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034-1072-50-025
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563822 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Vobejda, Allen R. & Joan Springfield, Town of 034-1072-50-025 CST BM Elev: Insp. BM Elev: BM Description: C6 SectionTrown/Range/Map No: / 'V (V\ G5 32.29.15.486A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (,J, e /Dp 3 31' 103.3 /od Dosin Alt. BM D p 1 e, 0- 4-O r' 4A~ S i +t. e vl C~ Z~ J t/~ / r T Aeration Bldg. Sewer Holding SUM Inlet TANK SETBACK INFORMATION St/Ht Outlet 7-5. TANK TO P/L WELL BLD . Vent to~lntake ROAD 4;1t We - %T 77 Septic 166 S3 Dt Bottom , L J4-- ON- Dosing Header/Man. ~ Aeration Dist. Pipe Holding Bot. System . 7 93. 9gY 8 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover - 9. GPM a GO O -C~ Model Nu ber TDH LFriction Loss System Head TDH Ft Forcemain Leng Dia. ist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / Z 176 '1"'j SETBACK SYSTEM TO 1O P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer 1 INFORMATION CHAMBER OR ~A ` 1 4_111_1 Type Of System: UNIT Model Numbery e5o .AJ~ Z b `7g f 5d ct DISTRIBUTION SYSTEM f-z, Ho f"4 & : 3 Z two Header/Mal ld / Distribution Ix Hole Size Ix Hole acing Vent to Air Intake 1 16 / Pipe(s) <0'j Length Dia Length Dia pacin SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dept's- 1xx Seeded/Sodded ed Bed/Trench Edges Topsoil Yes Rd NBed/Trench Center 5_-7-4 o jxx Mul es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2829 Highway 12 Wilson, WI 54027 (NE 1/4 NW 1/4 32 T29N R1 5W) A Lot 1 rcel No: 32.29.15.486A 1.) Alt BM Description `J C_A 54 2.) Bldg sewer length = L1 ?(t 1 -amount of cover = ~ 5V Plan revision Required? 0 Yes <vNo Z 3 13 Use other side for additional information. 7 ~ SBD-6710 (R.3/97) Date Insepctor's Sig ture Cert. No. County Industry Services Division -51*'T, ~~1oix us _ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) S P S P.O. Box 7182 Madison, WI 53707-7162 3 g 2-L Sanitary Permit Application State Transaction Number /In accordance with SPS 383.21(2), Wis. Adm. Code submission of this form to the appropriate governmental unit /64 is required prior to obtaining a Wmnt Note: Application forms for statewwned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety ad rvies. Personal information you provide may be used for secondary purposes in accordance wi , s. 15. 1 m , Stats. 12- 1. Application - P t All Informs oJ ii x XAIZ Property Parcel 034- /672 - 5,6 , 02S Property Owner's Mailing Address P"arty Location 4-9, A-) 0?.99 r, w r. .Z S / 4?0Govt. Lot r City,, State Zip Code Phone Number C ~A Section _f .7 Gv/L S o.J L✓ .r .S' o O 7 `-v, 0 s H. Type of Budiling (check all that apply) Lot # T 9 N; R /J9104 .9 1 or 2 Family Dwelling - Number of B .3 Subdivision Name Block # ❑ PubliclCommercial - Describe Use ~Ci Cllr Gka"f ❑ State Owned - Describe Use CSM Number 1 k ❑'Vtlage of Z D r y t` V l I 4-7b f'Town of S®R /w/L f/t'L O III. Type of Permit: (Check only a box on` line A. Complete line B V applicable) 'T A. ❑ New System Replacement System ❑ Treatmcet/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued - / 98 y Before Expiration paper S8 Y/ Z 11-2e IV. Type ofPOWTS System/Component/Device: Check all that a )g Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) GI/ e-r V. nt Area Information: Design Flow (gpd) Design Soil Application Ratcf) Dispersal Area Required (sfj Dispersal Area Proposed ( System Elevation 5/.So 7 .1113 4 z 93. S VL Tank Info Capacity in Total # Of Manufacturer Gallons Gallons Units o U m F New Tanks Existing Tanks N/ A e A a a C~ v~ m i= c7 a Septic or v-',.wevg a k O o Sao ! Cwt''"'i Dosing (der VII. Responsibility Statement- I, the undersigned, HHy fo iast.4aH f e POWTS shown on the attached plans. Plumber's Name (Print) P1 's Signature 1'1P/MPRS Number Business Phone Number r;- r .7.7 7.5" YS /3' .3S- f4C3 Plumber's Address (Street, City, State, Zip 7s'/ 8/ 9 .v /P .fir. E.vo o.✓reF' .7 OUR artment Use Approved Permit Fee Da°t-e7I J $ Issuing A Signadue en Reason for 4 76-, IX. CondidNOT K axons for Discpp J roval 1. 5epfiotank, eftltnt'fflter and j1 e~4 dispersal cell must all be services / inairijjs sd TL~_ as-per management plan provided by'plumber, 2., - "*l tk requ~ 6merft must be afaintained as per applcabto code ftlrdinances. Attach to complete plus for the system and sab adt to the Comity only on paper not less than g In z 11 raeies In size SBD-6398 (80313) 7 Private Onsite Wastewater Treatment System Index and Title Page Project Name: ~LLEN f .To," L146 E,0.4 - 2-,Idt . ~.