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012-1049-50-000
' f) to O C) to O ' 3 ~ n [~ °c ~ ~ I c ~ ~ ~ ~ 3 ~ ~1 ~1. ~ 'fl ~ • ~ ~ m ~ • ~ ~~ ~3 ,~ ~ d 3 ;• I •• Z' :.. '~ I ~ I ~ ~ ~ ~ ~ o o cAn ~ II o m ~ o ~ rn 3 ~ ~ N ~ `~ ~j' ? N ~• O `~ ~ ~ O O l~D OOi ~ 2a N 1~1 rll CO fl. ~ O 7 f` N N~ Z a C~D\ W O N ~~ O ~ N C ~~ tD ~ N 1 N A I N a ~ ~. m ~' v l a d ~' v '' m W tD ~ ` 1\ o h o ~ o~i m m ~~ m m~ 0 0 I o c ~ <° c ~ ~ I ~ o ~ j -~ ~ v~ ~ O 3 H N O 7 H y~ ~ O 0 !~ N N Q~ H W ~ v ~~ O I o7 ~ O j ~ I m ~n D '~ a s ~ I cfl y N a s m ~ ~ W ~ W c a o o .p I 3 a ~ m °a cAii I c~ c~ cn N I `0~. ~ rn~ I ~ rn rn N I, -' ~ tai ~ O O O ~ tD (O O n O C I y °a .°P s l ~, ~ w~ I 3~ Q ~ I ~ I .~ Z O O O W O O O v' ~ o ~ ~~~ a ~ c ~~~ a i o a Q ~ O ~~ I Oo ~ ~ O O~ n I c ~ ~ o • o O- fOD w N „~„ N N Z I ~ Z G7 Z Z~ OZ O I ~ D y ~ I O D a m '~ ~i ~ N ~ :U -O C C N G fD N i I W ~ c~ n I ~ n d ~ m 7 ~ 7 _ Z O N o ~ ~ A Z tNo F a I n A~ I 7. 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Ron.$ .~ t~ iitln y %/oo,EinS ~~n ~Q ~4"O rTa /nc6 h Wes/ey .~ Ter-fie F¢r ,s Inc. J 240 ~ itch- SlG//rsis F!~ ddard Ter{i e.n Q ~ /so,b ona ue 6GeunE:ri • C V ' L L ehJx ~ • both 94 ~~ /09 FD. cr~/f%th Mi/ions f Dorothy P ://p s ,B,.r.ow B /bo soo ~ V`\` O J .siz ~ \ ~ ~~i Bo Donohue•.~ ~ ~ /oa~5 Pete son o ' V w ~ Thomas w Doir/J. Inc ~ 'qtly C Friday ear~r// ~ ~ l'• /.cp rnO rockPah/e jcf/ C7eurrcnk u J ahn ~nG1 L .Burro ago ~ v t~ 4 3 o Co. ier ~ BO ~' }° ~ •m s ° /aJ h /sy ., 4 9' ~ m • e /1"9 rOCPJ` L u o • 99 ® ' y v S ~ 8a '~ o y o C d ~ veo y E. C. Lemke o~p $ l ~~ ~o~a/d f Ma 9 er."fe .eoy ~ o" ~aF e ~ 0 n ~ / B Q ~ vss ~Q />a/only ~., ~,~ , - LS ~ }a ~ o tTames .xoo Dorothy E nna Marie a ~ /~r'U3eny0-, ftOro/d Pribnow Coveter ,luhas.Fa /bo `Y l Flo ~tli y v ~ 1Jona,.¢z T K6rrn n 7o etL7J P/-ii/iP f Hoiy 11-- t^1 oh [ c c tl ~ 0 C ~ C V • /Cctmm ~ rGrs /S/25 a/B~os /9riso/7 W~ ~ ~91 ~oJ 9QW0 ~9-C}~ Kamm /moo /6 0 /~ J I • • Bnrl~f a L YM IJennic i/rthur Em rr • Z. - - V ~ 40 • ~ nc R j0./4 r _ . f/Cii/buck f/rthui L. 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OuanT ~zo an S s e ~ C V 6o qtr, H ` pp F s u uQ C ,~ ] u ptl /ZO /35 th Edna. k/Q.lkcr' S.~ /S6 `C ; I' 3 ~ 0 /6o T ~ KenGo , a o ~ ~ h / ~ V V ~ q O yM n ~ ~ ~ ~ nah~.es ~ -D°" f °r/~' ` A /a^encc ve/% Srre. cc tl C v `S~ (Ni% ram j Mary qn 3~ ~• M /zo e/so 40 ~ ~ M Q Dairy Snc ~ o .S¢ stern C o. a~ n a 995 q • ~ "V t~ ~ ~ ~ ~ Landry ibo ~ ~ ~~ UU Wvharn ,P (Maxine ,TOhn ~ G'aro/yn `C ~ Q l•V of . /zo ~~ Co ~ ~ Hrfhur E p~ann ~y b /oo= ~` ~ ~ 3 0~~. ~S.d n //sf h ~ k 3J • ~ '.(~,A w v~ eYCrSO/l !~ z .DGt/ton ~ '~tl ~4 0 Jensen > h ~ ~ r r Y ~ E, o E /. POTH 7z T ee.5• ~ 9~+ ,Poc,E r iNa,o ~,n/s, jnc. SEE PAGE 3 / tSY Croix lsfy i/i s s FARM COUNTRY SERVICE NEW R ICHMOND ' FIRESTONE PHONE : 246238 ON THE FARM SERVICE Tractor Tires • RIVE R FALLS ~ light Truck Tires PHONE: 425-7671 Car Tires ~ LAKELANDPLANT New Richmond 54017 PHONE: 436-8886 or 38&3922 Route 3, Box 317A 1'/s Miles East o~ County K 246-5040 SAND -GRAV EL -READY MI X CONCRETE ~~ , S~ ~" ~ ~S4 .~I ~ l~~/ /Yak ~ ~~ ~ 6 alc~; K ~ w~ sYaU L 0 ~ Parcel #: 012-1049-50-000 Alt. Parcel #: 22.30.17.336 012 -TOWN OF ERIN PRAIRIE Current ', X j ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Category Use Value Assessment Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -EMMERT, DENNIS & GRACE E DENNIS & GRACE E EMMERT 1881 140TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address s): ' =Primary Type Dist # Description SC 3962 NEW RICHMOND * 1 4 E ~~ 1 / G} 07 ' ~ (j SP 1700 WITC ~ ~ '" ~ ( l ' [ o ,S J \ ~ ~ ~~ ~ (,~ Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 22 T30N R17W 40 AC SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 06/04/2004 764832 2589/128 EZ-U 04/05/2004 758682 2541 /394 EZ-U 9A(1B SI IMM~RY Bill #: Fair Market Value: Assessed with: Valuations: Last Changed: 05/31/2006 Description Class Acres Land mprove Total State Reason G1 4.300 50,200 616,400 NO 02 AGRICULTURAL G4 24.700 4,000 0 4,000 NO 05 UNDEVELOPED G5 11.000 16,100 0 16,100 NO Totals for 2006: