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038-1058-90-000
i o a (D a a c I c o d c I N ~ 'C V O N O 2 W Y M 7 co O Cl) L a c) C ca (D ~ - II ~ rn• I o a€ o=ZZ a o - o a o m D ( v cU y amc> zo d?''aU c coo cn m LL C 3 U N N N cc 0 N c6 c9 L -0 CD L) U (6 ~ CL 12 tl! U) G N Y O LL ~ V Z d ~z am 0 c t7 m O Z ~ c N z m Z c ~ -o I •o Cl) ` N N O t(o N N N CD C13 C a O m 1 O O N ¢ 4_ Z m z Io ~ ~ I N N f6 c o G G a` C', m CD D a a I 3 3 3 0 i3 a a a d ~ z o • a3i a z U) cn -0 0) N J V U N N } V O O U o o m w a a~ W O N 7 O m (n U) to y C O O •1.~ O¢ E O L W N O ~ L N C C V 4. 0 CQ co -0 r- co a) LO v C Ln N C N N C 7 (n CN r_ CD ~ M O W O y N (6 Rf U • O O CA I O O Z N~~ d fn ~ r \ ~t E v v~ d ~o E a • a m d t A C)aa2 !0UU Parcel 038-1058-90-000 01/31/2006 04:29 PAGE 1 OF 2 F 2 Alt. Parcel 14.31.18.256A 038 - TOWN OF STAR PRAIRIE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - WALLRICH ESTATES INC WALLRICH ESTATES INC 4505 WHITE BEAR PKY#2200 WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): - Primary Type Dist # Description * 2140 CTY RD C SC 3962 NEW RICHMOND SP 7060 STAR PRAIRIE SAN DIST #1 SP 1700 WITC I Legal Description: Acres: 35.410 Plat: N/A-NOT AVAILABLE SEC 14 T31 N R1 8W 36.85 AC NE SE EXC 2A Block/Condo Bldg: ON S LN ADJ TO HWY C & EXC CSM 5/1425 & EXC CSM 6/1562 & EXC CSM 12/3383 MOBILE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) HOME PARK EZ-UT-1226/267 14-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 02/03/1999 597010 1400/538 WD 02/03/1999 597009 1400/537 WD 02/03/1999 597008 1400/536 QC 02/03/1999 597007 1400/535 .0W 2005 SUMMARY Bill Fair Market Value: Assessed with: 119034 883,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 27.410 537,100 291,100 828,200 NO PRODUCTIVE FORST LANDS G6 8.000 40,000 0 40,000 NO Totals for 2005: General Property 35.410 577,100 291,100 868,200 Woodland 0.000 0 0 Totals for 2004: General Property 35.410 577,100 291,100 868,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 IIIELCHERT / BLOCK ASSOCIATES ANC. 367 East Kellogg Blvd. • St. Paul, MN. 55101 • 612-228-9564 November 26, 19861 7 8 L lot* Mr. Barber Zoning Department ST. CROIX COUNTY 911 - 4th Street Hudson, Wisconsin 54016 RE: WALL STREET VILLAGE MOBILE HOME PARK, STAR PRAIRIE TOWNSHIP ST. CROIX COUNTY Dear Mr. Barber: Attached hereto please find two copies of "Verification of Exception Status for an Alternative Private Sewage System in the County of St. Croix." We are in the process of obtaining permission to build a new system for the park. Please sign the form and forward to: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P. 0. Box 7969 Madison, Wisconsin 53707 Attention: David Russell Your expedient attention to this matter will be appreciated. Very truly yours, MELCHERT LOCK ASSOCIATES, INC. William R. B1 ck Professional Engineer WRB:ms Enclosure ENGINEERS 9 LAND SURVEYORS • LANDSCAPE ARCHITECTS WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, SE 1/4, Sec. 14 T 31 N, R 18 E (or) WU Township T-ewR-cr=MUR-k4gal-ity Star Prairie Street Address Lot No. Block Subdivision Landowner's Name: Mr. Terry Myhre (Wall Street Village Mobile Home Park) The application for this site is for: ❑ new construction use. 1 replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers issued -to you.) one of the applications needing a quota number. The 9 quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑ for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑ for an application on file prior to February 1, 1980. ❑ for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑x a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. ❑ I certify that the above information is true and accurate to the best of my knowledge. "!"e Name Thomas C. Nelson Signatu County Official Title Assistant Zoning Administrator Date December 3, 1986 DILHR-SBD-6158 (R 12/82) AS BUHR SANITARY SYSTEM REPORT OWNERJ6w,,:, C~ f j_,P, nP-v,, . TOWNSHIP SECTION- j T_,5L-N-R~W ~ I L4 V [L,C- _ ADDRESS T. CROIX COUNTY, WISCONSIN SUBDIVISION LOT~f, LOT SIZE ILI ;I L `e• a.s6 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET O~F~.SY5TEM INDICATE NORTH ARROW BENCHMARK:Elevation and description: /D/t !~1•~.l/~ Alternate benchmark SEPTIC TANK:Manufacturer: "Liquid Cap. Rings used:--LManhole cover elev: Final grade elev: 9/.~. Tank inlet elev.: ~fD Tank outlet elev.: No. of feet from nearest road:Front Y, Side , Rear Ft X) From nearest,prop. line:Front Side,, Rear Ft. Ile No. of feet from: Well- Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I i 1 _ III i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Rt) Number of Lines:(:A_Area Built l~ Exist. Grade Elev. Z, S Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front r , Side, Rear Ft,.3a No. feet from well:--Z-4W No. feet from-buildingJr HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well building nearest road Alarm. Manufacturer: INSPECTOR: DATE: ~1 I PLUMBER ON JO LICENSE NUMBER: 6/90:cj p'a men Indus ryRlE 14.31.18.256A NE r SE HWY. C County: "'VO9eA0nTsiln TSrrt STS o ' Labor and Human Relations PRIVATE StWAGE tYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: .GENERAL INFORMATION 180260 PermltTiolAr's Name: ❑ City ❑ Village [Town of: State Plan ID No.: TTESON THOMAS A STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 038-1058-90-000-L TANK INFORMATION ELEVATION DATA A9200339 Via TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/-Ht Inlet TANK SETBACK INFORMATION St/-)-It Outlet Vent irIto ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic NA Dt Bottom 0 Dosing NA Header/ Man. Aeration NA Dist. Pipe 613 R4 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Q (p~ Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH WidtF - Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t DIMENSIONS-- SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER ~ Model Number: System:b E6 / OR UNIT DISTRIBUTION 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, `ersons present, etc.) 7 z ~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date ` Inspector's Signature Cert. No. 170---"ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Co SA _,e4t4t STATE SANITARY PERMIT # ` -Attach complete plans (to the cour~y copy only) for the system, on paper not less than fif ta~ Mevious Stfl x i T inches in size. ❑ cnec visioapplication -See reverse side for instruction for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION LEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Aj t/4.S '/4, S / T3/, N, R or) W PROPERTY OWNER'S MAILING AD RESS LOT # BLOCK # 3a_5 Y. r ?od t ilk k CITY, S-MTE IP CODE PHONE NUMBER SUBDIVISION NAME OR M NUMBER ss/o / A 11. TYPE OF BUILDING: heck one CITY NEAREST ROAD ( ) ❑ State Owned O 4!9-TOWW OF: VILLAGE : ...p N C. ❑ Public , 1 0 2 Fam. Dwelling~# of bedrooms PARCEL AX UM O 3 8, _ 10 S g _ 9D 111. BUILDING USE: (If ilding type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly H II 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campgrou 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. 9Replacement 3. ❑ Replacement of 4.0 Reconnection of 5-E] 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 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ .Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 15. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE OQ REQUIRED (sq. ft.) PROPOSEDD((sq. ft.) (Gals/day/sq. ft.) (Min./in h) ~yJ2 ELEVATION 9140 960 Eo~5 9,0Feet ?7.00 Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank a -77 F] Lift Pump Tank/Si hon Chamber 1 El Ej F-1 El El F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name P t): Plumber's Signat r (No Sta ps) MPRSW No.: Business Phone Number: CCkj u I h v we, rs 1563 (S- cW6'S J ~3S Plumber's Address (Street, City, StatLZjP Code): /96 ~l.Sl L44WDnW .r_ ss~oi~ IX. COUNTY/DEPARTMENT USE ONLY 0 1 ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) LL~ 0 Adverse Determinati n o J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. n 2. YoUr-senitary 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 subrpitted to the county prior, to installation. _ bet T 1 5. Onslttesewa e systems must be ro erl-'maintained. The sep tic tanks must pumpert"b g p p y y ~ licensed ' pumper,whgnever necessa: usually every 2 to 3 years. - : -2 6. If you Have questions concerning your onsite sewage system, contact your local code administrator or ffiie.. State of Wisconsin,.Safety & Buildings Division, 608-266-3815. T a J. To be complete and a.. TS accurate this-rtsanitar~1.permit applic ion must include: ~~a 1. Property owner's name and Mailing address. Provide the'legal description and parcel tax number(s) of where the system is to be installed. IL 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. ~t 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 performapce curve; pump model and pump manufacturer; D) cross section of the soil absorption system .ff4,r~ required by the"county; E) son test data on.A.145 fprm; and F) allalking information--;,,;; v GROUNDWA(TIEWSiJACHAAGE " 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. 'he monies collected through these~ur harges are used fdr_mgnltwipg grg.urdwater, grpvnd-, , water contami=nation investigations and establishment of standards. SBD-6398 (R.11/88) 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 ►-n O :.-!5 0 Location of property A) 1/4 S6 1/4, Section T. N-R I eW Township S ~a ~h a i r ► cp Mailing address ~S C S 7L 5 ,--Z~ 6z~ 5-t,P~ul~Y~\~ sslo Z Address of site Subdivision name Lot no. Other homes on property? yes No Previous owner of property ~2d v Total size of parcel VO n.-rw-as Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes >S::No Volume and Page Number a a as recorded with the Register * IN of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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. a.? C! , 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 the office of County Register of deeds as Document No. Si ature of applicant Co-applicant Date f ignature Date of Signature i "I f UUCUMGrvr NU. STATE' DAIL OP WISCONSIN FORM 16-1982 I111Y •rALK 1111 611VLI! MR 1ILL4.11DINU UAIA ASSIGNMENT 01= LAND CONTRACT 4'7` 244 V% 911 _ REGISTER'S OFFICE Assignor, whether one or more, for a valuable consideration, assigns ST. CROIX CO., WI + and conveys to homas...A1...0.tA Q.s.oA Reedlor Record AUU 0 G 1991 at 8-30 330 -~A-~ . M~~ ("Assignee" whether one or more) the ()glW8*N)EEK Purchaser's) interest in a Land Contract '4V dated the...... 2.iath............. da of........ J. executed by Reptster of Oeeds Jane E.