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012-1055-80-000
Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary ourooses rP~~a~" i ~.., ~ , ~ ~~ ~, ~~...." Permit Holder's Name: City Village X Township Doornink, Philli Erin Prairie Townshi SST BM Elev: Insp. BM Elev: BM escription: ~ ~ s~ SANK INFORMATION ~~ .-.,.~.,......___ TYPE MANUFACTURER CAPACITY Septic ~• / ICU O Dosing eration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic S I ~1 b~ ~ / 3 3 ~ Dosing ~1~1 ~ ± ~, y~o' Holding PUMA/SIPHON INFORMOTI~Iu ~~ ~ // Manufacturer D Demand 1 GPM ,~ •y Model Number {~ H Lift ~ ot.\O Friction Loss 2 . t S System Head , SS~ TDH Ft .~ Forcemain Length ( Dia. t1 Dist. to Well ~ r ~S vvr~ r+~avrcr r wrv ~ TJ I tM ' ~~Cnyui , ~~~.vr~rwr~ vri~/1 County: St. Croix Sanitary Permit No: 399418 State Plan ID No: 6 s ~r . ~o.~ Parcel Tax No: 012-1055-80-000 STATION BS HI FS ELEV. Benchmark G.Z3 ,z Alt. BM Bldg. Sewer -7 7-. t/Ht Inlet l •DO ~'~Z3 St/Ht Outlet Dt Inlet Dt Bottom O Header/Man. ~ .r Dist. Pipe ,4 .o S b.p to . Ioc.~S'' Bot. System ~ e(. l~ Final Grade '~ St Cover byc>A•f IM. l ~° .sue w~~S !~~' Of Pits Ilnsi'de Dia.- Liquid Depth ~_~~~+~~ JTJItM IV P/L ~- LDG WEI,~ D~ LAKE/STREAM LEACHING er: INFORMATION Type Of Syste CHAMBER O ~C~ ~ (~ 3~~ ~' r _ DN Model Number. DISTRIBUTION SYSTEM Header/Manifold / Distribution ( I Pipe(s) ~ ( (f f Length Z •~ Dia ?'~ L th ~ /2 2' ~ x Hole Size tt s/ x Hole Spacing r Vent to Air Intake eng Dia Spacing 3 2 Z ~ ~ 3 SC111 Cr!1V~1~ _ _ Depth Over - ------- ----~ Depth Over ............... ... .,.-.~.a.. xx Depth of ~ ~,~«~~~~ .,~~~y xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~~ No ~ Yes ~ No ~~ ~ ~• i u ae discre encies, persons present, etc.) Inspection #1: d /~` _/~ Inspection #2: ~ / / 3 / ~ 'tcvo ~ • ~. p Location: 1321 200th Street Baldwin, WI 54002 (SW 1/4 SW 1/4 25 T30N R17W) NA Lo / Parcel No 25.30.1 ~ A ~~ 1.) Alt BM Description = .S':~ /d~kn~bcr h.•cd~t/[wr.e~ 7~ r'c~/•rcc Pt t ~0%~ ~~~~ s~p~,~ 2.) Bldg sewer length =..s-S'-' /, r ~«s~C,~f ~~sP ~c~M C~ ! ~ / '/,_ ~ !~ yo/ ' - amount o gc~over =1~•~'1S ~' pi,l/ 6e iKsur',~c~ [~,~/cr t4k; s {5,- y~,vv,Es ~ ~O 6c !x.~vccy; tw Cr~a.,,,Es "~AWc rY~~e 3.) Contour , I•e~~~d'tu e w,~,y. is 4 {~e/%~ ,~w1~ •~ M.~u~ Lvon,~C (~ ~ N1, ` GB,-s r ~ ,/~ I~la~t ~ 3' ~ = l0 Z• `1 ~ ~,/. e8'`~ (a~{o ~z~ r~ e~,~ ~3~raL-~ /t rlo s ri~ fir. ~ t' 1~ G l~t.~l ~~ vision equired? `~ [,N 0~ Z( I ~'J-i•"ter ~_7~~ ~ Use other side for additional information. ~ ~ 7"l s~ SBD-6710 (R.3/97) Date Insepct`tor's Signature 4Y~ Cert. No. // S~ ~ ~ ` tlv i-titw,•~J Qlr/`t5 op ~ May << ~ ~•~ ~ted~ ~,ori~~r ... ~c r yo Ago ir: u~c xtnn~ X - SCG l~j~-- . -~~ / 9 S3 s~ .~ ~ Safety and Buildings DivisielYt a County ~ n 201 W. Washington Ave., P.O. Box 7162 ~ O ,' `SCOns,~ Madison, WI 53707 - 7162 Site Address ~ ~ Department of Commerce ~3~/ ~~'a -~~ ~n~~t.Ji Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ~~~ ma be used for sew ses Privac Law, s15. 1 m I. Application Information -Please Print All Information State Plan I.D. Number t~ Property Owner's Name Parcel Number a6. 3 O , ~ 7 3 `t ~. /t} ~o~~~ ~ . Property Owner's Maili g A s n ~ Property Location -~ a ~ G~.. I ~~Q Lt) Sf Str) Sf : S~~ T .~ N, R I City, State Zip Code Phone Number L.ot Number Blcek Number ~~ 1 ~~ ~ ~/ ~~ ~ • p~~ ~/~- / bl~.o. z~j r]/ Subdivision Name CSM Number Y G~ II.,.~~ of Building (check all that apply) ^Clty 171 or 2 Family Dwelling -Number of Bedrooms ^Village_ ^ Public/Commercial -Describe Use ,,__,,// c~ I>hTownstu ~ i i ' ~ ' ~ ~ P ~~ ~t~-- Y . ^ State Owned ~/ ~,t/1 ~~ /, ~ ~~ J~~ ~ ~ ~~ ` Neare~ 6O~ ~_ (Check only one box o line A (numbering scheme for internal use). Complete line B if applicable) III. Type of Permit: `,' 1 ^ New 2 Replacement System 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl Ezis ' stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued I(V. Type of Permit: (Check all that apply) umb g scheme is for internal use) ~~, ~a •Q ~_ 44 ^ Non -Pressurized In-Ground 21 Mound 47 ^ Sand Filter 50 ^ Constructed Wetland ~~e~3 - o, O 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Lane 45 ^ At-Grade 46 ^ Aerobic T tment Utrit 49 ^ Recirculating 30 ^ Other '~ V. D' rsal/'h~eatment Area Informati on: K ~ r ~ - Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.FtJ (Min./Inch) Elevation ~~p ~~o ~ S-~ ~ . ~ ~~ folio/ lD~.~' VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel Fiber plastic Galions Gallons of Tanks Concrete Constructed Glass New Existing Talcs Tanks Septic or Holding Tank / ~- /~~jO ~ ~ Dosing Chamber ~.+ D~ S®O ~~ v VII. Responsibility Statement- I, the undersigned, assume resporuibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature ~ /MFRS Number ~ 3 Business Phone Number alp ~. ~ . z~ ~~. 7/5 - 68y ~~ ~~ Plumber's Address (Street, City, Stan, Zip Code) VIII. Count /De artment Use Onl proved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchar e Fee) Date Issued Issu' A em Si tore (No Stamps) ^ Owner Given Initial Adverse g a q of ~ Determination n ~ r IBC. C01°l~ttA~{~t~(l~a~i~a~an o~n~pe°r ode requirements. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Well setbacks to be maintained per NR 811 & 812. Attain complete plans (to the County oNy) for the s~atem on paper not less than Sll2 z 11 [aches in Sze SBD-6398 (R. OS/Ol) +. • ' f ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary June 08, 2001 CUST ID No.220853 DALE E HUDSON 820 MAIN ST BALDWIN WI 54002 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/08/2003 AT77V.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Phil Doornink - 1321 200th Street St. Croix County, Town of Erin Prairie SW1/4, SW1/4, 525, T30N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 794406 Identifica'' ers Transaction ID No 648593 Site ID No. 63040 Please refer'to' both i entification numbers, above, in all corres ondence-with the a enc The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "SSWMP Publication 9.6 Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems (01/81). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of this information must be given to the owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. DALE E HUDSON Page 2 6/8/01 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ?~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to 4:30 PM j swim@commerc e. state. wi. us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DLTE $ 0.00 WiSMART code: 7633 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Prc~ect Name: P'htil~ ~ Joan Doom~k 3 bedroom residential mound Owner's Name: PhNi^ip ~ Joan Doomink C)umer's Address: 1321200th Street Baldwin, WI 54002 P,o W.Tn •~ty ~,.,. ditto Lega! Description: SW1/4SW1/4, Sec. 25, T.30N., R.17W. ~V~D Township: Erin Prairie OEP ~1AEN? Of COM~~~~ ~~ County. St. Crobc PENCE SEE GOR~P Subdivision Name: NA Lot Number. NA Block Number. NA PBiroel l.D. Number. 012-1055-80-000, ID# 25.30.17.391A Plan Transaction No.: RE~jE~vE~ Page 1 indexandtitle MAY 2 1 2~4~ Page 2 Page 3 Data entry Mound drawings SA cE~ ~ B f ~ ~ Page 4 Lateral and dose tank = , " Page 5 System maiM~enanc;e specifications Page 8 Management and contingency plan Page 7 Pump cutve and specifications Page 8 Site Plan Page 9 Sod Evaluation report Designer: Dale Hudson License Number: 220853 Date: 05/17/01 .~.... Phone Number. 715-684-3378 Signature: ~ ~,r,~~y../ Designed Pursuar-t to the Mound Component Manual for POWTS Version 2.0 SD&10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) Version 3.0 (03J01/01) Page 1 of 9 JUN-07-2001 12:10 PM A.C.E. Soil & Site Eual 715 248 7764 Mound and Pressure Distribution Component i~esi~n Design Worksheet (r or c) R Reeidentlal or Commerdal Deign tdcle~ SUnd fNI (D, pilaw N N e aoo.0o ~an,ated waetewate- Fio~w (apd> Taases.~.s r~.iar'.al t~.an«,tr« f«~ 1.50 Peatdng Factor (e.q. 1.6 * 95016) ooRrorm d 4. ae tnch.s. 450.00 Deeigrl Flew (gpd) 5.00 SttQ 81ope (96) Une Elevation (ft) /~_ ?2.00 Depth to Umtting Factor (in) 0.s0 In-situ Spit Applicatlorr Rate (gpdHtZ) DlstMbution Cell Infanr~atlon YO.00 Dispersal Ceti length Aivn9 Contour (ft) ~ 5.00 Cell Wklth (ft) 1.00 Cell Design Laa4ing Rabe (9f) 1 InfIUC~1t Wastewater Quality (1 or 2) Are the hater~ds the highest nt !n the cHastn'bution y Pressu~s Disrlbutlvn lafprntatloa network9 Enter Y or N (c or e) a Center or End Manifold 2.50 sparing (~ftj of the ih e, e~ the elevation ft ghost point. 