~/6aoud0 "0, rS Ci~EI°L.olEiyE,✓r) Owner's Name: /9LLE~ t ~A.✓ LJd.~ETDA Owner's Address: Sa 9 ~Ti✓Y. L'.~Ilsa,~ . wr W..17 Legal Description: 4 -7" /s- t✓ Municipality: Tow Verge, -Orly of .Sr~,p/.✓G/END County: Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: Page I 4)ACox,F~~P~-rLE Page 2 o r G'~A~✓ ti1~C~oss- ~E~ ria~ f t' Gov U~E~ Page 3 ✓~Dl~J r .S Ds.~.~E/l S ~,p„lu o /l.G~✓.atEiyEn~ Ir' ~IA•✓ Page 4 Page -5 F/L rEa Page b .~/dE~ rEZ lJ.y«e- ~~fo Page 7 F [ rt~,z .✓/1`0 Page 8 Page g C /~IE.~Y o/L U~d /IAT~o.✓ ~D2 T Name of D igner: rLE ~T License Number: Imes - a®7 7sy8 Signs e: Date: $-3a -.70/3 Design t to the Rowing POWTS Component Manual and D sla s 81-85: !~/loa.~0 ~aic ~,6~a~Prioa Zod/oA✓e~.Vr / ~.~~✓uvL SBL7 /o7oS-G~ ~/I/ o/%~~ !/Ea¢. ,7 D T a zk R NO , q aA~ ~ Zo N4 p0 / IN n C a W Oo law w x ~ ~ ~ w w n ZZ 1 b aA z ° is, M r a t ~ zz" a " u c Z w ~ ° ~ 3. `a1 w ,r `C w w w ~ x' ti ti y o N N r ~ l~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 7 FILE INFORMATION SYSTEM SPECIFICATIONS Owner G G Septic Tank Capacity Odb gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 08.*7 _ a ❑ NA Number of Public Facility Units NrNA Pump Tank Capacity al XrNA Estimated flow (average) pQ gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) .,SD gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit .'NA Fats, Oil & Grease (FOG) :930 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality` Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L Oln-Ground (gravity)- ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100m1 ❑_Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other. ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At [east once every: ❑ month(s) 3 ear(s) (Ma) imum 3 years) 13 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month (s) (Maximum 3 years) ❑ NA 3 IR year(s) Clean effluent filter At least once every: 3 Iff month(s) ❑ NA O year(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) hNA Flush laterals-and pressure test At least once every: ❑ month(s) )S. NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks. and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of 7 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: DC E~LA~Eiy~„~r ~Yjj'~rr J+✓srr1[6~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER / Name T' 1'Pj ,rE rror 1Wff-,47 ~yg Name ,.r rLE or C a.urJ d La 1VA Phone Phone l~ 3.~_ 3 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name e 4~27~ sz-,?v"ed- Name < ~/1o 2a;,/,✓8 Phone ZIX GLS_ -?112 1 Phone 71 8l - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page _ Zof 7 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat-scraps; "medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly. and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: W-1-t. eC1vr.#r ~YsTZrrr !,✓strl[~~ I3I A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER / Name T /fiTTLESrfo1' P.PS- Sy8 Name TAE 0l C t~ai✓r1,or to .,,►s Phone S O? 3.5 5'~ 3 / Phone ~JS' 3.~- L 3 y SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name M. A14 S !fv/C Name .5,jr Z/!o za:✓1✓Z Phone Gls-_ Phone 71.S .381- vd,510 This document was drafted in compliance with chapter Comm 83.22(2)(b)0)1d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. s of 7 • - Basins External Filter Basins (FTB) Orenco® External Filter Basins are used to retrofit an existing residential septic system with an effluent filter. They eliminate the need for costly and sometimes hazardous modifications to an existing septic tank with restric- tive access openings or to unusable outlet baffles or tees. External Filter - Basins include a basin, an 8-inch (203-mm) Orenco Effluent Filter, and a grade ring for attaching a section of riser pipe to the basin. • 18-inch nominal diameter (450-mm ON) basin • Ribbed PVC body • Fiberglass reinforced polyester base R • 12-inch (305-mm) tall, 8-inch (203-mm) diameter, Orenco Effluent Filter included" • Extendable filter handle for easy removal ` • 4-inch nominal diameter (100-mm ON) inlet and outlet openings • Grade ring for 18-inch nominal diameter (450-mm ON) riser pipe included • Adapter kit with grommet and 4-inch Type 3034 pipe adapter ordered separately (Product Code FTB3034KI1) • 18-inch (450-mm) grade ring ordered separately (See "Grade Rings and Grade Ring Inserts" in this catalog) • 18-inch (450-mm) fiberglass access lid ordered separately (see "Fiberglass Access Lids" in this catalog)`" Product Codes • FTB1824-0812 - Filter basin, 18-inch nominal diameter (450-mm ON), 24-inch (610-mm) height, includes 12-inch (305-mm) tall, FTB1824-0812 