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018-1027-00-000
? 6~1 ~ N O i ~ F'D OD c A fJ O N A ~p ~ No n ~ ~ o ~ ~ ~ (/~ Z D m so D y ~ a W it 3 ~ I ~ y I N ~ z o ~ -o n ~ c m c 3 I ~ o p~ ~ ~ ~ i m N < a m' Z ~ o_ =R ~_ _~ O~ ~ ~ ~ T1 fD C W N i a ~ Z ~ O N o' 4 i ~, -IQ~ Z D ? m m a ~'o~a r. y ~ ~ O 3 01 ~ f11 A y y ~ a o mm~~:~ a ~- w 5 ~~ o °-' ~ c ~o O d~ p fD a ~~ fD .~. M ~ ~ O N Q ~ a'• N O =7 7 =~ (~ (D ~ ~ Z~ ~ O •- N a ~ I o O ~ °o a ~c~o o m ~ 7 ~ N ~ ~ 3 3 ~: r: ~ ~ ~ O7 N f%i i W 7 ~, n '', v ' 0 (~/i f/1 N ~ ~ O a ~ a c~ °° °~ a A ~ m m °o °o v ~ ~ 7 O O ~ ~ N N N o '~ O O N ~ ~ ~ ~ ., L1 ~ 7 ~ o ~ .: ~ O ~ ~ 7 O N ~ N C_ ~ A N~ A a 3 Q O ~ ~ in ~a W ~ a ~ o 3 m w m m m T C 7 a 3 ~ n ~ v o 3 n n ~ C d ~ A _ -' O N W N ~ :~ N a ~ o ~ °o ~ o0 00 ~ o N S -o N o c ~ ~ GI 3 m m Q C a y --I fA A Z n -~ :Yl L. A ~ `~ ~ w z ~ ~ ~ ~ a d 0 C3 0 ^s O d !x~ [ 1• O ~• h A O a O O A b A ~ A N ,v CH ti -~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Platson, Cla on Hammond Townshi CST BM Elev: p~''~ Insp. BM Elev: BM Description: V U ~ b TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing i-(N Aeration Holding ELEVATION DATA County: St. CrDIX Sanitary Permit No: 453256 0 State Plan ID No: Parcel Tax No: ~. 018-1027-00-000 Section/Town/Range/Map No: 13.29.17.1986 STATION BS HI FS ELEV. Benchmark ba.a~,° 13. ~ 13- ~ oa~~ Alt. BM Bldg. Sewer ~' ~ ~~ St/ t Inlet d, O 3 SUHt Outlet ~, io . a Dt Inlet ~ Dt Bottom ~ ~- Header/Man. (f~,Q/l. ~. Q ' IO• Dist. Pipe s (? ~qS ' Q5: Bo s9s = ~ 9 FinaSGrad~_ / Ate/ i~ ~ ~ ~ St Cover / r Y~` S~ ?I .. ~~ ~~ ~ ~t / ~ TANK SETBACK INFORMATION TANK TO P/L W LL BLDG. vent to Air Intake ROAD Septic ~ ~ r -„r ~ 2~ Dosing Aeration Holding / PUMP/SIPHON INFORMATION ~~,GY~;.~wl.~ . TDH Lift Friction Loss Forcemain Length ia. SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ Le DIMENSIONS SETBACK SYSTEM TO INFORMATION Typ Of System: DISIBIBUTION SYSTEM Head c. to V5~ _S M Ft I BLDG WELL PI" T DIM C~No. Of Pits Inside Dia. Liquid Depth LAKE/STREAM EACHING an •-~ ,1 _ HAMBER OR X77 UNIT nrial IJnmhwr ~ r ~ ~ / x Hole Size x Hole Spaci Vent t (J ~ Length Dia i ~ Pipe(s) Z ~` Length Dia_ Spacing -- ~ Bader/M ifol Distribution SOIL COVER x prP_SSIIrP SvstPmw CSnly xx Mound Or At-Grade Systems Only o 'r Intake mod" Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~~ ~ Bed/Trench Edges Topsoil ~ Yes [] No [~~ Yes ~ No !•/`-• ~ - COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2017 Cty. Rd. E Baldwin,~WtIr5~4002 (NW 1/4 NW 1/4 13 T29N R17W) metes & bounds Lot "( Parcel,~No/~: 13.29.17.1988 1.) Alt BM Description = `ST~ ~ ~''`~ ~ Zi /~~~~/ ~/'`'~ /r'~-~s ~~~~~~~QS`^~ G~4~ 2.) Bldg sewer length = ~Qt /~~ ~:~2G%~n-^6~"~il~`i~i~'-vim" i't:N~ ~ T®U - amount of cover =~ ~ 1 0 ~ f , Plan revision Requirgd? i j Yes ~` 4'" No _ __ __ __ ~ _____ I r/~ r l Use other side for additional information. ~ ~ ~ ~ '". ~i -~_ _ _-' SBD-6710 (R.3/97) Date Insepctors S ature Cert. No. ~.