0.106 Orifloe Diameter (In) (c.g. 0.25) 3.50 (mated Orifloe Spacing (ft} = 6.25 ftxloriTioe 2.00 FOroeme~in ©lameter (in) 80.00 Forcernain length (ft) Does the forcemain drain beck? ~~ ~•~ Pump Tsnk Elevation (ft) Enter Y or N 4.55 System Head (ft) x 7.3 14. Forremain Drainbex•.k (gsl) 6.55 Verdcad Uft {ft) 81.25 5x Void Volume ~) 2.60 Ftxrtlon t.osa (ft) 96.93 Minimum Dose Volume (Qal) 14.30 Total Dynamic Head {ft) 38.77 System Demand (gpm) t..aterat Diameter elevator in. rile. 'ors dice 0.75 1.00 1.73 x 1.50 x x 2.00 x 3.00 x Tr+eetment Tank irttorenatlon 1000.00 Se Ic Tank Capacity (gal) Weeks Co~ete Manufacturer Tank Dose Tank Capacity (ga Done Tank Volume {gaU mete ~ Memufadurer anlfold Diatnotpr M Selection in. dia. Ions ~ choice 1.25 x 1.50 x 2.00 x 3.00 Ions/lnoh Calwiator (optionag 800.00 Toth Tank Capadty {gal) 4,2.00 Total Working Uquid Depth (in) 18.OG gaUln enter res<ilt in cell B49) Effluent Filter Irtfan/Mjiptl ------ 31M/TiwCM Fitter Manufacturer 5TF -100 Filter Model Number Project: PhlUip $~ Joan Doomink 3 bedroom r+esidentiat mound page 2 of 9 P. 03 JUN-07-2001 12:10 PM A.C.E. Soil & Size E~al 715 248 7764 H 1.OOft K 9.10ft t 8.80 ft L 108.20 ft J 8.77' ft W 20.38 ft '•' r~r`rtir' .:t ~: i:~i ir't'r r•+•~~}~i SStir.,i.5:'}'ti • ' r ~.r. r r.r.r. 4 1. ti.ti.y.} ti.{ ti{ti:{.y . r 'r •~f r • .~.•.ty 4•~ ~. y~;:Cr'r 6 r r r r.r. .~.r.}xr:~tir~. ti~;. r•r.~ r r r. .% r. ti~ ~~~fy~ r.l r.~•r. r. . .~. ,~ , ~' .~. Mound Component Dlmetalons A 6.00ft E 15.80 in 8 A0.00 ft t= 8.50 In Q 14.00 In G 0.60 ft 450.00 (ft'} olsperaal Celt Area 5.00 (gpolft) Unear losding Rate 1223.A0 (ft~) t3sssl Anew Available 9.00 (ft)1110 B ~. Pipe Placement Mound Cross Seaton Vfew Aggregate biapersa, Area Mound Plsn Yiew F[nlshed Grade 102.80 (ft) 101.01 (ft)-- ; a ~l Cell . ;N Shadtn~ Key ~ ~ Topsoil ~p ••'•• Subsoil Cap ASTM t~3 Sand TUled Layec © r.f•r`. Ab~gregate ' H o~pa+~e~ c.a 101.51 (R) Lateral Invert _ •d ~~1 ' s.a ~ site s,ape .~ ~~ 11.5-ft T _ Z 0.5 ft D~e~psras~l Cell r. r.r.t IplCellatefal "rS~ 'r'•r•r.r.f.r•t.r f. r:r_r_r•r•r•r_ 6 a ------* ~vject: lshillip ~ Joeat Daomird~ 3 bedroortl residential mound (ft) Contour Elevetlon Geoteucgle Fabric Cover see lateral detalfe on Page 4 for number, size, and sparing Of laterals. Laterals arse equed(Y spaced from the dlshibution Delta centerline In the disbibution Dell (AxB). Pape 3 of 8 P. 04 JUN-07-2001 12:11 PM A.C.E. Soil & Site E~al 715 248 7764 Csnbr ConnoGtlon Lateral layout Dalgram ~'arNc COttponsrrt >f property verged Weeks ConCrote Manufacturer 800.00 Gedlons VautTle tp.05 ga~nch Dimension tnche9 Gallons A 23.12 440.38 B a.oo 38.10 C 4.88 92.94 0 12.00 228.60 Tote) 41.88 800.00 ~- A B C D ~ Id11+d0a1 tabs and toctdnp de~toe and >"aNO waartlphc 4 h. min. ~~ NEOrrrele outlet b~'.alion Foroemaln dlan040r 2 in. Waop hole or ana- s~ deuioe . Purro orf aMvatlon rfh P. 05 3" Bedding u tank. 83,gg ~~ Alarm Menuafacturdr LevelAnn Alarm Modol Number O<.V Pump Manufscturer Gvulda Pump Motel Number 3885 WE03L Pump Must Deliver 38.77 gpm at 14.30 ft TDH t0. So' •~~%LElbr, /oss ~(ro~l. Project: PhilNp 8 Joan Doamink 3 badnoom t+aelderrtlal moundM~~ tom'/utn~+~ :•/~i'= /jl.~O' y~.,y, Page 4 0l< 9 Farorr ~n~ln aonnoNan da r~ at oraee eo nwibld at P ~~TunwuP+~bdtwlwor Wgnwltplu0. NoNs ArYMd on wf Oeergln W trN Na+M~ t.ao.ab t: fororrnNln a PVC aoM ~o ~r COM4V1 Ta1M a1.7G6 s ak. NumbK of l.ttte~ls t,.ateral Dtatlteter lateral Lectgth (P) lateral Spacing (S) lateral Flow Rate System Fbw Race Total Dynamic Heed Orltloe Dlsmater Otiflce Spacing (X) Orlflces per latetat Oriflge Iaenelty Maltitdd Length Manlidd Diameter FonOemaln Velocity Dose Tank Information E~ ~ ~ wec aoo enct ---- ~.~..: Cortxn 78.28 WAC Mound Svstem Maimnce a d aeration Specifications Service Provider's Name Boldt's Plumbing -Dale Hudson Phone 715-684-3378 POWTS Regulator's Name St. Cron County Zoning ~ Phone 715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle S¢e 1/8 in Estimated Flow -Average 300 gpd Ma~amum BOD5 T20 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soli Absorption Component Size 450 ftz Ma~6mum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mt_ rvice Fr+aauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other I and/or service once 3 n; Should i and clean at feast once eve 3 r3 Test once 3 Should test months Laterals should be flushed and re tested a 1.5 rs I for i and once eve 3 Miacellansou$_ Construction and Materials Stand 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. A!I gravity and pn~sure piping materials c:ortform to the requirements in Comm 84, Wis. Adm. Cade. 4. Tillage of the bassi area is accomplished with a mold board ~ chisel plow. 5. The mound structure and other disturbed areas ~nn7t be seeded and mulched to prevent sod erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • .............. ................ ...~... Grade \ , 6-8" Diameter Lawn ~• Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Dution Lateral '~~""+y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Phatip S Joan Doomink 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, tfYis. Adm. Code General This system shall be operaRed in axordanoe with Comm82-84 Wsi. Adm. Code, and aFtaH maintainedm aocadar~oe w~F- its' oompa~er>t manuals (St3[)-10691-P (N.01ro1) arxi SSWI~ Publication 9.6 (01/81)] and kxal ar state rules pdtaining to system ~ and ~ reporting. No orte should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Se~ic artd pump tank abandonment snail be in accordance with cornet 83.33, Wis. Adm. Code when the tanks are no kxgo' used as Powys corrrporrents. Septic or pump tank motltole rinds, acoros risers and covers should be inspec6ed for water tightness and soundness. Access aperrirtgs used for service and assessment shall be sealed watertight upon the gorrtErledort of service. Any opdring deemed unsound, Oefectlve, or subject to faikme rrwst be replaced. F.~osed access openings greater' than 8-inches in diameter shall be secured by an effective locking device to prevent axiderttai or tmautiwrirod arty irrto a tank or camponerrt. 3eatic Tank The septic tank shall be maintained by an individual Certified to service septic tanks urxler s. 281.48, Slats. The of the septic lark shall be disposed of in accordance with NR 113, Wis. Adm. Code. The updating cortdfion of the septic tank and outlet fiber shall be assessed at (east once emery 3 years by inspection. The outlet fit~r shaA tie cleaned as rreoessary to errswe proper operation. The fl'ker cartridge should not be rerrrotesd unless provesions are made to retain solids in the tank that may skxgh off the filter when nentau~ed from its enclosure. if the fir is equipped witlt an alarm, the filter shall be serviced if the alarm is activated cwrrtinuot~ly. Irrterrrtit6ertt flitter alums may irtdicarte surge flours or err urrpertc~tg continuous alarm. The septic manic shaA have its contorts rentaved when the volurr-e of skidge and scam in the tank euroeeds 113 the liquid volume of the tank. 6 the contents of the tank are not rerrroved at the tkrre of a trlotrriad assessrrterrt, maintenance personnel shall advise the owner of when the rvaort service needs to be pdfarrted to ntalrrtain less than rnaodrrtum scum arxi sludge accumulation in the tank. The addidan of biological or citonicai additives ~ enhance septic tank perfonrrerres is generally not required. However tf such products are toed they shalt be approved for septic tank use by the Departrndtt of Cornnrerce. Tank The pump (dosing) tank shall be irdpected at learst once every 3 years. AN switcttes, alarms, and pturrps shall lie tested to verify proper operation. ff an effluent filter is irdtatled within the tank it shall be inspected and serviced as necessary. Mourn! and Prwsuro DisMbutia>r System No trues or shrubs should be plarrted on the mound. Ptardings may be made arotuxl the mound's perimeter, and the mound shall be seeded and rrrukhed as necessary to prevent erosion and to provide some prdection from frost penetratbn. Traffic (other that for vegetative msrirttenarrce) onthe mound is not recartrnended since soil compaction may hinder aeration of the infiltrative surface within ttte mound and srmw oorr>paction in the winter will promote frost penetration. Cold weather irts~lations (October-February) dk~ate that fhe motmd be heavily mulched as protection from freezing. infktdtt qus~ity into the mound system may not eoaoeed 220 mglt. t3OD~,150 mglL TSS, and 