- .Dosedel,-_a ..t.enant...of.. Robert L. Dosedel her husband, as Vendor to R[TURN TO ~`erry L. Myhre and Thomas A, Otteson- as tenants in common, as Purchaser on lands in S.t,,...Cx:QiX..................... County, State of Wisconsin, Transfer fee on following together with (i ( ( (tXi~Gr j)(JF d(rXe)6 a( all the interest of the Quit Claim Deed Assignor in the Land Contract and the lands described therein, which Land Con- tract was recorded in the Office of the Register of Deeds of said County, on . June 2.7 19...8 5, an Document Number 4 Q 30 5 0., in (k~1 _.._(Records XW) (Vol.) 7-15................. of (I on (Page) ......13 The Assignor covenants i 44441 & mux~ t +x ~X . ••-----_..............)(10 IYrYi, wj YIYY~ raft eYtA AX)eYK")6X&MK" that Assignor is the owner of the above described interest in the Land Contract and has good right to assign the same, and that the condition of the title of Assignor's interest is the same as at the time of recording the Land Contract. PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMENT OF PURCHASER'S INTEREST: (Strike either 1. or 2.) By accepting and recording this assignment, the Assignee agrees: 1. That Assignee assumes and agrees to pay the obligation secured by the Land Contract, to comply with all terms and conditions of the Land Contract, and to hold harmless and indemnify Assignor as to the performance of all obligations, terms and conditions of the Land Contract, )tNXI ( 22. That this Assignment is given for collateral purposes only, and that the Assignor agrees to contin make all pay~lm+t squired on the Land Contract and to comply with Fill terms and conditions thereof. Th Ignor retains the right to occu of the property covered by the Land Contract. This Assignment is to a same effect as a mortgage. In the event o It on the part of the Assignor on the =T: eby, the Assignee's remedy shall be a foreclosure as if it het agePARAGRAPHS APPLYING IF TIS IS . IGNMEN i OF (Strike either 1. or 2.) 1. This is a complete assignment of the Vendor's in the above described Land Contract. The Purchaser under the Land Contract is instructed to make all fu pRymen Assignee upon receipt of a copy of this docu- ment. (OR) 2. This assignment of the Ven nterest in the above described Land Contra or collateral purposes. The Assignor shall be allowed to c e to receive the scheduled, periodic payments on the Land ct. Any extra or balloon payments shall ads payable to Assignor and Assignee. In the event of a default by Assignor obliga- tion secured by assignment, Assignee has the right to receive all payments on the Land Contract upon noti c to the P aser. This IS...UQt......... homestead property. (is) (is not)) Dated this • N........_... d y of AU,gUS.t................................ 1991..., AL (SEAL) • T.exry...L...MXhxe .....................................................................(SEAL) ....................................................................(SEAL) AUTHRNTICATION ACHNOWLSDGMENT Signature(x) Qf ..Texxx...L...NyJa e STATE OF WISCONSIN ss. County. authenticated this A..day Of.. All U 19.91 Personally came before me this ................day of 1 -19......... the •above-named c .+...G E. Norman _ TITLE: MEMBER STATE BAR OF WISCONSIN WOK ~ R~I'c4C~Q9C~CR~7p9f?~4'tX~ to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY B.AK.KE. N.ORMAK SCf1UMACIIER SKIN~iER F WALTIJI, N.ew ..ch~c .0..1Y.1......5 .81.7 Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is peranentIf not, state expiration are not necessary.) date: 19........) *Names of persona signing In any capacity should be typed or pri to below their signatures. l i j STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER r S'f $ k , 740 FIRE NO. CITY/STATE Y' ` h SZIP 'S.5101 PROPERTY LOCATION: /LJ 1/4 5 1/4, Section , T_,3~/ N, R /4? W, Town of ,-5 'q 1- 81 a t ti"l (p St. Croix County, Subdivision , Lot No. 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 a 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 $3000 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 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 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. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE lI1/ 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 Wisconsin Department Industry, Labor. and Human Relations SOIL AND SITE EVALUATION REPORT Page j -of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not loss than 8 112 x 11 inchos in size. Plan must include, but not limited to vertical' and horizontal reference poin4,(BM), direction and % of sl60e, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to, nearest road. APPLICANT INFORMATION=P-LE'ASE P.BINT.ALL INFORMATION REVI( WED W., DATE PROPERTY OWNER: .PROPERTY LOCATION : Tom 6:ft le -5 p GOVT. LOT 1/4 S,r 1/4,S T N,R /8r)1y, PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # -Sa5 Cale V. 5-t+e. 7Z10 N A N CITY, STAP ZIP CODE PHONE NUMBER ❑ ITYS ❑VILLAGE OWN NEAREST OAD :5 5114 ( C ~d New Construction Use)-'If Residential / Number of bedrooms [ J Addition to existing building Replacement [ ) Public or commercial describe Code derived daily flow (000 gpd Recommended design loading rate ,7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required 85 bed, ft2 trench, ft2 Maximum design loading rate gybed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) _ 95'D It (as referred to site plan benchmark) Additional design / sib considerations Parent material ~~('fed 6~~ gS1~ Flood plain elevation, if applicable _ N ft S =Suitable for system ONVENTIONAL 0 ND IN-G OUND PRESSURE AT-GRADE . SYSTEM IN ILL HOLDING T K U =Unsuitable fors stem ~S ❑ U ~S ❑ U S ❑ U ❑ S U ❑ S ~U ❑ S ~y hK~ (.~-dt - S•t"frr~ SOIL DESCRIPTION REPORT' Depth Dominant Color Mottles Structure GPD/f t Boring # Horizon Texture Consistence Beurx;;ary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& C zop- .7- sit, v%e_ 51 1s X 16 Ground C LIDIL-10yo ~?1ll)L2 5 C S C U) elev. ft. Depth to limiting ffa for Aelk Remarks: Boring # C STD A)0yA C .5- 161'. lmJ Ground i elev. YS,,Stt. Depth to limiting factor /b Remarks: CST Name:-Please Print ` a f rS Phone: U Yb S S Address: /96 l` s G .f lra / Signature: n Date: CST Number: u.~.r. Q - / ~~o~ x•5'3/ PROPERTY OWNER Y'd d TTeSGr~ SOIL DESCRIPTION REPORT Pageja_ of 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft t Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench r< : : <•<'•:'< o S' J rn Sr G c„J y~ Ground Jbw .elev. - q~,,, , F• Depth to limiting , faaActtor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # x~z Ground elev. ft. f Depth to limiting factor L I Remarks: • Boring Ground elev. ft. 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I; I'~ I I I I ~ I I II ~ I II r I I y r - I ~ f -I I ~ i I I ~ I I I DC.roSS Szc~lor, 01 ~cl~ S~sie~-~ f ° FrdsA Alr Int@I► And OD@@rrodon Plp# Approrid Von, Cop Allnlmum 12~ ADOr• flnol Grad• 20. 42' ADor@ Plpr _ 4" Coil Iron To final 0,44. @4w@n Hay Or Srnln4lk Cor@rln~ '4ln 2' A99r4941@ Ora( Plp@ DIU11b.11on PIp@ 0 0 0 T@• V Ao9r@9414 94n4Up PIp$ o F.P41101411d PIp4 halo. o -"Co,Vln9 T• I"In411n9 Al 04110m 01 S~a14m SOIL FILL DISTRtOF OM PIP APPROVED SyNP+ETIc covra 2E MATIE RI~t OR 9' OF STRA4J "o>F l1,GGR~GA1E oR MARS►+ HAy ELEV• OF E Jp -a%AGGRCGATE 3 3 DISTRI5'JTI,DM PIPE To BE AT d~ LEAST ay Iti1C.I"E5 BELOW ORIGIUAL GRADE AMU AT LCASTLO IIJCHES BUT 1,10 MORE THAN 42. IAICHES OELOW FIAJAL GnAOE M~XUIUM DaPrH OF F-Xc/IVAT100 Rom ORI& NAL 6gAt)F- WILL BE A0 _ IIJCHES 111h11MUh~ pL~'T"F; OF EXCAVi1TImN WILL BE, -SCLL__ INCHCS SIG U[:[): LIGC►.1SC kJUMBF-R: (S 63 DATE: _ 7a REPT131 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1 09./17/92. 09:33 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/18/92 AREA: MJ Activity: A9200339 9/18/92 Type: CONVSEPT Status: PENDING Constr: Address: STAR PRARIE 14.31.18.256A,NE,SE, HWY. C ,Parcel: 038-1058-90-000 Occ: Use: Description: 180260 Applicant: OTTESON, THOMAS A Phone: Owner: OTTESON, THOMAS A Phone: Contractor: POWERS, CALVIN Phone: Inspection Request Information..... Requestor: POWERS, CAL Phone: Req Time: 13:09 Comments: 1136 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION ~I IVNI JIIJO J~ Q z H0 0 I W Q m z J w a o a Q F w o a 2 ow o z x 1 z Z w~ L" Lu wa0 a < 0 a > r z r ~O LOA ? 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' ADDRESS TOWNSHIP4 SEC. TN, RIW jK ST. CROTX C UN WISCONSIN. SUBDIVISION ��� LOT LOT SIZE Distances & dimensions to meet requ PLAN IEwof H62. 20 SHOW EVERYTHING WITHIN 100 FEET( OF SYSTEM I i ate orthj Arrow j SC AL SEPTIC TANK(Sj MFGR. CONCRETE N o ring cover STEEL p PUMPING CHAMBER SIZE PUMP MFGR. GALL Cycle MODEL NO. TRENCHES N0. of length area BED NO. of lines width glen th fC depth -to top off, .pipe g r` area NUMBER OF SEEPAGE PITS Outsi _ AGGREGATE a iameter total pit area PERK RATE AREA REQUIRED A REA AS BUILT -C`�f Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes . There are other areas that it is not possible to inspect at ;this point of construction. St. Croix County assumes no liability for system.,operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THI5,-SY;EM.,/ INSPECTOR DATED S K PLUMBER ON JOB_1',�.l,�r LICENSE NUMBER �-� Plb 60 NAME OF BUSINESS (�/� f�,s� /�?/�,.A/ �`� �' '�� •- LOCATION etf10 street or highway city or township county OWNER ,ZA �, �• Mailing address �,, ✓ /�3 /,198/fi'c� _ ARCHITECT OR ENGINEER Address PLUMBER_L4Zeg,oe� ("� Z9A 6y Address �yE fj�'.,/S .✓�1 oe- 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition 1. If addition to existing building attach detailed memo for each. O Restaurant or dining room . . . . Seating capacity (10 sq.ft./person) O Motel ( } Hotel O Cottages Number of units: Regular Housekeeping 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS O Bar or cocktail lounge . . . . . Seating capacity (10 sq.ft./person) O Nursing or retirement home . . . Number of beds Mobile home park . . . . . . . . Number of units - dependent (X _ - nondependent O Service station . . . Number of oars served (dai]y) O School • Number of classrooms Meals served Yes No Showers provided Yes No O Faotory or office building . Number of persons (total all shifts) { ) Residence . . Number of bedrooms 'i ( ) Other - specify -2. Indicate whether or not the following facilities are oonnecteds Food waste grinder . . . Yes Dish "her . . . . . Yes No op6:R,C of,#Ti0 !��.�: 3yf' 4fSE 'Sd IAW 1P,4Z Automatic clothes washer Yes No 3. Fill in the appropriate information for the following as indicateds Septic tank capacity planned Normal septic tank capaoit3, ewe,e red Ir 506 increase for FWG or AW Total septic tank capacity required Percolation test results - ATTACH PEFCOLATION TEST P.EPORT SHEET Seepage trench bottom area planned width , linear feet , depth Seepage pit planned outside diameter , depth below inlet depth 7s�� / Seepage trench bottom area required width linear feet J. Seepage pit required outside diameter , depth below inlet Signature of person completing form: STATE BOARD OF HEALTH, PLUMBING DIVISION P. 0. Box 309, Madison, Wis onsin 13701 Address: - .,,zm Q EO &/ Approved: � . v k Date Date JUN 5 lin��� TENS APPROVAL 1S BASED ON STATE PLUMB, ING CODE REQUIREMENTS AND DOES 1,01 EXEMPT THE IN;TALLATiOr1 FRO14 CITY VIL• LAuE, iCW r°4iP 0;1 COUNTY RFC:m dflnNc 4 m v •v O N O N L O X t L •L • 3 �+ 4J •- m -p 41 7 N O CA N 4- N to a to .4- O •- M O 41 4- m d C a 4- O c c 4J x m - -C N m 4J m 0 N vI-C 0 N O a •- N O 4J a) r- N u 4+ c E O c )- •- N in N _ t r- In •o to > C 4 a E L •- 41 4) .