General Property 40.000 70,300 566,200 636,500 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 70,200 391,400 461,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 08/17/2006 05:18 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 =bVisconsin Department of Commerce Safetyahd Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH T(S PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Emmert, Dennis & Grace Erin Prairie Townshi SST BM Elev: Insp. BM Elev: BM Description: /e~ ~~~ ~ YY~ I GS ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (("~~`° ~i'dC'~; ~~~ ~~ Ili i Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic j 7i~a ~ '75~~ `l I '7 , I ~'T `~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num er TDH Lift Friction Loss System Head TDH Ft Forcemain Le Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA ~ ~.~ 1_~~ unt . St. Croix Sanitary Permit No: 453129 0 State Plan ID No: a C^~ Parcel Tax No: .G 012-1049-50-000 Section/Town/Range/Map No 22.30.17.336 STATION BS HI FS ELEV. Benchmark r1 Ib4~ -`1 /aLS Alt. BM /,~ f~~. Bldg. Sewer ~~ SVHt Inlet Q 1 U~1 ~'~ St/Ht Outlet ~' ~ G ~O • `~ Dt Inlet Dt Bottom \ ~ Header/Man. z . ~ ~y• Z Dist. Pipe f~ -7 ~~• L Bot. System X3.8 y3 ,~,~ Final Grade ~~ St Cover BED/TRENCH DIMENSIONS Width i ~2 YJ Length a Qa ® No. Of Trenches ~~~~~ _ t~ ~~~ ~ PIT q[MENSIONS ~~.• No. Of Pits ~~ Inside Dia. ~_ Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBE O Manufacturer: ~~ (~~ d ~ T e Of stem: R R yp y ` .`~ \ ~~~ / A ~~ UNIT Model Number: DISTRIBUTION SYSTEM yam' 7~~p),' -7 ,~ 'j~. Header/Manifold j [ ' Distribution Pipe(s) ` x Hol Size ~ x Hole pacing ~ Ven o Air Intak/e 1~ ~ Length 1 Dia ~ Length Dia ~ Spacin g ~ ~ SOIL COVER x Pressure Systems Only YY Mnunrl Or AT-Rrarle RVA}PHIS only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulc d Bed/Trench Center ~ Q ~ BedlTrench Edges Topsoil ~ _' Yes ~ i No `~ Yes i' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /. C~ i Location: 1881 140th Ave Baldwin, WI 54002 (SE 1/4 NE 1/4 22 T30N R17W) NA Lot I Parcel No: 22.30.17.336 1.) Alt BM Description = ` ~G v+~-f+-` C4~,ryt: ~ ,,`,S ~ I._.~e~c-S ~~ ,,~ (1 ~j ~ 2.) Bldg sewer length = Z'7 ~ / ~~Y~ ^ /I ~ t ,~~ ~ (~ ~ 3 I ~ r 1 -amount of cover = ~ r l%.~ c~ ~ ` "'CZ 1~ Plan revision Required? Yes o 'I ~~--- ~ I 'L-- --- - -_ _ _ ___ _-_--- .' r -~ --~ Use other side for additional information. [_ _ ~ ~ l~7 3 Date Ins ctor's na Cert. No. SBD-6710 (R.3/97) ~.~ ~F' /_ Safety d Buildings Division County ` ~ ~ 201 W. Wash gton °~ ~:O3Box 7.1,x,,, ' I~~Ol~~,~ Madis WI ~: ~ 1(~ ~ nitary Permit Number (to be filled in by Co.) Department of Commerce 08)266-3151 ~S3 ~Z Sanitary Permit Applle do T` iti ~ ~ ~p~~ rate Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal inf rmati ou provide may be used for secondary purposes Privacy Law, 15.04 (rtl~RQ1R G() UN t ; ~ Project Address (if different than mailing address) ONIN I. Application Information -Please Print Ali Information ~ ~ ~~ ~~ ~ Prope Owner's Name d Parcel # Lo Block # ~ ~ /~ -- Property Owner s Mailing Address Property Location RR f` City, State ip Code Phone N b / ~<, Section _~p - d um er c~~ (~/~ ~ ooa '~ ~ (circle ) T N R~ II. Type of Building (che all that apply) ; ~or W ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ S Su ivision Na m e CSM Number ^ Public/Commercial -Describe Use ~~ LL // Ta ~ arft. to ^ State Owned -Describe Use ~ , d , u ~'~~ r _^VTHage~T9wns~rip of p b Lr~ r III. Type of Permit: (Check only one box on line A. Complete line a plicable) - ~ _ SO _ c~aC7 A' ~ New S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision List Previous Permit Number and Date Issued ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 ~ 3 k gp ~-~,11y~ .,,.,LQ ~~Z~~ ~, ~ ~ Von -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil . ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatm t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation a I ~ a oo ! oo,~ - - VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber lastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or He~ldingTa}Ifc 1/ /~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the under igned, assume re po sibility r installation of the POWTS shown on the attached plans. p u ber's Arame !Print) P e 's Signature MPfMPRS Number Business Phone Number Plumber's Address (Street, City, Stat ,Zip Cod y ~S ~l a ~ 5 VIII. Coun /De artment Use nl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued su' Agent Signature o Stamps) ^ ' Surchar a Fee) g 2~ ~ v~ ~~ ven Reason for Denial IX. Conditio of Appro SYSTEM OWNER: 7 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. aawcn cump~e[e puns t[o [ne eoun[y onry) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) 3 3~ SYS'I'ENI SPIJCIFICATIONS In-~routtcl Soil Absorj~iion Component C~~mponent Manual # J~~ ~ ~~1 O j - ~~ f~/~Q~/Q~l _~- Project Nacne:.~1~/19r~,~ (~ ,( ~S T ~' Distribution Cell Type Aggregate ^ Leachyng chambers] Number of Bedrooms ~_ Soil Application Rate (DLjt) V-] gpd/ftz (Designed Loading Rate) Wastewater Quality Treated ^ Untreated Combined wastewater: Number of bedrooms ~ gal/day/bedroom x 150 Daily Wastewater Flow (DWF) _ ~ISD Clear and graywater orily: Number of bedrooms ~_ gal/day/bedroom ~ Daily Wastewater Flow (DWF) _ ~7D Blackwater Number of bedrooms ~ gal/day/bedroom ~, Daily,Wastewater Flow (DWF) _ _[~~ Dispersal Area (A te) - fc~ c~~ c~~ - Dispersal Area (leachine Fhambersl Leaching Chamber Chamber size, EISA Racing __r_,~ft2 System sizing = DWF ~- DLR =EISA (y 5(~ = b ~ ~ = F _ _,~ ,,hambers (DWG (DI.R) (EISA) Diverter valve ]yes ^no Manufacture __ ______ ~~ Septic Tank Min. Septic Tank Vol. Req. ~CL~~ gal. Septic Tank Volume ~ gal, Manufacturer Effluent Filter Manufacturer Model _.__ Pump Tank Manufacturer Volume Model Distribution Component Distribution Box ^ Hydro-sputter ^ Other Manufacturer ' p~,~ ~.6 b ..~.. (~(~.o-~,~. c_o~vurF.~a'~cnK" u~/ Cs~ Sz~s21~ I o.+.- °`~~z~le~ ~ ~,,",,,,q ~* s +ti,e~:cm:~Qao ~`~S ~ ~.~ e..wea~ s{vc.~~R °''~-~.v>,a~' . ~t.9,-w~q.SS+W~ S~Q-- ~csNtiwrz.,~S a. w,ew+e~c. WiscorZsinDep~rtmentofCommerce SO~~ALUATIQN F~EPORT C~~ Page ~ of~ Division of Safety and Buildings Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~-- ~ L) ,. •~ F-FJ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . ~ ~ ,.. l ~ --~ p~G, Please print all information. Re iewed by Date Personal information you provide may be rivacy aw, s. 15.04 (1) (m)). ~ / ~ yt Zfo ~cl f Property Owner Property Location ~~ 1~1~1 ~ ~. ,~ Govt. Lot S' ~ 1/4 ~"I/4 S~ T N R ~ 7 E (o W Property Owner's Mailin~Address , ,~ - Lot # Block # Subd. Name or CSM# ~d g I - ~ Yt~ a. .~~ :~~N- City State Zip Cod ,~J~FICF ^ City ^ Village ~ Town Nearest Road `` ~, New Construction Use:', Residential /Number of bedrooms _~_ Code derived design flow rate .1 GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~ Of_4S_~ay~-rr_"'~ ~ ~ Flood Plain elevation if applicable ft. General comments + c ~. and recommendations~SvSS~S+ 1-~~' ~~ a.+°~° ~' 7~y~"& -~~~°~„'~,4`'~"~' Fo•~° ~ ~ $.~t., ~~ //}} T.~ (foo.Viy'~ 'T9y (98.5'l'' ~~`~is iS Q,~°+~~~G?H-..~,,,' s:~'C.~ • -~.~(99,95'~ ~'` si~'~' ea~~ Te$ (47.~y•) /1pt3$~-1~ ~pr~ a,.. (4r^ ~,~ I ~ I Boring # ~-1 tonng u ~ pit Ground surface elev. ~a~ ft. Depth to limiting factor / o~ D in. Horizon Depth Dominant Color Redox Descri i Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 IS • ~I . AYR ~ ~ ~----~--____~. r~.~~t ~~~ ~'~ -fL ~~ C w l J ~ + 5 . `-I 1-~S ,~~'-'J b S, 4- FS t~. fi~~•~- C..c, --- ~ ~ . to Boring # ^ B°ring tu1 pit Ground surface elev. E? !e S ft. Depth to limiting factor ~ a ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~{ ~-c.~ s y ~Y/ s ~ ,~ ~ 4U - ~ ~ Sao 5 `i ~R-'~ --...~.-- ~.~~e ~,,, ~ ~ - r- tom, .f 00 . - tmuent FF1 = t3UD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODE < 30 mg/L and TSS < 30 mp/L CST Name (Please Print) ~ ~ Signature CST Number g ~~ a~ ~ ~ ~~ ~'l ~ ~„ Date Evaluation Conducted Telephone Number SBD-8330 (R07/00) ,~ ,~ •6 .y .~ Soil Application Rate #1 ern -S Property Owner ~ fttlPlrlP-C v-'"~ ! ~ ParcellD# bl~'~~~7-S~'00007 page « ofy~ Boring # ~ Boring Pit Ground surface elev. ~D.3,D0 ft. Depth to limiting factor ~a~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t O - ~ 0'1~.