30 mglL FOG for septic tank eFfluerrt or 30 mglL t3OD~, 30 mglL TSS,10 mglL FOG, and 10` cfW100 ml. for highly treated effiuort. Infkrdrt fkrw may net emceed rrra~mum design fknw specified in the parrot for this installation. lire pressure distribution system ~ provided wkh a fk~shirtg pokd art the did of each lateral, did it is reCOrrrrtended that each lateral be fkshed of accumulated solids at I~st once every 18 mprtths. When a pressure bast is parfomted ti stwtdd be carrrpared to the initial test when the system was installed to deterrrrirre if orifice cbgging has ooaxred and ff orific;e cleotirg is required to maintain equal distribution within the dispersal cetl. Observation pipes within the d~pereal Cell shall be Cheated for effluent ponding. Parading levels shall be reported to the owner and any levels above 8 irxdtes c:arrsidered ors an impending hydraui~ failure r~equirirg addifiorral, more frequerit mondorirg. CcrrWrt~anCV t~larn ff the septic tank or any of its carrtpaid~e became defective the tank or comporrerit shah be repaired or replaced to keep the system in proper updating coriditiari. tf the dosing tank, , alarm or related wiring bec~nnies defective the defective carriporrertt(s) shah be irtrriediatehr repaired a replaced wfth a corriporidrt of the same ar equal performance. ff the mound cornpatdrt fails to accept wastewater or buns to discharge wastewater to the ground surface, ti win be repaired or replaced in its' preserat location by increasing basal anew if toe leakalge occ~us or by removing biologicaNy clogged absorption and dispersal media, and related piping, and replarcirtg said corrp~ortdrts as deemed riecesaa-y to bring the system irrto proper operating corrditiort. See Page 8 of this plot for the name old beleptiorie number of your ktcal POWTS regulator and service . Project Ph~t~ ~ Joan Doornink 3 bedroom residenfiai unound Page 6 of 9 JUN-07-2001 12:12 PM A.G.E. Soil & Site E~al 715 248 7764 P. O6 i ~ ~ Performance ~~1~1"1'ie~''Sj~~e ~ ffl~~n# ,~ Curves ~ut11 S p ~,,,~ MErEFIS FtLT METERS FEET 1 36 1 ~ ti 25~ f e ~ ~ s 20 ~s ~ to x zo s io o a 0 o198S GOUItlt PV+nDi, Inc. 77~4n1, GPlyl ~~~ ~GC~Ul.DS PUMPS.INC, SB+SCA FiulS SEMI tDQC 13uA " "" "' ~p0 110 1ZO OPfy1 CAPgCITY m'/h . 70~" Q ~edve JWr, ~9f15 JUN-07-2001 12:12 PM A. C. E_ Soil & Site E~al 715 248 7764 P. 07 Z ~ ~7i/O6S~t/"Il~iorl IO'{ PPOpo~cd I`~~p~QCCr~cn~ Mown d a ~ ,Lo• ~ b' x ia~.za'w,~ s'XSl?' di s/t~sa/Cc //. l~k~(yJ Itf eii~l.S a ~ /1~t ~ 'v~:.~8'w: tc r/~~OW'tictsw.i.~R3f,"' ~ SCI a c.~ ny. v ~ ~/S~i'ny pteund ~o~e /~t~rce/cd or ~l/~pbCtlQ°~~bct~ivttn [X/sdn ~toa„d ~ ryebttn~,~ ~nvs..,,d (~^t/4s~ f~d,• oi'S.r~itts s.~~ 6e Ewun Sr••t.S, be cXP Uestd a.~rd iaau/a~cd as pcr Co,.,,n. 8z..3o(i~Cc~i~ ~rf.~~~~.,~;/ed etor~nd e.~~. =n~sibl~ bo~~o.w of R ~.. o«.b~t E : 97. /~.` r vpa~-a ssioca t latJ: = /AA Cp: * if . ~~ ~ 7o/a of Aug,. f~ ~~t~I: ~ /O/. i~- Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1418 page t of 3 AC.E. Sal & Site Evaluations County Attach complete site plan on paper not less than S'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and --------- - _ - - _ Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 012-1055-80-000, ID# 25.30.17.391 Please print all information. Reviewed gy Date Personal iMormalbn you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I Property Owner Property Location Phillip & Joan Doomink Govt. lot SW 1/4 SW___1/4 S 25 T 30 N R 17 W __ Property Owner's Mailing Address Lot # Block # ~ Subd. Name or CSM# ~ 1321 200th Street _ __ - - - - _ _ City State Zip Code Phone Number ~ City ^?~ Wage ~ Town Nearest Road Baldwin ~ W 1 ; 54002 715-684-3076 Erin Prairie ~ 200Th Street /~ New Construction Use: ~ Residential / Number d bedrooms -- - - 3 _ Code derived design Harr rate 450 _ ___ _GPD Replacement ~ Public or commercial -Describe: Parent material Glacial Till -. -- .---_-__-- Flood plain elevation, if applicable --_- nor ___- General comments and recommend ions: Mound system elev. = 99.84' at 10" above 99.00' contour. aB~~# ~~ 26" M Pit Ground Surface elev. 100_13 .__ ft pepth to limiting factor _ in• Sal Application Rate Horizon ' Depth I Dominant Caor j Redox Description Texture Structure Consistence Boundary Roots GPDIft' _ li ~ 'Eff#1 "Eff#2 1 I 0-3 I 10yr3/2 ~ none sil 2fsbk mvfr as. - 2f,1mc 0.5 '. 0.8 --- ~ ---~---- ----- ---------- ---- -- - - --- ~ r _ _ _ 3-20 . 10yr5/4 j none 2 ~ -1.- __ ail _____ 2msbk mvfr -----~ - cw ___._-._ 2f,1mc ~ _- __-__ ~ 0.5 0.8 7 __ _ 3 ~I 20-26 ~ 7.5yr4/4 ~ none sl 1 msbk mfr j cw - 0.4 0.6 ~ -- ~----F----- --1--- -- Qf7.5yr5/8& 4 26 37 I 7.5yr4/4 ~ f2d t0yr6/2 ------- sl -- -- Om - mfr ~ r -- t 0.3 _ 0.5 ' I I _ I -- -- - --- - -.. _ --- - ~~ ~ - ---- I - ---- goring # J Boring 22~~ 1/ Pit Ground Surface elev. 98.96 _ ft. Depth to limiting factor -- -in. Sal Application Rate Horizon. Depth Dominant Color Redox Description Texture Structure Consistence j Boundary Roots ~ GPDIfN_____ ~ Eff#1 Eff#2 1 ' 0-3 10yr3/2 , none sil 2fsbk mvfr as ~ 2f,1mc 0.5 ~ 0.8 ~ 2 3-19 10yr5/4 I none ~ sil 2msbk --- mvfr --- cw --- 2f,1 me II -- --- 0 5 ' 0.8 - _ -- ___ _ -- ---- 3 19-22 4 122-35 _ 7.5yr4/4 none y~ Qf7.5 /88c 7.5yr4/4 ~ f2d t /2 OY~ ---- - sl sl 1msbk Om mfr ~ mfr cw _ _ - ~j r t 0.4 ~ 0.6 ----t---- _ _ 0.3 ~ 0.5 _ _ _ _ _ _- _ I --_ ------ ~ ------ ---------- -----_._ --~ i --- -i -------_ ~-- - - _ ------ I er seepage observed at 32". ' Effluent #1 = BOD y~ 30 <_ 220 nxyL and TSS < 150 mg/ ffl #2 = BOD < 30 mg/L and TSS <~30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson _ ~5-- 3602 Address A.C.E. Sal 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceda WI 0 5/17/01 715-248-7767 _j Pd Ground Surface elev. ft. Depth to limfing factor in. Soil Application Rate ~~ # ~ ~~ - Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots PDIft' ___ 'Eff#1 'Eff#2 -~-- -- -____-_.J -- - - ---I -- ------ _._..____ ___ - __ .- - - _ ._-.-.-._. _-_-._._._ -- ~ ~ i ___ -_._._...___ 7..____.__.__._ ~ _ _- -_- rt___ -_ ___--_._- i I _---- -_-__- - ~. - .~._____.-..__y.___-__..._.___.. i __-.. _-___ i I __-_._.__-_.-_.-__-_ __-_. _.___. _..._--__~-_.-_-... ~ i i ____-_-_ __. ._ _.____t I .__ ___._._..__ r ___._. __._... _ _._. ~ II _ __ t_- . } I ~ III _ ___-.-~ _.. __-____.. __..__.-._..._-_._-__ f ~I._ --_. _ _.__ __-___ ~ l I -___._..__~. _.__.....__... .. _.. _.._.. .. _.. ''.. ~~ # J sonng Depth to limiting factor in ft . Pit Ground Surface elev. _ . Sal Application Rate - - Horizon Depth Dominant Color Redox Description Texture StrucUue Consistence t3oundary Roots GPD/ft' _ _ 'Eff#1 •Eff#2 I - -a----- I ---- ------- ~ i i _ - _ _ I I -- ----- -- i --- -- - ---- - -- _ - --------- - ------ I I --~-- r -- T------ - __ ----- ------ ------ --- -- --___ ---__. _ - -- -- ---_ _. .- --~- -------i _+ _ -- _ __ _ _ - - - -- _; -- _ ~ -~ I I ------~ ----- -- -- t --- - ± ~, I 'Effluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = GODS <30 mg/l. and TSS <330 mgll. 7'he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an attemate format, please contact the department at 608-266-3 l S 1 or TTY 608-264-8777. property Owner Phil-~_& loan Doornink p~ Ip # 012-1055-80-0001 ID# _ page 2__of 3 ~-~ - - - I '~ I Rcvim ~e ~n9 I ,r 83 ~~ C9c qqo ~o ~ 8~ ^ ~o~ ~ . ~z ~ Yt~e : Exis-~,~~ bu:/d,-.,~ sewer to b¢ eXfaS-era-nc~l i~sa/~~e.d osPGr' Cornrrr. S.Z.30(~)(C)2.$i ~a~a~¢. E,l~i~i.q 3 beds, /'csidirx.C ~, ' ~ ~- f~ ~,~ ~, ~; `. ,~ q S of .3 O V"/C. • / i1 ~~ ^ ~i/ 065c/'Va-/u'o.-~ P,~~ T' `I ~Y ry ,s~n~ hyd~waGta./y,ca; /Qd ~~.,~ =nsic~e baf~aM of G: = 93e% Tp p oI'z "~v~ce.~ta;h a~ RC,. oKElet :97.,8, ~-X,s~,-~ &t7~~wee~t's C' ors cre c ~ ccm~oC/ia.n 62~: J ` 5~~ry~`j-¢t~i SrF- ~G~D PAL'/ue.,~ Fi /Ecr~o bt in S-E~zCCtda6~r EXisr~r~q lc~o~.0. w~ _ Cone rcO~c Se~E~•cta.,~C. ~ 6t,ncl,wtari~: ~o~ovF~.a~a~c~Yuoi-S~a6. A ssum.cd clc.rt = IoO. ~: ~a ~e c~e(L \ buy ~~n y .~,qC.~. b.n{.: Teo o{'l~ury,p cliar,-, bcr mo~,lto% Cow: Qom'#/y/8 Wisconsin Departrner-t of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arrer~danr~ with ('.earn ti5_ Wipe Attm_ Cede 1418 page 1 of 3 AC.E. Sal 8 Site Evdualflons Attach carlplete site plan on paper not less than 8%: x 11 inches in size. Plan must i cl b d t t N B d t d h i l f i f N ~~ St. Cron( n u e, u no m e o: vert an or zonta erence pant {B Ca re Q, direction and percent slope, scale a dimemsions, north arrow, and location and distance to n~rest road. Parcel I.D. 012-1055-80-000, ID# 25.30.17.391 PI a lion. Personal information rposes (PriwacY Lew. s. 15.04 (t) (m)). ~ • ~ Z 5- ~ ~ ~~ i n ~' - ~ ~ P & ~ ~ rq~Y L i.t1 '~ •s n Do ~~,[,! Phi IIip J oa Govt. lot SW 1/4 SW 1k S 25 T 30 N R 17 W Property Gwner's '~"' Address ~ ` _ Lot # Block # Subd. Name or CSNMl: , 1321 200th Stre f '~~ ~# ~~fl~ ~- C8Y cs"~ ~, Sta~ ~~ .