External Filter Basin 8-inch (203-mm) diameter, Orenco effluent filter • FTB3034KIT - Adapter kit with gasket for 4-inch (100-mm) Type 3034 pipe ACT-PRD-GOP-1, REv_ 1.0 CALL ORENCO SYSTEMS AT 800-348-9843 - FAx: 541-459-2884 PAGE 31 r DIVERTER AND BACKWATER VALVES r.l"vt~-.r 1=1 V&Avvt: Here's the simplest, strongest, and most economical diverter valve ever invented for septic tank leach fields. It is made of tough molded plastic that will not shatter, bend, rust or corrode. It is lighter in weight, easier to handle and less expensive to ship. The diverter valve stem flow may be controlled to individual or multiple fields (up to three) in any combination. With a three-way valve stem, flow may be diverted to any two outlets. To allow flow through all outlets, the valve stem may be removed from the assembly. Connect 4" plastic sewer and drain pipe to inlets and outlets on the four way distribution box. (Unwanted outlets may be sealed by installing caps). The Diverter shield which houses the diverter stem may be cut to desired length. 6.305 1 Pkg. Wt. Ea. Product Part No. Description Color Qty As.) pass 575P 4" PVC Diverter Valve White 4 9.50 35PV a 575 4" ABS Diverter Valve Black 4 7.50 35AB CLOSED 1 2 3 in Cl) 0 0 TANK TANK TANK 4 5 6 4.125" O.D. R) 0 O #2 TURN TO •IAPMO Listed _ 1" 6" TANK TANK iREMOVE Ut CAP iNm siEm TANK The NDS gravity flow Backwater Valve is designed to protect low areas or basements from the backflow of waste from street sewers. It is available in 2", 3", 4" and 6" sizes PVC material. It is a cost effective and a chemically resistant alternative to cast iron valves. The quick action flapper allows unrestricted uni-directional flow. Elastomeric gasket in the flapper ensures a watertight seal. Flapper can be easily removed and replaced if required. Threaded access cap is designed for hand tightening. Access cap neoprene gasket provides a positive seal. Valve hub outlets fit 2", 3", 4", or 6" DWV pipe and may be adapted to 2", 3", 4", or 6" sewer and drain pipe with NOS DWV to Sewer & Drain Adapters. Lightweight, easy to install. Horizontal installation required, with arrows on top of the valve hub pointing in the direction of the flow of water. Access riser with cover offers a simple, economical <MD Item Number A 8 C Riser Height Riser Dia. assess to the valve for inspection and 275P,275 2.18 5.03 3.53 16 4 maintenance. The riser may be cut to 275PR 2.18 5.03 3.53 16 4 the desired length. 375P,375 3.51 7.56 6.10 16 6 375PR, 375R 3.51 7.56 6.10 16 6 475P,475 4.47 11.18 7.18 16 8 475PR, 475R 4.47 11.18 7.18 16 8 A C 1675P,675 5.50 15.25 9.90 16 10 MEMBER I` r a h Approvals applicable to valve only. f B„~. Note- AE dimensions are nominal. All weights are 6r shipping purposes only. Availability is subjed to dxuw. 2 For customer service, please send your fax to: 1-800-726-1998 or call 1-800-726-1994. Effluent filters improve the performance of new or existing gravity septic systems and extend drainfield life by reducing the amount of solids discharged to the drainfield. FT-Series Biotube effluent filters are used in new or existing tanks. Filters include a 4-in. Biotube filter cartridge, PVC housing, and extendable PVC handle. • Biotube filters have a higher flow area than other effluent filters on the market, so they don't have to be cleaned as often. • Sturdy tubular design resists crushing and warping, making installation and removal easy. • Both 1/8-in. and 1/16-in. filtration are available to conform to local regulations. • Optional float bracket allows attachment of float stem for tank • level alarm floats. • Optional flow modulation plate restricts flow from tank to prevent 1 solids from washing out to the drainfield when a large volume of 1 • water enters the tank. • Models to fit Type 3034 or Schedule 40 outlet pipe are available. See "Selecting a Biotube Effluent Filter" on page 12 to choose the right filter for the system's flow rate. STANDARD MODELS Orenco also manufactures commercial-size Biotube filters with FTS0444-36 4-in. diameter, Schedule 40 8-, 12-, and 15-in. diameters for design flows up to 8,000 gpd. FTW0444-36 4-in. diameter, ASTM 3034 Contact Orenco for details. 