~ ~~ n b~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy~aw, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Platson, Cla on Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION ~ ~/ V ~ Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CfOiX Sanitary Permit No: 453256 0 State Plan ID No: Parcel Tax No: 018-1027-00-000 SectionlTown/Range/Map No: 13.29.17.1986 Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/M2n Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM HeaderlManifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL OVER v PrQRS11rP Rvstams Only YY Mnund Or At-Grade Svsl:emS Or11V Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No [] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2017 Cty. Rd. E Baldwin, WI 54002 (NW 1/4 NW 1/4 13 T29N R17W) metes & bounds Lot Parcel No: 13.29.17.1986 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~ Yes [] No i ~ ~- Use other side for additional information. :_ J Date Insepctors Signature Cert. No. SBD-6710 (R.3/97) ^~-Safety and Buildings l]ivisivn ` rS~~>nS~ln 201 W. Washin~eonAve., P.O. Box 7162 Madison, Wl 53707 - 7162 D+~artment of Commerce (608j 266-3151 Sanitary Permit Application In at:cord with Comm 83.21, Wis. Adm. Code, personal itliormation you provide may be used for secondary purposes Privacy Law, s1S.04(1}(m) I. Application Ini?ortlaation - Plea'e PrLU Al n ~ EC ~ I~ F r petty Uwner's sva me ~"/a ~ ~,tJ ~cc.~so~ MAY ~ 5 2004 Property O rter's M ailit-g Address ~,-i , C R O I X C O U N i 's 024 •7 ~ ZONING OFFICE City, Stacy Zip Colo Phone Number ~` ~ urY~D~ 7~//s- G8Y-,?~14~J II. Type oP Huildin~ (check all that apply) ,~WNiJ-~ ^ 1 or 2 Farnlly Dwelling -Number of eodrooms ~ S ^ Public/Commercial -Describe Use - / ~/ ~~ ^ State Owned -Describe Use ~ ~ I.SJ ~ ~Z-~ (~c/ Z 3 Y °`7 ~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) County 5anittry Permit Number (to be filled to by Co.) ~~ State Plan 1.I~.~urnbtr s,"J Project Address {if different than maiiins address) ~- _ ~,~ -~ Parcel e Lo ~ Block rraporry a,u:a~evn ,/ /IJLc~ k(,~~~(,Section /3 _ (circle o > T~N; It /7 Eo~ Subdivlsbn Name CSM Numb LaCityMl~Village~i'ownship of ~,yy1i9B,~~ A' ~rt/sw System '~Replacemcnt System ^ Treatment/Holding Tank Replacement Only ~ ^ Other Modification to Existing System g• O Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New i List Previous Pertnit Number and Date Issued ~ Before Expiration Plumber Owner ~ '~ ~~ ~ i IV. Type of POWTS System: (Check all that apply) Non -Preuurizad In-Ground ^ Mound > 2~ in. of suitable soil ^ Mound ~ ?A in. of suitsbie soil ^ Atdrade ^ Single Pass Sand Pilter I I ^ Cottructed Wetland ^ Pressurized In-Ground Q Holding Tank C Peat Filter ^ Aerobic Treatment Unit ^ ltecirculatina Sand Filter '^ Reeirculatia S nthedc Med1a Filter Leachin Chamber ^ Dri Line ^ Gravel-leas Pi ^ Otixr (ex lain) i V. Disnereal/Treatmant Aren Infortnatlont U 7 t~ ..: n k U ~~ a' I _ ~ ~i~rr/nP~t. •1-~~~C Dcsiga Plow {gpd} Design Soil Application