n FRAVIL DEPTH FILL DEPTH DISTH IE DISTH PIPE DISTR PIPE MATERIAL NO D R NUMBER OF PROPERTY LL BUILDIVENTTFRESH LOW P ES1 ABOVE COVER EI EV. INLf f ELEV. ENU PIPE' LINE AIR INLET C4 FEET FROM 4 19V& 83.37 NEAREST z7 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PFHMANI NT MARKERS 71HVATIIIN WELLS ❑YES ❑NO _❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSGfIL SG)OOFO SEE UFD MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO. OF LATERAL SPACING 16HAVIL DEPTH HE LOW PIPI FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PVL ARTICAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST b .4 1 -11 G7 fill 0 10. V of Sketch System on ~C'f_ &Af ` Retai n county file for audit. Reverse Side. - IGNA - TITLE DILHR SBD 6710 (R. 01/82) =1L SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PE MIT# 93 7' -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8%'x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER U PROPERTY LOCATION 1► L I in ~''/a ~ %,S 33 T e ,N,R if E(or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE F ZIP CODE I PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ¢#1. Check 2,3 or 4, if applicable) 1. a. ~ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Moutd f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ seepage Trench c. ❑ See age Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROP/DOSED (Square Feet): 7 GO Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ Lift Pump Tank/Si hon Chamber I El ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system sho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: n~ a/~' ? ~g~ 1 oZ T lumber's Address (Street, City, State, Zip Code): Name of Des! er: c Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name aPhoneNumber: /yl~t S CST's ADDRESS (Street, City, State, Zip Code) 0 / IF IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date :Issuig Agent Signature (No tamps) Approved E-1 Owner Given Initial S T rchar a Fee /,7- Adverse Determination v X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT- ' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code admir'strator or the State of Wisconsin, Bureau of Plumbing, 608-266-381:5. To be complete and accurate this sanitary permit application must include: L Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartmert, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriatE) prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 x 11 inches must be submitted to the county. The plans must include the following; A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; frictior loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into aw. This legislation is more commonly known as the groundwater protection law. This change in statutes was the 1 result o' over 2 years of steady negotiation and public debate. The groundwater bill Groundwater - includec the creation of surcharges (fees) for a number of regulated practices which WrscorlG n's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tho` buried,ti ~asurE is used 'n your building is returned t_ the groundwater through your soil absorption f; system or the disposal site used by your holding tank pumper. The rnor:ies c:ollecte.~ through these Surcharges are credi''ed to the groundwater fund adminis- ierec' by 'he Department of Natural Resource,. These funds are used for monltor,rg grounr i N.atE' grourdwater contamination in •astigat;ons anc' est,f blishrnent of standa!ds Gro.,nd~R.a e it's wort:: protecting. SBD-6398 ?Fi.Q3 i 6 APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit iss uauce. Should this development be intended for resale by owner/contractgr,("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 Michapl R- T»ndin 1r, T+'.ilPP;n 14, T 3ndin• & Wa= Moggr Location of Property _V SE4 EF,__k, Section 33 , T 30 N - R 19 W Township St. Joesevh Mall ing Address, Route 2 _ Hudson. Wisconsin 5406 Subdivision Name Qpr .i f gd Suryev Mai Lot Number Previous Owner of Property Unknown 't'otal Size of Parcel 2 enr!Q pjUs Date Parcel was Created ri j,-4,1280 Are all corners and lot lines identifiable? x Yea No is this property being developed for resale (spec house) ? Yes X No volume 4 and Page Number 9213 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract . 