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014-1026-50-000
Wisconsin Department of Commerce ~ PRIVATE SEWAGE SYSTEM Safety and Building Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary n. irnnccc rpr;,,,M, ~ ..,.. ,. , ~ ,.. ,,., __.. - --_., i......,,r moo.., ~. i ~.vv ~ i ~tnip. 'ermit Holder's Name: City Village X Township Rosen, Lawrence & Karen Forest, Town of .ST BM Elev: Insp. BM Elev: BM Description: ~AIUK IIUGI!1CAAATIn1.1 TYPE MANUFACTURER CAPACITY Septic J~ Dosing ( C a.M~oO Aerfl4ion ~~ ~ 1 0 Holding TANK SETBACK INFORMATInN ~ ,._ _ ~~ ~ •, I . TANK TO P/L WELL r BLDG. o v,•v 1 a r ent to Air Intake yI`. r.... ROAD Septic ~ / ~~ /5 ~ ~ / ~ -_ Dosing '' II ~ ^,~ ~ ~f' S , V ~'T , ~ S ~ ~ l Aeration Holding PUMP/SIPHON INFnRMnTinnt nr\~ Manufacturer 1 c7 U l~ ~ Demand GPM Model Number n ~ ~j~ TDH Lj Z' ~~ Frictionvoss~~ r Syste Head TDH 13.~~ Forcemain LengtlL~ i Dia. ~ ~ ~ Dist. to Well vvl~ r.owr~r 1 wrv JTJ 1 tM BED/TRENCH Width ~ Length DIMENSIONS ~ '~~ INFORMATION Type Of System: DISTRIBUTION SYSTEM Header/Manyif'Id ~,~ ~Distnbutii SOIL COVER Z ~ ('e L BLDG ~ "l Z ELEVATION DATA County: St. Croix Sanitary Permit No: 479267 0 State Plan ID No: Parcel Tax No: 014-1026-50-000 Section/Town/Range/Map No: 12.31.15.180 STATION BS HI FS ELEV. Benchmark _ qqq Alt. BM Goy ~'.3 9 ~. a cp Bldg. Sewer ~J c~ SbHtlnlet ' ~ ,U.I j1 c~`/ 0 7. ~/~v ~t/Ht Outlet •~ \ '1 Dt Inlet ~ ~_ Dt Bottom I V $~' Header/Man. 5.5 y3 , ~g Dist. Pipe S•5 9'3•~f Bot. System ~ /a Final Grade c•..~ ~ ~ ~. ~SZ~ ~7 ~, S 8 St Cover _n ~ r ~ 3~ ``11.6 ~ ~, -~ t I ~~ ~ ~% ~Z 7,~ °-r.75 --I CHAMBER OR ~~~// ~ UNIT x rtoie size x Hole Spacing ~ Dia ~ Spacings ~ \ v Pro~m•rn C..~~....... n_•.. Number: Qv; 30 ~3 -- ~ Vent to Air Intake Depth Over / -+--- - -•••~ Depth Over ..w ~r~vu •u yr ru-VIa4 C J~/, LC/IIJ Vrlly ~r~wyry,,,yv~. Bed/Trench Center ' ¢~ 1 o ~ Bed/Trench Edges xx Depth of Topsoil xx Seeded/So ded Yes ~ No xx Mulched ~'~ Y N es [ J o ~+~I•11Y1G1Y 1 ~• (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2256 320th Stre~Clear Lake, WI 54005 (SE 1/4 NE 1/4 12 T31 N R15W) 40 acres Lot Parcel No• 12.31.15.180 1.) Alt BM Description = ~ `~ C8 J '~~ ~ j ^,.~~- ' Z r f ~ ~ /Q ~ 2.) Bldg sewer length = / (~ a ~v~-a J ~ -amount of cover = 15, ~oX~ ~~l,P~~t~~ ` ~( ~~ ~~c, v~y 3 ,ga,l c~,.,G.. ,,,~s d- L ~~5 ,J Plan revision Required? [] Yes o ~ ~ ~'~f6 ~s ~I - -~ 4 ~ Use other side for additional information. ~__-1"~J ~ _ I ~ V~ _~ SBD-6710 (R.3/97) Date Insepctor' Signatu ~ Cert. No. Safety and Buildings Division O1 W. Washington Ave., P.O. Box 7162 scons~n Madison, WI 53707 - 7162 n .of Commerce (~8) 266-3151 anitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, pwsona info may be uses for sec°ndary Proposes Privacy w, s 1 ~~p I. Application Information -Please Print All Information Property Owner's Name ~ ~ ~ ~ ~ 2 ~~~ l-~~ ~-~~~-~ T KAR~~-J ©,~jIX000N7Y Property Owner's Mailing Address 22~a 32~c~~H ~- City, State G1r~ AiZ C..AK.s~,, I.~,T_ Zip Cade ~~5 Phone Number 115,2163' ZOIZ II. Type of Buildin (check ll h g a t at apply) 1 or 2 Family Dwelling -Number of Bedrooms ~~ _ ^ Public/Commercial -Describe Use ^ State Owned -Describe Use u III. Type of Permit: (Check only one boz on line A. Complete line B if applicable) A. +~ New S rem ys ^ Replacement System ^ Treatrnent/Holding Tank Re l p acement Only Si GPc71~ State Plan I.D. Number --_~ Project Address (if different than mailing address) C32-a„` 5T~'~~ 2z ~ ~~ ~ A`'e i u9 ~ --, Parcel # L.ot # Block # ~I~-l~z.w-Se~~P ctro ne) /~( T~N; R~E~ ~ l UV ^City ^~i11"age ~Townshrp of~ ^ Other Modification to Existing System B• ^ Permit Renews! ^ Permit Revision ^ Chan a of List Previous Permit Number and Date Before Expiration ~ g ^ Permit Transfer to New issued Plumber p~~ IV. T of POWTS S tam: Check all that a l /~t.~. S I z ,~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade Single Pass Sand Filter ^ Constructed Weiland ^ Pressurized in-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiber ^ Recirculating Synthetic Media Fiber Leaching Chamber ^ Drip Line ^ (navel-less Pipe ^ Other explain) V. Dis ersaUTreatment Area Information: ~~ ~ (bpd) Design Soil Application Rate(gpdsC) Dispersal Area R s ~Njrod (f) Di Area ea lsfl veto... Ft.....:..- ©~ VI. Tank Info Capacity in Gallons New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit i dosing Chamber VII. Responsibility Statement- I, the Plumber's Name (Print) ~ otJ ~t~pt~t..L Plumber's Address (Street, City, State, Zip ~1I.19 13~n VIII. Coon /De arttnent Use Onl ~ApProved ^ Di ^ Reason ~ IX. Conditions Ao rov - - - Gallons of Units / W '~10 ~ ~t ersigaed, ssanme rtusponstl ~'s S~ store ~-.l ~ zs ~(1 s~-~1 g l .4 -lS~t I Concrete ~ Constnrcted of the POWTS shown on the attached ode} Ail ~A~~rJ ~54~( 2 sett P Glass (c3 ~ 3dZp . ,~ i~ ,~ mot' .