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030-1079-20-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 5638'16 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Sacher, Anthony & Mary I St. Joseph, Town of 030-1079-20-100 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: /v] G is 28.30.19.284A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark AM W 114450 / 1e 7 /jam Dosing 1 7,76 AI0 4 Ge'J • S`~ Apra O~b N w\ 'Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG/ Vent to Air Intake ROAD Dt Inlet S7~ 5a' 25 Septic ►f Dt Bottom Dosing Header/Mangy 9.56 7 ~ Aeration Dist. Pipe ~Q • ,Q % • 5 Holding Bot. System A b 1 PUMP/SIPHON INFORMATION Final Grade ~ ! • Manufacturer Demand St Cover ZoGi LA,... GPp'4 Model Number Zy TDH 11-iftFriction Los ~ System He VIA D /z ;t r iV I Forcemain Lengt~D Dia. Z ~I Dist. to Well x SOIL ABSORPTION YSTEM U BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -75 3 7TE0%.C. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur Z INFORMATION CHAMBER OR Type A Je~(O UNIT Model Number: r :t] DISTRIBUTION SYSTEM 7.5 7.$ 7. Z•$ Header/Manifold I Distribution x Hole Size x Hole Spacing ent to Air Intake ,I. Pipe(s) t T ~re Length Dia Spacing Length Dia 1411 I i A SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Depth TSeeded/Sodded xx ched Bedrrrench Center :3 / - Bedrrrench Edges Topsoil \ es No FE] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #\1: - / Z-/.-Nl spection #2: Location: 1348 60th Street Somerset, WI 54025 (NE 1/4 SE 1/4 28 T30N R19W) NA Lot 1 Parcel No: 28.30.19.284A 1.) Alt BM Description Z-DelU-- - 53 ` G t 2.) Bldg sewer length = ~j~ fj 7'^• Ge~~-I - amount of cover = ! a Plan revision Required? ❑ Yes 0 No _7 F] Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) II PLOT PLAN N Tony S Mary Sacher Legal Description: NE 1/4, SW1/4, S28,T30N,R19W P.I.D: 030-1079-20-100 Subdivision Name: CSM 8, 2142 Lot 1 Township: ST> JOSEPH Parcel Size: 5 Acres SCALE: I* 40' County: ST. CROIX System Elevation: T1=95.75' 4 inch Sch 40 -ASTM D2665 Slope: 5% T2=95.75' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 100.00' To of 2" PVC pipe T3=95.75' BM2 Elevation: 104.51' To of vent cover on dose tank. ■ Backhoe Pits: 3MI ~C~RTH ~RbOc~i~ LINT= 0 T Tfz T~ 3 ~ ey N \ Y ku c r A i BIM VA L& 8017- WOOL) -7.5-0 0. C i>L 5iPiii Eiµ ® Ffy!~4 / coo 3• ~ -100 T_ W ELL 3 g r~ec©iM 1) Qi'V tw/a i 7ZG`- SnonrN P IL County + / F ` Safety and Buildings Division 57, C/2~f X a t ; QQ M ~ 221 W. Washington Ave., P.96 Box 7162 Sanitary Permit Number (to be filled in by Co.) P$~ Madison, WI 53707 9Q 011 r`o~~ cJIIA t ~t 1 , : Sanit Xsubmission A lication 6 State Transaction N ber In accordance with SPS 383.21(2), Wis C of this form to the appropl?i 9 vem entunit / V is required prior to obtaining a sanitary it Note: Application forms for state-owned POV *?..1bmitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be usea,1$14"dary n ./~J!Q purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. s A ~Jl 1. Application Information - Please Print All Information (J Property Owner's Name Parcel # AR 1514 1 e 077 ZO -100 Property Owner's Mailing Address r Property Location 3 ©rH / keG 7- Govt. Lot 6 20A City, State Zip Code Phone Number V J , ~j Section pE2 $ FT V V 5S O Iq(circle one It. Type of Building (check all that a Lot # T N; R E or~J C&I or 2 Family Dwelling - Num Bedrooms 13 ` Subdivision Name OTNO' Block / ❑ Public/Commercial - Describe Use El city of 11 State Owned - Describe Use CSM Number El Village of Y a PZ'C XTowof .ST ©5F'9 3 III. Type of Permit: (Check only o box on line A. Complete line B if a plicable) A. ❑ New System 19 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) [I Permit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber Before Expiration Owner / Z, 6,17-bbW IV. Type of POWTS S stem/Com nent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank r Dispersal Component (explain) ❑ Pretreatment Device (explain) 72 4,* ek- a V. Dis rsaUTreat ent Area Information: Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed sf) System Elevation 0. q 117 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o d o New Tanks Existing Tanks e Septic or Holding Tank 00 1000 ! 16 W t 5 T C Dosing Chamber 75-0 17 so / t pw f ST P_C c 46 T ')C VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plm MP/MPRS Number Business Phone Number ©NN 5cHwt (rF ,Z~376 0 / 5 (e -7 L9 9YS Plumber's Address (Street, City, State, Zip Code) ~O -9 Alm 50141 Q5c7 >T sy®7s VIII oun epartinent Use Only /7 31 Approved Permit Fee Date sued Issuing t Signatur iven Reason for Denial OA rA.1L IX. Condit easons for Disapproval L 1 _ k, offluW* MW WA 3) dispersal cell must all efvlsea k tIaiataiAa~ L. p`v e,(~ . OS;W M"ement plan pmvWW 111 plufOb ~,~FICk rpt~emet~ mtl$11~t:R~t U ~ PK tort~ll~liON~ Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x I1 inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Sacher 3 Bedroom Septic System Owners Name: Tony & Mary Sacher Owner's Address 1348 60th Street Somerset, WI 54025 Legal Description: NE1/4, SW1/4, S28, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: CSM 8 2142 Lot Number: 1 Block Number Parcel I.D. Number 030-1079-20-100 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Effluent Filter Information Page 5 & 6 Management and contingency plan Page 7 Septic Tank Maintenance Agreement Page 8 Dose Tank Cross Section Page 9 Bull Run Valve Pagel0 EZ Flow Information Page 11 Warranty Deed Page 12 CSM Page 13-16 