- 41 VI - '0 N s 40 a m N — m •- O N E c 4+ m N o to ai 4J m N - N 3 - 4J L C •-i L 4J L N to -0 .- . i-. > •- m �+ L > L •,n -- O .- ,n 0)N O 'a 4- m N E m N N L O -0 m L u m o - = m N 3 4) - •- m 3 41 41 VI 3 = u — L N 4J L. 41 m 41 L > U 4J - 41 N 41 -0 to 3 1n O L vI a c 'A m O 0 -- m m 4J L 4- U N N .0 N 7 N .0 N M - IV C .v •u C 41 m e 41 o N L 4+ -0 --I t N — a N m aj o 4+ C N L VI m 4- N .0 O N 0 •- 'V 4J -0 - C) c -C •- N m a N o N O .0 41 - L 01 Q •O C N O 41 L L- 4 d N t t 4+ N c C - m m 4- in O r- •- O - 4) m 41 4- 4J "V U 4J '0 -- (n m > •- •- m O to E O - 4J �+ L 4- N OL c c = 0 — c — O -- x N m Ns- um > LO c O N m •- m •- m 0 0 - 'O ut 41 .0 u) -c L O N N > to m O U O M 4- N VI L L •- U L .- N N O 0 u 41 0 4J 4- 4J N O •- L L L. •- N O N C N vI 4J L N 4- •- S N c •- m m O In N 4J L .0 a 4) •- m a •- N 4J 4- N 4+ .- E •- L c - c 41 > Al a -m M 41 X w - -0 a m y •- > N - m 4) 0 7 •- 4) L N N L. 4- h m •- C g C U N •- t N C - > 40 L U .0 N t N O N m m o m O O N O a) — m 4J .c m L 4- v U 4+ 44 ,n t u L N 0 0 L In U C 4- u a t H N N m 4J m m c c N 4+ L 4J = 41 U t r- O 4J o N VI L to 0) 4- .0 41 N u -- •- •- N 41 N 4t U 4- a) N in N c O 41 c w N - > 7 N CL C 4- 4J 4- a = r- L 10 W IA 44 - .- - N 41 O - X N O C 4J •- O c O N Vt - F- 41 O N a) m m 4) - �%o O • 4+ 44 �U •- 4J .0 •- m N N v N - -C t 3 > 4J 4J N = N N ut 7 m E - C w C E V► L > c •L U 4J >. N •- a\ 41 c t v a c O 41 L O v N E N m U N c a) - 4- E - 41 v - 4J N tn c •- tm c U 4) .- L L v 41 L •0 m a •- 4- a) t N N a c �E Vt m E N N - 4J VI 4J U E m vI N 0 - 4J f- L L C V .- 13 0 N t -C 41 m c N •- N C - ; > L Im N m 4) m U E O C m 41 C u u E > C •- •C N o a C - 4J w•- L X M m N N C C •L m •- •- •- 4- t E a•- 0 m ut L 4J N O .0 - N 4J .- m O 7 •- O O E 0 41 N m •- L d wy -0 3 L m M C 0 N L ,= 4J •0 v -0 3 L 0 L E N = N N 0 m N - > Q 4J X 4+ N a) 4J m L L •- a) O 7 E > c O c L "0 aJ .0 4J - m t m •- C -c 4J - m m - 3 a •- 0 .- t 0 0 IA 4t = m L VI in N N N •- 4J C N O •O » •- N N E V1 E •- m c t O 4J - w V1 > L - u 41 > O 3 >. u -v N a L N L - JA •- Vt O N L N 7 m U) 41 •O m I- 4J a) - O N L O v E w E N c > N - L '0 N u a— L N 0 O 41 s - L N L O O L a N N t N > N CP N - m a N V1 N c •- 4j = a u N -0 4- u m L - C O 4J 4J - o C u U 4J a 4J N .0 4- O .0 N > 4+ 4J 0 .- c - N O C C L M m L U - 4J L N N L- N 4- -0 C C 4J L L •- L 4J • .0 L •- O m e 3 C - m N L- L a - = O 4J N C •- N N O a) O 4J CL tJ t m to •- m t 4J m 4J - 41 N O E •- VI a > a 4J C m m N v VI L = L 4J 4- u C m M - C 4) m O to 3 L N 4+ - VI m - N tn m 4J m t -0 O O L cn m N m 3 41 m 0 > N m N N a— O T m U N C •- t O L 3 C 4J L C O N O - L N to >. m N m L v 0 m N 0 N O C •- Vf a F- 4J '� L o u 7 4- L a 4J N N N m u �G C 4, 4J •- O a 0 m 4J t to 0 = 0 N U N N a.0 W N u VI m •- m a N L O L 4J - L N O N 41 0) E O a 4J E 3 N a 010 N O 3 N 4J m t t 7 m N 0 4J t > m C N O m of -4-_ � • 41 0 -- -Q C VI m C 4 N N C 4- O L 4J IA 3 M t -0 to N L L N m w .a N O - O - a) m N a) L N c N 7 N.-. 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C •- N O) 4) 0 -O - O - .0 4J N L m N u c N - O L U 4J N u 4- m t U > 4+ 4- 4 ; - O c O c C O 41 N O N c 4J O N w 3 u 4J N .0 • 4J L L 41 c - C O - C 4- N •0 c = W 0 'O C t m 4- - r 4- .O N N N O O .Q E N O L C 41 N m N N 4J E L N 3 41 a) O O m N c U O > O c 0 .- N L v •0 3 X O O O u •- t 4- .- 4+ 4J - c 0 3 N •- 4J m y m C DIN L N m 3 4J 0 O 4J C E 4J N -- tn .0 4J v m x N u - a N N L th 4+ m C 4- N VI L u o C a -v a L •- E U - to 4 E O O m O m {- c 4- H v c to N u •- c XI V- 41 C O N N •- O C N N - > VI •- L C C 4- N U t 3 m VI V -- m m - u - L o VI >. 41 N L W L 4) 0 -0 O 4J N 4J - C C M to - 0)- N - oI VI C - m L U N -C W .0 •- N N m V a) 4) 4- -0 41 N to VI •L C m C •- C-,O m •- •_ 3 C 7 •- C 4J U L N 41 L - "0 4J N N - L 4- •- - N O m •- N .L M C C = 4J t m •- 4J 4J O O N 41 O 0 N N w •• -0 4t - W 4- C VI v V1 m 3 L •- •- O O 1- - 4- a) u 4- to v L 4J tn N 0 .- m - w - C a) w >, N 41 .G C O .0 - N to N DIN O m o 41 VI E N N • •- m m 41 •- >. a m E - 41 x L - U N N v N a O 3 - v E C to 4- -0 N 3 N m - L L - > 4 L c t u .0 N O 4- = N N Vt O C N N - N - C N m N O u N _E 0 - a N 4J m N N = ' - C L L O .0 N .L •- - L 4J U m N 41 VI o 41 O m O a > - t C N - •- ' - O a 4- 4J O M - O to 4J N N 1A m E C L 4- L L c t- 41 •- X •- m •• M c O O c N - .0 L N N a L 0. 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O 1 H CA 3 c M MO O ro y0. � w.Y 'fir p H Q b C3 rt ~ O Pl tai iw �r m wM � Ali Mx o p w °x N � � z H t�+ '1'i a 4j N ¢ 6 - - - - g - - - 1� C En QOM ►`y �O 1 Cz H tzj .Oy Ci C�' jy 5ro fA �r � s•-0 V p � � a (IQ-~ ►17� � FWD r S! a _ O - - m a m �. H H � CD 1!•�JJ 1+ n x y n , R+ tD 1�l z O to f7 cn 'c+ m H C+y P+ Cgs O O > H FI H Z H r H O co oa - - - y - - y ^ w w zz 0 °a v 9 c+- µ O �, O t] r - En N `fir � oo `F H CA O v Nib cn Ea � - - .. K Fes+ ro ;yI�y E o G O o FiH w ti ,00 - c w 0 • � > a � a I- � H ro dC 0 a x O G \� Wisconsin State Form Plb 67 Division of Health APPLICATION FOR PERMIT .� for PURCHASE OR INSTALLATION OF A SEPTIC TANK (Sec. 144.032 Wis. Stats.) OWNER OF PROPERTY Type or use BLACK ink. A. Zi ode Name Address Str t, C' y, p � B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED County Check 1. _ City Mail address one: 2. Village 3. -7 Town Give license number held: C. INSTALLER Wisconsin Restricted -- Licensed Sewer Plumber Services Address X D. SPECIFICATIONS OF SEPTIC TANK NEW TANK REPLACEMENT __ Size in gallons: (Check one 000 al. 1. 500 gal. 4. _ 1,500 gal. 7. �, g 2. 750 gal 5. 2,000 gal. 8. 5,000 gal 3. 1,000 gal. 6. _ 3,000 gal. 9• IT-over 5,000 gal. give capacity Materials: 1. �,- Prefab concrete 2. Poured concrete 3. Steel E. TYPE OF OCCUPANCY 1. Single family residence 3• Commercial establishment 5. Other 2. Multiple family residence 4• Industrial establishment F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY G. PERCOLATION TEST MADE es 2. _ No Date By whom, (To be completed by County Clerk) r Date application is filed fee aid `� G Permit issued (date) S Permit Number County� ,J,(R�,✓i Clerk Note: The application cannot be consider¢ for filing until all of the above questions are answered and the fee paid. County'Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Z _ REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sann itas i y Penmt .� State ept.ic/ r 0 NAME rowna hip � 2L L . Cnozx co •. _ Lo catio K V kj _S,� S e c.t.io rx SEPTIC TANK Size ' 0 0 0 gattona . Numbers o6 CompaAtmenZa` _ ViAtanee Fnom: We.it ti 12% on gnea.ten .6 tope 6t �►�/o Buitd..i,ng Wetlands �... . H.ighwaten DISPOSAL SYSTEM .D.catance Fnam: weal S#. 12$ on gneaten Atope fit. Bu.itd.ing_6t. Gletiands Ft. Highwaten 5# {y- FIELD DIMENSIONS: Width o6 then eh it. Depth o j no ck b eZow t.ite in. Length o6 each tine it. Depth a6 nacfi avers tiie .L .in. Numb en, o 6 t i.ned Depth. o j tite b etow gnade ` 4n. J T l Tota.t .length o tined it. Stope o6 tnench _ I-in pen 100 it. Di-6tance between 2.ine� fit. Depth to bednoclt Totat ab.s anbt.ion area_ r,'F-"' 6t2 Depth to gnaundwate wit. Requited area it2 Type of Coven: /Papen�ox Straw PIT DIMENSIONS: Hum be& o6 p.i..tz A Ghavet around pits yea no OutA.ide d.iameto,, fit, p #. De th b e.2aw' :in.iet Totaa ab.sanbtion area it2, a ` 2 Area nequi-? ed it cr, INSPECTED TIT E L r APPROVED,' 1 DATE `r 191 ~`= s _ . REJECTED PDATE 191 EH 1 .15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH P.O.BOX 309 MADISON,WISCONSIN 53701 ' EPO,jRT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION '/4,-+ '/4,Section It,T3/N, R 'e !� f (or) W,Township or Municipality__...Sl`.�jP Lot No. +IBIIIkK o Cou nty C)e.,i ubdivision Name Owner's Name:Mailing Address TYPE OF OCCUPANCY: Residence No.of Bedrooms J Other ct I IV r Co t-t,v" 1,{� . EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENJT/ DATES OBSERVATIONS MADE: SOIL BORINGS ' r — 72 PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM— INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P_ a P_ P_ G �' 1+ ►� SOI L 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) SA Jq .7 C 7 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and squarkjust.QL4uitable areas. Indicate number of square feet of bsorption area needed for building type and occupancy. 00 -- �nOC�u-*;...te icate scale or distances. Give horizontal and vertical re erence points,Indicate sl e. 1 1 tN FA v I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) S Certification No. �S �Z Address Name of installer if known CST Signature�r COPY A—LOCAL AUTHORITY • _,�. �... . _. . . _ r.' ,- ,,.: _. ... , - . . _ ._ . . ... , .t � _ � _ : _ _. 1 _. �. _ __ `� ,, �_ __ . _ . . :. .. ;, ,..... ..,.,__�_ .z.. _ ,; , , .... r, _ ., � , - , �:, .- „� `r PLB67 State and County State Permit # 7 5 7 Permit Application County Permit # 36 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required -� — -' State Plan I.D. # —� A. QYVNER OF PROPERTY Mailing Address: �1�I n,� � tc:��.�n� w �•L B. LOCATION: '/4 '/4, Section T�N, R . gb(or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) r * ariance Single family Duplex No. of Bedrooms No. of Persons D- SEPTIC TANK CAPACITY 50CX> Total gallons No. of tanks Cq HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete_ Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement — Lift Pump Tank or Siphon Chambe✓2�Total gallons Prefab concrete>C Poured-in-Place Other(Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq.ft. New X Replacement Alternate (Specify) Seepage Trench: No.of Lineal,Ft. Width nepth Tile depth (top) No.of Trenches Seepage Bed: Length- , Width—�_Depth�Tile depth (top) a`( No.of Lines Z Seepage Pit: Inside Aameter Liquid Depth No. of Seepage Pits Percent slope of land_ Distance from critical slope `"------- WATER SUPPLY: Private Joint❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Cer ' ed Soil ster, n NAME Wit. , Yom., C.S.T. # �$"s_,S-3 and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# f54> Phone #oZ�6 —Sl�f' Plumber's Address �.�.�: PLAN VIEW: Provide sketch below of system,(include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. •e ,x � m.._..., d _m- �P a w..„ �... �. ,,_.r...... ... 4�, -...... _...,,.. ..¢ _rv,. .., .. ae:.e . __.m m - gym.. -� � � _ P•. P __. ,. .- . — .w s m . m . j mW „� s # s < E ._ �. E _. 