~ /~~ S nary a ~rt Fee ttrwes tirounawater Date issued I in gent Signature (No Stamps) barge ) 5Y5TEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintain as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code%rdinances. Attach cowpkte plans (to the Conaty o SBD-6398 (R. 01/03) ~"' --"' ~ .~3 ~IQ~' ~ G 6 r t '~e~QBw-- s c~ `~ ~ ~ ~ .~ ~~.-~~~ . sly) rot the system oa paper ant less than 8112 x 11 iocles in sim ~f) Pe fi-~a-c~,d~^^~ s ~~ ~ s ~.Q~~ ~~t`~~P Sys ate. ~~ i S -~ ~ a uu,o~ s Y~~~ ~ acs- ee,,, ~;e.~.12P . . ~, °``` "9 ~ ~ ',~m co.~.~e,~c~ -~i-,..t. S ~ ~ 36 a /j.a~a<.~ racta2 ~ i'~ SITE PLAN 9cT ,-. Mom ao ~ St~.~ ,~ ~1 ~ z s~° ~~~ BM Bench Mark EL 100.00 ~m ~ ~t lvn.o Tb p a F 5°~'~~t,.. ~~~ ~ogr ~M 2 L~l.. q~l f2~ Ta p o f ~n ~ g~4 LA5 5 ~ 4T~ PC, S~'p3,e.'1°ANK. / Pvr~p CNAr~F3~C, SKEW toov`G,oo gA~ Com3v TflNk G. Sa F i ~.-1'2AT - orJ C.,~ BLS 2 ~, 1Zfy~ 5~5'~ ~L T; ~ 92.4' T2,Q ~Z•35R r~ I - 50' ~" Prrm.p~ ~~, Le~A-r~oa 40 Ac~,~ `P~,~L coP~ 'p Q 2' r F WISt:OnSln Depaitrnent Of Commerce .• Division of Safety and Bupdi + f REck` ~~in a ance with Comm 85, Wis. Adm. Code Attach compie site plate on Pap~~~than x t 1 Indies ~ size. Plan must County S~ G~ 1 indude, twt rwt ' 'bed bo: verbc~1 ce paint (BM), direGian and Percent stile, ord~~sidhs, north and distance fio nearest road. ~~ ~ l ~{- - I ~7 P~e~~i~ ~ Personal ~ Y _ Property Owner LA w ~c N~ ~, ~ASZ.,~tJ ~s~~J Property Owner's Mailing Adds ~ 225r~ 3'ZA 5 i _f,, - Law, a t5.04 (1) (m)). Page ~ of _~, Date Govt. Lot s~ 1/4 N~,1/4 S ~Z T ~ I R 1 Jr ~Q~ W Lot # Biodc # Subd. Marne or CSM# ~fOQ~. (.,l..tr ATC. L4tC.~ __~ _.,, .,....,, ~ „~„~ rYUmoer ~ 545 ('Z l5) ZCo :3 - 7A 12, (City ^ ~p~ ~ Town ~[5 R-C-3 ST Plearest Road c32C~ ~~ c5 T ® New ~~~ U se: ~ Residential / Number of bedrooms Code derived design flow rate ^ Replacement ^ Public or corrxr~erdal - Descn'be: t.~PD Parent material _ 1 General comments ` r ~ tJKKO l:c) I Flood Plain elevation if applique . /V r /~ A . R- and recornmendations: I~~Gc) f h trrl u tJ t~ CsD ~J `~ 5 ~ _ ~ 1,.. ~ 1 @ 12 , ~ 4 ~ S ~~~' ~~ -- I~t3Gc~rnt~,t,,~n .4- `•~O 5A ~5T.3E !~ ~ i a' ~~, @ ~i~-. 35 `~ ~ ~ ~ Z ~.~- G?rs~~ _ ~, ^~~ Boring # Pit Ground surface el@v. ~ 3.3 5 ft Heron DeP~ in. Dorriinant Color Munseq Redox DescxiP~n Qu. Sz. Cont. Color Texture Gr. Sz. Sh_ f O- 10~2,g- 3 5( Zm r r Z ~- i ~1.5 ~ ~ IS Z.Y.sbk rnv r - Lo~e.Z~ ~ f 5 d5 m S °- ~ I ©`iR..1 ~-~--1 nJF! O tn~ te-~ t . 5.~~ ~ 5 Z-~ ~ . Z ~ ~~• vas ©w, w,fl ~w , t~ r•~1 A i ` I Boring ~ u o~nrg ~ 1 ^ Pit Ground surface elev. ~ ~ •-I ~}- R Defltn to tlmitina fawn 4 4 s., ~~nue.u rr~ = i3VU5 c JU ~t ana TSS < 30 mg/L :B3 GPD/flz 'Efflt1 'Eti*2 • ~ I,O • -i I . 5 •~ .4 •~ ~ ~ _~d Horizon Depth Dominant Cobr Red x D Sop Applicafion Ratae in. MunseU o e scription Q S C Texture Structure Consistence Boundary Roots GPDJft= u. z. ont. Color Gr. Sz. Sh. 'Eff#1 ' Ett~2 I O -8 18Y2 4 ~ 5 Z.m rn r 5 Z L a ( ~ 8 -- .5~t 2 - ~ 2 b K m~ r S ~ sS" . • ~I . 1. ~ 3 I - d 2~ 4 Os ml ~ ciS - :,5 to bw, 1 a,,t,~ -- , q. , , ~ 5 om m l .4 .~ Effluen t #1 = BOD_ > 30 N- ~ s t < 2?n mnA ~.,.~ rcc »n , , ~., __. ~a ~ i -~ c,~ e (Please Print) _ _ _ _ - ~ S~-ature ~o~ 1J ~li` 1 ~ 1U t_.t., t Date l4 ~~ l3 ~ A~/ 3,o,R~orJ l,tJ.i_ 54~iz Depth to limiting factor ~_ ~. ~ I Sinxdure Consisfienoe Bocedary Roots ~° ~ 1Q l~5 (`T 15~ ~3l - 30zrj 05~~ Parcel ID # Page 2,• afi Property Owner f~ a Boring # _ _ ~ ~~ ~ ~t Ground surface dev. ,9 3 4(~ ft. Deptt do faniting factor ~__ ~. ~ q~pGon Ra, ce i t C Botx~da Roots G PD/itz .Horizo n Depth Dominant Cola Redox Description Texture ~Strudure G ons s ~ ry ~~ ~~ in. CNunseO ~ Qu. Sz Cont Color ~ r. Sz Sh. I o S D [ - 5 ~ 2 m hn r 2 , ~o t.o ~ ~_ Q _ - - 15 'Z~•sb my ~~ I • ~ 3 o Z ~ 4s nn ~ aS -- .~ ~, d o rn --~ ,~} , ~ J ¢ (~~ # (~j~ ~ Ground surface elev. ~ • 24 ft. Deptn to limiting factor ~ ~ "~ -~=- ~• Soil pppflcation Rafe i ti Texture Stnrchue Consistence Bax~dary R~ GPD/R~ on p ,-lemon Depth Domin~t Color Redox Dessa ~. Mum Qu. Sz Copt Cobr Gr. Sz. Sh. 'Eff#~i 'Eff#2 . i o- is o ~. z '- ~ ~ 5~ 2 ~ r ~5 2 Z - - °`~ 3dL ~ - 7,5~c~24 5 i l 5 2 -r,~bic 2w~q,b k rh , ~ -- -- N-3 1 s ~ ~ ~~ p~ S ® ~~ # a Gro~d surface elev. ~ ' ~J' tt Depth to Fmifing facia' 41 in. Horizon Depth Dom~ant Cola Redox Description Texture Stn~dure Consstence Bamd~ in Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. i ap ~ I lo~c~. ~ s l 2n~-abl~ S _ --- 5 Z,,,,~,~-6 k m ~ i - ~ s~ ~ ~ `! Q-Z ~4 ~ ~ ~~ 3 d. ~ 5 '7.r..a b ~C, rn ~ ~ `--' Roots cure` •Eff#1 'Eff#2 l i S Ids • Effluent #1 = BODS > 30 < 220 mgfL and TSS >30 < 150 mgl~ -~1 Ettluent #2 = BODb < 30 mglL and TSS < 30 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alteenate format, please contact the departrnent at 6(18-266-3151 or 'TTY 608-264-$777. sso-aswfR-o~roo> SITE PLAN PROPERTY OWNER: ~, P~uJR~Nci~. ~ KAt~,t~ tZDS~~ PROPERTY LOCATION: ~~1'4 ~1~ ~ 'SQL tZ ~ 3ttJ 'R.tSW ~owti' of ~oR~ST - 5? ~~+oC Cam. ~ ~" ~ i~_ ~~ qg 6B5 So ~~~~ ~ ~ ~~~ f -~_~~. ~~, ~~, ~ , B4 Q i ,.. _~ -~_ .,~ .