11 The base inlet filter is a short 8-in. diameter effluent filter for use in residential applications where extended time between cleanings is needed. OPTIONS • MF1A-Y 5FTL float elbow allows a float to be attached to the base inlet filter to activate a high-level alarm. Can be used instead of the float bracket on new filters, or can be retrofitted in the field to existing filters. STANDARD MODELS FT0822-14B 8-in. diameter, bottom inlet FT0822-14B-FSO 8-in, diameter, bottom inlet, includes overflow plate Float elbow i W A PAGE 10 ACT-GOP-1, REv. 2.0, Cc) 3/10, [DISIRIBUTOR NEAR YOU, VISIT US ONLINE AT • • VOL 18 PAGE 4706 KATRCEEII H. N REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 02/20/2004 12:55PH CERTIFIED SURVEY MAP REC FEE" 13.00 CERTIFIED SURVEY MAP PAGES: 2 LOCATED IN THE NEi/4 OF THE NW1/4, THE SE1/4 OF THE NWS/4, THE NWi/4 OF THE NEI/4 AND THE SW]/4 OF THE NEI/4 OF SECTION 32, T29N, R15W, TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN. BEARINGS REFERENCED TO THE NORTH WI. D.O.T. APPROVAL NO. 55_12__390'e/_ 2c>oy LINE OF THE NW1/4 OF SECTION 32, ASSUMED TO BEAR S890 55'46'E. OWNER OF NE]/4 NOTE: NO NEW LOTS HAVE BEEN CREATED. THE PURPOSE OF THIS MAP IS TO SHOW THE ENTIRE OUTLOT 1 OF ALLEN 2e29 HWY VUWI"JUA12" PARCEL OF LAND OWNED BY VOBEJDA AFTER THE CERTIRM SURVEY MAP WILSON. WI. 54027 PARCEL TO THE SOUTH WAS ADDED. VOL. 14, PG. 38.50. OWNER 61 AOQFQ OF LANDS UNPLATrEwD-LANDS --J S WAN THUMPSON N14 MABLTHOMPSON TRUST U.S. HrY 'w 72& SECTION 32R I Sr~9°50'13"E 2891 HWY "12" - - - WILSON, WI. 54027 R NORTH LINE OF THE NWS/4 I NORTH LINE OF HE NE1/4 - c j------ 1. a-PRI i Se9°55'46"E 5139055'46"E 13213.07' - - - - - - _ S89°50'13"E 3328 28 Y' 66' 'EFTA WISCONSIN SETBACK LINE FROM RIGHT-OF-WA -I$ 2576.66' SB9 50'13"E.- - --p NW CORNER. 100' T. CROIX COUNTY BUILDING SETBACK LINE 66.20' NE CORNER, SECTION 32 8 ( i SECTION 32 m LOCATION of ` LOT 7 DRIVEWAY I J > 2,947,836 SQUARE FEET 1 ' I~ ( 67.673 ACRES ) I I INCLUDING RIGHT-OF-WAY f 2.901.837 SQUARE FEET ( 65.617 ACRES ) 1 r I~ EXCLUDING RIGHT-OF-WAY 0 /L POND I Icnn O ~ I yoyb~ io z m I Flo I ' APPROXIMATE LOCATION I z~ ~zQaDl~u OF BUILDINGS t75~~ t tti~777iSSS c0 f Ldw N S89059'38"E 1328.02' L--~~ SOUTH LINE OF THE NEI/4 OF TH\NMWI/4 NORTH LINE OF THE SEI/4 OF THE NWi/4 4' r I V,O UME _PDESCRIBED IN~/ 7 '~y_, PAGE I I IN THE ST. CR~IX COU_NTY W(NZSTE'Fl-_ J OF DEEDS. I I 1\~ I i ,I I 6? I 34 1 I N89°50'32'W 1393.e5' 2 t UNPLAnED LANDS LEG OW - INDICATES SECTION CORNER POSITION GRAPHIC SCALE 1"=300' - iNOica s -0 FR~~ OF RECCOORD ) IDE O - INDICATES i" XJB" IRON PIPE WEIGHING 1.13 LBS. / LIN. FT. SET. 0 300 600 900 - INDICATES FENCE LINE THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRNMERG SHEET 1 OF 2 Vol 18 Page 4706 c *'w Wis. Dept of Safety and Professional Services SOIL EVALUATION REPORT page of.7 Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not 812 x 11 inches in size. Plan must County include, but not limited to: vertical aln reference point (BM), direction and Parcel I.D percent slope, scale or rA north ar nd location and distance to nearest road. iVe print all information. R by. Date Personal Wortnafion You provide may be used for secondary Purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location _ .41 LEA f ,2t/D~B £ Govt Lot E 114 /4 S 9 N R ,S' or~ Property Owner's Mailing Address Lot # jBlock#jSubd.N0b a82 9 r. wY. - °o~ city State Zp Code Phone Number EFe9 2dlage ®Town Nearest Road ❑ New Construc3lon Use- ® Residential / Number of bedrooms 3 Code derived design flow rate VS-0 GPD ® Replacement ❑ Public or commercial - Describe: Parent material ©a r V.40* Flood plain elevation if applicable AM it General comments .1 .1 3 z L'G,, t✓l fit re A 0,sxza ,OidE.r rr t dAC uE Sys. Ei, - 93. S Boring* ❑ Boring ® Pit Ground surface elev. 98.8 ft Depth to limiting factor //D in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistance Boundary Roots GPD& 2 irL Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 11 am $1102 .z o- 4 o r S - 1 J /.•r -S or.~ it JS e. s -ev 6 y-80 /a •t L Il s c s - 7 / 6 S 80 -J/o x m' -r_ 7 //e -~i MA o G r - G Boring ;gk ® Boring i ❑ Pit Ground surface elev. 9 9 1 ft. Depth to limiting factor :",,W in Soft Application Rate Horizon Depth Dominant Coles Redox Description Texture Structure nce Boundary Roots GPDNt 2 in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. / oYa s o 11-4,6 d Y't S - -7 3 6- ~oY't yy - •7 1. Co o -A 4 IY' r 7 sr 7 s 8~-/a sye - it , -7 I , (o ' Effluent #1= BOD > 30 < 220 mg& and -MS >30 < * Effluent #2 = BOD < 30 mg/L and TSS < W mg& CST Name 0. me Print) - - - CST Number Address Evaluation Conducted Telephone Number 63 ,0Ittf4Y ~<r. ~i0u Z4 isE 7a S-3o- 0~3 /S 83y-8L/a SBD-8330 (Rl 1/11) ~ a/s .yet E rp - eo. llo. NN sr. /~wr /.Z (4 C-1 ►ri ro ,?8~ 9 H ci ` (-d 4 rr+~ C 0 ~ H H .Vaa4S C4 N t p z M p o ~ y H O JIL x ~n~~(JAI ®..~~ctL X a/ao Q 2 Z I /41s~ • _ ~ LAA ter 1 ~ 1 ~ ~ pBaK ~ r 7 Q tel. ? 