3 i . E "l E �. �. ...P. f P I 1 Do Not Write in Spac Below ^FOR COUNTY AND STATE DEPARTMENT USEDNLY �> Date of Application "j` �' �� Fees Paid: State .�) County `'. Date 3 Permit Issued/R 7No (date) — �� Issuing Agent Name t - a Inspection Yes State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 2. Indicate whether the following- facilities are present. ;y d Floor drain yes -no.-&— Number of. drains Food waste ,grinder yes no Dishwasher yes no Automatic clothes washer yes " no Number of clothes washers Septic tank capacity — �S �'O Holding' tank capacity` Septic or holding tank manufacturer (A.1 L Coy�t__Ao t 4. SEEPAGE TRENCHES:' total square feet width of trenches length of trenches depth number of trenches total square feet 6 000 width �D SEEPAGE BEDS: � length of bed / 00 depth,yO �� SEEPAGE PITS: ,total square feet outside.diameter depth below inlet total depth from top to bottom of pit Signature of on completing form: FOR DEPARTMENTAL USE ONLY Address - 3 a o c—, zip SS�oi 7 Telephone Number Date i I J r.na . ,r ! • pp l Plb. V 60 1/78. • PROJECT DETAIL DATA SHEET NAME OF BUSINESS LEGAL DESCRIPTION �wY., 5C,�'„ &.c T?1 le I STf4R,anr4tl OWNER Qp 6Q,T Oo t rl Q1 MAILING ADDRESS Z I P sv026 ARCHITECT, ENGINEER, ADDRESS PLUMBER OR DESIGNER Z I P :S Sroi TELEPHONE NUMBER 1 . Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( ) Assembly hall . . . . . Seating capacity ( ) Bar . • . . . Seating capacity # of meals served ( ) Bowlingalley Number of lanes ( ) With bar ( ) Campground and camping resorts . Number of sewere�sites Number of unsewered sites Total number of sites ( ) Camps . . . . . . . . . . . . . ( ) Day use only Number of persons ( ) Catchbasin ( ) Day and night Number ofmpersons Number ( ) Church . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) Dance hall . ( ) With kitchen Number of persons . Number of personslp� ( ) Dining hall . . . . Number of meals served daily ( ) Dog kennels . . . . . . . . . . . . Number of enclosures ( ) Drive-in restaurant . . . . . . Inside seating capacity Car-service Number of car spaces ( ) Dump station . . . . . . . Number of dump stations ( ) Employees ( total of all shifts) . . Number of employees _ ( ) Hotel( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses , medical staff Number of office personnel Number of patients (�C) Mobile home parks . . . . . . Number of sites ( ) Nursing homes . . . . . . . Number of beds ( ) Parks . . . . . . . . Number of persons ( ) Toilets ( ) Showers ( ) Restaurant . . . . . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service Retail store ( ) ( ) Schools . . . . . . _ • • Total number of customers _ . Number of classrooms Meals ( ) Showers ( ) Self service laundry Total number of machines ( ) Service station . . Number of cars served daily ( ) Swimming pool bathhouse Number of persons ( ) OTHER . . . (Specify) . . . . . .. 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' A ,n r,.r.-- a .* W A an ,p. 4 .1 'K� rtk '.,i+z .Y T a'r ,yaaro�e F Y ;� ".� J r�„r,{r%*' y 'rt^" ;€,'m �' , Er r k 4`9 ` y J& ?4E+ ay 0.1' h, b , F :f '�'( yt4'L" . t .,� .'4 x' &� r :.nt, ,+ a y.g:.., . '.' ,w a %°!w�..y -+1,.';°.ti:dz�r"� .t;a i.� c,-r°^S, } DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 N 2f SE%,S14,T31N-R18W ❑CONVENTIONAL UALTERNATIVE Ex P erimej an LD.Number. Town of Star Prairie ❑Holding Tank ❑In-Ground Pressure ❑Mound 87-04904 CTH "C" NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wall Street Mobile Home Par Route 2 New Richmond WI 54017 BENCH MARK(Permanent reference pmml DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: I.Tn'hn P_ Sykora ITT 15212 St} Croix 102840 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED DYES ❑NO EYES ❑NO BEDDING'. VENT DIA.. VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING.1VENT TO FRESH AL"RM' FEET FROM LINE: AIR INLET EYES ONO EYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED'. DYES ENO : YES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING IVENTT—OFRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES El NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING Or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH NO.OF DISTR.PIPE SPACING COVER 'INWSIDE DIA rs PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END'. PIPES FEET FROM LINE- AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER ITEXTURE JPIRMANINT MARKERS OBSERVATION WELLS 1:1 YES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. El YES El NO ❑YES [I NO 1-1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.' ELEV.. DIA.. ELEV.. PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO ❑YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER 31 PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES ❑NO ❑YES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. 1 DILHR SBD 6710(R.01/82) Zoning Administrator I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: I 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, estimatedlwastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfe�/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, contac your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must includ I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 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 ty'l,e. 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 to 'k, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site coi structed 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 applicatio 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 8'h 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 nd vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; ele ation 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. --------------—---—------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in stat tes was the result of over 2 years of steady negotiation and public debate. The grou dwater bill Ground Afeir — included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re c186: is used in your building is returned to the groundwater through your soil♦absorption o system or the disposal site used by your holding tank pumper. �- a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for',monitoring ground- t ` g g standards. Groundwater, water, groundwater contamination investigations and establishment of s it's worth protecting. SBD-6398(R.03/86) I - DILHR SANITARY PERMIT APPLICATION COUNTY /+ �a In accord with ILHR 83.05,Wis.Adm. Code 1. `JC STATE SANNIITARY PERMIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PL N I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. 7 I. APPLICANT INFORMATION—PLEASE RplpT ALL FOR IO PETITION }� FOR VARIANCE ❑YES 54 NO PRO RTY OWNER P TY LOCATION P O Y OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME I Y,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK ( ��� ❑ VILLAGE: \� C !/ II. TYPE OF BUILDING OR USE SERVED: ��// Number of Bedrooms if 1 or 2 Family / OR tN Public(Specify): M6//,/e w 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. 9 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 ernative C. V Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound P In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minute per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): ttwl_1 /e lIf 27 z ovo �fIQ Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Pref.b. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank El I Lift Pump Tank/Siphon Chamber ❑ ❑ FH VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) M /MPRSW Business Phone Number:&," 1 ( lR-C,s A dress( eet,City,State,Zi o Name of Designe - 7 , i. 7Z r o C VIII. SOIL TEST INFORMATION Cer'fled Soil Tester(CST)Name CST## +r`Q-s Sac g 2 ST' DDRESS(Street,City,State,Zip Code) Phone Number: Z �^ ss Z _a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial .�� Surcharge Fee /� Adverse Determination �� 61 ej.,",2 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 H z H a STC - 105 r" r a SEPTIC TANK MAINTENANCE AGREEMENT rH-� St . Croix County z d a OWNER/BUYER L rnt 1n,, � h-c y T2Yr—t [=1 ROUTE/BOX NUMBER_ tip- $ Fire Number CITY/STATE 57— r'a Y1-� r� ZIP 5-/ of PROPERTY LOCATION : 'YA& 14, Section, T_ 3 I N , R _W, Town ofsTd;r 9i-a.i , St . Croix County , Subdivision Lot number 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 of 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 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 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-site 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 three year expiration . 0 E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth , herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30�days of the three year expiration date . r. SICNEDX DATE Z 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 . � r o 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 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 Location of Property gection / ' T L -� _N-R I L W Township �k11A, Y, Mailing Address Q q U04 JK- Address of Site ID r� A a X 7 Subdivision Name D C1 r Lot Number Previous Owner of property ) e.� Total Size of Parcel b Date Parcel was Created Are all corners and lot lines identifiable? _ZfN Yea No Is this property being developed for resale (spec house) ? Yes -- No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Wartant�►Deed which includes a Document number, volume_ a_and page n_ umber, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be ielpful so as to avoid delays of the reviewing process. If the deed description refer- Mae to-a-Certified-Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION Ce�6y that of a m (44ment�s on .th,i�s olt.m ate tAue to the best o6 my (-a") edge; that i lure 1 am (-u�.p.) .Ui¢ ow ration 60", by viAtue o a ti the nnopy de�sc&i.bed in thiA RegiAteA 06 Deeds ass Doc eh b o eht ument No. eeonded in the 066ice o6 the 00posed 6jt to Oft the sewage di-spo�5 b s em (andl.tha,t I (We) phe.aentty t. to nun with the above deJsch.i.b¢d no �, (we) have obtained an and the name has been duty neconded to the,066.tceh06ct{e CountynReg.e,6teh o6 b Do,�wne►t.t No. 1 . adid A OWN SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED Swe of Wi awwn sow" of SL Croix I hweby ox*dx* this instrument b a fug, tM and aired copy of the docun>«tt on file OW of record in my office and ha: been compared by me. attest Mir_ 16 James O'Connell lames O' Carrell Register of Deeds 40'L Deputy 1� 11 Leroy G. Jansky, PSC Wisconsin Department of Ind > > INSPECTION Labor and Human Relation 2 13 East Spruce Street Safety&Buildings Divisio c REPORT Chippewa Falls, WI 54729 Bureau of Building Water ms �C �/� (715) 7Zti-2544 C ,EQ Inspection Date Anril 1.1--icicia 1 1 l? Name of Premises r 2��o �h, A ass rfl� al Description 1"/Township County Wall Street Vi NG4CV /c N`E;;` 14, 31 , 18W Star Prairie St Croix C. Master Plumber Name and Addre Master Plumber Firm Name and Address Plan I.D.No. � �� NA - John P. Sykora III Sanitary Permit No. Route 2, Box 75 Rlnnm r WT R&794 Journeyman Plumber/Soil Tester Licensed Person's Name(s)and License Number(s) PRESENT: J. Thompson, J. Neumeier, G. Dean, Owner's Name and Address T. Weeks, T. Otteson, and Karen ? Tom Otteson DDFR: 18100 gpd 4504 White Bear Pkwy White Rear lake, MN 55110 Mobile Home Park E Qnsite ,consultation at the request of the owner to discuss the operation, maintenance, and required reporting ,procedure for the private sewage system serving the park. Explained the operation of the system to the owner and new opator the Dean). We also discussed the types of reports 'to,be submitted to the hedule of r submitting such reports. The run time meter 'on the pump control panel has 'been replaced and . now appears to; be operational . The department should now expect timely and meaningful reports for the operation 'of this System ' Even though some of the `reports for the last half of 19911may be a little sketchy, I recommend their acceptance by the department. Future reports must,be submitted in a timely manneriand m9St A hgluoe All reportable parameters. Recomme'ndations ,include updating existing septic Aapk manhole covers with approved locking types that are at least 4 inches above finished grade. In addition, several valves should be replaced because of broken handles.