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/25/2013 Phone Number: 715-760-0486 Signature: ~t In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) 1 PLOT PLAN N Tony & Mary Sacher Legal Description: NE 1/4, SW1/4 S28 T30N R19W P.I.D: 030-1079-20-100 Subdivision Name: CSM 8 2142 Lot 1 Township: ST> JOSEPH Parcel Size: 5 Acres SCALE: 1"s County: ST. CROIX 4W System Elevation: T1=95.75' 4 inch Sch 40 -ASTM D2665 Slope: 5% T2=95.75' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 100.00' To of 2" PVC pipe T3=95.75' A BM2 Elevation: 104.51' ITop of vent cover on dose tank. ■ Backhoe Pits: BM I ►~o,TH pPo06Q_'rY LiN►" gt~ L T 9 63 J w "r \ 2 1= i \ \ X,14 x Wa QI VAIv ~YHZ tx/5rfA)b\ L Woods 7~ o c vt S 1 r C/ ~ X/,r. r 1 51,-06(11 ' p1 j000 5.T 4 a V ' W ELL ® 3 g~neoo.M ~ t-Inus~ 0 a~ DRIVIrWAY ~Z~` SourI4 P IL SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Tony & Mary Sacher 3 No. of Cells 7.5 Per Cell 3 ft Cell Width 22.5 Total No of 1203H 75 ft Cell Length 375 sq ft EISA Per Cell 3 ft Cell Spacing 1125 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H i Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent Soil Backfill 45 in ' ` ■ ■ Geotextile Fabric ■ ■ 95.8 ft Infiltrative Surface 12 in I 91.6 ft Limiting Factor 7 >36 in Slotted and Anchored Vent/ Observation Pipe with Cap ■■■■■■■■■■■■■■■■■■.■■■~~~~■■■■■■■■s■■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Plumber/Designer Signature: License MPRS 223760 Date: 25-Jun-13 1 S7 WE I/ AIL-: PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City, MI 49712 Fax 231-582-7324 Email salesimgag-simtech.coin Web www.gag-simtech.com INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be easily serviced. **Always use caution when starting threads to avoid cross threading". Plumb force main into the 2" sch 80 PVC union. 'We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface". For best performance, if a check valve is installed it should only be after the outlet of the filter. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Nobs that in cold condMons Me Mar cap may be df mx/t to rename Kee to MW be arse orpmrwarm waterovw the cap befe removing! Once Bte tiler is onft ed in the tw* # a al">I and nwooving the cap wN rat be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Tony & Mary Sacher Tank Manufacturer: Midwest Precast F NA Permit # 1": Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Midwest Precast r NA Number of Bedrooms: 3 r NA E~ Septic E Dose Holding Volume: 750 al Number of Public Facility Units: r NA Vertical Distance Tank Bottom (s) to Service Pad:_12 ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivce Pad: ft Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.4 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Sim/Tech F NA Fats, Oils & Grease (FOG) :530 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: F NA Total Suspended Solids (TSS) !9150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 5530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) !5220mg/L r NA r mechanical Aeration r Peat Fitter F NA Total Suspended Solids (TSS) :5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Fitter f- Other. Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L r NA r In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104afu/100m1 r At-Grade r mound Maximum Effluent Particle Size: %s in dia. r N I Drip-Line r other. Other: Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated MKS) Inspect condition of tank(s) At least once every: 3 r year(s) (Maximum 3 ears r NA r -"s) Inspect dispersal cell(s) At least once eve : 3 r year(s) Maximum 3 ears r NA r month(s) Clean effluent filter At least once eve : 1.5 r yes) r NA r- M-40) Inspect p pump, pump controls & alarm At least once every: 1.5 r year(s) Rp s Flush laterals and pressure test At least once eve : r- year(s) r NA moon(s) Other: At least once eve : r year(s) r NA Other: 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; 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, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name: St Croix County Zoning Phone: Phone: 715-386.4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2105) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Tony & Mary Sacher Mailing Address 1348 60th Street, Somerset, WI 54025 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 030-1079-20-100 LEGAL DESCRIPTION Property Location N E 1/4, SW 1/4 , Sec. 28 , T 30 N R 19 W. Town of St. Joseph Subdivision Plat: NA , Lot # 1 Certified Survey Map # , Volume 8 'Page # 2142 Warranty Deed # S10 ~ J I (before 2007)Volume /off Page # Spec house 13yesEho Lot lines identifiable Dyes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty dee recorded in Register of Deeds Office. Numb of bedrooms 3 06/25/13 S NA RE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) DOSE TANK DETAIL Owner's Name: Tony & Mary Sacher ft Inlet Elevation Weatherproof Manhole with Locking Device - Junction and Warning Label i • Quick disconnect fitting • ■ ■ ■ . ■ ■ ■ ■ • n I 1--_-'I-Alternate forcemain outlet co _ SimlTech Filter re [(d) Dimensions Inches Gallons -------------a alarm on - sepab 2 pump on dose Voc d Total off . _p 92.18 Intake Elevation Tank Manufacturer Midwest Precast Pump Manufacturer Existing (26 Q a 3 Tank Model 750 Pump Model Existing 16 Tank Capacity 750 gal Alarm Manufacturer Existing Tank Volume gal / in Alarm Model Existing Filter Manufacturer Sim/tech Filter Model STF-100 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow (DWF) 450 