Rate(gpdst) ~persai Area Required (sf) ~ Dispersal Area posed"(sf} 'System Hkvaaan VI. Tank Info Capacity in Total Number Marrtfacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ~7 _ ~/ Concrete Constructed Glass New ExGtting ~ iCf~ ~ !d~ ~i~ i Tanks Tanks Septic or Ho{din>i Tank I ~ Aerobic Treatment Unlt ~ Dosing Chamber i ~6D j ~ e VII. Res ttalbility Statement- I, the tlndersi ed, asstune res onslbflity Por iz Ilatlon of the POWTS shown on the attached plans. ---? Plumber's Na me (Print} Plumber's Si gnaorre P iviPRS Number B siness Phone Number ~' ~,' s °~ e y ~~~-~ 1 ,tea ~~ga ~ 7~~-3~~ -- 3~~ t i Plumber's Addre ri (Stroet. Clty, Stan, Zip Cada) j 1r17D S e o ~" yQ~ 11f~- ~ ~Approv@d ^ Disapproved Sanitary Permit Fee intaudes Groundwater Date Issued suing Age Sign rc tamps) Surcharge i;ee} ~ ~ ~ ~ ~ / b D Owner Given Reason for Denial i ~~~provalfReason= for Dlaapprovat~9~ / ~ ~y ~ 1 Septic tan , e uent filter and ~~yy~,yyt g3 ~ `~ ~~~ittiG(~4~~ A O ~l s'yn~iAG~ i dispersal cell- must all be service-d /maintained //~ ~ ~/ 3 as per management plan provided by plumber. "7~~' /,t~~~ ~~71't/til---+-, 6 ~• 3 2. All setback requirements must be maintained (/ as per applicable code/ordinances. C~m~-~~ ~ Atfaelt etxstplate ylsw (ta tAe County only} for tbo systom on paper not loss rhea g1/2 x tl kchea in sl:e SBD-6398 (R. 01/03) ~'~Q-/?o~c/ /~~a-~Sa~ ,,i~v~ti .Ucv~ ~'!3 y'ay ~i 71.,1 Totd..~/ ~r~ r~rhvxa.~/~ ~ ~~~ ~~ P~ ~~' ~'~bD is ~ ~ ~ II~`' aw 66~` 2a < <,~h rG~~~ aG~~~ ~,3~ ~O~pt ~~ ,`u ,~ ~~ ~ti tip' G/.~-~~..~-~ mom' a~~994 s~~~l°y i a iQd ~ ~~ai-~1/'~O.t/ ~~Q=~So.~ ,d/~IJ~H .UCiJ~ ~'!3 ~.9Y /~/ 7~ ,Tol~.t~ d ~'`= z~~xm>xa../~ _ ~ ~ G o ~?d ~ u .~ Gard ~~~ s -~ 8~'y p.~d~t i ~~' ~'6Q /a ~ ~ ~ ~~' b~ 6a°~ 2°~ ~ ~,~h . ~3 22 V~ ~ry l U+ ~Mt ~~ ~ l fo~° ~~1 ~ ~ ~;~~ ti~ ~ ~~ ~ ~rG~~ aU~~ ~,3~' ~-~~..~ ~~ ~~~s9o si~~~~y ' SEPTIC TANK ~ PI.IMF C~;n~S~R CR055 SI:C:Iuti ANA SPiCI'FICA'i'iU!~5 4" CI' VE~~`~PIRE~'1.2~"~ ~tfN: 'ABOVE GRADE ~ 1~EATNERPRUOF ?' 25' FROM DOgR ~ WINDOW OR JL3NCTION BOX APPROVED FRESH AIR INTAKE -- WITH CONDUIT MANHOLE COVER W/ PADLOCK ~ FINISHED GRADE ~--WARNING LABEL ,1•, ~ ~ ~~ C I RISER ~ 4, _'_'..._'~..-~~.....- 4 " MIN . Ju 18" 'MIN ~ 6" MAX a ~ eft \• NLET ' `~ • { ~~ WATER TIGHT SEALS GAS- ; '~ + TIGHT ~ ~ PROYED A SEAL ~ JOINTS WITH PPROVED --k-- ~ ALM APPROVED PIPE IPE 3' B ' pN 3' ONTO NTO 5ALI0 ~ ~ sacra sari. c OIL PUMP OFF ELEV . FT. -~-- ~ ppF ~'~ RISER EXIT °` D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIF~CATION5 SEPTIC / DOSE TANK MANUFACTURER: /,1,'~~e~ NUMBER LOSES PER DAY: _ Y.~.~.. TANK SIZES : SEPTIC 1'd~' GAL . DOSE ~ S`4 GAL. AI,.ARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER MODEL NUMBER 5WYTCi~ TYPE: REQUIRED DISCHARGE L. c u ~.t'a.~ sH ww~ ~ r i rrrrr G ~•, i ,~ p~~ ~; ~:.... RATE ~~ GP1~ Dt?SE VOLUME INC LUDZNG F LOw$AC K : /,r~ GAL . CAPACITIE5: A = INCHES =~~_GAL. 8 = 2 INCHE5 = ~+v~ GAL. __d_r_ .~._.