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays 01 Lhe reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceAti6y goat aU 6tatemen" on -this 6onm are tu,.e to the but o6 my (uun) k n owY edg e; that I (we) an (are) the owner (a) o S the ptopen.ty deb cA bed in th,i e (.MAunmation 6o4m, by vi tue o6 a wah arty deed necohded in the 066.ice o6 .the Cuurity RegiAtea o6 Deeds as Document No. 411651 ; and that I (we) p4ezentty own the, pnopoaed a.ite bon the sewage poaa.Fsyatem (on I (we) have obtained an eaeement, to nun with the above descAibed pnopeh ty, bon the eopo.tAuction o6 said ayatem, and the name has been duty neeonded in the 066-ice u6 .t{te Caurt-ty Reg. Ateh o6 Deeds, as Document No. 413 ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED z H 9 r STC - 105 a ' H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix Country z c7 9 OWNER/BUYER .Michael Lundin & Eileen H Lundin &Wayne Moser ROUTE/BOX NUMBER Route 2 Fire Number • CITY/STATE Hudson. Wisconsin ZIP 54oi A PROPERTY LOCATION: SE 14, N_14, Section 33 , T_30 N, R 1!9 W, Town of 'Hudson , St. Croix County, Subdivision Certified Survey, Lot number 2 I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function o"f- the septic tank as a-treat- ment stage in the waste disposal system...,. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation St. __Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by-a master plumber, journeyman.plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-pite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. £ I/WE, the undersigned, have read the above requirements and agree CA to maintain the private sewage disposal system in accordance with M the standards set forth, herein, as set by the Wisconsin Depart- Vo ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off:Lre within 30 days of the three year expiration date. SIGNED DATE 7 a~ - St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. • I • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 4PAGE- This Deed, made between Michael B. Lundin_ and NSTERS OFMCE RE ii Eileen H. Lundin, husband and wife ST. CROIX CO., WIS. - Roca. for Record this 2 1,,, Grantor, day of June .D. 19j6 and---------- Wayne _Moser - tit 12 :40 P MW i. Grantee, tpldr of DNdlt Witnesseth, That the said Grantor, for a valuable consideration---___ -Grantors-- • conveys to Grantee the following described real estate in RETURN TO County, State of Wisconsin: Tax Parcel No: Part of the SE-14 of the NE4 of Section 33, Township 30 North, I Range 19 West, St. Croix County, Wisconsin described as I follows: Lot 2 of the Certified Survey Map filed in the Office of the Register of Deeds for St. Croix County, Wisconsin I i on April.4, 1980 in Volume "4". Page 929, Document No. 363523 1 I , FF~ r+XE^ ~ I II This S-S10t-•-_-- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; j And l:Un.tors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this ------------------~40----------•-•---- day of 19 006 I (SEAL) X.. K4?....1 "cy (SEAL) * Michael B. Lundin * Eileen H. Lundin - (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT n~I 1 8 ~Lc~1G~.n' Signature(s) STATE OF WISCONSIN E1•Iceh ss. County. authenticated thi / s~v.