- The hydrosplitter manifolds and related piping should be Checked for leaks when weather conditions are warmer and again during colder weather. i a ' _i will `be ;available- to assist the�new operator during the new pump calibration in June 1992. ;The operator should contact me 2-3 weeks in advance to schedule an appointment. If there are any other questions 'regarding this report or the status of the system operation Or maintenance, pleasi contact this inspector{ i 1 r E i r ` i x E E.. E F ' ige Of Signature of Responsible Licensed Person(only one needed) Si re of Plumbing C ul rivate Sewage Consultant /Check all Original: CO les to: \that apply ^11/9o) District XILHR E)Plumber Ane �10�cal �Oth 59.5 D CYS Wisconsin Department of Industry, INSPECTION Labor and Human Relations Leroy G. Jansky, PSC Safety&Buildings Division REPORT 13 East Spruce Stree t t Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 726-2544 July 16, 1991 Name of Premises Address or Legal Description elly/Township County Wall Street Village NE, SE, 14, 31 , 18W Star Prairie St. Croix Mobile Home Park Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. John P. Sykora III NA -04904 Route 2, Box 75 Sanitary Permit No. Bloomer, WI 54724 Journeyman Plumber/Soil Tester Licensed Person's Name(s)and License Number(s) NA PRESENT,:_-m_S - .Howie,, T�Nelon,__J. -lyeumeier Owner's Name and Address _ Terry Myhre DDFR: 18100 gpd 289_E:.-5th Street__. St. Paul , MN 55101 USE: Mobile Home Park i i A C�hSi a on ul at on and i1sp, ctijon to, assist the owner And park manager in preparing h ' m a Ty. n -s n al re r-s_req 1 i reed--6nd' r_the approval f dr-the-p ri vat' -Sew e�"y a -T .e lroi eratttndandumaintrare calibrated,; and cells _ p ,--rota ed -- n_ dd .ding depths of all trenches w _ t-i- n_ we -di 3cu se- t�1e�den -ral �na ce aspectsf they s st m. Item -n a --d r-i.' -h4' i sp et one thpt fee tp bb rapati red-or-m i ntai ed -include the _, ; fllwig: I er- f vic --a -1- epic ta' ks an" the_ pump..station. X11 sludge and ScuT must' bet remov d from g ad a d-- pp o1/ oc fin m nh le co er i st 11 d. A 1 abovou�rade1r _l.e- t 4 inch as t e an s. The own rs sh ul h 1/e al sept c an m nh .las br ¢LVe __- _ __ _ .- , mu t be I e rade overs p d, _ _ 'ad . rm>; a d my rey 1 o s -- 2 e1/ ra o serve i � _ -� - � pe n re a n�tel o the monthl f� . I ._... t .. L _-v Iv s .n... he .h -fro pl, tt8_. _p ox�ma�ey 1 v lv rs ho'tdlea tuthr se al es will exactllr r6pl celseveral pro en are-,broken;- an --seve al spare e-s oud a was eon Flancl. In edit on ther are e1/ ra small 1 ak in the, in'h iip ng G-c- h ct�-d- o h-e pr ss re m _ ._. _m ! a i i•a l d f he l e ks ne d o 'be rep}i red �s ooil a! ss bl ' d fa 1;i 1_6._,_X t se 1/e em nnho Td Ce co to -te tt nd tef mine wthehpr blma nd r-eitobe airte __n om on -- This_ ho9ld be do e s oo ai possible b ca se ac urate re di gs c nn t e ad and 11 affe t the by ra li load ng calculation, r u r-e _prs,�an t the_ a pr Via Ah f r a prole t.i. . I q I all he re ui ed monthly end ;semiannual Information is_r ecgiv d the ode ar me:t _etc_ �. b fcs e� Ug st �; Y}e wrier it h 1/e co pl ed with he co di io s of ur ap ro al The next Oadljine f r subryissio6 of monthly an semiannual in ormati on is Janua.IT ! _. g di g--- hi --r po t-ir--pleas c nt Ct me. �_t -- - Page ' of I Signature of Responsible Licensed Person(only one needed) sig atu f Plumbing Co ulta ivate Sewage Consultant CO leS to: Check all �C Original: p thatapply SM192(R.11/85) District ®DILHR 0 Plumber (9 Ovar R Co /Local InsV9 otq A6. - be WALL STREET VILLAGE MOBILE HOME PARK PLAN I.D. : 87-04904 MONTHLY MONITORING REPORT SHEET Page 1 Date of Report July 16, 1991 Report Prepared By: Leroy G Jansky Cell No. 1 Cell No. 2 Water Depths Water Depths Header End Header End Trench 1 moist = m dry = d Trench 1 9,5" d Trench 2 d d Trench 2 9,5" d Trench 3 d d Trench 3 7,0" d Trench 4 d Trench 4 8,011 d Trench 5 d d Trench 5 $, n d Trench 6 d d Trench 6 7.5111 m Cell No. 3 Cell No. 4 IF Water Depth Water Depths Header -'E nd Header End Trench 1 3,5" m d Trench 1 5,0" d Trench 2 5.5" 3.0" d Trench 2 5.0" d Trench 3 7,5" 2,5n d Trench 3 10.0" d Trench 4 6.5" 3.0" d Trench 4 5.0" d Trench 5 6,0" 2.0" d Trench 5 7,5" d Trench 6 4.0" m d Trench 6 3.3" d Cell No. 5 Cell No. 6 Water Depths Water Depths W nmadw E We W Headm E Trench 1 d d Trench 1 d Id Trench 2 d d Trench 2 d Trench 3 d d Trench 3 d Trench 4 d d Trench 4 d Trench 5 d d Trench 5 d, d Trench 6 d d Trench 6 0.311 d Note: Minor repairs needed on observation pipes cell 2 trench 4 & 6. WAIF, STREET VILLAGE MOBILE HOME PARK PLAN I.D. : 87-04904 PUMP CALIBRATION FORM Date of Calibration: YZ16Z91 Calibrations Performed by jr To Calibrate Pump No. 1: Measure and record the initial water depth in the lift station: Initial Water Depth = 82!75 inches simultaneously, start the stop watch and Lift Pump No. 1 Pump water for approximately 10 minutes. Stop watch and turn off pump simultaneously. Measure the final water depth: Final Water Depth = 66.25 inches Elapsed pumping time = 10.0 minutes Calculate the pumping rate of Pump No. 1: Volume of Water Pumped = (Initial Water Depth - Final Water Depth) X 54.26 gal/inch Volume of Water Pumped = 895•�9 gallons Average Pumping Rate (gpm) Volume of water pumped (gall for Pump No. 1 Elapsed pumping time (in minutes) Average Pumping Rate (gpm) = 89.53 gpm for Pump No. 1 To Calibrate Pump No. 2: Measure and record the initial water depth in the lift station: Initial Water Depth = 94.13 inches Simultaneously, start the stop watch and Lift Pump No. 2 Pump water for approximately 10 minutes. Stop watch and turn off pump simultaneously. Measure the final water depth: Final Water Depth = 75.75 inches Elapsed pumping time = 10 minutes Calculate the pumping rate of Pump No. 2: Volume of Water Pumped = (Initial Water Depth - Final Water Depth) X 54.26 gal/inch Volume of Water Pumped = 997.30 gallons Average Pumping Rate (gpm) = Volume of water pumped (cal)_ for Pump No. 2 Elapsed pumping time (in tes) Average Pumping Rate (gpm) = 99.73 gpm for Pump No. 2 The results of the pump calibration efforts are to be used to calculate the hydraulic loadings on the Monthly Monitoring Forms WALL S'TREE'T' VILLAGE MOBILE HOME PARK PLAN I.D. : 87-04904 MONTHLY MONITORING REPORT SHEET Page 2 Date of Report Tu1V 16. 1991 — Report Prepared By:_ LerOV G Jansky Hydraulic Loadings to Cells 1, 2, and 3: Lift Pump No. 1 Pumping Rate of Pump 89.53 gpm Current Hour Meter Reading 699.3 Last jtQntkWMeter Reading 952.0 L12/19/89) Hours pump has operated _ 1±7.3 _ 574 days Hydraulic Loading to Each Cell (Assuming two Cells on Line) Hydraulic Loading = hours Pump 0 perated 2 Pumping Rate X 60 (147.3)(89.53)(60) 689.25 each pa to Cells Hydraulic Loading = _ 2, and 3 d s sine 5, and 6: Hydraulic Loadings to Cells 4, Lift Pump No. 2 Pumping Rate,•of ' ` Current Hour Meter Readinq �Y Last 18=J= Meter Reading Hours pump has operates X53 xy� Hydraulic Loading to Each Cell (Assuming two}Cel (535.1)(99:73)(60) t jk ax.•br c Hydraulic Loading a °2389. 4 Pd to Cell ' oar.t, s" and 6,.t�` days since last r NOTESi .' Cells 1 & 2 are ON; Cell 3 OFF. Cells 4 & 5 are ON; Cell 6 OFF. ' Y Repairs needed to several valves in each hydrosplitter, and there are several minor leaks that must be fixed on the hydro splitter piping. The run time meter needs to be replaced. or repaired. since it obviously is not recording the proper time interval. t a L l TyJb ri.d 1 .a * a py�t Yak'•¢. _ .. - ._ .- ..___ ....,.......,..,..»........••....o.c,.rrrrYrr.ir..e.wwM.a.n...«-^ • Master Plumber Firm Name and Address ■ I■■ ■■■E■■ ■ ■■■■■ 0 ■■■■■ ■ ■■ 15, ■�04'■r � !■MI-■WI■■IMr�rMeI-�MI rI U■ Now M�`sssaomo ■■■■/i°i■M■■■■■r■■■fiME ■■■■ ■■■■ MOMMIN Rom 00, IMMINOMMEEMEM■■■�■■■■ ■■■■ !M■M■ ■■■■■■■■■■■■■■■■■■M■ ■■■■■■■■■■ ■■ ��al ,�!!!�1,�!1i�::�OVIA 11!JIC�!OW , !�! M�%AM ■ ,I -..,� ,. ; ! ■ ■ ■ MM • Description Master Plumber Firm Name and Address • • .I IL.%ri.f. �r'ur _ a.� r::'rt7 %7asG7I/ .Wrl no WAPNER"" r"RE ■MMMMM ■MMMMwMMMMMM■r■MM■ ■MSMM■ 1111111101firruffir, .■..M■■■■■. ■■■.■.■■. 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ME Ili'( ■■�G�r�l��l�,�ll�l ill:'�'7��!��1�1�l.'�.,!.��1,��!�l��'����'�i■ NOUN KEENE Mormon ■ No■IMMEMM MMMMMMMMMNM ■■ ■■e Is. "WA-92013 900,01,116SWER40"I.M no 0 ■■M■■■t/ ■■■ill.!�I��/�I1�1��.��.I!!''!�!����■�`c�!�1��-'_�1�'1!�1�■■■ ■■rM■■■■■�■■■ ■■■�■■■■■■ ■�■IRY / /-;11.�!�� 1PAW-F WERn" Row"Ro!! N ■■ VA "RA Boom ■■■1,�1�IIIA�'�.��1,�!J1�!� �.�G�R�1/'�'-���i!'.�!�!��1�11�J1'J�1� 11 i Master Plumber Firm Name and Address e M gnomon 81 "FRE on go 0 0 MEEMMMME w• ■ ■■E ■NOMEN9 ■ ■EM■MMM■ ■■ INMEN .apow !!�■ loom NMI ► ■ ■■"■o■�.�ME ■■O■NM■M■■■O■■■■ ME■■■■■■WNHMM ■NNEWOMME■■■E■■■■■■■■■M■■■■■■M ■NOM ■■■■EM■M■N■ ■■■■■■ ■IN■■■MM ■■■■■■■■M■■ ■■OMEN ■ t■■M rAOX ■rim■omM■■■ MME■M■M■�cAM EM■■■■■■ NONE N■■M■■■■E■EN■E■ ■■OMEN ■■■■ ■M■■■■■■■■■■■N mom MM ■ NJ■M■■E■ ■EM■E■■■■■M■■■mom E� ■■ ■ M■■E■N EN■■■■mom E■mom ■ ■ ■ ■ ■■■■ ■ N■■■■■■■N ■ ■ MNMMM■E MEN on•p 1 State of Wisconsin \ DEPARTMENT OF NATURAL RESOURCES Carroll D. Besadny r Secretary y BOX 7921 -r MADISON,WISCONSIN 53707 July 29, 1986 A ' ? ' 'T� REPLY REFER T0: 3420 Mr. Terry Myhre �rF 236 E. 5th Street St. Paul , MN 55101 RE: Wallstreet Mobile Home Park Dear Mr. Myhre: Enclosed is your copy of the mid-course review report for the Wallstreet Mobile Home Park. You will note that the report concludes that a replacement drainage field system is likely to prove cost-effective. As a result of this mid-course review report, EPA will make a preliminary decision on whether an Environmental Impact Statement will be prepared for the project. The report also serves as a useful record of topics discussed at the meeting. If you have any questions about this report, please feel free to call me at 608/267-7632. 