~~ s , ~ a F~ ~2 r~, ~ ~ - , ~ ~ ~ ~ ~~ t_ 1 Fs ~ ~.~ ,~ Ff ~w -- y . 4a , .2~/ ~ ~~ I L___L__I Boring # ^ Boring ~ Pit Ground surface elev. ~'Db~ I ft. Depth to limiting factor ~U A in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ o- ~tR. ~ S; L af~ ~. n~~~ s ~ ~ ~ 5 . ~ - a 1D°~ ~ ~ S ~ >, of ~ !2> ~ Gw . 5 7a-r ut~ ~ ~ ~,~ ~ t~.~ I m s ~ ~. --- -- ~ * t~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the deparhnent at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) P~ ~ 3 ---- ,~~~ _ ~ ~- 1~~~~' ., t ~ ~~ _ ~ F ~ -c ~ t So ` . r ~ y Lw~r - ro~Sti F:tl c~ _M _.. ___,~..a..,._..~ - - - - - - ~. ~.. i~~~__ ~ _~ % ./ :_ ~ _ _ _ ~ ,~ _ f ~~. ~' ~~ ~/ / vP pt~ ar J ti~° ~ _ p ~ p©s+ ~ ~~ ~ ba.~'~. -hoc. ,p . -~- S • • r ~ ~ J'a a °' ! 0 ~ o ~ _.: ~ ~ f .~/ ~ ~ __ ~ ~c ~ $YY1 /OO.Db I ~° ~ . ~_ / _ ~~~ t'4 ~e ran t..~. ~ ~ . ~ a o~~ 01 ~i~°Q {.~-,~-5 g l t c 3.00 ` _ _ _ ~ ~°a. ~ `2T t ~ ~~~ Qa t oy,SM _ } ~' ~3 lo3,a4 ~ -fRE E a.hL o.~t-h !v "H t ~ "~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page~of f~ FILE fNFORMATION Owner ` •` S ~:... -Kl ~ r Permit # 31~ DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units '® NA Estimated (average) flow ~ al/da Design (peak) flow = (Estimated x 1.5) ~~ al/da In Situ Soil Application Rate Standard InfluenUEffluent Duality onthly average' Fats, Oil & Grease (FOG) <_ Biochemical Oxygen Demand (BODs) <220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/i_ ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m) Maximum Effluent Particle Size ' in dia. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. ^^w.-rr~w~ww~nc cnLJCr111r C SYSTEM SPECIFICATIONS Tank Manufacturer w ~, ^ NA ' ~, Septic ^ Dose ^ Holdi vol. ~ DO gal Tank Manufacturer ~ , ~ e ~ NA ^ Septic ^ Dose ^ Holding vol. gal Effluent Filter Manufacturer ~~~ -~~~ ^ NA Effluent Filter Model 5--~ (~ Pump Manufacturer j~ NA Pump Model Pretreatment Unit Q~ NA ^ Sand/uravei Fi!ter ^ Peai Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) C '~ ~ ~o,,,, ^ NA In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other. Other: ^ NA Other: ^ NA IYIMII\ ~ ~.~~e+~w~ v Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ earts(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) ~ When combined sludge and scum equals one-third ('f~) of tank volume ^ When the high water alarm is activated ^ NA Inspect dispersal cell(s) At least once every: '~ ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: '~. ^ month(s) ''$) ear(s) ^ NA Inspect pump, pump corirols ~ a;a;Tr~ At iea;t cr:ce every: ^ month(s) ^ year(.~~ '~ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ~ NA Other: At least once every: ^ month(s) ^ ear(s) ~ NA Other: ~ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken harciware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third ('/~) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with cf5apter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ~j~' 1~2) -/ncG ~. ~~ ~~ I ~~~~ 1'G.~~ ~~ i~ ~~~ ~ ,~~y ~O a./ al rte, ~, G~ / -~ Y ~ ~ ~~~ov~~ ~ _ 7/~- ~.`/G -557 ,~ y ~. ~.~~.I ~J ~ ~,; ~ ~ , ~ti1 ~ . S~ y c ~y Ste. aa~ T ~N ~~/ ~c~ .._ _ T~ w ~~ ~~ ~"p L !'ii ~r i ri ` ~ ~, r.-+- : ~~' L' tau i X ~i I{ . y I 3 ~~ i~ ~-- C~m~n - i yU' ___-~ - _ ~y Da ~ ~l- ~ ~ ~ ~ ~a ~i~"c, 1~~n_~ (1~.1 ('i ~~~~- `7 5~~ . ~ 07Q_~ /N. n~lv/ ) J ~s i vie. c- ~ l~'.~L~-~t1-~~~ c 2~~#-t~-{~ --~- ~~ v~ a.Tv~c-e. 1 Q. S ~ Y~ w1 ~ ~2 '~" ~ SC..rv~ ~_ ., ~J~~-~ ~ '~ ~ f ~ _ ~- P~~ i ~ START UP AND OPERATION Page ~ of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process andlor damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s). in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. ` Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sa: iitarf .