~ C = S INCHES = L•~ ~ _GAL. D = ~ INCHES = GAL. r.. PUMP E ALARM WIRYNG AS PER ILHR 16.3 WAC VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRIBUTION PIPE 1~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~~'FEET ~ „r,~,~ _ FEET FORCEMAIN X ,~?„~,FT/190 FT. FRICTION FACTOR 1 FEET TOTAL DYNAMIC HEAD = 1.~,s7I'EET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; k'IDTH~; D"I/AMETER LIQUID IIEPTFi"'• 1~,C7.. /,~~,~ < ,. SIGNED: f~,~ri~:'~Y ....... LICENSE NUMBER: ,r?,27~~t'~ DATE: _y~!~~~'_..- T/88 (~ GOULDS PUMPS Submersible Effluent Pump 3871 EP05 APpLICATI0N5 Spedfically designed for the following uses: • Effluent systems • Nomes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIfICATI0N5 • Solids handling capability; '/," maximum. • Capadties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/a" NPT. • Mechanical seal: carbon- rotarykeramic-stationary, BUNA-N elastamers. • Temperature: 104°F (40QC) continuous 140°F {60gC) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, t 550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 i2PM, built in overload with automatic reset. • Power cord: l 0 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug {standard on EP05}. ®2000 Goulds Pumps Effective February. 2000 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Methaniral Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron far efficent heat transfer, strength, and durability. ^ Motor Laver. Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe dory rated oi! and water resistant. METERS FEET ._. .. _.. ._...... __..... .._ __ 10 i r 9 30~~`~~ ....... _. 9 7 ~ 6 ~ s 0 g a 0 ~ 3 z 0 2 4 6 g CAPACfTY ^ Bearings: Upper and lower heavy dory ball bearing construction. AGENCY LISTING ~• canad;an wodat~ Assoaaeion (CSA listed model numbers end in "F" or "C".) Goulds Pumps is fso 9001 Registered. '__. EP05 _ 50 GPM 10 12 m~/h Goulds Pumps ITT Industries rr_~ uick4~ STANDARD CHAMBER Quick4 Standard Chamber SIDE VIEW •~tvrlvrV VICYV ~ [ ~ ~\ ,~" ,' I `~ J'1 - n n ~_! j~----__.. 34" ----_--y.~ SIDE VIEW Ff~ONT VIEW nr.rra, TOP VIEW ..Size (W x L x H) ;i4" x 52"x S2" Size W x is x H~ ~`° - -34" x 16" x 12" Effective Length 48" Invert Height 8" or 1.25" Invert Height 8" ~FILTRAT R SYSTEMS INC. STANQAAp ~,~(y~ITEL11~lyAF~q~~ (a1 l he slnr4'tUral hteq Ity p' e- r+. ,harnber, ~;U Vlaie, wtldyc and other ac[, s ry a I ~ipralt Cr. InWi elOr t'Ur' ,, unren Ins[al![.1 &-ut Operalatl in a Ica 1 I aid of an ensitc sfKr c system in axordanca with 1ntiNratnr's Ins) u runs, s~ arrarned to too oriryn"1 pt"chase) ("HOLAa ! niwu!s! detective n lutenals and wurkmarship 4n one year hem the dato that 1ha sapl!n permd is ssustl Ter the septic system conuinirry tM: llnics_ prcrudcd. nounrver. Inat ,7 0 5ep1!c permit iF rkri reyuirW by aPpllGabla law, th9 warranty ;kXltkl wr!I bog,n tq~or ~ ton dale that irl:JalldUm O1 the set}IiL sy::Iam ~OmmanGfr,S, T.; axan;ise Its warranry rights, Hpklnr moat rrptlly Infiltrator In writirg at t; l'Arpnrete Neh3d+_p,art~+ls Irl Old !, cU+ti of IM all>ged decoct. InRnmtor wBl slrpply replaoement Units Irx l;nns celwmnxl try fntlltratcv 'o bo [rr`~r+uru oy 6` s~LmNr..t iNarrutty~ (1~ Inc r'+ta = liabdrty spertdicaly excludes 1+~.e c[st of amoval arxUa rnstz'.tatan of (he Unir„ iL,I THE LIhtIT~~bV'AknAN?YANG[?EMFDIE^.