~ ~ BM BENCHMARK: f3rn, tat. tov•c~ I op of ~~~~. ~~-~c,~ ~asi` 6mL mac.. q9.2. -~`~~, of ~,`` F~~,R.c~,t,ASS ~r~ Lj BORE HOLES - ~,,f3, ~t3 , 35' - ~1.6Z q3 ~ 14 ~-B3 93.4t~~ ~~ B~, $a . 2.4' ~L~S So. 15 ~ Nv l~f;~ 4~ ~U~ ~A ~.~ ~ Ron Friedell #226564 SITE PLAN 'n~ q2 ~ ---- ~O ~ ~7.' ~, Mom do ~ 51T~ r----~'" ~ ~~ ~ z s~° .~--~ ~" s•t~ rye. . BM Bench Mark EL 100.00 ~M, 1~L ltX7.U TaP a F ~~~L ~r3wK.~ I~a~T ~~ Z tsi L. qQl ~'l.r ~O P O f Z!r i 1 ~31~s r2.G1 ~.AS 5 ~D ~/T ~ P'C , SL~p'j!!J'{~AN K I Pv1~ Ght A M (3C~C, SK,aw toovl[ooo gA~. CAmr3v TANk t~I3AgcL q-ioo Fig.-~~~. .~. , G • ~a ~ ~ L-rr~7 ~ orb G~ L,LS T2,C x2.35` ~~ . =~ 4v AcR,~ `a'rt. ~~ 2 c~~ ~~~ (e~~~^'°T ...fie. ~-. ~ - ~° ~ d~ `~~ ~ ~ ~.eo~ ~~~~. ~~ ~~N/~NNN^ ST. CROIX COUNTY WISCONSIN ZONING OFF=CE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 Page ~ of ~_ COUNTY ON-SITE VERIFICATION FORM Ins ector: P ~ V f'I~.1 C`'l 2~~ Date: ;~w~F~ E~, -7~00.~ Parcel ID Number B ~ ~oZG, - ~ - v~ , /~/ roparty wnar ropertyLocation ~ala.1 Q.-En! CE N ~S ~1 tarot. Lot ~' 1 # N ~ 1 F4 S ~~- T ~ ( N R (,~ ~(or)~ PropeRy O stter~ tvtailin9 add, e Lot # Block;/ Sind. Name ar C81N~' Zo S-~-- '-~ ~- ~ • O A-t.~,f. CxC itY to Code Phms Number ^ City ^ Village axn Ne rest Road wConstruclion Use:^ ResidentiallNumberof6edrnoms ................_............._ Codsderivsddssignfbwrate_..______._._.....----.~.~_GPD ^lteplaoament ^ Publicorwmmerktial-Desr~ibe : ..................................................._....._....___...._.._.__.._........___........_....._.._._..__._._......__._..._.........._.__.----_--_-- Parerrt material _~ __.-_ `~_.~~____~ _~... ,.,- ~_, ____ _ _ Flood Plain eleroativn if applicable .__ __ _ ___. ___ ~ __.._~ _._.__ ft. General earnmsnts and rsoommendations: _~.._- __~`" . © Boring df ^ Baring ^ Pit Grokmd surfaces elex __- __ __ ft. Depth to limiting faksrr _ _ _~_ in. Roil Mnlirafim Rufo Horizon Depth DominantCobr RsdaxDescription Texture Structure Cansis~nce Boundary Rods GP DV'llt in. Munseil au Sz. Cant. Color Gr. Sz. Sh. 'Eff#1 "Eff~ Conditions: ~ win, Soil Survey description: U~Lu, N 9 ~-C-~ZI~~ Notes: `~ FEE: `-~- .~- ~s-~~ ~~C S r CK¢s ~ I~ k ~-k~`~. S "~-Y~ sow ~'ta"` 'f~ ~- ~ 2~ - ~~ _~~ ~ U ~ D wf" t~ v.~ ' ~ ~d~ S S ~ a~ ~ " b. i f ST. CROIX COUNTY ON-SITE VERIFICATION FORM PrapertyOwner_----------- ParceilD~------------- Pag'e----of---- ~Boring # ^ 8oring ^ Pit Ground surface alev ......................... ........ ft. Depth to limilfng fac0ar _......._....__.........._... in. „_„ .--~ -.. . Horizarr Depth Dominant Cabr Rledax Description Texhrre Structure Gansistenco Boundary Roots v.w~ ryq,n GP ws~u~~ rv~ux Ohf i~ Mansell a,. st. cart. cd©r Gr. sz. sn. ~ •~ tl Notes: 1 V 71 Boring ~ ^ Boring ~~~ ^ Pit Ground surtace elev. _-_..,_._-_ ft. Depth to limitingfactor--.--_ in. ~~, . __r`•__ .,_._ Horizon Depth Dominant Cobr raadox Description Texture Structure Ga~isteru:e Boundary Rods ~ GP DJfR in. Munsall Ou. Sz. Dart. Cdor Gr. 5z. 3h. •Eff#1 . Notes: Boring ~ ^ Boring ^ Pit Ground surfaceelew._.,.,_--_..._ft. Depihtolimitingfacbr-.--_ in. ~~~ ~__~„~,~_ ~~ Horizon Deptir DomirxantGobr F~doxDesaiption Texture 5tructu~e Gasistenr~ Boundary Rods GP DAF ~. Mansell i3u. Sz. Gart. Cdor Gr. Sz. Sh. 'Eff#1 •F~2 S Notes: r SITE PLAN PROPERTY OWNER: C..AU.~R,~tJG~ ~ KAtz~~1 ~pS~rJ PROPERTY LOCATION: S ~ Y - IJ~Jq~"-- Sc~c, tZ 'T31 ~ "~ i5 ~ Tows o~ Foa.~S-r - 5~ C.ROI~ C.o . ~ 3 ~3 ~`~ ~~ ~ ~, ~~I~rt ~~ ' S 1`C[§ i ,~ ~.: s `' /~ I , ~Z ~ ILA ~ 1~~ ~-~- -~- P;~ ~ ~..~.~ O BM BENCHMARK: P.~iY1~ tel. il7p•~` Top P Eii= J1~~1.. ~t~n)~ POSZ° BmZ ~,~ R9 ,2 'i'op ®~' !rL ~~g~,2,G,t,,,ss 12ot~ ~ BORE HOLES: ~~. 43, 94 •Io4 ~~ ~ 9 4•~4' ~ ~-~-- ~~~ e~~ ~L83 93 •I 4' ~~`ES ~^'~ ~k' Na L~E?1,~, ~c=t~ ~. O Ac.i~ pA `s ~„~ Ron Friedell #226564 Q St. Croix County Map Output Page Page 1 of 1 St. Croix County Mapping ~~ °~,~ ~2 `e~ tY~a' . ~~~ S~" BiC2 t>s SE 114-NE 1/4 st 12 110 f II RhA i foB StIB 1M SeC2 M~ 4- test MC2 PpD2 ," ~`# St. Croix County Planning Department 1101 Carmichael Road Hudson, WI 54016 Phone: (715)386-4674 DISCLAIMER :The information contained on this map is advisory. Map accuracy is limited by the quality of the public records from which it was prepared. It is not intended as a substitute for an accurate field survey. AERIAL PHOTOS :Aerial photography is date-sensitive. Features that exist presently in the County may not be present in the photos. Legend .. MazYc7oa1 6oar~.lakz 36c11 V ks I Oftf v~erl7c a 3r~eey IH ~rz I°Ur xlz 0 Roal Q aarroaa D1-ai rage Streams oA.., P1C rrlry~ '~itCaT t~krml IknluKarn http://72.21.230.178/servlet/com.esri. esrimap.Esrimap?ServiceName=StCroixOV &ClientV... 