'Sincerely, RussellW. Pope Municipal WastewaterfSection Bureau of, Wastewater Management RWP:jk/7681A Enc. rIk cc: Bill Block - Melchert & Block Issociation Jerry Chasteen - W.C.W.R.P.C. `::�, Harold Barber - Zoning Administrator Joan Ross - DNR, Eau Claire Connie Johnson - Wall Stree M.H.P. WALL STREET MOBILE HOME PARK MID-COURSE REPORT Project/applicant: Wastewater Treatment Cost Effectiveness Analysis/Wall Street Mobile Home Park County: St. Croix 208 Basin: St. Croix River Consultant: Melchert - Block Assoc. , Inc. 367 E. Kellogg St. Paul , MN 55101 Project Engineer: Bill Block (612) 228-9564 Date/Place of Meeting: 6-27-86/Wall Street M.H.P. Report Prepared By: Wisconsin Department of Natural Resources 101 S. Webster St. , GEF II Madison, WI 53702 (608) 267-7632 Background Information: The Wall Street Mobile Home Park is located in the northwestern corner of St. Croix County in west-central Wisconsin (figure 1 ) . The Park consists of 67 mobile home units . There are Approximately 200 residents. The Park is located between New Richmond and Star Prairie on C.T.H. "C" . Land immediately surrounding the park is devoted to agricultural production (figure 2) . The Apple River, a popular recreational stream used in some areas for tubing is located approximately 112 mile west of the Park. The River at this point and to the north is classified by Wisconsin as class II trout waters . In addition to supporting brown trout, the river supports a broad range of fish including walleyes , rock bass , black and brown bullheads, carp, white suckers, muskellunge, northern pike, perch, largemouth and smallmouth bass , bluegills, black crappies, pumpkinseeds , burbot and rainbow trout. Residents of the mobile home park are provided with water and sewer services. Wastewaters are currently directed to septic-tank-drainage field systems. In response to the failure of two of the existing three drainage bed systems wastewaters are being hauled by a certified pumper for disposal . A surcharge levied against residents has proven very controversial . Project Need: Failure of the drainage bed systems has resulted in orders from the County Sanitarian. As a temporary measure the septic tanks are being pumped regularly by certified hauler. The septic tanks are in essence functioning as holding tanks . . -' �•�r•��f�y`"7 It ► � !rl!�l"' '� V f � /f� \' J'/t' � I •1 ) ` �1 '� '1 � �O -`� i �'p1;l� `� \. 91y f t -\�''1iJ \ ) � ' 1 Lr 'q•I. ,�� f� � � r I r '1!�' /•� 1 t� ( ` / t ) / •Star Pra I 1 \I° j f , I 1 f )r J• _111 ( 1 1 0� `°° i f 1 ' sill ' t►rS$ton,`' egg � ) ntrovd Pit _ !°r5 wl10 '� r r r ) r r l a�i J , �9lA I •, 1 j �. I ui I 9S8 t gY.Gravel Pit i -i14 r 1` , { f113 -Tiaiier { k .- ,• /ti J k �i � t I 1 J i / O ,✓i �' ,{ CC _ 1003 ---'� (4 P" .., J "• 975 ..� T-*-- I �-y -T 99b Gravel i •%,t 1 1 i - .9 O �il I � ,, i' ) 11i \� l_ _ter t r I" __-- (• ���•-- �• _ _ _ ,` N % e9s Stra d l La e '` '"�C �'" 4_ 124 098 �• 978� (�,� f\ f 1)r E{ r �' ( l000 � _ tom.._y� .:�✓% ��' � s, '�� .�.-.Y fi 1.i, ,+�F"� N,�1����.:2 4�..0{!.=1 . •��' �' �.t ..`w. y ,a p{ i i r• r2 :4 r} .y'J 1p.:��+i.'wvP i p� � � � �, .��•K'�. � a I. H ' a� Gaya" o} �tY ��: � � ,t y .> _ s' i�. � � -w < ,++•Y � r � ,F w3Y�... �:>� ,+..- -s •� °� .����•, i' fir. s \>- � y °'�+t� c, 4. :3�� 44 ig - F " t �y+'w"{♦+,� .�,tl�F :,}� t,$,J, � T ! ? � 'i C « _^ '�_ '. ..ra:,..1. .,gig �,� +�a _ ,�'� .- '; •...,fir _ :rr— CIS�6r E a F J�. r���. pig.•/ + L� ' + -' �� � �� ��-g� �ire ,;' tt ' -�'..�.. ���� ,� his' mss• 3�"�i� v.� :S r:�. 3 � }.,aL._rt t'rr�,x, ♦' ,1�� �'+xa.S. �. -yr• S I. 1� �ti -2- Progress To Date: The consultant has reviewed plans for the existing drainage field systems and has gathered information on various treatment options. Treatment Options: The consultant will evaluate joint treatment with Star Prairie, construction of replacement drainage fields or mounds, and construction of a stabilization lagoon system with the discharge of treated effluent to a seepage lagoon system or to the Apple River. Resource and Policy Issues: The most promising option would appear to be construction of a drainage field or fields . The consultant plans to have soils studies conducted by a Minneapolis soils testing firm. The consultant was advised to closely coordinate such work with the County Sanitarian and DIHLR representatives. The presence of representatives from the county and possibly State DIHLR office was strongly advised. The consultant was advised the DNR would be involved in a joint review of the project if design flows exceeded 8,000 gpd. Residents of the trailer court expressed considerable concern that they were not being informed of the actions of the owner and that progress seemed extremely slow. The consultant and owner' s representative were urged to keep residents informed of actions on this project through the mailing of news letters or through informational meetings . While no issues were identified which would require the preparation of an environmental impact statement, it was obvious that residents of the trailer court do not feel that the owner has kept them adequately informed. The surcharge levied to offset costs of hauling wastewaters has proven a financial burden and is resented. Prompt correction of the existing situation is essential . Finally it will be necessary for the consultant to supply the DNR with evidence of public ownership if and when a facility plan is submitted for review. ATE OF-WISCONSIN INSTRUCTIONS TO SENDER: (3 YrV PLY MESSAGE REMOVE YELLOW COPY FOR YOUR FILE. P SEND REMAINDER OF FORM INTACT WITH CARBONS TO PERSON ADDRESSED. ) L ME AD-16 _ L. �. FROM: JOHN R GRUMP LGro�•/ -J w•ws k� �� �• DEPT OF NATURAL RESOURCES /3 mac, 5toe"cc - 57rY`c 2004 HIGHLAND AVE S47 EAU CLAIRE WI 54701.4346 i JBJECT-MESSAGE y - wwK C4 6aw-rc dw-c` te Say hoc- a �•� i SIGNED DATE EPLY 1 I SIGNED DATE r" /r. +�•, Aj1. w �� v cn D z -<O s t0 DO D Q O �o m IX��IX11II <n v -Di x m m D ..u�= m �(� 00 7C O d z r Dn Oc I-� r CD �m c m r n1 -�j O-'cm r I D� { N "� D c c^cn OD > O m 0 N �D N G c z Z zDin Z� Z m z < �I nD �� 3 0 m m m� �cn cnT 1 � 0 T z Ord z ro ; z zi Zy rr� I 'gym D T D O O z r� mC m s =� T -i cn D- D O z -1 z fn x l �' �- m C OD D z z n m cn m m m r1m h� mr , x tTn y D`, rj O m N p ; C10 Z m m °m Do� m0 g° y U 1 - 4 TJ = In On 4N Mm 1 r �.y� Z �\ 3 A �I�. m D C , ? � C. m I \\\ o m m m m T ; z m +� m m CD 0 -4 Z> < w O T n m 3 .A. n D D rZ M 0 0 -0 -0 .4 K j � ` 0) c 0 0 -T m ry �'0 �7mD r0 Z m m m n� a � . 0 z 7D0 T T c c m Qx Z d z z zr C M -m1 O O 70 3 80 m Z 1Tl O QI a O m -i m -%1 --j Z 3 o r C+� m n n v -� M < Cy ,M m m m p- m w rt1 F-+ C O —I my ° zr a A m y C7 o IT m x x \ �� N CT1 m z m -4 N x r G� cn In 0 -n r4 >00M cn IC Q1 za C?1 Ov O0 ci CZ)OV(nm 1 111.,4 N Cia w 0 fn O D r vJ C to p m D T t a m mKZ I O D z0 O� r- 'D n O O D ,D �� =mO Drr r r- D DN2 m �m m 7o z n Zi 0m v �m rte, n 9 0 mm D p. 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TEST IFIE;. 07/28/89 16: 15 P.02 . O-4 r -o �, N Oy , .mm _Di C n C n Z C O yf . r7:)JI �ii Y .tTl = fTl � � m mm m D O .0 M z — z.m Om �n r �-. �`''02•,-:0.. f•'• Z.:7 AA cntn x m -o N -4 � > m '� m o� > � � l ,�„yy rn c�•: zDN I z� ,� z m Z { 7p ;) 0D �� O m x { O T .fY �r�r 2n S'3 m W T y O O Or m m '—"� Ym y Z O I J . di to 3 'C I m c z m , N RI oo z 4 0_ Q r V m w N � m T m z N t 7p O N Q x m 9 tl _ C Z i rl M. m T m ml v m ;• m f G G D O �-. O �) N A! r r X Z-� m t;1 u+rn f i C�-� Z D m 00 0 r'n H> �� 0 z N m m QZ Z.i i. •�C Z04 z O r '' c c —0 m `~ r- �r 0 M R. C 00 Ln M to Jmo J >0 ° ow -0 00 I 5. 4 m z r 0 cmn A �'+ n 'Q D Z N � Z�mN > ,. I W410 _ -� m o m i I u N o C, NM ; �0 .. N D t!1 m c m{ v m m ` `� 00�j r I t � Lvw ••N_ -JVa IM T-1 :A ivi ............ . ............................. 0 IS c: f cz J .1 j (M.-v .......... 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SEWER BACKUP PROBLIY','�.3 December r..: 1987 Page 2 The past two years 1 have had to un-plug my home actually backs up into our home plumbing SyEtef. and even to the point of twice at the draiR level out of the bathtub. Each time we have had to clean and sanitize, at ,, ,, expense, for problems that are noi.. of oui, making or control , i .e. I have had to use pressure canisters to clear th-t�? system,, Since Terry Myhre purchased the mobile home court in 1985, our lot rent has almost doubled from $95.00 monthly to $155, 00 monthly. 1 realize there isn 't ,,, cap on rental increases for mobile home parka, but surely there must be justice or help available when a renter is never late with rent , keeps the premises neat and orderly and obeys all the park regulations, yet does not ge-t-. the basics for which lot rent is being paid. The particular sewer line problem 1 have has nothing to do with the problems incurred by the main septic system, which is now finally in the process of beingl- corrected. The new system Mill, not take care of the stoppage and backup oroblems on the line to is connected to nor will it cap the end- of-the-line pipe that Can spew raw sewage under our home. 1 am saistance you can, pro-Ow".. in this matter. Sincerely, Walter R. Freiermuth Route 2, New Richmond , W! 5401".*.';' (715) 248-358f:) CCI Helene Nelson , Deputy Secretary of Agriculture Elmo Smyth , 1113B - Mobile Home Park RegulatiOniii-, Leroy jansky , Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson , Zoning Administrator - St. Croix CountV k,r.y u-4ntz , Chairman - Star Prairie Township Wall Street Mobile Home Park Assoc i ati on Terry Myhre, Owner Fil- Wisconsin Department of Industry, INSPECTION Labor and Human Relations REPORT Safety&Buildings Division Bureau of Plumbing Inspection Date / �f I fit, Name of Premise6 Addresser Legal Description G##-Township County Val A!-t. T;ZF VT JA U.61 Q=_ Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. (Y-4 �)La Sanitary Permit No. Journeyman Plumber/Soil Tester Licensed Person's Name(s)and License Number(s) Owner's Name and Address X ���.uL M t�J !-5 I o I E F A . 2.,.- s'" i ♦ _ '- i �. ff Page--Lof Signature of Responsible Licensed Person(only one needed) Signatu�of Plumbing Co tant/Privati�Sewa7Consultant /(Check all Original: Copiesto: %tnatapply/ , ,.r �, 2� SBC-8192(R.11/85) District N�ILHR O Plumber 0 Owna'r ,,CRC our{ty/Local Insp.:-© Other M Description . s a ► • • Master Plumber Firm Name and Aiddrew Licensed Person's Namel and License Number(s) r • r•.r„#������r�l :I+•. .:/ir�"...... .aIL/rt .r_. w..