-IN SL'!+I'AgAU[tgrlH (a)Ar~! EiC~I';t >_ 1tll: rlE grlCN(7 i~THFFi V1gARANTI£S LVUH RESPECT 7Ct f iJINT N LlN)hJ(' N7 IMFLIEn WAHFfgNI'.E OF M}-I'C.HANTAO l1'Y OR I NF - F(~H q PAR fNi11LM PI)RPCAiE- fr l 5 I ' ed Wa H t e l f ~ EM rdire~tt dm la y -lam l r to I ued ry a~ v~,a char lhar+ ulNl aIJ.. .ha _"~t x< ~~'1a~ranty floes r t t , M to irx a.. t ~ frw uiur s - yrte ,nfrltr icy ~r.N nU; k,a Na1N; far pr?naN a cr ~prXr3NM [kanwln r .I.roing TOSS o! ur[M[ t c A y I l ~. ar U mater als.. overh[,uG rn~ls cr other bsses pr tixpen$es u-,curreo by 1 e NOlder nr a!ty Third party, Sn[x;rkc:aNy exr Il Und rmm Lim"w y4a arny:U+,tlracte arp damage t,r the Units due :O Urdniery wear and tear, ells aiA~n, dCGdant, msuss, atxtse el ragla~l o! In~e IJn s, Ync Unts ! ,y subjeK led to vrmkae traffic or other F.ondhvns which are npl parmNl[Id by the Inslelietion instruarons: Tartu e t ~ roam?ain the minor rt ~lmM1rnd cu ors Sel Ipdn in the insia.lat+en instruuicrc,: trq plecanrunt 0! impr::prr meta^015 into the system Cpnlajnalg N>e Url;!s; t~ittM 01 the UnNS or the senor, sy5lam due tc improper sNrny~ or inlpr[>K;ar sizing, excpssiuE water nsa3a +riproper grease dispdaal. or improper .pYrei',Gn; or any other eutM1 ov! ceu,eq kry Inldlralce. Ards Limited Warranp~ shall be voil) h Iha ElgfUt•r lets ro comply witn dl Of the lawns sal forth rn thls LHalied warranty further, in no evarn scan Lniiiualor be responSb,'e for aly Inns N damage to the NoIGeS thr0 Unds, nr any Thud Patty resuNina frc»n instaKat+On a 9hrp- man! or from a^Y produ ,l Ilat»Illy claims of Fioldyr cr sry thrnl p,.lrty Frr th s I; Inl[q Warranty to aaAly the Uhits must be rlstylea an au:ordanre with al' site cond!trons req!urtx; bt slate antl hxat r[x)os; a!I olhor ap{NicaNe law; ~, arc IMinralor's insla!!a1 Cn insin:clions. jnj fib reprosentatlve of irit'Lralw has Ills atNl corny to charx3e a awland tl'„ u!n:lrxY '.hanargY, Nc warranty ar-rplia5 to arty Iaarh nt~,vr a do Ih6 arg- r,a! No4Tar the BbnVU repYesenl. 41e StanlJarA t J.. -l[Xl WdRanty ONaratl tJy I rhralcrr• q t "I G nnmbal 11 ,IaI03 arN GWrrite611(w0 [tilfarwn wd a, y nr(~ ~;e_ +l'rtn15. q!IY FarGl a, I '. rwl~ rY+ I 1 r:Oniap In}i uatr~ 5 c.-xy t NatXl luan0 -r Ultl SayD'ID.rK, tA'Inel,tll:l:t, enOr [0 Such 111N_l-aStl, ,O Ct;laill 8 Gr%pY Gt 1hB app~toab a war anly, and .,hould caretuly read (hat warranty pr pr to tho purrnase Ct t!nrrs. . ~ ~ ~ SYSTEMS I NC ~ ~ntrironmenlal Onsils Wasfettraler Sdutlans'"' 6 Business Park Ruad • P.O, f3ox 768 Oid Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-2.21-4438 U S. Patents: 4,759,EE1; 5,017,Od1; 5,15E,4tk3; 5,3,^sE,017; 5,40t,t 16; 5,401,4ti9, 5,51 I a03; 5,716,163; 5,588,77E; S,p39,944 Canadian Patents: 