6/6/2005 `_ _n ~ r ~,Q r1.'~v~C ~e-i ~ CI.tQOf~ , ~a ~-t,..,~. ~~ WisoonsinDep>:rimen o mmerce SOIL EVALUATION Division of Safel y and Buildings ~Q°D REP T~ D Page i of,,,~ In accoraance wlrn Comm o5, ms. ram. t.oae Plan must 11 in hes in size th 8 112 t l l County Sf GTZDIX . an x c an on paper no ess Attach complete site p fnciude, but n„t limited to: vertical and horizontal reference point (BM), direction and parcel LD. ~ ( 4 - i C 2!0 "" 5 v `• L~oO P percent slope scale or dimensions, north arrow, and location and distance to nearest road. Please print al Reviewed by Date ~~ Peroonel Infonnation you provide may be used for i w, s. 1 econd ~RA .04 (1) (m)). rty Owner Prope P arty location p l..D~v~3a'~EI~IC..~ ~ KA21;t9 2)~ s 205 Go .Lol j~ 1/4 ~i~1/4 S IZ T 3 I N R I5 ~(or)W Property Owner's Mailing Address ~~ ' ST.CROIX000NTY Lo # Block # Subd. Name or CSM# Si 1-25ic 32U City State Zip Code City ^ Village Town Nearest Road C,C•EAR ~'~ WZ 54005 ( )'L(o3 - Z.Ot2 ~p(t..LS j ~JZ~~ ST ® New Construction Use: ® Residential / Nurnber of bedrooms 3 Code derived design flow rate ~-YJ d GPD ^ Replacement ^ Public or commercial -Describe: Parent material _ y r,{,KO W rl Flood Plain elevation if applicable ~ , A • fl. General oommenls .%~ ~ and recornmend~ tions: n~~ mm~+ ~ ~'~ ~ Sy 5'(. ~ (-' 9 l .~" © Boring # ~ Boring pit Ground surface elev. 4 • (04 ft. Depth to limiting factor ~ 15 in. Soil lication Rate rizon H De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Et1#2 1 0 -~ Ic~~tsZ 4 3 S1 2m r' tY-v~r S 2 ~ .!o I .c~ 2- ' - I `i..y 15 Zrnsbic tint r .5 I r~ I . (o 3 t~-2 5t~ 5~4 -' Fps os ml a,5 - , 5 i•O -3t~ 5 e 2. ~rz~r 3~. I~5 Ern mfI a~ --- .5 -.o - l 5 iZ --. ~-s 'o sg y~ I - --- . 5 I ,O 9/.ya/ 3~.~fS ~ . 84' Boring # ^ Boring ®Pit Ground surface elev. X14 ~ ft. Depth to limiting factor ~ 5 in. Soil lication Rate Horizon Deptt Dominant Color Redox Description Texluro SWcture Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i o`i iZ 4 ~3 S ~ m ~ l,r.~/ ~- 5 2 . S~ I . ~ 2 - 2 -1.5y2.5 - IS Zmsb~ ~v r' S I ,1 l.b Iz- ~5y~-1 - S ~5 m I d,5 --~ . 5 l.d 5-~ ~. ~~ I 3 5 am rnv I S -- , 5 I .o 1R- i •S~tR. ~ s 'o s M I ~~ I .© ~ ~ 3S ZFf' ~-(. Zg' ' Etflr ent #1 = BOD > 30 < 220 mg/I. and TSS•>30 <_ 1 50 mg/L ffluent #2 ~ BOD <_ 30 mgll and TSS _< 30 mgll_ CST Name (Pies se Print) Signature ' CST Nur-~ber Fio>!J FiZt~D~u- 22lo51c4 Address -Date valuaG n Conducted Telephone Number 419 13T'~ Av ~A~~ t~ 54812 4 ~~ ~ C~5 ('1 t 5~ ~ 31 ° 302 I Property Owner ~ t~ )~ r~ Parcel ID # ©14 - I O 2L;, - 5 d - O~ Page 2- of _,~, ®Pit Ground surface elev.9 3 • i 4 ft. Depth b Mmitirrg factor ~a ~ in. ~ Rate Horizon Depth Dominant Cobr Redox Desaiptiorr Texture Stnrcture Consistence boundary Roots GP D/iF in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff~k1 'Eif#2 j a -5 l ayr:.4 ~ 3 ,---- S 2 m 56i~ ~~ S 2- . t~ I.O 3 i1' b0 7. -re -1 "~' S osS rn ~ a.S ~ ~ . S I .b u -~ 5 ~I rz 5 ~ 4- 2.~~+ ~ 3 d. I ' S o ~ I e~.s ~' . 5 I , o b -iiZ .5y2'~ -- ~'S a 5 m ~ - -- . s I o. ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soft Rab Horizon Depth Dominant Color Redox Descxiption Texture Stnrcture Consistence Boundary Roots OP DflP in. Munself Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff1~2 Boring ~~ # Ground surface elev. ft. Depth b limiting factor in. ^ Pit Soft - R~ Horizon Depth ~ Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIIF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD, > 30 < 220 mgll. and TSS >30 < 150 mglL 'Effluent #2 = BODs < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. SBD-E330 (807/00) SITE PLAN PROPERTY OWNER: t,.wuoR.~riLi/ ~ KARC~tiS ~ag~~ PROPERTY LOCATION : S ~ Y - I~~j9. Sic- lZ T3 i t3 ~ i5 ~ To~~ o~ Foa.~s-r - S~t Gizol~ Co • [.~ f ~ Q2r o13 a,e BI ~ Z, PQ. C (~ lse.S, `~ l,1 ~ Q ~ 25~' B ~ ` 2~~,., / \ a ~~ 3 ~ .\ - ..i ~• .-~_ ~j11i"3 i ~~ i ~"~,. ~~i p BM BENCHMARK: P~t,n~ ~~ ino•tJ` Top of ~~~~, ~c~~J~ Pc~ST Bmz ~~, R9.2P 7~p QF ~ F~g~~wss IZoo j, BORE HOLES: ~~ ~r3, 94 .