~•apl:ins; t^.mp~~~;; a^d water voften^r brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ~) A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption / ~ system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mnund and at-grade soil absorption systems may be reconstructed in place following removal of the biomat a`, the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name 0. Phone ~ ~ ~ .. ~ ~ 8 ~ POWTS MAINTAINER Name ~ /lo ~. Phone '~ j_ ~~~_ 3(QO SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name ~ C,RO l ~. ~~ ~pN ~ Phone Phone ~~, ~ , t:~ _ •• .. ....e. _e .." n__._ , _..- •~_......,w.. .....~ U/....n/.n... !`n..M.r 7nninn en.~ ConiNelinn enonnlne in Mr~n11A I` r~ n -~ la Pt~~V~~ INSPLC-TION GUVER Approved IJa[er Tight Ga Ice[s /$ ~f-i' ~' (v~ o Sce_ _.r _r bl • ~_~ ~, I ~,~ lr. f. eo VGf ~i./~ ~/~a I~u~~ k ~ ~ 4i1 milt. __`~ GRoU t~l~ LEVEL Approved ~-Z-ll~ 'dater-t igh _ GaskeRS \~ ~ ~ n 7radient of ~er/er Lateral ~ s '~" / f t . ~ r'~~Tc~zln. 13L s;~l~e ~.. I~f~dlr5~f;,l.l S o U ~r~L~~ S ~B f -f' . 1- ~-Gradient of ' Sewer Lateral ." per ft: - , ~~~h~ ~ vab-1- -dam s~(~~ _~ j-.. ~ b vnln. _ 1- ° ~ 1 ~ I ~., ~. - to u. d ~ __ - I FI~~ --- 1 ~._ BnFr-~r_ s or ~I~~=1:ov~r~ -- ~ 1`1/~TLI~IF,LS I~ ~ o L ~ ~~~ ~an = . s I ~~ w ~~f k ~- ~~ ' . _ `~~ I ,Kt ~ ((([~~ tl .~ ~• ~~ ~: ~h ' ~ I ~ La'1 "a I I E_ ~~t ~ fl I 1 ~ ~ I~ t _t_ _. ~SLI - ~ 1. .:s ~s~ ~ .~ n ~"Y , J-1 ~ ~. y ~~;{ ~ To: ' ~y~~ S - ST CROIX COUNTY K MAINTENANCE AGREEMENT ~ ~;~r~t~ AND ~ ~ , From: '~~ . ~~~' ~ I, ~ 3HII' CERTIFICATION FORM ' A Q , /J(~, T~ 4 ,,/~~ l // ~ ~~Gr v ~ - ` o ~. P AA1~~ (~,~ (~~l 1 ~ 5 annin De artment for new construction) ~!. g P ( arcel Identification Number 0 (2-10 ~(% - ~ - o~ ~ 331 t p~$ 4-692-2416 T "We Love To Property LocationJ~ %, ~ r/., Sec. ~~, T3~ N-R~W, Town of ~ ~ l~'I v Subdivision ~~ .Lot # Certified Survey Map # /V~ ,Volume ~- , .Page # Warranty Deed # 33 7~D~ ,Volume ~~ Page # °~~ Speo house ^ yes ~ no Lot lines identifiable [~. yes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system caa affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastCrplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, fhe undersigned have road the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comnrcrce and the Depa_~tment of Naturrl Resources, State of Wisconsin. Certificatron stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office wrthrn 30 days of a three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the ropcrty descn d above, by virtue of a warranty decd recorded in Register of Deeds Office. ~i /9 G SIGNATURE O APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this xpplicxtion: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Of3CUMENT N4 STA;E ttAi't (5F E<ISCf)N9[NE~-MGRAt 3 q:Jt1 CLAIM DEED < 1 ~ ~ ~ ~~~~2~~ THe~~ zrs.°t ttt6EW~FD KBE RECt'ttt1,KG (3A7A .. ~~ - Env TIIIR lar:r~f~. Arthur Emmert... anc~ Evelyn A. Emme ,t, . ; , R~,.GISTER$ OfrI..E husband and w i f~ ___~ _ _ ~_. _ __. _ . _ . , _ ST. IRO;X CQ., WIS. _. ' rrrn sir S Ret`d. for Record - ~ .Donnas l~Inmcrt and Grace E Emmerta._ 1.IS- da ~"°~' quo., tn~ma ty ' Y G~~~A.~. ~~.,?b ..band„ anti wi fc, as tenants: i.n common ~_.~ n o! 1hh1FF Grunl..~c ~.. , rw • vr(uatsle ~ ~. n..trt.•ratton . .. ,- ~. " . _ ~__{-.. _.. ! ~ ,. ~ Fl Ij thr t•,Ih,wrnKdeYCrtArd teal e!FtHta rn ~t a. Cro,.~c;.. ~ _ County. S[wte of Wrscon+tn: .__ -.. _. ~..,,,. ._., ._. . --- -' The 3outhE;ust qua: `er of Northwest quarter (SE'z 'wttuekro NWt,J ,' they .,:South , ~ f of Northeast quarter of - Northwest, quarter (S~ of NE~i NWT) and South half __ ` r,x K v s.,.- _,.-~ .,.~ _... ~ of Northwest quarter of Northwest r{uarter (S'~ -~, /G~ ~ of NWT hW~) of Section 22 Township .,0 North Range;- n,,, to t~~,..humeataaaprop~,t-. 1? Wr°:~_q~cep*_ ane acre fn the'Narthwest corner of thy: South hal f of Nar~hwest.._quarter, of Northwest tlLarter (S~;of NW~I tilti`';J arld atlsa,. the West half of Southeast quarter (W~; SE~a) of Sectic~z 23 'Cown4h=i.g_~0 NUCth, Range li West: ,r "I'his..deed is .made for the sole purpose of releasing the, grrantors interest created in this property by the grantees deed of April 3, 1~7rJ, which was given for-the sole purpose of securing additional financing.) 9 ro~_ _~0~-2~9~~ r c.S~ ~~ ~ ~~ /~8) FEE olZ- p ~` _ ~: rW tT""'~ lt~~r~l,~~ I~,'CD~ ~t it f Executed at .