9/, 9 ~.iSE' j J aura 6ic. //NSPdc ri a GAP T'rrw.VsfO/tr/E~. ~ ~ r /8 x3d ~ ~ I qgg O/titiNac R6PLACdrrf~yr ~ L R /ZIre l t Aar sR I I t y-.cEFS p a 94.1 ~ E,OGFrorr F/Q'tD ~avft/EB ELEGrArL ~J f/EtD / yo o Joy Yor r fir Qc ,aoaao6 .SE/>rAG~ tGV.rc i„~ S.T = 9y.S- X4 1444E '014'Ece-4 A L t SPS dA3. Y3 ,tEr,Qq~,r S iyE r /t1o re': ~o~G ~dA~~r~e,~ Lo~/04c rEB 1-0 Go.JFis.•i So/c ~d'fGal/jio.✓s oa .Sec ffsr Y .~f'fnE of Z4 Y a f - /983, SEE -SioNi r.►.~ r Eit~ri r .S-8 9/1, /SSue~O 0 iZ a~ o 4 0 4 o C ~ H I v N 2 rn no o fd M ~ V1 X D C a0 C >I- N (0 d No 7 f0 W O U. C T (6 N 3 O no0) m - 0 O U CD 7 Q Q Q 3 co y I E o o r ~ ~ O N N LLJ a m o L M H Z ~v m I N_ C C9 O O O Z c V O 0 O N F- d 00 - (D O _ _ O N > N N 7 C_ lO N N O ~ O O. Q' L >c y y o • d w 3 0 O O a3 O O N Q Z co Z N w ~ y L q i CD O LO d N O. CL a +`r N ago 0 (n to a a > Q ° H f2 Fes- a Q Z 0 0 0 •N ~ Naaa I a ~ ~ I o (n 3 } v) U rn rn _ Cl) O %%ft-l N (0 O O O O E N N O M c ~ n N a~ o !i 0 'O dp Q (1) Q p ca 7 ai O LO c C N 3 Q O r.+ O Q O c O E N o M 0 (D H N N .9 C U a p a O r f6i M 00 -p ! Q N O N 'O N N N V O f0 ` m O C s O n ~ ~ M O p) y "O Z rOi. 'O r p N N 00 7 N C r Y O C N ,It D C)) • '1 ~i' Cl) M U) ~ (00 O Z y 2 H 2 w :E E d a ~ d6 a 0. _1 A V a 2 f 0 N U Parcel 034-1072-50-025 ' 10/10/2006 02:14 PM Alt. Parcel 32.29.15.486A PAGE 1 OF 1 Current X 034 -TOWN OF SPRINGFIELD ST. C Permit COUNTY, Y' WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # 02/20/2004 00 0 Tax Address: O = Current Owner, C = Current Co-Owner Owner(ID/ ALLEN R & JOAN K VOBEJDA O - VO , AL LEN R & JOAN K 2829 HWY 12 WILSON WI 54027 I Districts: SC = School SP = Special Property Address(es): * =Primary Type Dist # Description * 2829 HWY 12 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 67.673 Plat: 4706-CSM 18-4706 034-04 SEC 32 T29N R15W NE NW & PT SE NW & PT NW NE & PT SW NE CSM 18-4706 LOT 1 Block/Condo Bldg: LOT 1 (67.673 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-29N-15W NE NW Notes: Parcel History: Date Doc # Vol/Pa e 02/20/2004 754792 18/4706 Type 02/20/2004 754791 2513/417 CSM 02/10/2004 753914 2507/186 TD 07/23/1997 1092/004 EZ-I 2006 SUMMARY Bill mod Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/14/2006 Description Class Acres RESIDENTIAL Land Improve Total State Reason AGRICULTURAL G1 5.000 31,450 155,900 187,350 NO AGRICULTURAL FOREST G5M 1 271.000.670 .0000 3,750 0 3,750 NO ENTERED BEFORE'05 CLOSE W8 1.00 900 0 900 NO 34.000 30,600 0 30,600 NO Totals for 2006: General Property 33.670 36,100 155,900 192,000 Woodland 34.000 30,600 30,600 Totals for 2005: General Property 33.670 36,600 155,900 192,500 Woodland 34.000 30,600 30,600 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Cha 0 00 Delinquent Charges 0.00 Parcel 034-1072-50-000 10/10/2006 02:13 PM PAGE 1 OF 1 Alt. Parcel 32.29.15.486 034 - TOWN OF SPRINGFIELD Current , X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/20/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RETIRED VOBEJDA O - VOBEJDA, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 32 T29N R15W 40A NE NW NKA CSM Block/Condo Bldg: 18-4706 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1092/004 QC 07/23/1997 1073/10 WD 07/23/1997 679/473 LC 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/28/2005 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- ST C- 104 • AS BUILT SANITARY SYSTEM REPORT OWNER &/It P7 V6 = * d TOWNSHIP , d SEC. 3 T Z~ N-R_W ADDRESS et 2 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f i f r © Key INDICATE NORTH ARROW I PR eg t L, I BENCHMARK: Describe the vertical reference point used 1~1e p ~ qVer Elevation of vertical reference point: O 1 8 Proposed slope at site: 20 7e SEPTIC TANK: Manufacturer: ~n/t►st~~ Liquid Capacity: 1(200 - Number of r-ngs used: Tank manhole cover elevation: Tank'[nlet Llevation: Tank Outlet Elevation: Number of f( et from nearest Road: Front,O Side10 Rear, O feet From nearest property line Front,O Side,0 Rear, l feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: Length: 3 Number of Lines: 3 Area Built:C Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear, eFt.