~04 ~~ ~ 9 4.34' ~~-83 `i3 •I 4~ ~k' 1~0 ~s/l~. O AGR-t~ ~ACL-C.t~. l.. Ron Friedell #226564 Q CONVENTIONAL INGROUND DISTRIBUTION DESIGN Residential Application INDEX AND TITLE PAGE PROJECT NAME: l~ ~ff (J~ ~ ~A~>~ ~ ~©5~ 1" OWNER'S NAME: L;4ls~jZ~NC,.t~ ~` Kf~rr~IJ `~OJc~,N OWNERS ADDRESS: ~~,~ ,~~ ~ ~~ L~ k~ ~T ~4.ao5 LEGAL DESCRIPTION ~ _ ~ ~ 5 (~ ~ ~ ~ ,~ `~ TOWNSHIP: ~~~~~- COUNTY: 5 ~ C~ ~~ SUBDIVISION NAME: LOT NUMBER: BLOCK NUMBER: PARCEL I.D. NUMBER: btg' _ LOZ(o -- Jr0 "' OQC~ Page 1 Index and Title Page 2 Site Plan Page 3 Page 4 Page 5 Page 6 Designer: Ron Friedeq Date: 5 5 ~y System Crossection Management Pfan ~"f~,a. ~ k Cczo ssr~c.T' tdrJ ~l.~M W~~ Licence Number: 226564 Phone Number: (715) 637-3020 Designed Pursuant io the Conventional Soi Absorbtion Component Manual for POWTS SBD-10567-P (R.6/99) SITE PLAN - ~ ,`_ Z.C~ / ~ a ~ ~ 8 \ ~ / \` o ~, ~ P~ / s-r) Pc- ~ '4N 3cr~- Pvr. BM Bench Mark EL 100.00 gym, ~~loo.o`°f`ap o"r 5~~g~. ~~a~~Pas~ $m z ~L 9~ • 'L ~o p a ~ c~z • Ft Biz-G,IASS RvD 51 ~ P~- Sr~r~c,'1 Aa-~-- I~,~ mp c ~I~mFS~~. ~KA~ I~~f (o0~5AV • Camt~'rA-~k- wl~a~ A-~~ ~-~-~,~.. ~~.~.. Z.G• .S~JfILF 2~:T-o~ C~u-5 i ~ ~QoS~s~ W~u- ~'a''T-n ~ 4o A~ ~~~~. ~pg 2 r~ SYSTEM SPECIFICATIONS In-ground Soil Absorption Component Component Manual # ~C3L7 ~ tO ~if,o7- P ~~=lo ~4 g, Project Name: L A r ~ ~ ~Z,~3U~ ~oSE,; >`J Distribution Cell 'type Aggregate [] Non-Aggregate, T)•pe of Non-Aggregate Component _ G,,lamr~~2s l~~tanufacturer~p-~~ tt.~"11At2~2 1~4odel Q U ~ G K .~- Number of Bedxooms ~ Soil Application Rate (DLR) ~ gpd/ft2 (,)esi~ned Loading Rate) Wastewater Quala Treated ^ Untreated Q Combined wastewater: Number of bedrooms gal/day/bedroom x 150 Daily Wastewater Flow (DWF) _ -~"- Clear and graywater only: Number of bedrooms gal/day/bedroom x~0 Daily Wastewater Flow (DWF) _ 131ackwater Number of bedrooms gal/day/bedroom x 60 Daily Wastewater Flow (DWF) ._ Dispersal Area ('Aggregate) - _ - ft2 (DDV~ (DLR) Dispersal Area (Non-Aggregate) EISA Rating t ~ l ft2 System sizing = DWF =DLR =EISA ( ~0 _ ,~ ) - ~9 ,1 = ~ chambers (DVUF) (DLR) (EISA) illiverter valve A4anufacture ^yes ®no Septic Tank Min. Septic Tank Vol. Req. ~_ gal. Septic Tank Volume l~_ gal• Manufacturer sl~Ai~ Effluent Filter Manufacturer ~ At3 !- _ Model (~ - t00 Pump Tank Manufacturer ~J~11J Volume Iota Model 1DDC~ ~ bO~ ~OmRD . Distribution Component Distribution Box Hydro-sputter Other Manufacturer Cross section of distribution cell(s) F~atSN Ga,PO~ ~'~4r ~~ .~, r ,ria` 3 rY+,,,- .e---~- 5ksr'rt X12,14 ~ 5~ts~r T24z.3S c o .~-- s o [Zo ~~ 3 SYSTEM SPECIFICATIONS In-ground Soil Absorption Component Component Manual # 5 S~ ' ~ ~ 5Ev~1 ~ P~~ - lc' ~q~ Project Name: ~RO.~a~ 1 1sstribution Cell Type Aggregate ^ Non-Aggregate T)•pe of Non-Aggregate Component 1\~fanufactuter ~' ~~~ V`fS2~`f D 2.. 1~4odel C~ V ~ GK,~- Number of Bedrooms Soil Application Rate (DLR) (()esigned Loading Rate) .. J ~/ft2 ~~lastewater Qualt Treated (~ Untreated (:ombined wastewater: Number of bedrooms gal/day/bedroom Daily Wastewater Flow (DWF) _ Clear and graywater only: Number of bedrooms gal/day/bedroom Daily Wastewater Flow (DWF) _ Blackwater Number of bedrooms gal/day/bedroom Daily Wastewater Flow (DWF) Dispersal Area (Aggregate) (DDUk~ (DLR) Dispersal Area (Non-A egate) EISA Rating 9 • ft2 System sizing = D (~ _ (DWE~ R) /" Diverter valve ^yes Manufacture ®no % ~~ 7 Septic Tank Min. Septic Tank Vol. Req. Septic Tank Volume Manufacturer ---`_-~ Effluent Filter anufacturer M el ~,= J Tanks H Box W Cross section of distribution cell(s) N~~ ~ ~~~~ ~~~ 3~ `~„~ r F =DLR =EISA . ~ _ ~~ chambers (EtsA) ., Stiff ~~..• °iifi 12~ 1-----~ f a r l~ o c ~ qb` I qZS gal. ldoC'.1 gal. ~~ 3 COM[3INAT_lON_SC!'YIC t~~FliahUMr CiN~IOER (No Scstlp! •Approved Lorkin~ Manhole Cover Tit th Warning L~tbei Attar_hed We~tfterrronf -___I~~ dunctf nn Nox - r -fl 11-- lfl" Ptinimum -- -- - - Y --- - -~ ~' B~~fies 3- A~oi ~'.+..Z-.31G + Arhr~crvEt~ JOtNtS Wt111 Ahhttot-f:b hihE 3' ONtO 501IU S01L Approved ~ Vent Cap ~- 1. m+ nimu ~ 4" Minimum n. , Al a r,n Q~ ~ on ~ - t C t off d' ; ~~ T7'1 ~-~ b 1 sc onnec t 1 /4" Weep !tole Cvnc. Bloc 3" of oeddi n+i Under flank N~-t ~ ~ 1'urnp :,nd A) hrm Are On 5er:,rAte C i rcui t9 Tank M~nu~acturer: ~A~__________-----Gallons tank Site-Saptac/hump: l~~Qj1~~----- A1 irm (4inufacturer:_~~- g~t~ _..____ - ttnriel Numher:~ to i ---- ---------- ----- Swi tch Type: msr~t ------ -- hump ~linttfar.~urpr:_~~~_^____ -~- t•1+r+1e1 Number:_ _IJt~Q~,NN -R~. f•tininntm bischarge a e:; ~c~ -" Numbnr of hoses: 3 her bay Gallons her bay/~-Uoses: i5t~ Gallons Volume tip gackflnw:...:...+__~ Gallons total bbse Vnl t»n~ :........ = t~Gat 1 otts Capacities: A inches or Gallons + g ~ inches at~ Gal 1 ons + C 1 ncltes nr~~ ~Ga 11 ons + ~7 inches b or Ga11 ons tdtal.....= . inches _ o Gallons vertical t1i ftprencp between rump Ofd and bistributinn Pipe: ~~ ~ppt + r=- i'eet Minimum Re~Tuired Supply hressure:........