gal / day Min Network Supply na ft Number of Doses 5 /day Passive Vertical Lift 3 ft - (Header/D. Box elev. - Pump intake eta.) Max. Dose Volume 90 gal Friction Loss ft Factor)/1001+ Filt er Friction Lossoss 16 Drain Back 7 gal Total Dynamic Head 3 . / ft Design Dose Volume 97 gal Min Discharge Rate 20 gpm NOTE: Pump and alarm are to be installed on separate circuits. Z INTERNAL DIMENSIONS OF TANK l Diameter in Liquid Depth in Plumber/Designer Signature: License 223760 Date: 25-Jun RGOULDS PUMPS Submersible Effluent Pump MODEL 388 WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion-resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. • Homes to guard against component • Built-in overload with damage on accidental reverse automatic reset. ■ Bearings: Upper and • Farms rotation. lower heavy duty ball bearing • Trailer courts STTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant power • Schools stainless steel. cords, ■ Power Cable: Severe duty • Hospitals ■ Capable of running dry •'/3 and 1/2 HP models have rated, oil and water resistant. • Industry without damage to NEMA three prong Epoxy seal o motor end • Effluent systems components. grounding plugs. provides secondary moisture • 3/4 HP and larger units have barrier in case of outer jacket ■ Designed for continuous bare lead cord ends. damage and to prevent oil SPECIFICATIONS operation when fully Three phase (60 Hz): wicking. Standard cord is 20'. Pump submerged. Class 10 overload : protection Optional lengths are available. • Solids handling capabilities: MOTORS must be provided in ■ 0-ring: Assures positive 3/4" maximum. separately ordered starter sealing against contaminants • Discharge size: 2" NPT. ■ Fully submerged in high- unit. and oil leakage. • Capacities: up to 140 GPM. grade turbine oil for lubrication • STOW power cords all have • Total heads: up to 128 feet and efficient heat transfer. bare lead cord ends. AGENCY LISTINGS UL 778 T~to10 St and TDH. ■ Class B insulation on ■ Designed for Continuous 2 ndards • Temperature: 1/3-11/2 HP models. Operation: By Canadian Standards ■ Class F insulation on 2 HP Pump ratings are By adian 104°F (40°C) continuous within the motor manufacturer's ick-5 Association 140°F (60°C) intermittent. models. recommended working limits, is IS • See order numbers on Goulds Pumps is ISO s 9001 oot Registered. reverse side for specific HP, METERS FEET voltage, phase and RPM'S 40 130 Y. , available. 15H 5 ZEES: WE 120, SPM 1/4" SOLIDS 35 LI ER~Qg FEATURES 110 W H _ i s. --L~SGPM 30 100 , ■ Impeller: Cast iron, semi I s Fr 771 open, non-clog with pump-out W zs { { . vanes for mechanical seal 80 70 protection. Balanced for a 20 protection---- - smooth operation. Silicon ; 60 - bronze impeller available as F 1 s . 50}'"f.o H an option. o 40 i p ■ Casing: Cast iron volute type 10- 30 wEOlvl for maximum efficiency. i l.. 2" NPT discharge. 5 20 wE03 f. ■ Mechanical Seal: SILICON 10 - CARBIDE VS. SILICON o o:-_ ; ^ CARBIDE sealing faces. 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM Stainless steel metal parts, o sue- 1I0 1I5 20 - ' 25 30 35 m3/hr BUNA-N elastorners. CAPACITY Goulds Pumps ® 2003 Goulds Pumps Effective July, 2003 www.goulds.com `I~; ITT Industries American Manufacturing Company Bull Run Valve rage i or HomS° About Site Map Order Info Training Videos Contact Data Center Drip Systems watermastewater Controls Products Downloads Design Guidance . THE LL RUN TM VALVE 'WATER-TIGHT ACCESS CAP RI 9E R CAP 01 ADAPTEP. I " RISER TIJBE a VALVE DIRECTION 144NDLE The Bull Run ValveTm is designed to split flows to septic 4„ OI JT PORT fields or systems. In addition to the advantages of longer life and easier installation it is the most public 4° OUT PORT health safe alternating device available for wastewater k, disposal applications. The use has absolutely no contact 1111 with wastewater due to the valve's leak-proof and s T external operating characteristics. The change over from , C IN PORT one drainage field to another can be accomplished in less than a minute by simply turning the valve without The Bull Run Valve is available in 4" sch 40 pvc digging or contact with wastewater. and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated Ftrid' Fasid Fieid Fisid periodically to direct effluent to one or the other No,1 No, 2 No 1 No, 2 of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. ~Jalue ~ Ts1ue 1 ~ Positioned Positioned BULL RUN VALVE on No 1 on t-lo. 2 Complete Valve Kit dwin g during Odd Year-, Septic Septic Even Years Contains Tank Tank 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVCIRISER - 4" BRVKEY28 BULL RUN VALVE KEY 28" ADJUSTABLE TO 28" BRVKEY36 BULL RUN VALVE KEY 36" HIGH POLY RISER http://www.americanonsite.com/american/catalog/brv.html 6/26/2013 1 E417,wr by INFILTRATOR rte. ~ Y * x - i5 I, ' 3 r _C ulc. _.lffr a ) ~':)vJ r9 [,eC • ? 6(.e rc~rr rt + E dNF4LTPATOR For technical assistance, installation instructions or customer service, call Infiltrator Systems at 800.689.7759. J EZf1ww by INFILTRATOR Single Pipe Systems Horizontal Systems 2 _i... ~G: r ~ Vertical Systems Triangular Systems E Y INFILTRATOR 800.689,7153 '-'vww.ezflowip.com wry vv inf=ltwatorsystems.com For technical assistance, installation instructions or custorner service, call Infiltrator Systems at 800.689.7759. n 1 WARRANTY HEED-By Corporation it DOCUMENT NO. I STATE OF WISC-ONSIN-FORNI 2 ~j it r- ! 'r"IS SPACE RESERVED FOR RECORDING DATA i( 51L0439 -;,It 1055FAu 14 is REGISTER'S OFFICE pp THIS INDENTURE. Made this_...... 