~ Number of feet from well: ~p A/C 91 Number of feet from building: ~p ok,r (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of 'the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Num§,er of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: 11 Inspector: Dated: 50 Plumber on job: License Number: gG7 7 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O, BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 : LCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: [INSPECTION DATE: 11 A/ 1 - 4 00y BENCH MARK (Permanent reference poi DESC BE IF DIFFERENPLANEF. PT. ELEV.: CST REF. PT. ELEV.Name o Plr: MP/MPRSW No.County: nitary Permit Number: r Of .5"/I'~ SEPTIC ANK/HOLDING TAN : MANUFACTURER: A LIQUID CAPACITY: TANK IN//LET E TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER . / / / - - l fl PR V ED: PROVIDED .YD YES ❑NO ❑YES ❑NO BEDDING: VENT D A . VENT M TL. HIGH WATER NUMBE OF ROAD: PROPERT WELL BUILDI VENT TO FRESH ALARM FEET FROM LINE A> AIR INLET: ❑YES O~ ❑YES ❑NO NEAREST DOSING C VA BER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP ON MANUFACTURE WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS O R AL NUMBER OF PROPERTY WELL: BUILDING: VENTTOFRESH (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 JLFNCTH JDAND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: NIDTH LENGTH. NDISTR. PIPE SPACING. COVER JINSIDE DIA #PITS. LIQUID BED/TRENCH C TRENCHES MA T-IFFM L: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH JDISTR. PIPE DISTR. PIPE DISTR. PIPE M TERIAL. Nb. R. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIP S. ABOVE COVE ELEV. INLET ELEV. END. PIPE LINE AIR I .6V .T FEET FRAM 4jL 9G • 7~ 7Z 1 NEAREST I2 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: NIDTH: LENGTH: NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.. ELEV.: CIA.. ELEV.. PIPES. OI A.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES El [:]YES ❑NO NEAREST ,10 Mtcw z ~.SS Q, yZ- r Pik c_c rv C_tj Sketch System on aln in co ty file for audit. Reverse Side. -11 TURF.t TITLE. DILHR SBD 6710 (R. 01/82) 1=7 wisconsln APPLICATION FOR SANITARY PERMIT COUNTY (PLB 67) UNIFORM SANITARY PERMIT InDUSTRV. LRBOR 6 HumRn RELRTIOns 89 i ;U -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS LL Z-c o 1, 'r ' of f1Gc~w i~ i X PROPERTY LOCATION 1 /4 ii/ 1 /4, S Sot , Td9, N, R / (or OWN OFF: 1~ I /•~L~l LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAM , LAKE O LANDMARK STATE PLAN I.D. NUMBER p 4~~ "s w• )1q TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: X 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 ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity d~ O Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: s -E X I1 K X -re IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 0 6 (d N Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: STS h Ek. L jq .S IS (,M) AV0 7 Plumber's ddress: OF N, Name of Designer: ,taik r woo~i•,GGx G~/i ~yo ST : Ars, COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / P 0 rp~/ ❑ Owner Given Initial c IS 7 Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS 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 perm it; 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 properly 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. 3 r~ V,~ Q /Va w JdL i t V,c T s,r t v r~ to a ' 34 11 Q~ LIO sys7-r FZ-k ,q o~ 4.F ' arh S'a~ jL. r~~c,~ Pn~pr tir No Sc pt ®Q.m ToPar `Ixq At !da' At )s ~c 14 at,ES - GE v,gTiG ti 7p prL K _ a h s; T E ulgs7r PLjr-tr P 17 s'l94~ 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/contractpr,("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. - - - - - - - - - - - - - - - - - - - - - - < - - - - - - - , - - - - - ` - - - - - - - - 0 Q `fit Owner of Property ~ V l1Z 0 Location of Property &_W 34, Section _ :32 T _HN - R ),'~ZW Township Mailing Address Subdivision Name Lot Number w ` \ Previous Owner of Property ~JC 1) 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 x No Volume and Page Number All? 3 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 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. PROPERTV OWNER CERTIFICATION I (We) ce&ti6y that att statementb on thiA jonm ane true to the but of my (oun) knowtedge; that 1 (we) am (ore) the owner (.d) o j the pnopeAty deb cA bed in th,i.b injonmation Jonm, by viAtue of a wa4Aanty deed neconded in the 0jjice ob the County Regi--ten of Deeds a6 Document No. 39 b 1 ; and that 1 (we) puzentt.y own the.pnoposed .6 to bon the sewage posatsystem (on I (we) have obtained an easement, to nun with the above debcA ibed pnopenty, Jon the constnuct%on of said system, and the same ha,b been duty neconded in the 0jjice o6 the County Regizten o6 Deeds, ab Document No. - i• SIGNATURE OF 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT No. STATE BAR OF WISCONSIN FORM 11-1888 THIS 1PAC6 RES[RVFD FOR RECORDING DATA LAND CONTRACT IRd 390201 ALidual and L TRANSACTIONS t~ ~ (TO BE USED FOR ALL TRANSACTiON9 WHERE OVER $25,000 IS FINANCED AND IN OTHER NON-CONSUMER ACT TRANSACTiO f VO! 6 ~7 ~a E `l REGISTM5 OFFICE C n raet, by and between .