~ -_. R1.Ver_.E~_lls,__-Wl~-C9R~1LL --- this ,2~.~1 ._ day of __.~eCt.'Id~t;L.___..., 19_~L.: ~f ~ .,(~ S[ONI:D ANA SEALED IN PRESENCE OF ,je~"`" "~'rC.-/f ~~"I~E.~Zrt A (SEAL) . _ .. ., _ ~r.hu~r._E._mm__€xL t~ . !_ , .. sALr .. t ~L°Ab 1 ~~_ .. - , -> .~ ~L ~ ' ~- ~. _ . ~., . _. ., ... _. _ _. -~___.-_- - - ~ H.~ ~ ~'~ ': rsEAG)~,,: _-___. ;~ - ~ ,; Signattuea of ...-- r~r,t}1.11T'_~.(Tltflel}'ti, ~YE:~-yI)..t'~. ~Ill.m4'I'1~ _ _-- - -.. ~t.. __ __ _~ 28th ___ _______.__-December_~ __- _. m .,.~:~~ ~._:___ authent icaEed tbia .. _ _ --- -~. dray or ._ . _ ~ .~.__ . , 19_ __r , '~ fl ' R ~ ~ ~ _...~._~~ H- `_ _ _ Ttle: Nernber State Elar of BEi-consin w Other Party K Authwrzed under Sec. 706.8& •tz. ~ __.__ ~_ !'fATB OF WISCONSIN -.._ ,; _ ;. Cuurtty. ~ ss. tj Peraon++lly camr b: fore me, tY.3s ,,,_ 11 _ ___ day of . _ __-.~ _ _____. __ _, 19_~., - the above natCed;~ .~ - i~ to-~me known ta_h~thr p~raon.__ ._ wha executed the Coregoing inatrutnent an.f sektrowledged the aatne. .. -; _ - rl J This inatrui~ent was;fraEt»dbv "_ r{ C . M. Bye - ~ _Ri.vP.s_,.F~l.1s,:_t~iSCS?A~7 n r ~totarp Pu43ic ~ County, Wis. Thr uae of witmeases is optional, My Commission {Exyvta) ([a}~_,,.______A__ _ .,~, .?~ r Names o[ pElraOna aigrtrng m any capacity ahoutd be typed w prtnted below their aignaturea, r ~-~~ ^ ~~ MC-~~. ~.,.`?.+~, ... ` MGalMrtorv~thytl 1.. ;._ QUIT CLAiIt DLCD-S7ATC RAtt OF tRSCON3IN, !•ORµ NO, 3 - 14}1 __ ~~. ~ rm~ CC f7I $ l~)~ZZ~ ~ r. a ~2*1 N O ~ a ~ ~ ~ -1I*1 ~ Z 0 NZ -~ ~ ~ ~ '"~p'~ ~ W ~ f'1 -1-1 r~*t~ G W •J ''R • c ~~ r Z~ ~ g o l7z ~ - O n'r~C r w ~ ~ c M .o Nv~ n ~ ~~ ~ ~ ~ ~ 2 g N ~+ ~ 0~ ~ d 3 ~+ ~ ~ °o .~ o u.,~ z •• ~•~ o uu d o .A ~ ~ O v r~ON ~ #~ O.P .. O O g~ ~ O OOA-~ $ ~ OfO D O =~ ~ ~lNJ1tNAN Q ~ ~ ~ 70 C7 O ,~ ' OJ~~N ~ -• IB y . ~ o a• 9 o`Z `.gyp1 ~~ O~ ~+ 3 ~~gg ~ ~ 1 u W ~-+ ~Z M~ ~ ~. N WWWU ~ r Z-N~4 Z~ w ~r a ~ ~ ~~ ~ z m~ ua a o~ w w •-oru cn ~ ~x.~ o ..pper C1 O W W OtA~~OW N I*I ~ 2 OOf~'1 t*1 00 Q~ Cs ND•.l~+O~ O 1'1 ~ nO ~ ~_ N P1 N 0~ ? O~ON~AN: N ~ ~ C ~ n ~ •.~ .1 Q~0•NUQt" <~ ~~~ z A ~ H{ ~ z .+ ~ ~ ~ ~ ~ ~ N ;^ WP A~10~~0 N C ~ O n "om~ "'~ fH dgm ~ ~Q • • • • • O (n~ W m < vv =m S -+rk N2a r Z ~t D= /..~wfit ~ ~ O O ~OO-+N~ ~ ~3 ~ ~ 17 Y W `~ ~ • • • • / • • n x • s a mm 0• A m •A is 0`O~DQ`N~ C ~ ~'O n ~ UI~,~ 8`m ~ :C X7.?~?~T~ fA N~ U1 g ~~ca v (/~ m `r a C s .°- mo x; yq ~-~ ~ Z .10~ m n's°' O ~o ~` ~~WNgP ~~o ~_ n~ S°~Dr W~ " Qr~o OOQ .~ T ~~~ ~ , v rN F ~ ~I ~; 00~ plc= p~31 Z ~~ O s3 ~Iill~ -' o;g A _ °p ~ ~~ ° o ~ rn~eesn 1 i13~aFi y~~l V LON ON7lll9 ~(V; !~'l~"!Nt~dJW?aV V S ~~HL ~R ++om ._. _ _. .. ERIN PRAIRIE 45 T 30N-R 17W K SEE PAGf 57 . ~ SEE . . 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'Bu~cow /6o zoo a` ~ ~~; S/Z `S 200 Bo ~~ eO Do on t ~ ®O Q~~ Thomas O 47 0 .~ d C Fi d / ay ,. s e/ Pe S' ohen f ~¢/'o/yam MG/v.n E ' ~ V 0 h N n CTahn f L. .Bu/Y'o v+! /60 W t y C 3~ Cann ~9 c F• za7as B/~oc.EPah- - iect Mi% pve na/- 9 g° V o a ~J en a v2 •~ /59.~ ./° He/en ` ug 0 y °. eo ~. ~ • ~ .. e/nyhry ~ r a~ a ~ arn_ G ~ eo 0 h~ .. • ,.. R.. RNE /zo 6 •• • W VJ ~1 - .snvt ? o w\ /S9 So ~ tl U ~ V a e / s~ va • ~ ~ 9~t//...- t Evt/ n go go y Ed Le'm~Fe CQ ~ ~ D M ¢e~ ~ 5 .C 0 QF ~ ~ d ~ ~ C e y En'"'en~ Busse// vas ~Q ~ te ~ Ma/on~r. _ . ~n ~w ~ 0 y ] n Denn/s t Emn ic . c ~ /bo Ma .E g Ed. Le/n~fG ~he~~y Q -x oo E nesY°' fL Tho ~ -~ °n C. P f /ern • zoo G/a~i-en f Ka en {~Qr°/d P~"bnow /Tac.E~son,T, CYOI Ku.E.~s /GO y ~ ~~`~V~ Bonn an fK6 cn 17o ahuc 60 70 ~ ¢//id9e Phi/P•9 /fo/%y ah 6 ago/ l ~~~ ~ ~ ~~ p~p` v ' U K¢mn • /va e9 e4' Do~¢ an f Ka/-e.~ /ba .mid. os .9~.so/7 /zo / ~ Q l 9 /bo Ka/rsm /G o • 40 ~ A 'b ~ /2o • O p • •/o YiY .De/~n/s .o f Lj ra..cC /° .De's is f H ih ~' ` E • is ~ ~ U C o .ry/en y Ca /o "' RD ne ` 70 /b Be/'ff-,ct G. Hlfhu~L.l 0 \ E r•r me/'/ Ma~/~ f } ~1 o V ~5 NQ-/'l/5 y /~n f0 /~eii/buc.~ M/domed . U Bo / 7O zoo k Ed Lem/cc V\ .