1_4t:.`3...... ..day of A_.. .uqu_.s_t ~ CROW Ca, I I! I A. D.. 19-52.. between ..........ER.I.GK.S 11211.1...._lisp.. 4 Reed it?T Record I a Corporation DEC 1 1993 duly organiz:rcl and existing under and by virru- of the h1WS of the Stare of Wisconsin, located 11:55 A. at ..........°_..GO.Lfax.._...--•-°--............Wisconsin, party of the first part an at M iJ Anthony.-Sather.-.and Mary_•S_._•••Sacher•,.--,husY~and_•_...... ........and w................................................. rRc~stsr of Deeds r part,j-eS.of the second part, RETURN TO 0 W f it n e s o e t h, That the said party of the first part, for and in consideration of the sum of.-.._.Onie.._Dol.far.._and.,,other.... yaluable...consider- anon . .....to it paid by the said part1.e,5._of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give. grant, bargain, sell, remise, release, alien, convey and confirm unto the said part j:.t'...-..of the second padfy_hAlXcirs and assigns forever, the following described real estate situated in the County of...Str•••_ Cr01X ................and State of Wisconsin, to-wit: i Lot 1, Volume S of St. Croix County Certified Survey Maps, Page 2142, Document Number 450710. Being a part of the NE1 of the SE'-h of Section 28, T30N, R19W. II I 131 9 II F- EB (IF NE-CESSARY. CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate II 4 right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy I4 ii of, in and to the above bargained premises, and their hereditaments and appurtenances. l I To Have and To Bold the said premises as above described with the hereditaments and appurtenances, unto the said part.i-eZ.of the l second part, and to...thei-M.heirs and assign..n.-- FOREVER. And the said BRI..K,S.K.I.Ta...... I.NTC..............................................._...... I Part), of the first part, for itclf and its suc•ccvsora, does covenant, grant, bargain and agree to and with the said part.]..gi.of the second part th§tir ...................heirs and assigns, that at the time of the enzealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the I same are free and clear from all incumbrances whatever I and that the above bargained premises in the quiet and peaceable possession of the said part..) a.9.of the second Fard~h-_iXeils and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. i, . In Witness Whereof, the said .....-:ZRI.Cr.K._m,1.mi. s....LN party of the first part. has caused these presents to be signed Ly......~~~n~ 5... N EX 7.G}SSQA its President, and II countersigned Uy... .[lr~. •.5 .:...R~.];4J.YL...Sm.1.th its Secretary, at. ........H~4:5g.4>n . _ , Wisconsin, and its corporate seal to be hereunto affixed, thi,......7.4:~.h.....day of.... Au-gtl•~.t.--.._..... . - . A. U., 1992.._ SIGNED AND SEALED IN PRESENCE OF CKSMITH INC . c 11 t_o,pu,utc - Denis....I^1...._.ktr_~S..S2.I? li NTE [GN ii Aeci ary 1 ~ ff~~ .k2a.~k1_ax.d ...Rez.g1~...Sma.tkl 1 nx. STATE OF WF9t°t7N81N, 7 d li ...._Washington ..............................county. ss. I Personally came before me, t!tis_A:A. -;=.dayoE..Au9L1St........ A. D., 19g .Denis-is...W.....Er cKson-....._...._ I ['resident, and....-Ri .c1h.... 0..jn t2?................ Secretary of the above it ~I named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to Uc such.............. President II and ecretary of said Corporation, anti acknowledge,] that they executed the foregoing instrument as such officers as the . -deed of said Corporation, [b' - ROBERT N NOTARY PURL NIINNESO 4 INASHING P~ my commission pires/7N i ~~,Wis. This instrument drafted Notary Public-._..k-./ " " ' County Dennis W. Erickson My Commission (Expires)('TJy) y-18-94........ - (Sectlon 54.51 (1) of the wlsrnnein Stat." p-ldea that an Instruments to he retordad shall have ptalnly printed or typewritten thereon the ~I names of the prantora, arantaee. witaeasee and notary) WARRANTV DECD-STATE OF WISCONSIN. FORM NO. 2 450'710 1 FILED y ° AUG181989a► Bearings are referenced to the cast n JAMES O'CONNELL line of the SEJ of Section 28, assumed Regi L rar s 2 to bear S0012012011W. 9 S rt 0 ~ H Unplatted Lands W t+1 (A r y N00020'20"E 300.00' ao n r~i ~t m H- w o X o ° n O O ro ~ n ~ rt rr ~ P N a cJ+ _N a 1'G'. ` o O V ~I N O V A m V 2-1 M 2.2 ~ V d O d 1"1~ o n x n o H• ~r En Zr «e1Oi~ a c u~i ~ c A CD c ? O I T 'TI = O z rt rtm NW ~o a H. .r' O C) z r 0 ° r oo ~ n a, Co cD rr7 w N t~rJ to cocoa 0 s ~ 0 v p o, Qn 0 m r+ L 3 1 r p - V1 -Y, 1 rt 1"11 t= e=e• N A ~ 1 7 rt I d (1) C N O I N ~ v' N m cn = is ~ rt iC -j :C rt, °o rt rn Nay.- = en a m In 2. I--'- M s c - O : o s ~ ~ 3 z N eAr cn n Co r+rlb. eQOi~g N 1-3 Z4~~ V - m O cn f S R i en m 0 w 0 0 0~ S0002012011W 300.001 2305.071 60th STREET y y S0002012011W S60-20'20--w 300.00' C.I 19 rn East line of the SE} of Section 28 O Cn o ro n ~ a- N 7 n O° o Unplatted Lands o ~ a A N 7 APPROvEr. VOLUME 8 PAGE 2142 ADS 18 tgq9 F NWN. -k I'MR h Department of SOIL EVALUATION REPORT #1714 r3 - Safety and Page 1 of 4 p in accordance with Comm 85, Wis. Adm. Code ~t Professional Services Schmitt Soil Testing, Inc. Coun Attach complete site plan on pa than 8%Z x 11 inches in size. Plan must ty St. Croix include, but not limited to e I d ontal reference point (BM), direction and percent slope, scale or arrow, and location and distance to nearest road. Parcel I.D. 030-107W20-100 ease aH information. Date Personal information pr a maybe used for secondary purposes (Privacy Law, s. 15.04 (1 e1viewsy 41-A' 3 Property Owner Property Lortion Sacher, Tony & Mary Govt. Lot uUN 2 8 1/4, S 