••r•+• "'••`••~~~+~T'net ~~__Feei; of T'orce Main x I,~i4 Friction ~~ctdt"/10U feet. ~ loch biameter Force F1ain Total byttamit: Head:...=3b sheet internal lank i)lmensions: Length 5~t_; Width (Q~i Liquid bepth ~~ ~. License Number'22~5b4 bate 05_ (~ GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering • Fully submerged in high grade turbine oil for lubrication and efflaent heat transfer. Available for automatic and manual operation. Auto- matic models indude Mechanical Float Switch assembled and preset at the factory. SPECIFICATIONS • Solids handling capability: a/a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. Disd~arge size:1'/z~ NPT. • Mechanical seal: carbon- rotarykeramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length,16/3 S1TW with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug __ (standard on EP05). FEATURES ^ EP041mpeller. Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS I FEE 101" 0 a W x u z 0 a r O Submersible Effluent Pump .. EP04 & EP05 Series ^ EP05 Impeller: Thermoplas- tic endosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effluent heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. CAPACnY ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING C Canadian Standards Auodatiorr SP° Ae # us3asa9 Gadds Pwnps is ISO 9001 Registered. Goulds Pumps / j ~1 ITT 1.~ J..~t..: ..~ ~ ?003 Goulds Pumos n ~ 4 6 8 10 12 m'/I1 (e~ GOlILDS PUMPS APPLICATION! Specifically desi~lned for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry . • Effluent systerls SPECIFICATIOIJS Pump • Solids handlin f capabilities: 3/0" maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: u ~ to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60" C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cas' iron, semi- open, non-clog lvith pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller ,lvailable as an option. ^ Casing: Cast i ~on volute type for maximum eff ciency. 2" NPT dischargE . ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. Submersible Effluent Pump WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. ^ Shaft: Corrosion-resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components. ^ Desiyned for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/s-1'/z HP models. ^ Class F insulation on 2 HP models. METERS FEET 40 - 130 l20 35 110 30 -- 100 90 y 0 w zs - ao to - a 20 - 60 F 1 s - so u 0 40 ..-. 1 U - 30 U 20 s_ 10 - Single phase (60 Hz): Capacitor start motors for maximum starting torque. • Built-in overload with automatic reset. + S1TOW or STOW severe duty oil and water resistant power cords. •'/3 and'/z HP models have NEMA three prong grounding plugs. +'/a HP and larger units have bare lead cord ends. Three phase (60 Hz): + Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturers recommended working limits, ~~ ~ ~ I ~r•rGPM can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS S ~ ® Tested to UL 778 and CSA 22.2108 Standards By Canadian Standards Association C US Fle #LR38549 .Goulds Pumps is ISO 900t Registered. 500 & ol_ oL-..C__L_L1~1_1_1_.[_L_L_~_.LL_L~~1:J-~T`l_1;_i_.I_!_a_:L.~C1J_l__L__L_! _I 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 0 5 10 15 20 25 . cAPACiTv 35 m3/hr Goulds Pumps 2003 Goulds Purips ~~ Effective July, 2003 vvww.goulds.com ~ ITT Industries 83885 ~V~~~jjj :~~~ T~q/ WN &~ OUNTRY HOUSING 16x76 y~~ #5 ~~: F .,.. .,~ r ., OPT. PAIlO WOR ~-•tZ' d ~~~ ~ r Features Front Walk-A-Bay Window Shingle Roof tt Vinyl Siding 6" Walls Et Northern Insulation Lighted Ceiling Fan Frost Free Exterior Faucet Thermopane Low E Windows Water Shut Offs Throughout 1 Piece Fiberglass Tub in Hall Bath 2 Skylights 9 Lite Rear. Door With Stone 1 Piece Garden Tub In M. Bath Dead Bolt Locks 6 Panel Front Door w/Storm Oak Cabinet Doors Comer Cabinet in Dining Room Dishwasher (2) Exterior Outlets Range Ft Refrigerator ~ Perimeter Heat Vents Backsptash On Counters 8' Side Walls 100 Amp Service Single Lever Kitchen Faucet 40 Gallon Water Heater Larger Moldings in L.R and D.R. Sturdy Board Sheathing Boulder Stone Wood Burning Comer Fireplace Wainscoat Paneling in Living Room Town and Country Housing 4285 S. Prairie View Rd Chippewa Falls, WI 54729 www.townandcou ntryhou si ng.com ~....~:F~~~tinc ci~hiort to Chanae Without Notice rxor~x~ oWx~x ~io5~r~1~ ~xsair ~o r~s t' Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System {POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-1056-P (R.6/99). Table 1: System Design Spec~oations Sanity Permit Number - Number of Bedrooms Desi n Flow -Peak d O Estimated Flow - Avery e d p Se tic Tank Ca aci al app Soil Abso Lion Com onent Size . 