•` ~ D e / ~nis $ z-lo be~sle. Q Ed. Gen /6e C g C //S a y\ /~.3aa .C M ene de ebe~ S'o zoo v o ~`r ~9 ~ • ,s 6 - B O x ' V\V\ b ~C~„~ -; \ - ~ t i1¢/-y S¢~ i~.s.E: wC ~ M U/ enTs p, \~ u Louis H f 7.3s @ ~. U C ; ~d y 7 Robe/`Y f Shi -/ spa AA Q; D O ~ ., /eO e {~`( f BO `0 Qi%a E/i /-io/' Chi/Q/' \ 0 V 0 0~ F7//en f '~ W l "d~ ~ d / e y R ' ~ f . C BO ~ i To/n Ca ~ / Y/c f L ~: \~CO C V C8 m. f K6n/ V V O ~ D • d eta ,Ber / s e / E / o Y A / o n a \f .3 70.7 -~ 208..33 ~ R BO d ~~ / ~~ s • 40 ~, /(E • 6. . . do e o ~ RO.'J ~~ ~ ~ P 9/P V ta.fe sconsri • Ca~% Howard C. ~` n u 3 . B ~TOw Cam/ R l C /acs ,ce V ~( ~ u ~' D ~ /le/ .h o ~s a K h/ an /zO ~V~~t/a ~~~ ~ • C ~ ~ r/> 0 h/key ~ fodda 1 C Ci tl 9 ~ N A 63 9 // h C ~ q ' /vo 0 V Bo /v B ' O ~ ~ /zo /bo e~ /60 V 6 ~ ~ /Sb.s C o~C w s°a- C ~ 0 \ ow ao /60 7 ~ /Z tlQ " [~ n /6yda- S ,~ Y L• ~o 0 ~ Ke/sGo , ~ y C C ~ V ~ \ vH V ~ o C an,E O/ a llor/ ~ N Ta/»es• .+ Snc. l ~ C ~ y Wiz/am M ~ V ~~ • d, /ZO a/so 0 `" `b `i~ ~ Q cbh~ J W¢/sh / g o'f c-„e a sa she/, /bo Lave/% 9 ` ; V ~ atey L 4 C w P//V 5 9 M n' a O 41~ and y • A ~'C n tlV W7/ia/T/ :P a X%ne ` cToh + n ~ '~ ~ ~ l /2o CC CO N C f~~fhu/- /oo _ cxzm (~. f lJOn d n>G ~ ~ ~~ Y. ~ Bp /60 ^ LJ~ Qf/ > PG tG/'SO/1 G a~o/ / o D ~ ~ ~tl v . o l ~nsen e3 ~ a/ Nels~ ~a / X90 . _Q ` • i /2o . a n ~` (~ 7Z r .. P/NE LK RD • Y ~ E o/96B/Poc.E o~ f /'/ajo uo/s.Inc,Rov./979 E R - L/NE R0. SEE PAGE 3/ . c5'f. Croix , LJITt /w. `/ BERG BARD E UIP. P. & D. Silo Unloaders DeKalb Seed Freeport Silos MILTON PETERSON New Richmond, Wisconsin JOHNSON NEW RICHMOND MOTOR PHONE: 246-4238 SALES INC , . ~ _ RIVER FALLS Chevrolet -Buick PHONE: 425-7671 Olds -Pontiac Serving You With Sales & LAKELAND PLANT Service Since 1925 in PHONE: 436-8886 or 386-3922 New Richmond - 246-2261 SAND -GRAVEL -READY MIX CONCRETE ' E'ER r - i ~ -_.. ., r v /~/~'/f/%~`i c 0. ADDRESS ~ ~ TOt~,TNSHIP~/~ f /l~/ SEC._ T~ D N, R_~W i ST. CROIX COUNTY, WISCONSIN. .. '" ,' _ '3DIVISION LOT ~ LOT SIZE . ~ PLAN VIEW . •Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 00 FEET OF SYSTEM ~O ~~,~P~' r , • ~ ~ ~~~`L .. h ~ ~ - ~ ~ .- ~ r :, ~ ~• -- \ ~~ • o=y ., '~~ L . ,•1 ~~ ~° ~, ~~ TIC TANK(S)~Qdd MFGR.~~ /V ~~ f~~' ~ `. CONCRETE~C STEEL • N0. of rings on cover ~ Depth DRY WELL- )16 'NCHES N0. of width length .area no. of lines width_~~ leng~ h_ ~~~ areas/ ,2s ~-y ~ T dep h to top of pipe ~~ ee ~' ~REGATE ~_ i . .i:{ RATE~~~~~!~ AREA REQUIRED ~,?'~'' AREA' AS BUILT f~~~-, ~~" J"_ ;claimer: The inspection of this system by St. Croix County does not imply complete j :pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted .the County will make every effort to -ermine cause of failure. ~ • .LASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. • • ~ 'INSPECTOR U /Vl D~iTED U ~ - ~~ PLUMBER ON JOB . LICENSE NUtffiER '~ ~f . •. - .. ~. . ~ , ~ vp .. ` REAORT U~ INSPECTION - ZNDIV"LDUAI SIwa~F cv~r-=~~ "'S ~~~al • S avu..t.aic y 1' e 1c m.i ~~__. S .t a .t. e. S e p~:ti c~-~~~ _- ~!/1~1' Tawneh~.p - is i ~~_S.t. Cna~i x Cuun..ty I ~~~~rr ti un ~ ~ ~~ Se.c.t~.an,~lu~t ~ Subd~.v~.~~.an ~,11'"I IC TANK ~,i zE' __~ ga:~~anb Numb en a~ earnK,an.~tmen.tb ~ ' ~~~ ~ fiance sham: GIe,Q.P_" ~ ~ Bu~,~d.i.ng__ ~~~ 12$ ~.P.a,pe. N~,ghwa~te.n. i~11M1'1NG CHAMBER ~ , S.i. z e. ga.~.Eo n4. _.. .A, ump Manu ha'e.tunen. Ma de.Q Numb e.n ~<<~I ~INt; TANK ~''' __._._- gaQ.~Qond Numb en o ~ Camparc~tme.n~te I'nrn~,p.h-~ A~ahm Syb#.em err ~ t~rnce ~nam: we~..2 .Bu~..~d~.ng~ _ 12$ b~ape_ N~,gkwa.ten '' . ~~ ~~;SORI'-I"I~ON ,BYTE ,~ ~ ~ " t.~~ r1 T!ce.nch r ti t c r n c c~ {~ ~i. a m: GJ a .2 ~~f~ ~; B u y .~ d.i n g ~~ t 2 s a .C a p e _._ H~.ghwaaten ~.~- . ~h~,ORI'TiON SITE pIMENSIONS _____ _ _..______- a.. . ~.~* w,i d.th a {~ ~~c.ench ~ ~ 6~ Req,u.i.ne.d anea ~ ~ 2 ~ ~.t /.~ ~ teng.th a~ each ~~.ne ~~~~.t Depth o(~ n.ac-z be~aw .t~..2e~_(~ .i.n Nom(>en a~ .~ti~.e.b ~- --- T~,ta.P ~.e_ng.th ~o~~ ~tine.a (~ ~l ~6~ U~i~#anee, be,xween .C~.nee ~ ~.t. T u to (! abe o~.p.t~,an anea_ ~ "~ {~,t ~' I f U 1 ML~NS_1 UNS N r, r,r 1, e ~~ ±, ~j p,~ .tb Or, In i ~l e dtiame~te~. Uep.th a~ Hoch aver z~~e Z ~.n Ue.p.th u~ ~tti~e be~aw grade 2- ~ .tn ~.Zape. u ~ ~~.eneh ,. ~;i,n . pe.n 100 h~` Type a ~ Ca Leh: .°Pap ~ h e ~tnaw ~~ ~. 