1/4, 8, T30N, R1 9W Property Owner's Mailing Address Lot # Block # Subd. Name o CSM# 1348 60th St 1'r` a rdr„1 CSM 8/2142 (5 Acres) City State Zip Code Phone Number City ❑ Village own Nearest Road Somerset WI 54025 715-808-1575 St.Joseph 60Th St New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD EJ Replacement ❑ Public or commercial - Describe: Parent material Outwash (Sattre Silt Loam) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.4 gpd/sgft rating. Possible system elevation for replacement area is 95.75'. and recommendations: Slope of are isP/o. Boring # Boring F-11 Pit Ground surface elev. 101.76 ft. Depth to limiting factor 105+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 1 0-9 10yr3/2 none SIL 2mgr mfr as lc,2vf 0.6 0.8 2 9-19 10yr4/4 none SICL 2fsbk mfr gw ivf 0.4 0.6 3 19-28 10yr5/6 none S Osg ml Cs 0.0 0.0 4 28-105 10yr5/4 none SL lcsbk mfr 0.4 0.7 5 Horizon 4, 28-105" has stratified bands of 10yr5/4 SL I!csbk an loyr5/4 GRCOS , the weak Sandy Loam reduces the gpd/sgft to 0.4. ❑ Boring # LJ Boring Pit Ground surface elev. 99.51 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff91 •Eff#2 1 0-11 10yr3/2 none SIL 2mgr mvfr as lc,2vf 0.6 0.8 2 11-33 10yr4/4 none SICL 2fsbk mfr gw 2vf 0.4 0.6 3 33-50 7.5yr4/6 none S Osg ml Cs 0.0 0.0 4 50-63 10yr5/4 none SL lmsbk mfr Cs 0.4 0.7 5 63-96 10yr6/4 none COS Osg ml 0.7 1.6 !l -17 Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS <_30 mg/L and TSS S30 mg/L CST Name (Please Print) Signature: / CST Number i---17''° 227429 Thomas J. Schmitt :Q 1Z--717;-- Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 5/17/2013 715-760-1978 SBD-8330 (8.07/00) Property Owner Sacher, Tony & Mary Parcel 1D# 030-1079-20-100 Page 2 of 4 ❑ Boring a Boring # Pit Ground surface elev. 99.51 ft. Depth to limiting factor 95+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#t -Eff#2 1 0-12 10yr3/2 none SIL 2mgr mvfr as 1c,2f 0.6 0.8 2 12-28 10yr4/4 none SICL 2fsbk mfr gw ivf 0.4 0.6 3 28-48 7.5yr5/6 none S OSg ml a 0.7 1.6 4 48-95 10yr5/4 none GRCOS Osg ml 0.7 1.6 J ❑ Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#t 'Eff#2 Boring F-1 Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *E #-I -Eff#2 ' Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of 4 ' Conducted by: Conducted For. Schmitt Soil Testing, Inc. Name: Tony & Mary Sacher Thomas J. Schmitt, CST 227429 Address: 1348 60th St. 1595 72nd St. City, State, Zip: Somerset, W154025 New Richmond, WI 54017 `r Phone: 715-760-1978 PID: 030-1079-20-100 signature Lot No. 1 CSM 8/2142 (5 Acres) Date S^- /7' vJ3 Legal Description: NE1/4 SW1/4 S28 T30N R19W Backhoe Pit Township, County: St. Joseph, St. Croix County Bench Mark 1 El. 100.00' Top of PVC pipe. Bench Mark 2 El. 104.51' Top of vent cover on dose tank Slope= S% It. 40' 701` T 6 E d Frd3V (46.- 1V ~ co 6 gr~.t y WELL DUS[= D } Ar. T A. ,i .a. ,L ~f •r~ x < gin' F 00 - ~ _ N Q. ou F. W N e FM,€rr 1.. - . A:~y ~:'_q~°ky "•4: .~T"'. .fit t yr - ~F'kx~.•Xng Yg~ ~ Fi~~' tX•.'.'i~` e • k:.v` _ as Fe: 71 RN~ 10 K4.. ; •v,- it 1 ;1s,r} 3 rs~5., ~~a%,: yyt`<~,eL. :sta. V }Y 'Sid 3 ~ ~ i:v M1 -124 5- F.: _ R ' r ~ 00 I ~y O . ~ O I ~ O y N 0. 0 ti Vl C L ~O O N ` m c N m C M LL N Y C J U ~ ~ U U h 7 0 c ! 'O U O N Q Co m f6L I C z O N p fn 7 M 0 co N~ 0 LL 1 0 3 :o ' m . (D 'a o~ j E a F cn a 4) 2 m I~ a. co CL e h n v 4) r H 0) W Z r- ~ d a~i I 0 z V ~IVC O z c F +Os- n w m ~ ~ N y E_ -hw Se ~rrn~ Ppn`~S ~A m 61" h O e N v a m I DI i LO 0 N C, N O d = ` c rn CO CL CL co MA ~I!oo CL L z~> ~ ~ooo a3 y'f~~fPr ~cef.' •N co CL CL CL CL O (n ' y co W to J U m rn rn LL z f- W co O O O O N N N N y co N rn °D O Z d a r lT) f6 p ! y 7 Z E 3" 8 LO 0 c O ~ V N Q1 O e- r N N C O CO N N N V C1 a) C N y = M v O N N O (n V D1 - Z a0+ 'O O O Cl) .`NO.. y O O N ao rn l=y~,J ~ O M N E O N t6 N L LL In O V ~ I `m a La. CL -ii _1 A 0 a j!Ov U L Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT y. OWNER L It J(''VIC tOWNSHIP SEC. c.~ T ON-R W ADDRESS ~.J(,U ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ti 6 ~ ~ 41f jCL V/ ~s INDICATE NORTH ARROW r BENCHMARK: Describe the vertical reference point used : C rIco fin Elevation of vertical reference point: b`o'o Proposed slope at site: ?7e SEPTIC TANK: Manufacturer: It fC 04S Liquid Capacity: Ir OL Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ` Number of feet from nearest Road: f FrontO Side ,@ Rear, O feet t -From nearest property line . ' Front 10Side ,©Rear, 0 feet n~ Number of feet from: well / building: s} (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE ,RRVE.RSF, SI])Z PUMP CHAMBER ` lie Manufacturer: i jr f 's' Liquid Capacity: Pump Model: , 04''t t Pump/Siphon Manufacturer: t.Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: 16t ki-M Alarm Switch Type: ~C P, t f Number of feet from nearest. property line: Front, ® Side, O Rear, © 1 Number of feet from well: % D Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1 r~ Lengsth: > Number of Lines: t" Area Built (r Fill depth to top of pipe: Z~ Number of feet from nearest property line: Front, O Side, ® Rear,0 Ft., Number of feet from well: Number of feet from building: 7 (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: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: f Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR -84 HjJMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7!)69 BUREAU OF PLUMBING MADISON, WI 53707 NE,',,S`E%,S21,T30N-R19W XNCONVENTIONAL ❑ALTERNATIVE state Ian I.D. Number: JG4eph ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (It.