~ ~ City _! viNage ~ Town Nearest Road Baldwin .r ^,, ~ Wlr' r 84-3076 Erin Prairie 200Th Street ~ New Construction `'. , t7se: ~ R~ ~ ~ of bedrooms 3 Code derived design flaw rate -I Replacement ~`'~~. l J~ublie,~dr -Describe: Parent material Glacial Till _ _ Flood plain elevation, iF applk~ble General corruttertts and ~xaarxrfarrdaions: Mound system elev. = 99.84' at 10" above 99.00' contour. 450 GPD na Bonng # ~ Bonng rJ Pit Ground Surface elev. 100.13 ft to limiting factor 26" in. ~ App Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rools GP DIiI= •E *E 1 0-3 10yr3/2 none sil 2fsbk mvfr as 2f,1mc 0.5 0.8 2 3- 0 10yr5/4 none sil 2msbk mvfr cw 2f,1mc 0.5 0.8 3 20- 6 7.5yr4/4 none sl 1 msbk mfr cw - 0.4 0.6 4 -37 7.5yr4/4 ~f2d j~'`sy~~ sl Om mfr - - 0.3 0.5 oBori~# ~~~ ~/} Pit Ground Surfarce elev. 98.96 ft. Depth to limiting factor 22" n. Soa Appficatiorl Rate Horizon Depth Dominant Color Redox Description Texture Stnxx:ture Consistence Boundary Rohs GP D/ftt "Eff#1 'E 1 0 10yr3/2 ~ none sil 2fsbk mvfr as 2f,1mc 0.5 0.8 2 -19 10yr5/4 none sil 2msbk 4 mvfr cw 2f,1mc 0.5 0.8 3 19-22 7,5yr4/4 none sl 1msbk mfr cw - 0.4 0.8 4 22-35 7.5yr4/4 fL~,d j(~y~/ & sl Om mfr - - 0.3 0.5 seepalge of~erved at 32". * Effluent #1 = BOD y> 30 <_ 220 mglL artd TSS < 150 ffl #2 = t30D a 30 rnlglL and TSS <~0 mglL CST Name (Please Print) Sig ure: CST Number James K. Thompson ~S-- 3602 Address A.C.E. Soil 8 Site Evaluations "Dam Evaluation Conducted Telephone Nurtd~er 340 Paulson Lake Lane. C+sceola WI 5/17/01 715-248-7767 Property Owner PhiiGp & .loan Doomink p~ tp # 012-1055-80.0001ID# Pace 2 d 3 Borirg # ~ Boring Pit Ground Surface elev. 99.02 ft. Depth to limiting factor 23" in. ~ qpp Rate Hor¢q~ Depth Dominant Cots Redox Desafption Texture Structure Consistence Bound~y Roots "Eff#1 'Eff~2 1 0-4 10yr3/2 none sil 2fsbk mvtr as 2f,1mc 0.5 0.8 2 4-22 10yr5/4 none sil 2msbk mvfr cw 2f,1mc 0.5 0.8 3 22-23 7.5yr4/4 none sl 1 msbk mft cw - 0.4 0.6 4 23-31 7.5 4/4 ~ f2f 7.Syr5/8 & Qd 1 /2 sl Om mfr - - 0.3 0.5 Groundwater seepage observed at 32". Bonng # j Bonng ;J Pit Ground Surface elev. ft. Depth to limfir-g factor in. Sod Applicirbon Rate Haizon Depth Dominant Cola Redox Desrxiption Texture Structure Consistence Boundary Roots 'Effilk'I 'Eff~t2 Boring # ~ ~~ Pit Ground Surface elev. ft. Depth to lirratirg factor in. ~ q Rake Horizon Depth Dominant Color Redox Description Texture Structure Carsbtence Boundary Roots 'Eft#1 'Eff#2 ' Eff~nt #1 = BOD y.> 30 < 220 mgll and TSS >30 < 150 mglL " EfBtrent #,2 = BODS <~30 mglL and TSS <~0 mg/l. The Departrnem of Commerce is an equal opportunity service provider and empbyer. ff you need assistance to access services or need material in an atterr-ate forma[ vlease contact the department at 608-2fi6-31 S 1 or 1TY 608-264,8777. 83 ~~ ~c a°`~ ~o ~ / 81 ^ 39 ~O~ ez i'~~e : ExiS~nq bu;/Q/:n~ Se~vei to 6e eXfas~a.,c~l i~sa/¢.~e.al as,ocn Corn. sz.so(,)(c)~ ~a~a~¢, ~~. sof3 Z P,~~ T~ y "Y ti Sf~'n~e hyd~+a~G'ta/y fa:/ed irtou~nN =nside boffo~ of To p off' 2~ /CorcCr7t a ~., o f RC,, ou.~let _ 97.:8., C' on e.~e e ~0 u-~.~pC/iarn 62i: Siin~`Tec,11 sTV_ iG~o P~f'/u~nt ~i /f cr~o be in S&tCCt~da6out/, E,t'iSfinq ~,Gbo~P. cclee~ -Cone rc~ Se,ofi'c~.n~. ------ 6e, cti : 7opof'~ ana~ c .~Yaons/a6. EX%~' 36e ~" cue bk~ k~~n9 /'cs~4~~cC % ~~ EJev~= poi 68; ~, ~~ ;~ ~~ i~ f~ ~~. ~, ~~ i; •, ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM w oa/~~^/, ~/ Mailing Address _ ~.~ ~ / ~ ~d~ ~• Property Address ~Gt /!~l ~J/ 1'`~- f ~i~~ ~~p~~- (Verification required from Planning Department for new construction) /V/~ City/State U pf c~~'Y~- ~s' ~ Parcel Identification Number 4/Z -~°c~5'S - ~~~ ©D~ LEGAL DESCRIPTION ~ Property Location S'L~J '/4, S~ '/4, Sec. yJ • T -~~N-R ~~ W, Town of~Y'i~•- rr~a,~,~~ OwnerBuyer Subdivision /~1~ ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # J ~ ~ ~ ~ ~ ,Volume /n ~d g .Page # 3 8 Spec house ^ yes Lot no Lot lines identifiable (l~ 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 can 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposalsystern 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, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da the ee ye expiration date. °`1/1~/o I SIGNA 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 p described above, by virtue of a warranty deed recorded in Register of Deeds Office. i _ / /~ SIGNA OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 59456' REAL ESTATE ~" -`RTGAGE ' ' (For use with any size first lien/mortgage real eatah co an Individual for personal, family, household or agricultural purposes. Also used for suoordinate mortgage loans over $25,000 or a second mortgage real estate loan where the Credit Union also holds the first mortgage.) Acct. No. 305876-22 In consideration of the sum of Thirty-four Thousand and NO/100--- Dollars ($ 34,000.OU ), the receipt of which is acknowledged, Phillip L lloornink & Joan E Doornink, husband and wi e ("Mortgagor", whether one or more) mortgages, conveys and warrants to WESTCOnsin Credit Union ("Credit Union"), of Baldwin ,Wisconsin and its successors and assigns the following described real estate in St. Croix County, Wisconsin, together with all privileges, hereditaments, easements and appurtenances, all rents, leases, issues and profits, all awards and payments made as a result of the exercise of the right of eminent domain, and all existing and future improvements and fixtures (all called the "Property"), to wit: v~~ ~ G~~~a,E`3~0 REGISTER'S OFFICE ST. CROIX CO., WI Reed for Record .lC~L 2 6 1994 ~ 8:30 ~ ~ ~~a.M Regifaber of Deeds RETURN TO W~;STconsin Credit Union 860 Cedar Street Baldwin, WI 54002 Tax Key # SW~ of SW~ of Section15-30-17 EXCEPT Lot 1 of Certified Survey Map filed September 23, 19130 in Volume "4", page y87, (No. 53) This (iaatet) homestead property. ^ If checked, description of property is continued on an attached sheet. 1. Covenant of Title. Mortgagor warrants that Mortgagor is seized of good title to the Property in fee simple, free and clear of all liens and encumbrances, except restrictions and easements of record, municipal and zoning ordin nces current taxes and assessment no yet due and First National Bank of Baldwin Dated 3-3~-tip with a principal Sba~ance of 2%,443.12. f:b0i;8 (ESIL '~F!) lf1~M •ew!l of aw!l wa; pa~egwnue~ eq bew ~tayl se suo{loss esoyl of aye seln3elS u!suoos!M eyl;o suo!loes of a6eBUOW s!yl u! seoua~e;e~ Ily •saoua~a;sly tio3nie~g '14 . 'es~an ao!n pue le~nld 6y3 0l ~a;ea osle ~(ew u!e~ey ~eln6u!s syl ;o esn ~(ue su6!sse pue s~osseoons 'sen!leluese~de.l leuo&.Led 'saley en!loedse~ ~!~yl pus (s)~oBeBuow spu!q pue 'su6!sse pue saosseoons sl! 'uolu~ l!pe~D sll;euaq eBe6uoW s!yl 'le~anes pue lu!o(e~e s~oBe6>JOW pe;o suo!leBpgp eyl •auBlsed pus s~ossaoong •g ~ vo!s!nad ~eylo ~(ue;o,~lll!geeao;ue ~0.~(3!p!le~ e41 toe;;e lou pegs s6eBiroy~ s!yi;o uo!s!nad ~tue;o ~lll!geeao;ueun ~o Rl!p!lenul •Rlp~gwaneg •gl •eBeBUow eyl uo line;ep luenbesgns ~o ao!~d ~sylo Rue 6u!nlenn lnoyl!M line;ep ~(ue en!enn stew uo!u~ 3!Pe~O •~sAlsM 'bl . •eBeBl~ow s!yl Bu!so~oe~o; u! uo!u~ l!PeJO ~(q pa~mou! 'souep!na ell!1 Bu!u!elgo;o sesuedxe pue ('3e3S 'sIM (e)£OL'8Zb§ ~(q Pel!gWad lou luelxe eyl ol) see; s,~fewolle Bulpnloul 'sesuedxe pue slsoo elgeuoses~ Ile dad pays ~oBe6uoy~ •sasuedx3 •¢ ~ •pe~elue s! ;uewf3pnl emi;oloe~o; a ~aut3 syluow amyl ~Uedad eyl ;o ales e pjoy pus 3ueuaBpn(~(oua!o!;ep a of ly6!a 6yi en!em ''leis 's!M f>Ol'9b9§ of luensand paeoad of uo!ldo eyl uo!u~ l!pe~O 3!w~ed of see~6e ~oBeB>JOw 'uo!lez!ue6ao elgel!ae4o 3dwexe xel Rq peumo ~o yo~nyo `wae; a 'eouap!se~ ~(I!we; mo; 03 euo pe!dnooo-~aunno ueyl aeylo s! ~tl~edad peBe6>,oW ayl }! •peaalue s! luew6pnf emsoloeao; ~eue syluow x!s ssel ao saaoe OZ !o ~(uedad syl;o ales a ploy pue luewBpnf ~(oue!o!;ep a of lyBu eyl en!eM ''leis 's!M lOl'8t+8§ of luensmd peaoad of uolido eyl uo!uC l!pe~D i!w~ed of sae~6e ~oBeBl~oW 'uo!lez!ue6~o elgel!