-.Norman L. -_Nelson _and _ ST. CROfX W., w; ~rene L. Nelson husband and wife Rec d. for Record this 28th -----------•---------------------------------A--- llen ("Vendor", day Of Dec - 93 da and Joan A. D. 19 _ _ whether one or more) and R t ob..e .A............................ : Vr!be1daa bl' b nd aild---if ;--.as-•-ao.in-t at 8:45 A , _ M. tenants ("Purchaser", whether one or more). James O'Connell Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the 11001w of DeWs rents, profits, fixtures and other appurtenant interests (all called the "Property"), in---------- St---- Croix County, State of Wisconsin: RETURN TO The Northeast Quarter (NE 1/4) of the Northwest Quarter (NW 1/4) of Section 32, - - Township Twenty-nine (29) North, Range Fifteen (15) West. Tax Parcel No. i i This .._iS not homestead property. (is) (is not) Purchaser a *rees to purchase the Property and to pay to Vendor at their residence (See below) 21 00 OQ in the following manner: (a) $_5500.-00.............................. x - at the execution of this Contract; and (b) the balance of $-16,000-._OQ................ together with interest from date hereof on the balance outstanding from time to time at the rate of.- 9% . . P9 cent per annum until paid in full, as follows: Monthly payments in the amount of 202A to be paid directly to FMHA commencing thirty days from the date hereof and on the same day of each month thereafter. k In the event the Seller is required to pay FMHA, and is required i' to borrow funds in which to make said payment, then on the 5th j anniversary date of this contract the rate of interest shall be adjusted to be 3% below the rate of interest that the Seller is required to pay on said date, but said rate shall not ~e less * I, M:Sf Provided however, the enytire outstanding balance shall b paid in~ fu 1 on or before X en years 0 *9--_--_ ( the maturity date). i Cta e hereof . Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount i in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). I Purchaser, unless eycused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of ! i taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not beer interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time)g;kK XXXXXX-XXXXX-XAJtXXX)WSJC t49C9CJ41fi?CJ~9U44C~~3fRfiJF~JEIXlAe1Q~lCX3~1X°~I~iCR~X9lIReJt°JL'7t°~1JR9f~ I In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated (I as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first, specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned-;premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination, except:. m0r,t a es to FmHA, recorded in 457-558, 481-263, and 548-8~. than 9% nor more than 12% on this contract. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract; it shall he retained byr'Vendor until the frill purchase price is paid. Purchaser shall be entitle to take possession of the Property on..-._d................ xA !I •Croar Out One. pt~'~?"?°"'P! STA -F.BAR OF WISCONSIN 11 - 1982 Stock NO. h..;..,........,.. VOL -7 Purchaser promim to #i„y wl,en dMe al t"ep and ~a~''nc,~,r•n w Irvi d nn 1-14111 f'a'ogrrty or YftBfi V1010051Ta inlertaa~ in it and to deliver to Vendor on demand receipts ahuwing such pays Purchaser shall keep the improvements on the Property insured ainst loss or damage occaaio4, b~"Rye„ ex- " 14 tended coverage perils and such other hazards as Vendor may require, without co-insurar:ee, through In:tliters approved by Vendor, in the sum of vacant and , but Vendor shall not require coverage in an amognt more than the balance owed under this Contracturchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance procoeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: AOI?e • Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 61) days follow ing the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of .h0..... days following written notice thereof by Vendor (delivered personally or mailed by certified snail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (inwhicheventall amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equtiable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforceany remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be field and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding „ balance payable under this Contract shall become immediatly due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights In the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) "Vendor agrees not to withhold such consent unreasonably. Dated this -23---- day of --WQ 19- 83... R,.--- •.v- - • .(SEAL) .Gr !a??!' :'..........