7 w ~/ Gnave4' ah.uun.d p~.~:e ye.e na (~ x D e. p.th b e..~. ow ~. n .~. e, .t 1 ~, Ca Q aba u~.p.t~Lan a~ea~'~~ ~: ~ (~.t ~ ,~x~, ~ NSI'FCTED 'i it c'i11) r~f.A',~~N 1"OR RL~'ECTION '`i ~~ ti v~ ~ ~~~~ ~~ T T T L f. _ ''-~~ --- - D A T E' ~~ .Z ~ 19 8~ DATE 19 8 ~, P L ~ ~ 6 7 ~ State and County State Permit # Permit Application County Permit # ` for Private Domestic Sewage Systems County 65,~~~U / X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. /OWNER OF PROPERTY Mailing Address: / .~ /js~L~yv~IV ~rr~ic~~ B. LOCATION: ,~~'/~_'/4, Section Jam, T,~_ N, R~ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~~//t 7X/~ C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family _~~ Duplex No. of Bedrooms' No. of Persons < D• SEPTIC TANK CAPACITY /aUd Total gallons No. of tanks 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 Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ,,~a ~-Total Absorb Area Zs sq. ft. New Replacement~_Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed:.~_Length._Width___,+~~Depth~L~Tile depth (topl~~ No. of Lines ~ Seepage Pit: Inside dia ter Liquid Depth No. of Seepage Pits Percent slope of land_ a~`° 'y(/ Distance from critical slope_~~.e tir 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 Certifie Soil Tester, NAME t O ~ C.S.T. # ~ and other information obtained from ' ,U r (owner/builder). Plumber's Si nature f5 g - MP/MPRSW# ~,~Phone # ,~G ~~$~~ /~ 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. . i Do Not Write in Space B~~elow p-~ FOR COUNTY AND STAT~~E DE ARTMENT SE ON~LrY1 _~ - / Date of Application ~oflp"U~ Fees Paid: State C unty Date Permit Issued/R'ejgC'rd (date) ~~ alp ~~ Issuing .Agent Name Inspection Yes~No 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 E H 115 Rev. 9/78 ~. ' N, ~ ~I l l g~ REPORT ON SOIL BORINGS AND PERCOLATION TESTS ~~.,~-~----r ..!`~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ,* P.O. BOX 309, MADISON, WISCONSIN 53701 m Rfc~,~~j MAY 2 4 1981 ~+g ~-l ~~ ~ .. LOCATION4 x '/a, ~~*%a, Section~,T~~'N,R~E (or)~~'~T'ownship or Municipality '~j'~ ~ I ~ /(~ Lot No. ,Block No. County ~ u vision ame ~. Owner's/Buyers Name: ~ ~lvru ~ S ~' 11 ~ ~---~- Mailing Address:_,~~_~ ~ o~I~~G~G..'Irv' ~~~1_SC' A)vSi~/ TYPE OF OCCUPANCY:. Residence 7~ No. of Bedrooms .COMMERCIAL ""-~ EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT x ALTERNATE SYSTEM OTHER DATES OBSERVATI?ONS MADE: SOIL BORINGS1/ 11i'1 ~ N ~ I PERCOLATION TESTS ~ ~ ~ /~~/ ~~ SOIL MAP SHEET_~> 7 "' ~~ c~ ~ NAME OF SOIL MAP UNIT -~ ~ ~ ~iCt ~ Si 1 ~ 1 aq n'~ PERCOLATION TESTS TEST NUM- DEPTH CHARACTER OF SOIL HOURS SINCE HOLE WATER IN HOLE AFTE TEST TIME INTERVAL DROP IN WATER LEVEL, INCHE RATE BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- _~ S Ts ~ > /v c7 U ~ ~ /~ / / j/ X1,5," P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TE T RE MOTT ING NUMBER INCHES OBSERVED ESTIMATED HIGHEST , X U L AND DEPTH TO BEDROCK IF OBSERVED IN INCHES B- ~ 7~ 0~> 7 ~6 `law ~'TS T k~ /,ir .~' ~ ~~.~ ~• B-c, 1 wows ~`3'l ~'/~r~~'~ c7~ 7 T~~~~ /1 ~~.' s 63 e- B- B- rLH~v vitw ILOCate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the locati nand square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ?S ~f T E~ ~ dicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ~.. . _. I f~cK1tS - O ~ ~~E"~~ ~~~Un~~pcc.5~ ' _ ~ _, °_ ,~ g f~~' .. ~ ~E.~t~ENCf.S_4 ~ t E .. . ~. ~ _ S.~ A IE s - %y "-1 f~ ` ~ _. i ~?~~~ pcp[ S''1TF. ° k~H~k _~ ~,._ m s. _ _ __ ,~ ~~ ,>t~_ ~_~b.b'j;s,'~%z9 i~~,~~'Jaf~IG _ ~ ~~ ~iS/~ !~ 1'v.,~~l~ ~ _ a ~~. _ E , ,~, d... _ .. ~ ~ . _ ~~~ ~ _ .. ,_ _ _ ~ l~ _ _ ~ ;~. ,'il r,;; ..1 ~.L e,wiS~ei ~ tTP F t i s~~ NaY ,. I ~C'S!r . c :.. `---~ N C~~ ~~r; w y svsyiti ~~, --T-T-~--ai tc~ !ll,,.. ~l ~EP~9~EME~T / _I ~~ i mu~~_.~ W;~F if.~ a~ ~_ ~ ~_ ~ ~.m. _ __~ _ ~ I, the. undersigend, 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 1 ~~U Certification No. -5-~ '~~~ ~~ Address NBme Of installer if known ~--~ Copy A -Local Authority CST ~ ~/ ., ~ ~~~, ~ ,~ ,~ y N ~ fy ~~ ~, -~~ Tea ~~ l~ ~ ~ t~. c,. ~,c ~~V ~~ \ Y \~~ V r~ V ~~P~~ ~~ !~c/~c si R