~eyo idwexe xei a Rq peunno.lo yanyo `wee; e `e~nso!oe~o_;;o ew!l ayl ie pe!dnooo-~euMO s! leyi eouep!se~ ~t!!we; ono; of euo a s! ~tUadoad peBeBUoW eyi 11 'iuaw6pnt• l(oua}aµap inoy3lN- ®~nsopao~ •z G '1da11D dew LnOd 8Ul Se palldde pue p19U 8Q of 'Peloelloo ~' ; ADDITIONAL PROVISIONS YOL ~UCJJPAr,E•,)L)1 3. Taxes. To the extent not paid to Cr~_.. Union under §5(a), Mortgagor shall pay before they bec~ delinquent all taxes, assessments and other charges which may be levied or assessed against the Property, or against Credit Union upon this Mortgage or the Note, or upon Credit Union's interest in the Property, and deliver to Credit Union receipts showing timely payment. 4. Insurance. Mortgagor shall keep the improvements now existing or hereafter erected on the Property insured against direct loss or damage occasioned by fire, extended coverage perils and such other hazards (e.g. flooding) as Credit Union may require, now or later, through insurers approved by Credit Union, in amounts not less than the unpaid balance of the•Note without coinsurance, and shall pay the premiums when due. The policies shall contain the standard mortgage clause in favor of Credit Union and, unless Credit Union otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Credit Union. Mortgagor shall promptly give notice of any loss to insurance companies and Credit Union. All proceeds ~ from such insurance shall be applied at Credit Union's option, to the installments of the Note in the inverse order of their maturities (without penalty ~ for prepayment) or to the restoration of the Property, including improvements. 5. Mortgagor's CovsneMs. Mortgagor covenants: (a) To pay monthly to Credit Union one-twelfth (1 /12th) of the estimated annual taxes, assessments, property insurance premiums and mortgage guaranty insurance premiums upon the Property. Upon demand, Mortgagor shall pay Credit Union such additional sums as are necessary to pay those charges in full when due. Credit Union shall apply said amounts against the taxes, assessments, and insurance premiums when due. Amounts paid by Mortgagor r~ pursuant to this paragraph may be commingled with Credit Union's general funds, and interest shalt be paid on those payments to the extent required \ ' W by taw; "~ (b) Condition and Repair. To keep the Property in good condition and repair, and to restore or replace damaged or destroyed improvements,and fixtures; (V (c) Liens. To keep the Property free from all liens and Mortgages other than this Mortgage and those liens and mortgages to which Credit Union has \`~ consented in writing; v (d) Waste. Not to commit waste or permit waste to be committed upon the Property; (e) Conveyance. Not to, without prior written consent of Credit Union, convey, sell, mortgage, assign, lease, or in any other manner transfer any interest (legal or equitable) in all or any.par~ of the Property or permit same to occur, except as provided in 12 C.F.R. Sec. 591.5; and Credit Union may, without notice to Mortgagor, deal with any transferee in the same manner as with Mortgagor without discharging Mortgagor's liability under the Note or this Mortgage; (f) Alteration or Removal. Not to remove, demolish or materially alter any part of the Property, without Credit Union's prior written consent, except Mortgagor may remove a fixture, provided the fixture is promptly replaced with another fixture of at least equal utility; (g) Condemnation. To pay to Credit Union alt compensation received for the taking of the Property, or any part, by condemnation proceedings (including payments in compromise of condemnation proceedings), and all compensation received as damages for injury to the Property, or any part. The ~ compensation shall be applied in such manner as Credit Union determines to rebuilding of the Property or to installments of the Note in the inverse ' order of their maturities (without penalty for prepayment); (h) Subrogation. The Credit Union is subrogated to the lien of any mortgage or lien discharged, in whole or in part, by the Note proceeds; (i) Ordinances; Inspection. To comply with all laws, ordinances and regulations affeoting the Property; Credit Union and its authorized representatives may enter the Property at reasonable times to inspect it and, at Credit,Union's option, repair or restore it.. 6. Authority of Credit Union to Pertorm for Mortgagor. If Mortgagor fails to perform any duty imposed upon Mortgagor by this Mortgage or the Note, Credit Union may perform, or cause to be performed any of such duties, including but not limited to signing Mortgagor's name or paying any amount so required, and all amounts so paid by Credit Union for performance of such duties shall be secured by this Mortgage, shall be payable by Mortgagor upon demand, and shall bear interest from the date of payment by Mortgagor at the rate stated in the Note but shall not exceed the maximum rate permitted by law. 7. Change of Ownership. In the event the ownership of said mortgaged property or any part thereof becomes vested in a person other than Mortgagor, the Credit Union may, without notice to Mortgagor, deal with successor or successors in interest with reference to the mortgage and the debt secured thereby in the same manner as with the Mortgagor, and may forebear to sue or may extend time for payment of the debt secured by said mortgage without discharging or in any way affecting the liability of Mortgagor under said mortgage or upon the debt secured thereby. 8. Hazardous Substances. .Mortgagor shall not cause or permit the presence, use, disposal, storage, or release of any Hazardous Substances on or in the Property; Mortgagor shall not do, nor allow anyone else to do, anything affecting the Property that is in violation of any Environmental Law. The preceding sentence shall not apply to the presence, use, or storage on the Property of small quantities of Hazardous Substances that are generally recognized to be appropriate to normal residential uses and to maintenance of the Property. Mortgagor shall promptly give Lender written notice of any investigation, claim, demand, lawsuit or other action by any governmental or regulatory agency or private party involving the Property and any Hazardous Substance or Environmental Law of which Mortgagor has actual knowledge. If Mortgagor learns, or is notified by any governmental or regulatory authority, that any removal or other remediation of any Hazardous Substance affecting the Property is necessary, Mortgagor shall promptly take all necessary remedial actions in accordance with Environmental Law. "Hazardous Substances" are those substances defined as toxic or hazardous substances by Environmental Law and the following substances: gasoline, kerosene, other flammable or toxic petroleum products, toxic pesticides and herbicides, volatile solvents, materials containing asbestos or formaldehyde, and radioactive materials. "Environmental Law" means federal laws and- laws of the jurisdiction where the Property is located that relate to health, safety or environmental protection. 9. Remedies of Default. Upon the happening of any one or more of the following events or conditions, or in case of default in any of the terms, conditions, or agreements of this Mortgage or the Note which it secures, the Credit Union may at its option and without notice declare the. entire principal indebtedness evidenced by this Note due and payable, together with the interest thereon, costs and other expenses, and apply any indebtedness of the Credit Union to Mortgagor toward the payment of said indebtedness, and thereafter proceed by suit at law to foreclose said Mortgage given as security for "payment hereof, or both; upon default by Mortgagor in any payment provided in said Mortgage or by the Note said Mortgage secures; upon the making of a contract or agreement by Mortgagor or permitting anything to be done whereby anyone may acquire the right to place a lien, mortgage or other encum- brance against the mortgaged premises, or in case of the actual or threatened alteration, repair, or addition to, demolition or removal of any building on the premises, without obtaining the prior written consent of the Credit Union, or in the case Mortgagor or Mortgagor's spouse dies, changes marital status, changes marital domicile or becomes insolvent or a subject of a bankruptcy or other insolvency proceeding if that occurrence materially impairs the Mortgagor's ability to pay the amounts due under the Note, or in case of any act done or permitted to be done by Mortgagor, whereby the security hereby affected or intended to be affected shall be weakened, diminished or impaired, upon an adjudication in bankruptcy or a voluntary assignment for the benefit of creditors; or upon the failure of the Mortgagor to observe or pertorm any of the covenants and agreements contained herein or in the Note secured hereby. It is understood and agreed that the failure on the part of the Credit Union to exercise any of its rights hereunder for a default or breach of covenant shall not be construed to prejudice its right for any other or subsequent default or breach of covenant. 