60 - o.e i ~S r T of Wastewater Domestic Table 2: Soil Abso tion Com onent _ Limits of Reliable O ration Se tic Tank Com onent Soil Abso lion Com onent Desi n Flow -Peak d 4.J Maximum Influent Partide Size in NA 118 Maximum GODS m L NA 220 Maximum TSS m L NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule S tic Tank Ins ect and/or service once eve 3 ears Outlet Filter Should ins ect once a ear and dean once eve 3 ears Soil Abso tion Com onent Ins ect once eve 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servidng Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet f shall be deaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its endosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shalt have its contents removed when the volume of scum and sludge in the tank ~-~ ~9 ~" Management Plan for a Septic Tank and Soil Absorption Component exceeds 1/3 the liquid volume of the tank. !f the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatmerrt or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe d~cult or impossible. Tank abandonment shall be in accordance with Comm 83.33, ws. Adm. Code when the tank is no longer used as a POWTS component. Soil Absoration Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential faality. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing: This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct _ wastewater_flo~r. - : - Coatingeacy Plan : If System failure axurs and repairs are not possible, a aew system Sitc is to be located, and a new system is to be instafled per comet- 83 VVis. Adm_ Code. ,r. ~~~ C.c~-,~~ ~r :~~tiG = ~(S • 38(0 . ~f6~o ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ i~6 ~p ~/~ ~ ~ 2~d ~l Q,,~ ~ ~ ~ ~~~~1 Mailing Address -_~2~5(0 `~~,p ~ ~~ ~-rP~-~ Property Address ~~2 (Q d20 ~ ; (Verification required from Planning Department for new construction.) , City/State C_s_.~~~ L~J~ Parcel Identification Number (~l y - ~~(o - S"~ -(~~~ ~j `~UOoS LEGAL DESCRIPTION Property Location 1~'/4 , ~~'/4 ,Sec. ~, T _3/ N R /~~ W, Town of ~p~ ~~ Subdivision Certified Survey Map # Volume ,Page # Lot # Warranty Deed # ~(~~/g ,Volume ,Page # ~~ 3 Spec 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 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 County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. I/we, 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 Department within 30 days oft 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. 1/we am/are the owner(s) of the pro rty described above, by virtue of warranty deed recorded in Register of Deeds Office. ~/~i ~ ~ SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. DOCUMENT NO, WARRANTY DEED TNIa Bract RE9ERV[O FOR RECORDING tiara STATE BAR OF WISCONSIN FORM 2-1988 454119 v~• $~'7P~cf REGISTER'S OFFICE Phillip K. Anderson, a single roan.-...... ST. CROIX CO., WI ........ ..... ... ............................. Recd for Record ..................................... ._ ..........................._.......---- JUL3/ 1989 at s:oo A.M convr~s and «•arrants to .. Iawrenoe L. FbSen ar]Cl.iCdrell,A._ R768i1, /~ .. ......... - V •v .... husband-.and- wife,_as..Joint .tennazts,... ---..._ . ............... . .... ........... ...... . ................_. _ _...... ....._..-.......................... R9glsfhr~' .. - ........__....-...._ ................... ._....... ........ ... ............................. AlT/AN 1E~LTON a SWANSON . ..................._ _ .. - -.... ... ._. ..._ - ...... Attorneys at Law . _ - - -- _ .... . .. ............. . ..... _.............. _ _.. _..-- - -- ---.. P 0 Eiox 211 the following described real estate in ................CJ.t._~L~1X.---....,-,.-County, 8RlSd(Tt Lake, WI $4$1!1 State of Wisconsin: The Southeast 1/4 of the Northeast.. 1/4 (SE 1/4 of NE 1/4) , Taz Parcel No : ....................... --..... Section 12, Zbtvnshi.p 31 North, Range 15 West. This deed is given in satisfaction of a particular Land Contract by and between the above named parties dated September 22, 1972 and recorded Septe;nber 27, 1972 in the office of the Register of Deeds for St. Croix County, Wisconsin in Volume 489 of Records Page 581 as document number 312619. ('RANSfEF. ~ ~ •~~ ~s This 1S IlOt- .-..., homestead property. ~ (is not). Exception to wars~anties: ReseZVations, restrictions, and easements of re~rds, if any, public highways, zoning and building regulations, and any lien or inclunberance created by the act or the fault of grantees. Dated this ..- ---_._.-__.~~-----_--_.......----. day of ....--..._ __.- July 89 /~ //77 ~~~~ _ _. 19- . .......(SEAL) _V`_~L~trI~G[/'o ~`/(;ZCi4h~`) _ (SEAL) Phillip K. Anderson ..__...-..-..._.._.._..-...------•-- - - - ...(SEAL) AUTFIENTICATION _.. .