� .-I. - .w�� ��`�.a�����!%����� �� r i .!.// I!r E I . erf:. r/ •_ /_.! .:tea''/ ,w �_:. ,� j � r = - _ _ .• • WAT.'- �a. r •_ire/ ®,. May 20, 1988 L)1 LHR F'rivate Sewage Section 13 East Spruce Street•. Chippewa Falls, WI 5479 1 _715-7'. 3 F3'786.) Myhre Investments Mr. Terry rlyhre ` . 236 East 5th Street r1 St.. F'aUl , NIN 5 ,1ol r f Dear Mr-. Iylyhre. �:,per;�: ,• Fy�ryu Wall Street Village I"lF lP NE, :1E, 14, :: 1 , 1£3W Town of Star- F-'rair••ie„ St. (*.:rr-)i:c County, WI 01*'1 May 1Ea, vi psi.t:ecl tl°rt! above- r"fi?ter (r?nc::ec:I =ai to to determine if the newly i n`_it.isl l f:d pri vi.-ate sewage <_;yS •:, s f Ul l y Oper'isti Ona1 . At the s-i te„ 1 w a i n f orined by y0Ur'- p:L umber , ,:Jo1--in SyE:ora, thicat pump number 2*1 Was not yet on--:Line as the plans call for, but everything was ready to go. Considering that t1le syt tem WRS actually put into operati on this last January, wi tl-i only of the 4 cells operating, we felt it necessary -to turn on one additional cell to prevent overloading of the system. Actually, this should have been done several months ago when the forcemain was unthawed. As of this date, cell numbers 2, 3, A., and 5 are on---line and ceU -,# stand b are It is now time to complete - he project as approved by the calibration Of pump number- ^ and pressure testing of h•iydrosplitter number 2. In addition, pump and hydrospl i t ter- number 1 should also be looked at again. These item, were part of the Planning and Design Documents that were approved by the department and thus their completion. is recaui red. Moreover, there were s:i gni f i cant pl an changes made cluri ng the construction phase which dictates that an as---built plan be submitted to the department prior- -to final approval of system operation. I can see no reason to delay final system, calibration or any other aspects of final approval. . YOU should be prepared to submit the first semiannual report and groUndwater quality analysis by July 1 , 1988- Please be' advised -that in accordance with ILHR 133. 0b (S) , Wis. Adm. Code, this system can not be accepted for use until all. calibrations and as-built plans are complete. All work: must be clone by June '17, 1988. If you have any gUestions regarding this matter, please contact me. Sincerely, L.e r�c-.)V C',. , ansk: Private Sewage Consultant cc: Dave Fussell - DILHR St. Croix County Zoning Ayres Associates -- Madison SAFETY&BUILDINGS DIVISION 201 E.Washington Avenue P.O.Box 7969 Madison,Wisconsin 53707 State of Wisconsin Department of Industry,Labor and Human Relations March 16, 1992 TOM OTTESON 4504 WHITE BEAR PARKWAY SUITE 2000 WHITE BEAR LAKE WI 55110 ') Plan Identification No. �o Dear Mr. Otteson: Re: Wall Street Mobile Home Park, NE,SE,14,31 ,18W, Town of Star Prairie, Saint Croix County Groundwater Monitoring This is to acknowledge that we have received a portion of the required groundwater monitoring. Still needed are: 1 . Daily wastewater flows based on monthly readings 2. Monthly ponding levels 3. Monthly groundwater elevations 4. Annual system rotation 5. Periodic calibration These readings are required to be submitted with the groundwater quality analyses and are required to meet the conditions of approval of this experimental system. Thank you for your continued cooperation. Sincerely, David Russell , P.E. , Environmental Engineer Private Sewage Section Bureau of Building Water Systems (608) 267-3605 DR:0046n cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - ,U-.—Croix County--,, SBD•55M(R.0"I r D.I.L.H.R. Wisconsin Department of Industry, INSPECTION Leroy Jansky, P.S.C. Labor and Human Relations 13 E. $ ruce Street Safety&Buildings ivision REPORT Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 723-$786 ..�AL. Name of Premises Addres&w Legal Description Gilt'/Township County Poo( Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. Sanitary Permit No. Licensed Person's Name(s)and License Number(s) Owner's Name and Address 1'9Y� f' v T T Z E i)A.A WIP,E; 'T4t " T Fa T k.Fv I 04s. Plpr�, T `5 i_� t' T J tJ:P C tl. + 1 , i� i:�Ry T"IW c�fi "I +t .. a 'Oh T5C ,)R•S T � r f' ;I 19gp E Page of Z"' Signature of Responsible Licensed Person(only one needed) Check Signature of Plumbing ConSU). UPrivate Sewage Consultant Copies to: that apply ,'t"! Original: ,- SBD-6192(R.11/85) District R b l-HR O Plumber D OVllner �'C my/Locat lnsp QO r l�f l�l::S � D/�J C 1U, /A-u OA%)Fr ko5,,C L I D.I.L.H.R. Wisconsin Department of Industry, INSPECTION Leroy Jansky, P.S.C. Labor and Human Relations 13 E. Spruce Street Safety&Buildings 9 ivision REPORT Chippewa Falls, WI 54729 Bureau of Plumbing Inspection Date (715) 723-8786 Name of Premises Addresser.Legal Description 60YOTownship County V1LlflC tsll(� t.}t - Vii: f`! • 'it - l ��tii 2>IA j^ 21A 1JZ! Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. Sanitary Permit No. J01AFROY aw r E:,N+ Licensed Person's Name(s)and License Number(s) Owner's Name and Address 1 VJ 1>P-.q TA Uj OP-1 T 4 uj t) :1y/l::.t a. 7 !. }.� _, f`_ l7-•,N11 ! �-r �y {t') fad { " " 1 UM OA t=- ctc� r, t,�+til GrJ A Tom_. t-{-'ir�t .�°2 -T' !�l�C�s�) �►�ixravf�yts ^j F Page Z_ of Z.-" Signature of Responsible Licensed Person(only one needed) Check all 1 Sign at of Plumbing Consulta vate Se wa a Consultant Original: Copies to: `that apply/ - SBD-6192(R.11/85) District 5VILHR 0Plumber E Wfler i Cotivlty/LocalIQ0W C�--Othgf Aq�— . T-0 AIRES RECEIVED RECEwEO ASSOCIATES DEC 13 1989 -°� SAFETY&8LDGS.DIV. December 12, 1989 „�'� ` t..` . �e- Mr. David Russell Department of Industry, Labor, and Human Relations Safety and Buildings Division 201 East Washington Avenue P.O. Box 7929 Madison, WI 53707 RE: Wall Street Mobile Home Park - Plan Identification No. 87-04904 Dear Dave: Per our discussion yesterday, Ayres Associates is once again providing engineering services to Myhre Investments for the Wall Street Mobile Home Park in New Richmond, WI. Our intent to re-start the project about where we left off. Per the November 20, 1987 approval letter, this would be item 11, providing a set of "as-builts" for the system. We have prepared the following list of tasks which we anticipate to begin on December 18, 1989. 1. Calibrate the two lift pumps and the two hydrosplitters. 2. Evaluate the impact the current effluent loading scheme has had on the system function. 3. Establish an appropriate infiltration cell sequencing to maximize system operation. 4. Determine system modifications made during construction°for the development of "As-built" drawings. 5. Prepare an Operations and Maintenance Manual for the system which is required for proper system operations. 6. Collect and analyze the required ground water samples and report the results to DILHR. Following the completion of the above tasks, we will prepare a interim status report and submit it along with the as-built drawings. We have indicated to Myhre Investments that a second calibration of the pumps and hydrosplitters would be necessary within six to eight months. Additionally, it is necessary that the operator monitor the ponding levels Owen Ayres 8 Associates Inc Engineers I Photogrammetrists I Architecls I Surveyors 2445 Darwin Rd., Madison, WI 53704. (608)249.0471 a Mr. David Russell December 12, 1989 Page 2 monthly during this period. After the second calibration procedure has been completed and the results of the ponding levels have been evaluated, a final report will be submitted to DILHR with the test results. Per your request, upon arriving at the site, we will monitor the flow from each hydrosplitter in the condition they are currently in. If lines in the hydrosplitter are plugged, we will measure the flow leaving the line plugged and report the flow results. After cleaning any plugged lines, we will once again calibrate each hydrosplitter and report the flow results. If you should have any additional comments concerning this project, please feel free to contact us. Sincerely, Owen Ayres and Associates, Inc. 7 Daniel W. Conway, P.E. Project Manager cc: Steve Howie, Myhre Investments Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Human Wisconsin a INSPECTION Leroy Jansky P.S.C. Labor and Human n Relations ons Industry, 13 E. $ ruce Street Safety&Buildings Division REPORT p Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 723-8786 Name of Premises Add egal Description Gily/Township County "E f�# i r7-1(Z f f I Si- x Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. Sanitary Permit No. Licensed Person's Name(s)and License Number(s) Owner's Name and Address i c,4 l M r I !&S lot —1r-t E-1(, `'t p� /�=�''^� i"�-�rtr�.-G,-.t... _•L. ��`•�,/�st'G '.s<� �i•--�" �s�2-c�-c1'..u•1� .�.�+-� ,�'�',�% 4c-Q.. ' K ' ' 1 fs`,vC4i 1 %J xf A� 9 _ , 14- 4 F1�t�j t1 U - 2 _ 5 � 5 lL1LN�'T � .�� ` ' Z. ! ��rJC kl �• _ 'i�.,,..C i `f Y F =fit r".�v• I ���j � N -l� 1.�' '`�����-�( !tom .�•'��' rn-t.a �:./ c-� , ... YF `.�... 1�E"`' ,/ -u1-t. .�'.`1. �,ft' ,!�J �',` �.1./!...r-.'(.�- ►•�„r� GL+CQ.... .. t4 C_ 7t4 jjC ti alai Jf t .d A 9 ._.. y_ic. '"1'+�.•.r :4!^-�s'�y , .'..� ,✓'C,,`.:l1-•-- 0 � - '�,l/1'x ]+r 'FE l7.Lt..!_'C �'.,�.'/ 's'�yy�'�G?' °'7 • K .Q Page Of t Signature of Responsible Licensed Person(only one needed) Check all1 Si�n#Wre of Plumbing Con;af�ant/Priv to Sewage Consultant ( Original: Copiesto: `thatapply/ =�. Ps SBM192(R.11/85) District [%ILHR OPlumber Owner Q County/LocWInsp. NfOther 4+6 { WATER QUALITY SAMPLING WALL STREET-VILLAGE MOBILE HOME PARK NEW RICHMOND, WISCONSIN Date: August 9, 1991 Submitted to: Myhre Investments 289 East Fifth Street Market House Building Saint Paul, MN 55101 Submitted by: Henry F. Grote Certified Soil Testing Post Office Box 57 Knapp, WI 54749-0057 -� e r. �t c T ��Jf TABLE OF CONTENTS Page 1 Introduction 2 Objectives Description of Work 3 5 Results 8 Appendix i LIST OF TABLES Page Table 1. Measurements and Calculations 5 Table 2. Chemical Water Quality Analyses 6 Table 3. Bacteriological Water Quality Analyses ll 1 INTRODUCTION The Wall Street Village Mobile Home Park is located in the NE 1/4,SE 1/4,Section 14, Town 31 North, Range 18 West, Township of Star Prairie, St. Croix County, Wisconsin. A soil absorption system serving the park was approved November 20, 1987 as Department of Industry, Labor and Human Relations Plan ID No. 87-04904. A condition of plan approval was the periodic sampling of ground water via three ground-water monitoring wells for the purpose of assessing ground-water quality. On July 23, 1991, Henry F. Grote, Certified Soil Tester# 3065, and John R. Tinker, Certified Ground Water Professional # 264, sampled the three ground-water wells in accordance with NR 140 procedures. On July 24, 1991 samples were shipped to Enviroscan laboratory, Rothschild, Wisconsin, for analyses of chemical parameters. On July 24, 1991 samples were hand delivered to the Eau Claire City-County laboratory for analyses of the bacteriological parameters. This report is submitted in partial fulfillment of plan approval conditions. 