10. Power of Sale. In the event of foreclosure, Credit Union may sell the Property at public sale and execute and deliver to the purchaser(s) deeds of conveyance pursuant to statute. 11. Receiver. Upon the commencement or during the pendency of an action to foreclose this Mortgage, or enforce any other remedies of Credit Union under it, without regard to the adequacy or inadequacy of the Property as security for the Note, the court may appoint a receiver of the Property (Including homestead interest) without bond, and may empower the receiver to take possession of the Property and collect the rents, issues and profits of the Prooertv and exercise such other powers as the court may grant until the confirmation of sale, and may order the rents, issues and profits, when so I I I I 3 ~ o N o w m ~ c a coo A I co a~ d m~ H N a 3 O~ N C A ~ ~ N t~ ~ ~ n o d I ~ ~ ~ CD t0 'A Iy ~ ~ W i c a o r. I 3 ~- ~ O I ° m I c .y-. ~ 2 '0 ~ c I o ~ ~ ~ O N N Q I Z 0 I I ~ ~ ~ I ~ x ~ I c I W o' °• ~ o 'oo m N M N I ~ ~ O 7 ;j I a I ~ I N O I I o~ a a I wp °-' ~ N N d O O y N oa N '~ fyD 7 O O ~ ~ I °o O I ~ ~ ~ ~ ~ 3 3 :~ o ~ g I ~ ~ s 3. I ~ ~ ~ ~ ~ ~ ~ ~ fD ~ NO ~• 7 ?_ ~ C !~D ~ H ~ I ~ ~1 _ a I p a N m of ~ c°~a c°D ~ I 3 W !\i ~ L O O ~ 'O O d ~- ~~~o I~'« O O O ~ z ~~~~I o N y N ~ovv,o -- {~p ~ fA N j N .di B m N o ~~ I n °'• I z 0 D D o °• I o I ~ I I ~, I a z I ~ ~ ~ a 3 $ ;: I y ~ v I W O1 ~ I 3 I m C a ( I I I I I I i I I I 0 o=i ~ O 3 0 ~ ~ ~ a ,. ~ Vi 07 t=li fD n I° ~p N co a W O Z O o ~ c a ~ m m fD O m m c m 3 m y o' _~ o ~ a v _ na~v ~ ~ 7 d ~ n ~ ~ •~ z ~~•s3 0 0 O ~ f~Di ~ Uri to fD O ~ N y ~ (~D ~ d ~' O U1~ (D ?7 M ~ ~. 7 N O ~ ~_ O y y ~~~ ~ m ~ c O fD ~ ~ ~ 3 ~ ~ ~_ 1 >'~ y ~' •p ? O N ~ N d fD .+ N ~ O 7 N O ~ O L ~ ~ ;.. 3 o tJi n AN O. m d 7 H N y ~ W N a a N 0 o ~ ~ N N ~ fD CO ~ .~. A ~ fl. ~ ~ ~ j O O O N ~ ~ v v c ~1 ~ N C~1 c3o 3 D D o c n 3 ~ c 1 ~~ ~ ~ m ~ ~ #', m N o ~. cn ~ o s ~ _ ~• V ~ ~ W W ~ ~ O o D o ~ °o O N ° a r- v w y ~ ~ A 2 !D ~ ~ .~~, A ~ ~ C ~ ~ ~ O < a ~ ~ z c 3 a ~ o ^' c~ N ~ g z ~ W •P e j a d ai O ~1 0 ~• O C (~ !~ ~• O ~• l a A a A `~ H N O Q w 6p Oo lp ~ ti Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _~~~~~ C',.~G~~q~/ TOWNSHIP ~ ; ~ ~3.-p ~'^i'(° SEC . ,Z.S T 3d N-R~W . ADDRESS 1`~7~ Gam' ST. CROIX COUNTY, WISCONSIN SUBDIVISION /~~ LOT /"~ LOT SIZE ~ `-~~- '" PLAN VIEW _ ~~~~ .;,~ ~-.-~, y'd'~ ,a`r,~ ~ I~,e . ~', o~,n rain `e.:4 ~~:ti i Distances and dimensions to meet requirements of H 63 ~/`~. ~,,, SHOW EVERYTHING WITHIN i00 FEET OF SYSTEM ~~--~ ~~ ~ i - `>~~ '~ ~ _.~ / ~~ C ~~'~ ~ZS o' ~, f ~ \ !D , n:~,l` 'f o ~DUI'1G~ /0 I ZS~ ~' r~°Q a `T~ Sys7~e r,» ,; ~./,~ . ---7 ~ go n A..1~ ~ ~~ _~ `" ~ h~ 0 1 ~ r I~`~~ ., i .~ INDICATE NORTH ARROW ~"' /Vp. BENCHMARK: Describe the vertical reference point used app ,~p~ S/c~7~ 7/' /y0/'~/1 Elevation of vertical reference point: /l~D ,~ ~ Propos d slops at site: SEPTIC TANK: Manufacturer : .fie ~ Liquid Capacity: /DDO ~ Number of rings used: amour- Tank manhole coved elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Raad: Front,O Side,O Rear, 3UU ~ feet Isom nearest property line.: Front,OSide,~Rear,O /UO ~~- feet Number of feet from: well ~Q , building: (Include this informat-ion of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: ~ ~ Liquid Capacity: ~~~ Q/ ..~ p ~ Pump Model: s~~fy Pump/Siphon Manufacturer: ~/y~,/--n/yll~/. G, Pun-p Size ~T ~ Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: ~/ Gallons per cycle: /~O Alarm Manufacturer: ~~i/Y~-~ /~ Alarm Switch Type: ~~~'Cc:~+^~. ~ /O~'~ Number of feet from nearest property line: Front, Side, Rear, Ft._ Number of feet from well: 75 Number of feet from building: /~~ (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: ~~~7 Trench: ~ ~ D Width: ,~ Length: '~ 7 Number of Lines: ~ Area Built: 76 Fill depth to top of pipe: ~~~~ , Number of feet from nearest property line: Front, O Side, © Rear,O Ft. /I~YJ ~ Number of feet from well: ~~ ~ Number of feet from building: ,2~ ~ (Include distances on plot plan). SEEPAGE PIT Size: Liquid depth: Botto~(~of seep~/ge pitl ~l~vation: Area Built: Has either a drop box O or distr uti n bo O be us absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Ele~t~.on of bott Elevation of inlet: on any of the above soil f tank: Number of feet from nearest prape~rt~y ~in~: lf~t, Number of feet' rom we 1: Number of feet fr bui d' Number of feet from n crest r ad: Alarm Panufacturer: Dated : 7~~~J J o Number of pits: /1 D~.~eter: Side, O Rear, O Ft. Inspector: Plumber on job: ~Q/e ~ ~Gll.~/S~/7 License Number: ~ ~ ~~0 3/84:mj DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISON, WI 53707 INSPECTION REPORT FOR SAFETY & BUILDINGS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING ^CONVENTIONAL X~ALTERNATIVE State Plan l.D. Number: ^ Holding Tank ^ In-Ground Pressure ~ Mound IIf~~+9~~240 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: i..{ k_ r IN ECTION DATE: ~ ~~ ~ ~ j) William Crandall Baldwin, WI iJ ~ -> v _. _~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. SW SW, Section 25, T30N-R17W, Town of Erin Prairie Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Everett Boldt 4489 St. Croix 54921 MANUFACTURER:, LIQUID CAPACITY : TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ^YES ^NO ^YES ^NO BEDDING: VENT DIA.: VENT MATL: HIGH W ATER NUM BER OF ROAD: PROPERT Y WELL: BU ILDING: VENT TO FRESH ^YES ^NO ALARM. ^ ^ FEET FROM LINE: AIR INLET YES NO NEAREST vuslNU GMAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER ^YES ^ PROVIDED: PROVIDED: NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PR OPERTV WELL BUILDING: VENT TO FRI (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I r°~ +++ DIAMETER: MATERIAL AND MARKwG or excavation. (lf soil can be rolled into a wire construction shall cease until FORCE , the soil is dry enough to continue.) MAIN CC]NVFNTIf1NA1 SVSTFM• BEDITRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA #PITS LIQUID DIMENSIONS TRENCHES: MATERIAL: PIT DEPTH GRAVEL DEPTH BELOW PIPES FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH . ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: I LINE: AIR INLET FEET FROM : NEAREST MOI1N17 CV CTFM• Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ^YES ^NO meets the criteria for medium. sand. TIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BEO CENTER: EDGES. DEPTH OF TOPSOI L: SODDED: SEEDED: MULCHED. ^YES ^NO ^YES ^NO ^YES ^NO rrlt~~uRl[ED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: DIMENSIONS MANIFOLD PUMP ELEV.: ELEV.: ELEVATION ANO DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACI COMMENTS: PERMANEN Sketch System on Reverse Side. DILHR SBD 6710 IR. 01/82) NO. OF TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MA DIA- ELEV.: PIPES: DIA.: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO P PLANS. ^YES ^NO ^YES ^ IKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL E ^ ^ FEET FROM f LINE: S NO YES ^NO NEAREST- --~I Retain in county file for audit. ~~~ wlsconsln APPLICATION FOR SANITARY PERMIT ~DILHR P - OEPggTTEI"1T OF ( LB 67) - InOUSTRV,LRBOR6 HUTgn gELgTlOns V 7~. CRa ~K rOUNTY UNIFORM SANITARY PERMIT # ,~~9z~ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/Zx 11 inches in size. -See reverse side for instrurti~ns fnr rmm~latinn rhfc ~nnr,.