(SEAL) Allen R. Vobejda orman L. Ne son - .....(SEAL) ----LL~ / ^-r✓.(SEAL) Joan H._VobeJ4 Arlene L. Nelson AUTHBNTICATION ACHNOWLBDOMENT Signature(s) STATE OF WISCONSIN St,` Croix as. ................................County. authenticated this ........day of 19...... Personally came before me this ?3..... day of AMPM 19.83... the above named Norman_ L. Nelson and Arlene..L.... Nelson. and Allen 8e Vobe jda and TITLE: MEMBER STATE BAR OF WISCONSIN : Joan S. Vobeida (If not . authorized by $ 706.06, Wis. State.) to me known-to-U rson who executed the foregoing instru nt an w e. THIS INSTRUMENT WAS DRAFTED BY ROBERT G . WALTER.. • LeRoy Storley Wis. Attorney i Law Notary Public gtl Croiz _ .alur►ty, (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) •Names of persons signing in any capacity should be typed or printed date : .5............---..........-........, 1984....) below their signatures. H r-~ STC - 105 r " SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County d OWNER/BUYER ROU'T'E/BOX NUMBER ~C)`i' 5C) IR~ Fire Number _ - G it, 5.4 0-? _ C I T Y/ STATE_ . -~'Q W\ 0..----z PROPER'T'Y LOCATION: )'E NWJ4, Section_$ 'r_ZgL_N, R 16'-W, Town of 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 5~tic 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 ma be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix'County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. _ The property owner agrees to submit to St. Croix County Zoning a certification form, signed. by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- rv 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. 0 SIGNED DATE St. Croix County Zoning Office P.O. Box 9,3 Hammond, W. 54015 715-796-2239 or 715-425-8363 Sign., date and return to above address. z N m > 0 o E d E O C dv v; . - o E o Env 00er r rn0 Coo e ss~ 00 r-cm 0 0►- ~ EmLma~. c73~ 0 3 C a 0.0 ma 0 r- -0 C co W o 3 oa v E' tv vI 0 CL.• %.C w0C°1>= o°~ -..om o o Q m-:a4)r ~ 0 ` ~ m3 d v "cow N c c 0 a~= m~ cd o~. .C0 nl cc W c0CM U) to 0-0 4) 0 0 cc 3 c F- N cv t N 035. rn~c aye Q y cv +r - o N 0 y~ 0 U) D Z cc CL c C G" O t U d tti 0 tv CD C 3:2-02 o s s cc O j 0 cv - L 0 O N O O~ wad NQ C co 0 mac aaCL o~o 0 E N ev to r L ev C C3c.0~o ~Z._ 0-0 0 0 0w. E750E 3 :3 C C Z C C ~O cc O O E 904)00 6. 0 tm C) m C w 4) = o C _ V to 0 L- 2 CL m t5 mjbl Icvcc0xZ 00.02 a O C m .wi 0 3 0 4) = L- O 0 0 CL 0 :s 0. ~ z w >,C O O°'0 E 0 .0 " m Cd ttv O O _ is CL E L: C O 0 0 O W 0 O '0 3 ~ O C O C L` N .m. m O Eci n = to c = ~ ~ O DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 769 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (1-163.090) & Chapter 145.045) SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: LOCATION: NA 1/4 VA 3A /T N/R/ (o COUNTY: OWNER'S /BUYER'S NAME: M ILIN ADDRESS: -5-rXxvix /71,4x, vob 'do T ALp(w'H w''~ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DES RIP- R F R NS: PERCOLATION rTESTS: 19FIesidence New ❑Replace I - 8' 3 1 - r 3 3 _j RATING: S- Site suitable for system U- Site unsuitable for system MOUND: IND-PRESSUR ZSTI❑U. ZS EA IN-GROI OS DU E:SaEM-1EILLHOQj NTAI\ J R / M XN i tYSTEM~G.(optional) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: j Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS PA 7a. S O I 1 Pa 8 BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- p6'' y. sly 02 ''81, st IY"K. s y"2. t`s h'6"R. S. B- 6 9y. 8' NoN r& 1_ sL ~a"R. S R o'' Fs s B-3 6'' "001-sC xo'~Ls. x0'k.rs sA", Its. B- 4'6'' y.S Alo Na '2" L. s rx- s zy'R.fs y6"rz S B- S q6'' ~t S.3 6N - y''h st ~o"' .s .20 'rn• >:s B- AI PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER-90101 i AFTERSWELLING INTERVAL-MIN. PERIOD-1 PERI D2 PFHIUUJ PEWINCH P P- • ; P P-. P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION R7. 9 j i i_.. } _ - 1 _ 3 i i ~ 3 c i - - JN ; I 1 _L_1 I l..__ l__ .__J _ i 1_ _ ._.1.__. i l ► ? J.- I, the undersigned, hereby certify that the soil tests reported on this form were made I?V me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: .5 ti h L /a -a -83 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): a v a Gic / O S= 9~= o CST SIGNATURE: P s• DISTRIBUTION: Original anti nne ropy to Local Authority, Propei ty Owner and Soil Tester. DILHR-SED-6395 (R. 02/82) - OVER v U.S. Hw S' c~ 44 f4 F- Y 4 lac 2 s Gf.S Hwy I SF~.. 3 ~ / Sp ti; ~ y ~►k td /'Ta 3' s~~CC bx- lz~,~ovaa i~ w, rap o F T~sr.Eow gRfA, l< qoi iI ~sy 1 Baxx Helre- Pi I o PieR c-__ I foL i or QjeNO ti mg&-K-- I 8 31. ~y 601 aO !o P3° I SL°,O,1; ap _ e P~ 1 8' a ~r OAA i 8. n1. _ - ~li4T4 -PFhCE PRo~'rnTy Top of yXy„ PosT /00,