__day of__~!t 19___ Personally came before me this day of `~~t ~Z/ ~r:llh E ✓ 1 19________ the above named * 1 r-- fi:---- _ l ~c _yz~c_Ll c /V MEMBER STATE BAR OF WISCONSIN (If not- - - authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Lundeen Attorney atw------------------------------------------ Notary Public ----------------County, Wis. res may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration necessary.) date- 19......... ) signing in any capacity should be typed or printed below their signatures. <n STATF TSAR Or WTRCONSTN ' t ; I i rr DEPARTMENT OF REPORT ON SOIL WRINGS j1 =TY & BUILDINGS INDUST8Y, 6 L7 DIVISION j LABQR AN[). PERCOLATION P.O. BOX 7969 HUMAN RELATIONS 53707 TESTS (11 ISON, U11---- (1163.09(1) & Chapter 145.045) lpy~ty`>>:~a I OCATION: SFC TIOiV'- - p r -u- TOGVNSHIP/MUNICIPALITY: LOT NC K. N I 0n,I "E- = /4 "TE'/4 _ _/T ~N/R 19 E (or)'Yf 1 1-[FAA-Ft 7``f ~ a t ^'/1 ~ ♦rS+t~ ~vMrJ N't' ')LINTY. ~OWNt.ii- i,'ER N~.ME: -G ADDRESS: - 7" G' .E~ ,e'~ ~ ~ 1 - ~~(~'Z.t} f ' ~ ' ~___1-'C..- 7'~ Glv ~ rJ ~ • J <; ~ ,:V : uJ I , SCf U / (.n USE DATES OBSERVAT NS MADE I Q'G F0, CIAL!)ESCFt1PTION. PROFILEDESCRIrTIONS: PERT O~TIONTESTS. Residence New C~Replace I ~ ~ /Z L ' - , s* . "err-.t Z I C_ AL nl T- I A,-C-r Q RATING: S= Site suitable- for system U Site unsuitable for system ~1~1VENfION.^LTte1 IN-GROUN[nRFS~UiE'-I5YS(E~I-I i\1 FILLHOI_OINGTANY E-cbi5,vi-_NDEDSYST3VI:(n, un:,I) LL~j Fil s ❑u ~ . ~s ❑u s au as ou ->riJ N'T r1iA 11, f Percolation Tests are NOT f quired DESIGN RATE: If any - porUOn of the tested area is in the if s.H63.09(5)(b), r uir ,,re ~ _ ~ {w Floodflain, indicate Floodptain elevation: PROFILE DESCRIPTIONS 1`Et=T nRING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO.'LDR, TEXTURE,..'1ND DEPTH -NUMBER DEPTHS ELEVATION I_ _OBSERVED kST~HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) ,3•Sp u pn1 Z.ty S,.r L ).od' Q-o je~ N is 1,67' Ro 3N S-' 1.33' F-ID (3.r! L z.~7' k?a BG/ 5: L 7 Sri 3,&7'P-0 nJ ~ ~.2G 1-D $ta! 7.93 e)7, 79 3 ,00' ZD SfkJ SO' 120 8.J ~ 0.83' 46 S t ^ 3, 3 3 ' R o 6 j _'5; Z.& ii a 13 X11 /j 6'j - - bsun.a~ PERCOLATIO TES S -3 4. TEST DEPTH WAI ER IN HOLE TEST TIME DROP IN WATER LEWIEUi!:wCHES ; RATE MMUTES NUMBER bVBAdtS AFTER St:'EL.LING INTERVAL-MIN. PERIOD 1 PF~9lOD11 PER a PER Ifi';:H P_ 30 PLOT PLAN: Show locations -of percolation tests, soil burincs and the dimensions of suitable soil areas i4ndli•-n;*t scale or distaneas. Describe what are the. hori- /:,ntal and vertical elevatio:: referen-,e points and show their location on the plot plan. Show the surfaaefdliua Jw.an at 211 borings;wnd the direction.:*nd percent of land slope. O P--r H L= n L. Or SYSTEM ELEVATION 93, oa g-( 191°x.: O - a - E -P C-C)L 9!i~h` M O ej regr NGt:. 7 r : c B-L ns $-4 i is I Qty a v t.:R Z 3 S :Q.. FT, a 0. , Z C z71 ` .5 UII"L-6O<ea p N MAIL TRAC . ' 'J - 'c 'a 3 oAK j . Mr. I 1, the ut,dersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures:and methods srA6firdrin the Wisconsin Adrnirtistrative Code, and that the d.-;a recorded and the location of the testvare correct to tha best of my brmviledge and belief: AF/"E (printl: TESTS 4VER~ COMPUTED ON.- iDDRESS: I - CERTIFICATION NUMBER: PHONE SVUMBER (optional).: - 4~a8d C O ► ti "r S7_ DON e 1"-)'79~ FoF_tA 9LSE/tSED iGNAT'UR A-PPuL., :984-. iTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. HR-SE 0-6395 (R. 02/82) -OVER- 4r- v4W S,50 ti ~o 5tfi~ l ~ J~I v h i Ntl. 1433S ~j oo e G' ` ST. CROIX COUNTY WISCONSIN 4 ZONING OFFICE . 798-2239 (HAMMOND) 425-8383 (RIVER FALLS) - - HAMMOND, WI 54015 July 29, 1986 Mr. William Schumaker Rt. 1, Box 426 Hudson, WI 54016 Dear Bill: The Town Board, Town of St. Joseph, feels that the soils are bad on the Michael Lundin site, located at the SEh of the NE14 of Sec- tion 33, T30N-R19W, Lot X12, Town of St. Joseph. At the request of the town board, more soil borings will be required to verify the soils before an inspection is made on this site. Should you have any questions, please contact this office. Si ely, Thomas C. Nelson Assistant Zoning Administrator TCN/mj V/CC: Ray Brown