~t,,,., n~ cncc no~w~T PROPERTY OWNER ~R /~ MAILI~c~- DDRESS ~ ' ' A,v g ~tS a L d w~ •~, G/. Sto a Z S S PROPERTY LOCATION W 1/4~~''~1/4, S°~~ , T3~N, R ~ 7 E (o , CITY: _ ,Q OWN OF• ~~iN l ~A / R I ~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~• o3iy~o TYPE OF BUILQQII~G OR_~ISE SERVED ~~ A% l~C. ~/e M G y~ 1 or 2 Family umber of Bedrooms: ~ ^ Public (Specify): THIS PERMIT IS FOR A: New System ^ Tank Replacement ^ Repair ^ Replacement Soil Absorption System ^ Revision ^ Privy Alternate System ^ Reconnection ^ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ^ Seepage Trench ^ Seepage Pit System-In-Fill ^ In-Ground Pressure ^ Vault Privy ^ Existing, For Which A Previous Permit Is On File, mit # issued ^ An Existing System That Has Been Inspected And Is Co liant As Far oil Conditions. ^ Holding Tank ^ Pit Privy Total Gallons #o nks Prefab. Crete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEPJI COMPLETE THIS BLOCK: ~ Mound ^ In-Ground Pressure Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity d~ O p ~ C Lift Pump/Siphon Chamber o Q ~i ~~ Manufacturer: G S PERCOLATION RATE (Minutes per inch): ABSORPTION AREA REQUIRE D (Square Feet): ABSORPTION AREA PROP WATER SUPPLY: OSED (Square Feet): ~© ? d 7-~ ~7 (~ f~ Private ^ Joint ^ Public I, the undersigned, hereby assume responsibility for i Ilation of the private sewage system shown on the attached plans. Name of P umber (Print): ign t MP/MPRSW No.: Phone Number: /e~ea~f /~oGv~~ ih,o ~,t~y9 (7iS-G8's~•33r Plum ress: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of issuing Agent: Fe Date: ^ Disapproved ~~1 yi,~~~~ ~ .,~ ~ a i~~ ^ Owner Given Initial eason for Disapproval: Approved Adverse Determination Alternate course(s) of Action Available: ~~~ --- ---- ~ •• ---~ ~ ~~~ ~ ~ ~~~~ ~ IVIV. VI iginal io county, une Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING TIiIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system., circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.-, location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be property maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. .. _ ~,, ~ -' '= r ,~ L~ \~ ~o ~ ~ ~ d ~ `~ . ~ ~. alt .~ .. ~ d O ti .~ v ~ ~ ~C '~ "' M "' ~/ 843 ~0 -~~~~~ i ~ ~ ~ r ~`~~~~~ a •4 'J {~ ~..~'1iJlynacV R~LA....~.. ~ q ~ ~ a JU ~ `~ ~9~~ .~ Z 7 S Q ~~ ~ ~ ~. ~? ~ .., ,. ~~ .~~` J .. _ F ~~N e•¢ ~M , ~ R 9 ~ ~~1 L C Page ~ pp S#raw, Marsh Hay, Qr Synthetic Covering ~istributi0n Pipe . t4 s`I/ Medium Sand ~, Topsoil ~` _ ~G ~~ ~ ~ u . ,~ j -. r^ tl ~. ~ ! +y ~~ `U N N ' ~ ~~ ;~~~ed Qf %- 2 % Force Main Plowed R ' ~, ~a,., << ,;`, r 6~,Y".,.u A49re to From Pump layer i :: o ~~ ~. ,~ ~`~ C~'~ ' `~ C CrQSS Section Of A MOUnd System Using ~ / r(o N" ~ A Bed For The Absorption Area F •75 ~ / O ~ ~• A g0 Ft. ~ H /.5 signed; B ~Ft. License Number: M ~' ~~~9 I ~3_ Ft. c~e i)att?; ~ - ~ - S~ 5F J_~,Ft.g ~ ~~ ~~~3 - IC ~ Ft . ~. , ~ v { f F~~-. Al tern~to fPosition L L~ Ft. `~U~~ ~ 1~ ~ Farce Main W .~5.5 Ft~a ~a~ . 4 , ,~,,~ ` ~~` `}%``~ r °9f ,t ~ Obs~rvatpn Pipe--.,,~ ~ 8 ~ - _ A 1•-- ----- -- -- ---- ~_. - - - - ---------~'-1 ~ +-- -- -- -- - - - - - -----*~ .Farce Main W ° f From Pump Distribution Bed Of ZN- 2 %2p Prpe Aggregate t Observation Pipe Permanent Morkers Plan View Of Mound Using A Bed For The Absorptian Areo ,~ _ ~. .. ., __ __ ' ~ PAGE ~_ QF ~- W"'~ . 11 PIINiP .CHAMBER CRQSS SECTION Alp SPEClFlCATIOAIS ~~ ~.. c~ W / n~ r ~1 ~ 5 1/EI.1T CAP y'~G.I. VEA1T PIPE WEATHER PROOF APPROVED L.OCKIIIIG ' ,~1JA1€TIQ1~1 BQX MAIJHQLE COVER ~' 25~ FROM D40R, s WINDOW OR F~{ESH IZ°MIU. I ~'; Ai;. I,'.;TAKE I GRADE ~ Mu MIr`1. - ~^ 18 MI f N. GONDUiT L~_., ~ - --- 18"MIAI. ----- --- -- ,_~ ~~~ _~-_- PROVIDE f ----- liJl-ET AIRTIGHT 5EA1.. f III... 1~ ~/ '~~' I I \/ A,PP 4VE OIRI ~~"~~~~~ I I (I' APPROVRD J01-JTS x R [? ~ T A ~~~ , ''"'~i I 1E,l~C.2. PIPE ~,~~'~ ~' ~~. ~ ,,.r.`~ I II~ W/G,I. PIPE f~XTENDIf,.lG-'~' ~ '~ '. ;v~ti~ I II ALARM EXTE-~OItJG 3' L1A1TO SQf^ID ZaOtt,. ~._,, ~NGS ~ II ONTO SOLID SOIL. .. •. ~ ; •_ `:~..JF~ C J~~' ~. e„r."" I O W ~ v ---_.w.....,, _ _ J. O~ Pit ~~ iR~'~~ti PUMP--,~„ OFF SEA ~~` COAlCRETE 6LbGK ^~- RISER EXIT PERMITTED dtJLy IF TANK MANUFACTURER MAS SUGM APPRQVAL. &EPTIC +< SIaEC.IFiGATIQt~JS smsss~as- DQ S E ,(~ ,L TAA.IKS /"~IAAIUFACTUR~R: '=~~'f~~'!-s I.IUMBER pF DOSES: ~` PER DAJ ;~ TAAJK SIZE :-~c? GA~I.ONS QOSE VQIIJME .~lnrly' P ,(''~ INCI.LIOIAIG bACKFI.OW: /a0 ~AL1.oNs l.ARM MANUFACTURER' 5~.._.__ MOQEL 4~lUM~ER• "~~<~~''~~ / CAPACITIES: A; d,3 IAlCHES OR .,~.~L GALLOAJ9 SWITCH T~PE% R'",'~~C'r''~...,~aL~ ~f~ 8=~3'3~ IWCHES OR 4~'~•;~ T GALLOtJ$ ~ ~~ PUMP MANUFACTURER: .~L'=!'r''~~~~~ C= ~~n IIJCHES OR .~~ ~~~~ GALLOWS MQDEL IJUM6ER. a~ ~' '`~~ D=L~_D i11GHES oR QS..~.5._ GALLOAJS SWITCH T~JPE. -~'l ut='y G;~'Y"k'~~ ``S~'"~ AIQTE; PUMP AWD ALARM ARE TO 6~ ~'~, '"~ INSTALLEQ ©Al SEPARATE CIRCUITS MIIJIMUM DISCHARGE RATE _.,,S~GPM ~ ~~; ~g '; , . VERTICAL DIFFERENCE DETWEEN PUMP OFF AR10 DISTRIBUTIOIJ PIPE,._.~ _ 1;EET ~~tli'L~ -1- MII.IIMUM RIETWORK SUPPLY P~~RE~~S,,[LEU~FREj/.,, .. , -,.~~5~: FEET/ ~,~~/~ 7, -1- --~=~ FEET OF FfaRGE MAItJ X ~=,-,.,-~tooFr.FRICT1o1.1 FAE,fOR...,.: FEET ~;,~;,_ 9~4 ,~ >, .> ~ `, - TOTAL DyAJAMIC. HEAD = 1~'-~J~ FEET J~~ ~ ~ ~~• r ,°- `~ AlT E R N A L. DIM S i O A.{ ~ O F TA Al K% -i~rt~s=~ ~ ;k~l"@ 'r„~,,,,~ ~,. f :; I Q U I D D E P T y. ~'")~ - SIGIVE D ~ ~ LICEA.ISE 'AJUMBER:' M P 5~~'P ~ OATE:~_8 ~ ~~ ~~~~ ~DILH R ~ GEPFli77R1EllT OF - If10USTRV,IRBOp6YNJlTIgII RELiiTlOllS F~F/~ ~ `s,FO s ~ IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION N0. .~~ - (> ' ~ yip NrA^ME OF PRO~EC ~` ~J ~`1 ni rn 1 L JLrY I'1~1L V17L I - ^ GENERAL PLUMBING PLANS '"`'~ ~-- > Fee Received: L~ATION Priority Plan Review On y CITY OR TOWN r - ~- ~ Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of weer required inspections are to be made. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, ~ James Sarg t Bureau Dire or Department of Industry, Labor and Human Relations Division of Safety & Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 ,, ~ 1? ( ,A Tel . ( 608) 266-3815 For Private Sewage Systems Qnly: This approval is valid for two years or it wig be v4ud until the exp~'etidh date of the ir~a~ sanitary perrx-+t. H & R & Rec. San. Section Bur. of Health Fac. & Services DILHR SBD-6099 (R. 05/82) -- __..,. . _ _ Z ~: ~ ~ ~ 3 ~, ~ ~ _ ~ ~ ~~ a °- ~.. ~i ~~ ~ ~, n a r' -~-- 'a`- ~,° ~ ~.. , ~ ~ '~~,~ l ~ ~ ~ ,~ ~ ~ ~ ~ ~ r ~+ l ~ j ~ J ~~ ~1 O ' ~Q ~ ra ~1 ` N ~'~ ~ ~ O~ ~~ ~ ~ ~ r ~' a . '~ .~ ~- a ~ ~' L `' ~ '° ~ ~ o \ Q ~ Z _ ~ ~ ~,, ~ ~ -~ -~ o o C ~ ~ D~PaRTMENT OF ~~~~RT O1, ~'~ BV~'~VS e~A SAFETY & BUILD. '. INDUSTRY, LA80R AND NUMAN RELATJ'OFV~~5 pIVIS ,.. PERCOLATIQN TESTS /115} P.O. BOx'969 ~H63.A911~ & Chapter 145,045) MADISEQN, WI 53707 O A f N:,r ~ Ll1 ~/4V ~~ CTI j / ~~ ? ~ for 7~ / T ~ TpWNSHIP '" ~ ~ OT'N .: / ~ BLK. NO.: ~' SUBDIVISION NAME: (' ~ . / i f ° r : f? i 7^d , / ~ OUNTY: OWNER'S DYERS AM AII-IN A DR S: Tr~ ..X ~~,. ~.~P 1 / y 1 / ~'.. .(.-~/ ~~G//,A/ f'!~ SJS .C. t+l~/~'l %' DATES OBSERVATIpN8 MADE A 1 N TE`S>TS: QI ~'(`~''V~'E TI NAL. S ®U M~(Oj~'~U;~~N~\yD: (("~' U IN t1PR~ ~ S ®~ ~ -I -FILL ~ S QU OL1DING TANK: U S ~ C RECOMMENDED SYSTEM:loptional) j L.....1 .K»~+ V ~-..~J . J G7 ~.f If Percolation Tests ate NOT re wired DESIGN RATE: q / If any portion of the tested area is in the ` under s.Hfa3.091511b), ind'ICatq: //'°"~ I Floadplain, indicate Floodplain elevation: ~~ P60FILE DESCRIPTIONS BORING . TOTAL P O U D ATE CHARAC Eli OF SOIL WITH TMICKNES ,COLOR, TEXTURE, ANO DEPTH NUMBER DEPTH IN, ELEVATION O SERV TO BEDROCK IF BSERVEp (SEE A BRV. ON BACK.) ~- ~'../y Q ~rf // Id 4 .. 8_ r4 ..T, ~ !'ii'i r ~ • 6 ~ / ,~°',l / f ~ir O~ 3i • ,~ ` . ~~ ~/ . '' t~ 1.1- - /~ , B- PERCOLATION TESTS. DEPTH WATER IN HALE TEST TIME OP I ' R L . -I S RATE MINUTES NUMIBER .INCHES AFTER SWELLING INTERVAL-MIN: Rl b t R PER INCH P- ~ , .,, ~~ ,A a ~/~ P- P- NAME (print :_ TESTS ERE COMPETED ONp: (ADDRESS; CERTIFICATION NUMBER: ~._. PHONE NUMBERIoptionall: T S1 TURE: ,r ,......`, tf? p15TRIBUTION: Original and one copy to Lot:al Authc:~rity, Property Uwner and Soii Tester DILHR-SBD-6395 IR. 02!82) - LIVER - •'lc,'? ~ :v M RATlNQ: S= Site suitable for system U= Site ulxuitwt,lw fnr system b (' ~. ri ~ -~. .~. ~, ~-.. l n ~. 1 ~a ~~ r _--- W ~ ~ 1a 4th ~.,, '0 1 ~~ ~ ~_ ~ ~o n h .`~,~ :~ v ~ ~ ~~ o .~~ Z Q~ a ~~ 0 a ~` r L ~ O o 3 L ~~ -I- 'A w b N ., Q `~ ~. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER GtJ/~ . Cg~4~vgl~~~ ROUTE/BOX NUMBER ~Cf_ ~'~ Fire Number CITY/STATE ~R~-dw,:,• ~~'S ZIP 5'~0 D Z PROPERTY LOCATION:sw ~, SGJ ~, SectionoZ~ Tao N, R ~7 W, . Town of ~R/N ~R/Rt~~. 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 maw a maximum of 60~L of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly 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. '. 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 Depart- 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. SIGNE DATE 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. 