2 OBJECTIVES The objectives of the work were: I. To obtain measurements of the depth to ground water relative to the tops of the ground-water monitoring wells; 2. To obtain ground-water samples in accordance with NR 140 and DILHR Plan ID # 87-04904; and 3. To obtain analytical results concerning the parameters of interest for ground-water quality. 3 DESCRIPTION OF WORK Depth to ground water was measured in each well using a Slope Indicator electronic tape measure graduated in 0.01 of a foot increments. The reference point for the measurements was the top of the PVC well pipe. No reference point was indicated on the top of the pipes which were not cut perfectly perpendicular to the long axis of the pipe. The north side of the top of the pipe was taken as the reference point. Standing water in the well pipes was removed by bailing three well volumes of water using a Timco four foot PVC bailer. Prior to introduction into the wells the PVC bailer was rinsed three times, inside and out, with distilled water. Following removal of standing water, a one gallon sample of formation water was obtained in one gallon plastic jugs which had formerly contained distilled water. The jugs were rinsed three times with distilled water and then rinsed three times with-formation water prior to sample acquisition. These samples were obtained for chemical analyses in sequence, and the wells were capped to allow sediment to settle prior to obtaining bacteriological samples. Based on field interpretation of the measurements to ground water, the well sampling sequence was upgradient well first,side gradient/down gradient well second,and down gradient well third. This sequence was determined to be M' onitoring Well#1 (MW-1),then Monitoring Well # 2 (MW-2), then Monitoring Well # 3 (MW-3). 4 The gallon samples for chemical analyses were field filtered through a 0.45 micron filter directly into the sample jars provided by Enviroscan laboratory. The filtering apparatus was triple rinsed with distilled water, then rinsed with filtered formation water, which was discarded,prior to sample acquisition. This decontamination procedure was followed between each well and between filter changes. Frequent filter changes were required due to considerable sediment in the samples. After all samples had been obtained and filtered for chemical analyses, the wells were resampled for bacteriological parameters. The same sampling sequence was observed. The decontamination procedure for the bacteriological sampling was to use full strength commercial bleach followed by a distilled water rinse. Prior to introduction into the well,and between each well,the bailer was filled with undiluted bleach while the outside of the bailer was wiped down with a clean paper towel saturated with undiluted bleach. The bleach was discarded, and the inside and outside of the bailer rinsed four times with distilled water. Ground-water samples were then obtained from the top of the water table with as little disturbance of the ground water as possible. The goal here was to obtain samples with a minimal amount of sediment. Samples were taken from the bottom of the bailer after discarding the initial sediment rich portion. Samples were taken directly into the sample bottles provided by the Eau Claire City-County laboratory. All samples were placed on ice directly after acquisition and labeling. Samples were refrigerated overnight, and either delivered cold or shipped on ice to the laboratories. 5 RESULTS Elevations of the tops of the PVC well pipes were obtained from copies of the plans as MW-1, 74.25'; MW-2,48.62';MW-3, 52.07'. These elevations are relative to the system bench mark of 100.00'. The measurements to ground water and bottom of wells, and calculations of depth of water in the wells and the water table elevations are summarized in Table 1.: TABLE 1: MEASUREMENTS & CALCULATIONS (feet) MW-1 MW-2 Bottom of well 82.1 66.2 73.7 Water table 76.45 59.26 65.21 Depth of well water 5.65 6.9 8.5 Elevation of PVC pipe 74.25 48.62 52.07 Elevation of water table -2.20 -10.64 -13.14 Monitoring well locations are, nominally, MW-1, south; MW-2, north; MW-3, west. Ground water flow is, nominally, in the direction somewhat north of west. 6 Chemical water quality analyses are summarized in Table 2: TABLE 2: CHEMICAL WATER QUALITY ANALYSES Units Detection MW-1 MW-2 MW-3 Limit Hardness as CaCO3 mg/1 0.1 157. 204. 169. Nitrate N mg/1 0.1 7.04 6.75 5.87 Nitrite N mg/1 0.5 X X X Dissolved Solids mgll 10.0 211. 254. 206. Total BOD 5 mg/1 6.0 X X X Soluble Cl' mg/1 1.0 14.1 13.3 9.97 Soluble SO,- mg/l 3.0 12.2 11.8 9.46 pH - 7.70 7.63 7.74 Alkalinity as CaCO3 mg/1 20.0 115. 196. 163. Kjeldahl N mg/1 0.2 0.536 0.926 0.903 Ammonia N mg/1 0.2 0.383 0.236 X X = analyzed but not detected Background quality data is not available, and discussion of the meaning of these results is beyond the scope of this project. i Bacteriological water quality analyses are summarized in Table 3: TABLE 3: BACTERIOLOGICAL WATER QUALITY ANALYSES Units MW-1 MW-2 MW-3 Fecal Coliform-E. Coll - Negative Negative Negative Fecal Streptococcus colonies/ml 0/10 0/10 0/10 Fecal Streptococcus colonies/ml 40/100 40/100 40/100 Negative for fecal coliform-E. Coli means less than 10 colonies Bacteriological analyses are complicated by fine sediments in the water samples. Fecal streptococcus are ubiquitous in the environment and are often associated with soil particles. The colony counts associated with the larger volume samples analyzed for fecal streptococcus should be considered tentative given the significant amount of sediment acquired with the water I sample. i Background quality data is not available, and discussion of the meaning of these results I is beyond the scope of this project. If more meaningful data is necessary for bacteriological water quality, the monitoring wells should be developed sufficiently to obtain sediment free water. It appears likely that considerable time has elapsed since the presumed development of these wells. Development data is not available. This time lapse may account for the quantity of sediment observed. August 5, 1991 Certified Soil Testing P.O. BOX 57 Knapp, Wi 54749-0057 Attn: Henry Grote Re: Analytical Results Please find enclosed the analytical results for the samples received July 25, 1991 . All analyses were done in accordance with EPA Methods (EPA-600/4-79-020, March, 1983 or SW-846, Third Edition) . The chain of custody document is enclosed. If you have any questions about the results, please call . Thank you for using Enviroscan Corp. for your analytical needs. Sincerely, Enviroscan Corp. 131 ('S/C� ry\ • � CL I Bruce M. 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MILITARY RD. ROTHSCHILD, WI 54474 1-800-338-SCAN CLIENT INFORMATION Name. c VA 1_'J �__• G .T Turnaround Time Company: C_ tr-kcso So%L_ -EsT 1 Nct Address: 5-0� HA,N ��•�. o� s� ❑ Normal ►.4APp , \-� 1 C c Rush S-DC�� T•.dt.►ACto...+� Phone: to 6s- Z b 1s i Date Needed q P.O. #/Project #: W IA'-t- ST rL V �' �� (Preapproved by Lab) Quote/Reference #: ANALYTICAL REQUESTS Note: Terms and conditions printed on back apply. (use separate sheet if necessary) Sample Type Sample Handlin 1 r (Check all that apply) ❑ Nonhazardous Refrigerate Z V 1 ' 'roundwater 11 Flammable El Work in Hood 0 Wastewater ❑ Skin Irritant ❑ Wear Gloves JJ d ❑ Soil ❑ Highly Toxic ❑ Solid Waste 'Other(specify) l3 �'°RYA�� C j j• r"' p ❑ Oil es XOM C-s►v u'' k ❑ Other No.of LAB USE ONLY DATE TIME Containers SAMPLE ID A 27. COMP GRAB REMARKS 03054345 w s - 1_b �C 03054346 w s _ 2, X 7c DeIV Hand CELAIN OF CUSTODY RECOPJD Ship.Cont.OK? N N/A Recd Ref rig? N ' NIA SAMP R :(Signa re Seals OK? ? N N/A Samples leaking. Y N NIA Comments: R'E\LINNQQUISHED ignature) DATE/TIME RECEIVED BY:(Signature) RELINQUISHED BY:(Signature) DATE/TIME RECEIVED BY:(Signature) RELINQUISHED BY:(Signature) DATE/TIME RECEIVED FOR LABORATORY DATEITIME BY:(Si nature EAU CLAIRE CITY-COUNTY HEALTH REPARTMENT Lab No. Certifed Laboratory 1001 ,.JZ 3�9 Tests Requested:_ BAC�ERZOLOGICAL WATER TEST bacteria j / ( x ) cc,+c Go«i�'� t-�+ Date/Time Collected ( ) nitrate f` Owner 4VJZL S 7,e4-4 r 4 l 4 4�r Phone Property Address ' /,,v ') G City Nc w Zip County 57- C/O ox / Unique Well # o,v�.'o-z�� uW Co 1ecte . b Source of Sample (kit. tap, etc. ) 0 , l_ YJi 7;&AF 2 Send results to: (if ''different)Name. & ""ICY G'Qo `` Address 7? v. �jvt( s 7 City �='l°� , Lv Z1P—T_ FOR LAB USE ONLYi RESULTS: Total Colifyorm /100 milliliters ( ) negative ( )o positive/ Fecal Co rm-E. oli/100 mil Cite (�, n�ga� j�i �,) positiv* Other Bacteriologcal Interpreftation ( ) SAFE ( ) SAFE Nitrate-Nitrogen (NO3-N) PPM Nitrate-Nitrogen level in water ate r below 10 ppm is considered safe. Lab Technician ( ) Paid �) Bill { j No Charge L/3 R2/91 EAU CLAIRE CIT776 UNTY' 1AL Lab No. Certifed Laboratory #001 M Test Requested: BACTERIOLOGICAL WATER TEST ) bacteria ft'uL CocL.�z•�. Date/Time Collected ( ) nitrate !G�`.�� `S�"° ' lti�A� �Ti?E�=%' � [.L�S'c= Phone # Owner Property Address Cwy G City w ' "t°" Z p County ST G a 1,Y Unique Well # Source of Sample (k t. tap, etc. )�-'%0't"') �_>Collected by Tom. Send results to: (if different)Name t''��'y G.t°o i8 Address ,-P C>, '30K S7' City �,+t ono , to _Zip Y� FOR LAB USE ONLYS RESULTS Total Coliform /100 milliliters ( negative ( ) ppoo�ss�itive Fecal Co ' form- .Co i/100 mi� itite:Cs itive Other �Uj'�` Bacter ologcal Interp etation ( ) SAFE ( ) UNSAFE Nitrate-Nitrogen (NO3-N) PPs Nitrate-Nitrogen level in w9ter at or below 10 ppm is considered safe. Lab Technician { ) Paid ( Bill ( ) No Charge L/3 82/91 I I . 4 EAU CLAIRE CITY-COUNTY HEALTH UPAIfTMENT Lab No. Certifed Laboratory 1001 / Tests Requested: BACTERIOLOGICAL WATER TEST 7fZ3l�j � S •yo P"� ( X) bacteria F�uL Date/Time Collected ( ) nitrate Fr�-q STn Owner 6u4e-t Phone # Property Address Ciy CG is rroZ-,5--z ip County 67— C,<o X Unique Well # Source of Sample (kiX. tap, etc. )Hto.+��¢��+�) cv�l� Collected by �1 Send results to: (if different)Name < - 072r_ Address /36'x 7 City Zip FOR LAB USE ONLY: RESULTS Total Coliformd /100 milliliters ( ) negative ( ) positive Fecal Other Coliform-E.Coli/100 mil ititers negative ( ) positive Bacter olo gcal Znt rpretat ion ( ) SAFE ( ) UNSAF/ E Nitrate Nitrogen (NO3-N) ppa Nitrate-Nitrogen level in w r at or below 10 ppm is considered safe. Lab Technician ( ) Paid Bill ( ) No Charge L/3 R2/91