-fined) Town U St. Goth Avenue NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 1 aAm Ctedit SeAvicels NoAthw t Hwy 35 N. RiVeA EaM, WI 54022 /a - /3- _6$ J • d C~ BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber JMPIMPRSW No. co""" Sanitary Permit Number. Tho=6 A. Wan 3231 St. cuix 112839 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER `w PROVIDED. PROVIDED- ( o OYES ❑N0 DYES ®NO BEDDING IVENTOIA, VENT MATNUMBER OF ROAD: PROPERTY WELLU iL DING(VENT TO FRESH JALARM FEET FRO I b LINE p~ AIR INLETDYES 5&NO Cs► DYES ®NO NEARESTM v D OSING CHAMBER: MANUFACTURER BEDDING jLIOUIDCAPACIrY PUMP MODEL PUMP/SIPHON MANUF ACTIIREH WARNING LABEL JLOCKING COVER .yq PROVIDED: PROVIDED M L') . DYES ❑NO 1~7~ GLoLJd YES ❑NO DYES iXNO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY JWELL BUILDING VENT TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) YES ❑NO NEAREST o 9a SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH IDIAMETEIT IMAIIHIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LNO uF DISTR PIPE SPACING COVER JINSIDE DIA -PITS LIQUID f 4 I BED/TRENCH neEN(:HES MATERIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL FPTH DISTR IP DISTR PIPE DISTR. PIPE MATERIAL: NO STR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BE LOWuPES ABOVE COVER ELEV INL t ELEV END ^ G PIPEJ~j FEET FROM LI 0 O~ G AIR INLET 4' ~I d 7 4 NEAREST a If" 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- DYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NO DYES -]NO UEP7H OVER 7RENf,H ~TII(IVIIITIIINIII~IEI) DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER ES DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA ELEV. PIPES. DIA: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 3<3 YES ❑NO DYES ❑NO N~t t Sketch System on Retain in county file for audit. Reverse Side. SIGNATURES. TITLE. DILHR SBD 6710 (R. 01/82) Zoning Admini6tAatot fi DILHR SANITARY PERMIT APPLICATION CTf In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT EC:'c.aw,_wvr 0$3(~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION KA 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES VN NO PROPERTY OWNE PROPERTY LOCATION C' ~r:°k'1~I~L°S !Jt lu e'/a S T N, R E (orto PROPER Y O R`'S MAILING AD RESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAM KJ ~ yid CITY, STATE ZIP CODE PHONE NUMBER CITY EAREST O LA E OR ANDMARK VILLAGE : 5 X T05e D Ir TOWN II. TYPE OF BUILDING OR USE SERVED: ~Eublijc(Specify): Number of Bedrooms if 1 or 2 Family RIII. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1.•_a. ❑ New b. X Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative c. ❑ Experimental 2..a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. R1 seepage Bed b. E1 Seepage Trench c. ❑ Seepage Pit d j o7 ~E' 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in gallons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INF RMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks R El Se tic*01, or Holdin Tank Z L__oo re ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ 1 1-1 ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print : Plu Signature: (N St ps) MP/MPRSW No.: Business Phone Number: ~ Plumber's Address ( treet, city, StEb , Zip C e): ~ ~ Na esigner: t~~ 9 VIII. SOIL TEST INFORMATION Certifi oil Tester (CST) Na e CST 711LA CST's ADDRESS Street, City fate, Zip ode) - Mv IL)j Phone Number: 1/1" 9 bb IX. COUNTY/DEPART ENT USE ONLY ❑ Disapproved S ary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Mpproved ❑ Owner Given Initial nit Surcharges Fee Adverse Determination Ir?0.0 ^ C C) -C ~F C.S~ I)b X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: 1. Property owner's name and 'mailing address. Provide the legal description where the system is to be installed; 0 II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check exPerimentat•onlY if prol'ect. is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks -for this system. Check experimentak approval only if. tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designee name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. . IX. County/Department Use Only; X. Comment area for use by-county or resaon given when application is disapproved. y Complete plans and specifications not smaller than 13'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; close volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. - - - - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wiscorisin's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of ' the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property AM--_1/4 1/9, Section T 3e) N-R W Township A/G 7 3 Mailing address 14 1,E Address of site Subdivision name Lot number Previous owner of property ~a Total size of parcel Date parcel was created Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes No Volume n O and Page Number o C as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deeded in the Office of the County Register of Deeds as Document No. F- ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described., property, for the construction of said system, and the same has beerN~l}i}.