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 ____~i'r1 • yR ArJ~ F1 ~' Location of Property SLV 'QSkJ ~L, Section o~ ~ , T 3 v N - R ER/rv I RA~R~ ~ Township Mailing Address ~l4 ~-~w i h. 1...~ ~ •S Subdivision Name ~/9~ Lot Number NR 17 w Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? ____~____ Yes No Is this property being developed for resale (spec house) ? Yes ~_ No Volume G J Z- and Page Number ~/ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPFRTy OGINFR CFRTIPICATION I (wel celi..t,%~y -that a,22 e~atemen~ an ~h.is ~onm cute ~ic.ue ~a .the beat o~ my (sun) f~naw~2edge; ~h,a~t I (we) am (ane) -the ownelc(h1 a~ the pnapehty de~sc~r.%bed ~,n .thus ~,n~anmax,%an ~anm, by v-v~tue a~ a wcvvcan~y deed necanded ~,n the 0~~~.ce o~ the Couvtty Reg-ia~eh o~ Deedb cv5 Document Na. and ghat I Iwe) pne~ en~2y awn the pna pas ed b.cte ion the ~ ewage pob ~ y~~em ( an I (we) have ob~a,i.ned an ea.6ement, ~o nun with the abave deacn.%bed pnopenty, ion ~h.e cona~.uat,%an a~ baid byb.tem, and .the game hab been duty neconded ~.n the 0~~~.ce o~ .the County Reg.c~~en o~ Ueeda, as Document Na. ~7~ f a ~ 1 . SIGNATU E OWNER .~ DA SIG D SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED Location: STATE bF WISCONSIN-11~'f~x~`l'~NT 171x' INDU9'i'1tY, LASdR !4 HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.0. BOX 7969 - MADISON, WI, 53707 APPLICATIOPJ FOR THE USE OF AN ALTERNATIVE SYSTEM Township/Municipality: SG1 ~~ S(V ~~s 25 itreet Address: T 30 N/R l1 l~:~Mif~(W Ca----~_ ubdivis ounty: owners Name: Gl,i,e.P%am J. Cnanda~ ling Address: 590 K.~e~%n D~u,ve, Hammond, GII 54015 I (We), the undersigned, hereby make application for an alternative-system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and spec~.fications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved. the Eureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN SS. COUNTY OF Subscribed and sworn to before me This day of 19 .~. Notary Public, State of Wisconsin DIL1~lR~-SBD-6413 (N. OS/$1)~ My Commission Expires: SBt~ G6;''8 i9/81} {Pib tOOa) STA?E OF WI DtLHI~ ~~ I~eta~ch And Return Upper ~#visloN off. ~~~v &~ ~' ion 4f Tfiis~ farm With . ~R~~.- o>~ , ~e , ~,-;~~ { ~~ ~7 E, wA~u~tc>rNl ,AY~.r~ir~~~,. a~y~ Return ~orresRond ~ , ~s P:o. so~c ~. ,~ ` M~1l5UN,1Iwi 53709 ,~ DAtE. 46/07/4 ~~~•4„~ ~ PROJECT: ; f: I' ~~1~ Crandall, Wiliam -Residence ~-. 3a(a) ~ ^i SW,Sw,25,30,17W ~' '~+' 7;n Erin Prai r~ e ~ .. . ltverett Roldt ~ i~ t ~ St.~ Crof~x~ WY ~~ ~. ~~"~; _ 820 fi9ain Street x~ r~aldwin, WI 54002 ` ~''~ _ PLAN Ip. # $4~-a~24d i' v. ~ r 'r .~ at. DETACH HERE. ti ~~': i : ~ . Crandall Wil1i~ Residence 84-fl3240 ~ ~` _ ~ ~y _PROJECT NAME ' PLAN 1D. # "~:'-~ i ~4'; ~ ~~': ~ ti u ~ *~ This i~ to.ackrn~w#edge r~eipt of your plans Ond specifications for the above-indipct. , r , ~~ Pr~lir~nary rsur indicates the required fee. is $~©- Fee"~eceiued is $.~ o~`~ ~' .~ ~~ -; ~ ym~tf -- Please submit the additional fee. Overpayment -Refund forthcarnin~'~ ~r ~ .~ ~ ; wed for reuiew. ~ Plans being returned. ,~~ ;~ x`~ ~ r x{~; ," r ~+IO #ee ttas bee» re~-it!led: plans su}xnitted inrith no fees v~ril# be _ ^ Additional it~ormatian requires: ~~• " ~,~ ~ Ict in abeyance. ,; ~r ~ - -~ . .„ ~, #. - Plpn Submission ^ Complete-data relaiive~ to antrte8rs~i1~~",~ '~~ [~ ~fitional infonmatioo shall. be submitted. in dttplicaxe un- ^2 copies of PLB b~;ertclo~l. ~ A ~ ° ° . ~.~. less specifically noted. ~ - ^ Deed restrcticsn requirea(< (1 coAY~ ~;~ ~.~~. ,, ~}] P'lar-snot dear, legible or .permanent. ©Cortdominium declaration. {1 cop's) Ala J»~srmation ~bmitted steal I be signed, dated arid:sealed _~'~ ar stamped i» accord with Section H 63.1)8(2)(a) Wisconsin ~ ~ ~ x ~ ~, . ~ ~ ~ IV:` Holding Tanks ''' b . .. ~ Adrrtini"strartive:Code. ^ Af~i-davit er~c#osed. ' ^ Profile of holditlg tank shy~~g;Y@43t,'~~~ ~ ~ ~~~ ~~~ ~ _ _ manufacturer if precast.' Corr»pteltlr ~ . ((, . Istfessurize Distribution Systems (Mound or In Ground Pressure) site constructed. ' ; -~ - ' Application for use of an alternative system signed by,own~r . ^ Holdi geed by l~i~. ~ ``{ ' ~ hg'tank agr~ment ai ..anti notarized. (1 copy) government (ample cnctosedif. ' ~ ~~ ~ : ' ?' ,County onsite required (1 copy), ^ Desi~- calcu~tions_;- ^ Reaxnr# for ii+sfsit~~- ~~ for pressurize distribution. ^ Soil baring:"& percolation froth tx~urtty (1 copy)• ~- ~~° v'~' ` ~- test data. ^ Plot :plan showi .location of I~o1di r ~ ~` ~ ~~ Cross section of system. ^ Pipe lateral layout. anceS to any buildin , welts, w Plan view of s sterr-. ^ Plo tan. g ~? y ~ P course, lot lines; swimming pt~#s, At#'1. _ ' - ~ "~ Verification of Exception Status Form by Gaunty. f1 copy) Etc. Provide benchmark with~R _: ., ,.. a ~ ~,~ ~> 111. Private Sewage Disposal-Systems V: Lift-Pump k ,~ 'r '~ ;'~ (~ Ground slope with 2' contours in entire area of soil absorp- ~ ' " ,` ` ^ Calculations for total lift pnrt4p",~w tion system extending 2.B' on alt sides. pumped per cycle. ~ ~ '~ ~~ * ''" " ^ Elevation of permanent reference point (benchmark).. ^,Size, length & depth of .force iti ~~ : j„ ~~~: ~ ~~:~'~'` Location of area suitable for replacement system -provide... ^ Detail & model of pump or ar~t~f7~~~rs!-" soil data. size, pump curves, drawdown and ' ~" . ^'Plot Atari bowing lot size and all lateral distances from. ^ Cross section of lift pump tank: `" t sewage disposal systevxt to buildings, lot lines, vreq,-wafter ~ ~" siphon(s): , course, stivimming pools, water service piping,'Etc. - ,? ~.~ ,S, ~' -~ `. ~.~ ~ = ~ ^ G'wnatruction sietait oft septic; ho1,~ling or #ift pump tank if ~ W ~~ ~":• ; ~,~., `~ site constructed or tank manufacturerif~recast. Vl: Systems In Fil1,(Fill rrivstfie plac~f [.} Construction -detail and cYOSS-section of soil"absorption ^ Tatal area filled (fitl to eictet~d F. system. ~ ~ before side slope begin):- - ,, ~' -. '~ ~" Soil boring-:and percolation test on 1.7 5 completed .b~ car- ^ Depth and type of fi##, ' '~~` ~ "~'~ ?~>_, 4 ~ tified stfi# tester (1 CctPy)~~J . Cc;c~f,, ~ , ~. , ~_ ~+~ ST. CROI X COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W 154015 June 4, 1984 D~.v.c,a~,an a~ Safety and Bu,%1'd~.ng Bureau a ~ P.eumb~.ng P. 0. Box 79b9 Mad,%dan, WI 53)07 ~ean• S.v-.: An an e~ite ~.nve,~.ii.ga~i,on ion .the W.i,Q,t;%am J. Cnanda~ pnopen,ty .t;oeated ~.n -the SW% o~ .the SW% a~ Seeti,on 25, T30N-R17W, Tawn o~ Eti,%n Pna.ih.%e, S.t. Cno~.x Caunty, nevea.Ced .au,i.tab~.e aa.i.~ at a depth. o~ 3 ~ee.~...~b4,~o~+: ~~~ wh~.eh a eaa onab~.e h~.gh ground wa~e~c wab noted . Th.id d.cte dhou.e.d be au.ctab.~e ion a mound ayd.tem. Shau.~d you have any quea~i.on.d, p.E'.eaae ~ee~. knee .ta can~a.e~ .thie o~~.%ee. S.i,ncene.~y~~ -~, Thomaa C. Neon Aea.ca~a.n.t Zo-tii.ng Adm.i.n.ie.t~caton.. 7CN: mJ . WISCONSIN DEPARTMENT OF INUUSTRV, LABOR AND NUMI~\N RELATIONS DIVISION OF SAI=LTY & BUILDINGS, BUREl1U OF PLUMBING P.O. BOX 79Gy, MAOISUN, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewaye System In the County of S~. C~r.a.ix Location SGl 1/n, SG! _ 1/~, Sec. 25 T 30 N, R 17 kX1U~lR:~ W Town or Municipality Cady Street Address Lot No. block r. Subdivision Landowner's Name: GJ,c-(-Piam J. Cna~^da00 The application for this site is for: [X^ new construction use. ^ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~X~to have one of the first five approvals guaranteed for this year. This is r-umher 59 - 05 -_ _5 of those applications. (Use one of the first five quota nuirl.~ers issued to you. ) one of the applications needing a quota number. The quota number assigned to this application is - - ~._]for one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [.Ifor an individual lot for wYiich a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ~_~for an application nn fide prior to February 1, 1980. ~__.~for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USI_, thc~ altr~rnative private sewage system is replacing: ^ a failing conventional soil ata~c.~rption system. ^ a holding tank that was installed and in use prior to February 1, 1980. ^ a privy that was installed and in ~.~se prior to February 1, 19nU. If this is a REPLACEMENT SYSTEM USL and the lot meets the criteria for a convertional private sewage system, check here.~_~ I certify that the above information is true and accurate to the best of ~f~y k~Owledye. / //~/~~_ Name Thama~s C. Ne.~~an Signature County Of~=icial~~' Title A4~5,~,d~a.n.t Zovr-i.~r Adrn.~viiwsxiia~:on Date June_ 4y 1984 DILNR-SBI)-615II (R 12/f32)