(SEAL} ACSNOWLEDOMENT Signature(s) --...---•-•--_.----••------••--•----------._ STATE OF WISCONSIN ss. --•--••---------•-----------•--------Y .._...---•-----••---•--•------- --•-•--- ---.St. Croix • --------- •-----..._......County. authenticated this .__..._.da of ........................... 19...... Personally came before me this ~l y July •-- - ...---• -da of ------------•-•-- ---- ------------------ 19-.89.. the above named ------•---------------------••---••---••----••----•- Philli K Anderson TITLE: '.MEMBER STATE BAR OF WISCONSIN ~ - ~~- - ~ -~ -" - f not. ---••-•-•-•-------•----•---•-------- ---------•-••--• ---•-- suthorized b .-- - - ....._.. .... Y $ 706.06, Wis. StatsJ - - - - -- "•jo me known to be the person .__-___ who executed the /f~~~rq~' instprment anrl~.hnowledge the same. 7HIS INSTRUMENT WAS DRAFTED BV ~ '•, ,"--- ~.•• •., ~ ,~ l/ ~7~T~rTYV~t ~t~~~~~~~r .. ~ r f :y, i 1~I:~L1 vLV St ~7v't1-11V.7VLV ~~'• '.. {~-..-t~_.. .- Z.-~. E, ~. ~1'C-~ -.. - ~~---•---~ - .- )tarry J. Demers ... - -r.. __. .....................-••-------...----•---•----- ------ - -- 1~ to a Public Polk --•• - (SiKnatures ~r.ay be authenticated or acknowledged. R~ h - ~+ ~f}~ (~mm~c;inn is pe•rmanenL([P not, staeoesh~raltin~ are not necessary.) 7-22-9U `.t date: ~ \- ]9 •Names of persons aitninQ in any capacity shrwld by typed ..,r ;rrinh~J brimv their -it: r.;r; .r.-_ WAARANTT DEED S'fA'f F. RAR OF WISCOYB[N Xl+~:~n-~.n I. Pr11tN t:o. 2- I•r•r yrr4 RI:.-.. r... ,,...r. 0.'... Page 1 of 1 Pam Quinn From: Monica Lucht Sent: Thursday, September 08, 2005 11:42 AM To: Pam Quinn Subject: Something going on that doesn't make sense :) Pam, Had a call earlier today that needs some detective work. Lawrence & Karen Rosen - 014-1026-50-000, Town of Forest Own 40 acres and had septic put in this past July. Apparently, they've got one driveway on the property going to a house which I'm assuming has the septic. They have a second driveway on the same 40 acres that hooks up to a trailer home. Now they want to sell the house, but keep the trailer home on the property and have a separate fire number issued for it. Somethings not right here and I'm not sure if it's a septic issue or a land division issue. My feeling is there's no septic hooked up to the trailer and unless it's family buying the house, I think the Rosens will have to split off some acreage to keep the trailer on. What do you think, let me know whatever I can do to help. The Rosen's are e ecting a call back today sometime @ Thanks, ~ ~ Z Monica 2 O r 715-263-2012. I was talking w/Karen. ~. ~~. P~.~ ~.Q. ~ `~. CND ~ V ~~ ~~ ~o h°'~ _-i --- ~; e(C ~a~ 9/8/2005 E "`~;; FOREST PEAT ~ T-31-N • R-15-W ~~E c~1:~At(71fi;~?lIiVT'Y, Wi5C~I+F51N ~? .. ~ . ? ~ ~' (Landowners) ~ See Pane 112 For Additional Names. a. POLK CO. ~~ 2800 2900 3000 9100 3200 2800 POLK / ST CROIX RD 2700 ,. pad g $ ~ ,t,m„,r Lori g ~~ Harold g °` ~ C'm °` Sandra Carol N gg erammy Kr(stle crendaW ~Ddores ° Cormican StreK S~ r HDaz,,~g ~,yc~ ~, r e~w, s Rosen as Levendosld pa ~c~ `Boqg ~~ dJ~ $ 102 47 R ~ m N ~ s I Sha 8: Roger ` ~ ~ ~ 6 Mazlyynn Scepurek I ~ s~ Ruses '~p s~ Gerald g 41 ~ ! {^, ~ +' N ,Roe Priebe \ r g Zmcher 137 CREEK V ~ ~' Trust tJ V M~» Sandra ~ Q ~~. 167 V ~ day GREEN mat 62 S3 80 43 133 m Cormican 224 63 I61 s~ ' Dorothy La~ ~ DHaKBS & W & N eT 00 &)une Kloss- [~s ~ n o ~- m r Ma ~ ss ~ So g I Laursen 90 70 b r ~ Biskupski gp ~ ~ z"°dgdp ner ,b ner ~ vats ~ m ~ 4o g Hel® P eertm - s rand N LOUan Todd S °~ ` L zo sobers ,~~ David B: Fred Clemas re~snm Frank g sits sbasoa ,~ sa I ~ Annum 6g Pietr l~ ~ Mc- ~ ~ P Stella 80 8: IBa e eetcra<a 7 ~ 160 0 °` 38 80 50 g&roo° ^z °ena""a Fu1kr60 °° 260 Blomberg Nitchey 80 39 40 ~ 156 r o o "' $ N aobar ~YY Four 3 37 230TH VE ,~ $ ames g ym„ g p~ g IwsT,a ao 0o ru a laurel Star W~ na ~ p sandr6 ~ Ph9~ s 25 ~ $ me a I N~ w Ropertles 80 40 Iliricb U 40 w ~ ShlLlee „~ CMar ~ f Kevin g ,B ~ C ~ ~ v, a Rose, Wayne I Hazold 8: Brooks ~ p~gp LeAnn 'd O ",.' ,^, ~ ~ ~ g Beverly g ~~ Shirlee Anda• " • Lombardo ~ ~ 12 40 80 ^~ ~ ,5 .9'9s Alverman 120 Cress 60 Brooks 120 16.t) wn 6o N ' 88 C7 s~7C oq ,. 1 Michael ^ ~ Nell g Rl~no dga Hdgeson ^ Ri ~~ ~~I E~ Leong ~~~ s~~~ra ~ Walana 13 g phyuts N 1 NBssett IS 160 BeEdeett Z 40 gettson ° Asomas so Ulrich 160 147 Rgy~p p~~ lark en ^ Dennis Patrick ~~ F S Lyna sutsff r>awa Clar~enu Richazd sGeao- Hati~ ~ 1 g Doris Richter g Kathy g Trade gp .a Z ~o « Gale 40 OAEEK 79 s~mss 8I Hdbel ea,d EBgert 96 Steinberger 160 ,~~ s -- -- T g p& 80 80 O 195 _ z $ F 220th AVE $ Neu g D ~~ Laretd bernick ~ 5 1 r Glennis ~~ NBBes poel~40 Sam 8: 39~ N N 97 40 ~ n Sanft,ters ~ I &{' Ahles Mary .. .. 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