~corded in the Office of the County Reg! sr o Deeds, as Dpcument No. ~~77// Signature o Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature • ^ 441290 , 822 PAt,;E29y 'STATE OF WISCONSIN CIRCUIT COURT ST. CROIX COUNTY Federal Land Bank of St. Paul, Plaintiff, VS. SHERIFF'S DEED Richard Rivard, a/k/a Richard E. Rivard; Elizabeth Rivard, a/k/a Elizabeth Rivard; Stewart Rivard, a/k/a Case No. 87-CV-689 Steward Rivard; Production Credit Association of REGISTER'S OFFICE River Falls, n/k/a ST. CROIX CO., WI Production Credit Association Rec'-4 for P--,,r,4 of Northwest Wisconsin; Bank of Somerset; Cemstone S E P O 9 1988 Ready Mix Co.; Vincent Germain; at 11:00 A M Annette Germain, Defendants. d ~f Register of Deeds WHEREAS, pursuant to a judgment of foreclosure and sale rendered in the Circuit Court for St. Croix County, Wisconsin, on June 20, 1988, in an action between the above- named parties, and, after due advertisement, the mortgaged premises designated as Parcel A in said judgment and as hereinafter described were sold on August •23, 1988, to Farm Credit Bank of St. Paul, f/k/a The Federal Land Bank of St. Paul, the best bidder, for the sum of $2511764.92, And, WHEREAS, the said Farm Credit Bank of St. Paul, f f/k/a The Federal Land Bank of St. Paul is now entitled to a conveyance according to law, NOW, THEREFORE, the undersigned in consideration of the payment to him of $251,764.92, receipt of which is hereby acknowledged, conveys to Farm Credit Bank of St. Paul, f/k/a The Federal Land Bank of St. Paul the follow ,,-t-J~"art of land in St. Croix County, Wisconsin: r t~ ~yJ~ Bye, Krueger p~G 2 & Goff, S.C. P. O. Box 167 River Falls, Wis. 54022 can 822 PA'E2Otj 1 ~ E 1/2 SE 1/4, ection l0; SW 1/4 NE 1/4, SE 1/4 NW 1/4, all of SE 1/4 and Government Lot 3 except part to Waldemar F. Davis and wife in Volume 265, page 348, and except part to Ray F. Wert in Volume 174, page 631, and except part to Eleanor Vanasse in Volume 290, page 102 and except commencing on N line of said Government Lot 11311, 1071.2 feet W of NE corner thereof; thence SWly by a deflection angle of 110301, 652.43 feet to PLACE OF BEGINNING; thence SWly on said deflection line 132.0 feet; thence W parallel with N line of said Government Lot "3" to Ely shore on Perch Lake; thence Nly on said shore line 132.0 feet, more or less, to a point W of PLACE OF BEGINNING; thence E to POINT OF BEGINNING and except commencing at NE corner of said Government Lot 113"; thence W on N line of said Government Lot 113" 1071.2 feet; thence S at right angle 100.0 feet to PLACE OF BEGINNING; thence S 288.43 feet; thence SWly on a deflection angle of 11030' to S line of said Government Lot 113"; thence W on said S line to shore of Perch Lake; thence Nly on said shore line to a point W of PLACE OF BEGINNING; thence E parallel with N line of said Government Lot "3" to PLACE OF BEGINNING, and except commencing at S quarter corner of said Section 28; thence N8901814111W along the South line of said Section 28 (bearings assumed and referenced to said line also recorded as being W) 420.00 feet to" the point of beginning; thence continuing N8901814111W along said Section line 300.00 feet; thence N0045134"E 500.00 feet; thence S89018'41"E 300.00 feet; thence S004513411W 500.00 feet to the point of beginning, containing 150,000 square feet and being subject to all easements, rest- rictions and covenants of record, and the existing right-of-way, all in Section 28. All in Township 30 North, Range 19 West. Dated this 14day of August, 1988. Ralp Bader, Sheriff St. Croix County, Wisconsin Bye, Krueger & Goff, S.C. -2- P. O. Box 167 River Falls, Wis. 54022 NOW Deed exempt: 77.25(2) and (14), Wis.Stats. STATE OF WISCONSIN ) ss. COUNTY OF ) On the day of August, 1988, before me came Ralph Bader known to be the individual and officer described in, and who executed the above conveyance, and acknowledged that he executed the same as such Sheriff, for the uses and purposes therein set forth. S~g t~~y Notary ; v_ ! St. Croix county, WisconagLn 0. My commission expires: 9 Xv N j p I al ~ S 7- Q tp~ This instrument was drafted by: Bye, Krueger & Goff, S.C. 710 North Main, Box 167 River Falls, Wisconsin 54022 III Bye, Krueger & Goff, S.C. -3- P. O. Box 167 River Falls, Wis. 54022 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER F ROUTE/BOX NUMBER 3 1~ FIRE NO. ZIP CITY/STATE f L) I\ PROPERTY LOCATION: 1/9 1/4, Section 0' Town of .341 St. Croix County, Subdivision i , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN; RELATIONS 9(1) & Chapter 145.045) LOCATION- SECTION. T UNICIPALI Y: OT NO.: BLK. NO.: SUBD1~!.'cinni ni " 44M/ T~ N/R E CgTY OWN BUYER'S NA E: _4MAILIN DDR SS: Jr rotX a e l'f ~~rv~'e or w~'7- hL 3S USE DATES OB RVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: PILE DECRIPTTIO AT N TESTIS: Residence ❑ New Replace e 33 g e ~Ifc 3v Q RATING: S= Site suitable for system U= Site unsuitable for system rNS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL rING OLDTANK: RECOMMENDED SYSTEM: (optional) ❑ U HS ❑U ES❑U ❑Sa ❑Sc2u c6l" v. 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 6 699 OCR s'd /00 B S 'd 4 50 16 B 1,063e B- a ~.`ab <00 ~ ~o cels; , ov X95 / Sb /e 66 G~ B- 00 >6 <56 B- B. B_ PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RIO 1 PER D2 P QD3 P_ 3.S© /0 t 1 P- 50 /U LPEE 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, ga D 3D' SYSTEM ELEVATION _ a _ 1 t ~r~a P r .1•h, t QA 3 I , Nt U) I i a L__L_J LL I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME r' TESTS WERE COMPLETED ON - 6 30, InEpt ADDRES : CERTIFIC~Y N0NUMB R: PHONE~UJVIB ~tional): & r7- - 1 1 Y' S5 CST SI TURE: / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - J " t '_'CTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a 'id accurate sail test, your report must indtAde: 1. COOT, , ion; 2. The a Est clearly ind to whether this is a c - r commercial project; 3. MAXI r of bedroon - -:,>mmercial use pl - 4. Is this a I -,ent sy 5. Cord i?y rating be <es. A SITE IS SUIT D-d A HOLDING TANK ONLY IF ALL OTHER S) ARE RULED OUT BASED ON SOIL. :CONDITIONS; 0. PLEASE use the abbreviations shown here for v!riting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Ear i.:j `o scale is preferred. A e rate sheet may be used if desired; I sure your benchmark and vertical elevation reference point a vn, and are permanent; e all appropriate boxes as to dates, names, addresses, flo, percolation test exemp- appropriate; 1 formation (such as flood plain, elevation) does not ar}oly, ~.Fi. in tl~^ - box; 11. '')e form arxj place your currenl address and your cert~'fi, a >er; 1 Legible copies and distribute as required. ALL SOIL 1: 7TS MUST BE F`" VITH THE f AUTHORITY `vVITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TEL', Sz " d Textures Oth yrnbols st _.10 "j BR ~irock Coo t - 1011j SS - ~dstone gr - ides 3"} S - Lim ~s - L tar, f l (1y Y _ `r c- 1 sang - rra H W BM - VRP- T( Tr~ l,~~rm n, y<luest Inv Con t l • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LPBOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 M & Chapter 145.045) LOC / SE~,CTION:~~N/ r( )W TO UNICIIPALI1AY: OHO.:BLK.NO.: SUBDI1&S4QALi1lAME: C TY OWN BUYER'S NA E: MAILIN D;RyySS: USE DATES OB RVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PRCIFIILLE S PTIU Re L I O?T~ STS: Residence ~ ❑ New. eplace \J ~ /X 30 5 J uA L tom--- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑u s au Lis au ❑ s ou o s a e6p 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: Il Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 6' 77• Db 6 6'. 'f6 / o0 6J s l` ~o S h s i a ~P oo s Sod' B- 65ab <D0 0 1s; , oo ns'' ~a / d 1A 66 B- 3 9200 >6.sG QU S!-5/0 61 ~66sr -3v,6 a B- B- B- PERCOLATION. TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN.--- PERIOD 1 I D 2 PER INCH P_ - 3. o /U l l P_ o D i~ 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. as SYSTEM ELEVATION o Duet o_ 7 _ , _ P J 1,6 I 1 1 p 7 --C fAC s' I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME r' TESTS WERE COMPLETED O ADDRESS: ~ ~ CERTIFICQ~ NONUMB R: PHONE JVIB~~~tionall: 9 l (~1 /1! ll ~L/ Gr CST SI TURE: L) Xgj~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ' Cl &4j r 1~1 5E PS-- ~ o--~q Jg►~,, .n Co v e h tom/ f~ Pa F 3~ ~ 6 © 3► ~a''PU~ t~~r~' 6'r~~h l a ~k , Ele v. 9s'. So bad 3~o ,►~ob®2a1 S eP- c rs i i ` ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ' 911 4th Street I" ti Hudson, WI 54016 Val Telephone - (715)386-4680 Irv 1 l The St. Croix County Zoning of f ice of f ers the service of septic V' and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. ---------------------------FEE: 35.00 550 WATER TEST r nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) f~~ e PROPERTY OWNER'S NAME : J M c~ (Z- PROP. ADDRESS:- Jog CITY SO,nx e rS e+ w 1_#iLegal Description 1/4 of the 1/4 of Section T N-R Town of T ~_P,oh Lot Number Subdivision: t //c FIRE NUMBER 15 T LOCK BOX NUMBER mD / D -101Zd 7 Color of house LQ'h Ott Realty sign by house? D If so, list firm: ~j ~ ~'tr~cr~D PLEASE IIVNt UDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: VAPARA 4mai Telephone Number F-vEs ; `]i g _ . ► c. r i>mt -6i'A3 REPORT TO BE SENT TO: A q H0tA. CN<✓P'- b o -ti, S ~ rnv~_(,e-t- uJ,z S 0l_CLOSING DA Signature • t . . C j I- 7is - 2~47 - 3213 Coll, a~ 9 _ 1U/n ~l lfSl i~ i e Erg ►,,w~ ri dip lgDue ~ j 90 COMMERCIAL TESTING LABORATORY, INC. 5A Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. MIX ZONING REPORT NO.: 32435/01 PAGE 1 ST. MIX COUNTY REPORT DATE: 11/16/92 COURTHOUSE RATE RECEIVED: 11/1.2/92 HUDSON, WI 54016 ATTN: THOMAS C. NELSON el~ f/2 1~- 3 OWNER. Mary 6 Anthony Sacher LOCATION: 1348 - 60th, Somerset COLLECTOR: M. Jenkins DATE COLLECTED: 11-09-92 TIME COLLECTED: 11:00am SOURCE OF SAMPLE: Kitchen faucet a :f DATE ANALYZED:11-12-92 TIME ANALYZED:2:00pm COLIFORM: 0 /100 mt INTERPRETATION: Bacteriologically SAFE NITRATE-N: 14 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Conform Bacteria/100 ml Nitrate-Nitrogen, mg/L 8 9 co o 'o z CZ) LO oar .C co LAB TECHNICIAN: Pam Gane .O''NDE7ENOFH `\,,q Y ~o WI Approved Lab No. 19 V ~D < Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~yb Pt~`R o eta " ~7y IZ®A" CT I HuD.SOP C7~ Q lu -To Mpg/s~ , ~ /y;•'-/L- 1._1..1.. ~ _ _ _ j _ • r Vic,.. `i P__ 4 507.10 0 FILED N L AUG 181989► i - Z ° Cf) Bearings are referenced to the east C n JAMES O'CONNELL line of the SEJ of Section 28, assumed > O~ Register ot Deeds to bear S0002012011W. v, ttri St, Croix Co., WI 0 ~n H z •P Unplatted Lands rt o_ o h] 0 o LTJ y cnr. N00020'20"E `tO d 300.00' 20 n ((t rn ht (D N 0 0, N I n O 1 n 0 1-0 P N° a tr rN a , It 0 v v ro o ro 0 o a o v d a a co m n 00 A X A =3 co M Cn ,-J ro U) F-• Vf N L N 0_ (7 N N " 0 -n M' .1 z (n tTJ 0 at' • 0 M . c-) Z Fh co X o o c N 00 tt N co x M 0 Cn z C7 Cr 11cn co (D M s o ro o I v o W 1 0 A`te' T o tro = w r w 1v CD O ~A I d 0 r'1"t O• O• v• O V 'h I rt 111 d ro ro ro ~ I~ - I t~ ro ro N ro I r (D C o =Y r'r CD to i o ro c~i O C1 ~7 o v m 1 n. ~i rt G -n I CA 0) a, U, T a O c, z N cn n 00 Z7 . • cn , o o o OW O t' Via' " ~ N is L f> w .w F-r ..A y'' i~ to ~ y w 0 r:• w o ~ 0 S0002012011W 300.0 1 2305.01, 60th STREErt 7_ r S00o2012011W S00 20' 20"W 30ro East line of the SEi of U l v rt c-) 0 N• ° U) o -1 _ ° 0 W (b co m smi- Unplatted Lands C11) 1 ro N 7 co VOLUME B PAGE 2142 A i R fQt~ts~ x rdFfifrt wf PA 1-SPLANININ\ , ,hil) : ~!v2t+G C Vtlvll I iT t