1.329,959; 2,004,581 Cther patents penning. In'utrator, EquaFzer antl Sich~Wlinder are registered trsderriarks of Inflltrdtor Systo,l~s Inc. infiltrator is a rt~gis2ered traQ2ntark in France. Infdirata Systelrls Inc. is a registered Vadamark ir, MBxir,O, CDn(ottr, CiOntOUt SWNP.I Corln8cfi0rl, MICfULHJCrlip,g, PolyTuff, SnapLock, CharrlberSpacw, P[reit,[lck, OulckCut, (luickPtay and QLCIIck1 are tra[lemark6 of fnfilfralor SySlamS inc. ~ 20031nffftralrr Sysfatrls Inc. Prtnirsd in li. S,A. NECYCLEp PAPEq MuitiPort End Cap ,,,,~«.~,m. -r.-,. , . ~- Wisconsin Department of Commerce Division of Safety and Buildings ~R1~~~4AL RECEIVED 1936 SOIL EVALUATION RE RTNOV 0 7 2003 Page 1 of 3 in ~cenrri~nee with Cnmm R5 Wi¢ Atlm Cnda. Certified Soil Testing CourBT. CR Attach complete site plan on paper not less than 8%: x 11 inches in sae. Plan must ZONING OFFI~€ include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arcow, and location and distance to nearest road. 018-1027-00-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Platson, Clayton H. Govt. Lot NW 1/4 NW 1/4 S 13 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2017 CTHW E City State Zip Code Phone Number }City _~ Village ~,~ Town Nearest Road Baldwin ( WI 54002 715-684-2443 Hammond CTHW E New Construction Use: '~_ ', Residential /Number of bedrooms 3 Code derived design flow rate 450 /? Replacement _,4 Public or commercial -Describe: Parent material sandstone Flood plain elevation, if applicable NA General comments and recommendations: install trench system w/ 0.5 gpd/sq ft loading @ system elevation 4.0' below surface contour lines as trench center lines GPD Boring # ;Boring Pit Ground Surface elev. 101.9 ft. Depth to limiting factor 70 In• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-9 7.5YR 3/2 - sil 2 m gr ds gs 1f/m .5 .9 2 9-19 7.5YR 3/2 - sil 2 f sbk dsh gs 1 m .5 .8 3 19-32 10YR 4/3 - sil 2 m sbk dh gs 1 m .5 .8 4 32-44 10YR 4/6 - sl 2 m sbk dh cs 1 m .5 .9 5 44-53 10YR 5/6 - sl 2 m sbk dh cs 1 m .5 .9 6 53-61 10YR 4/6 - sl 1 m sbk dh cs 1 m .4 .6 7 61-67 10YR 5/6 - Ifs 0 m dh cs - .5 .9 1 a Boring # --~ Boring Pit Ground Surface elev. 101.9 ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 8 67-70 7.5YR 4/6 - sl 0 m dh cs - .3 .5 9 70-76 7.5YR 4/6 f2d 7.5YR 5/3,5/8 sl 0 m dh - - .3 .5 I occasional high chroma s in horizon6; likely residual SS colors; possible redoximorphic features; avoid this area due to this & dense, deep sl textur Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ent #2 = BOD < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Sig at re: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/3/2003 715-233-0398 s Property Owner Platson, Clayton H. Parcel ID # 018-1027-00-000 Page 2 of 3 Boring # --i Boring 1!j Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10YR 3/3 - sil 2 m gr mvfr gs 1f/m .5 .8 2 4-10 10Yr 3/3 - sil 2 f sbk ds cs 1 m .5 .8 3 10-38 10YR 4/6 - fsl 2 m sbk dsh cs 1 m .5 .9 4 38-69 10YR 5/6 - fs 0 sg dl cs 1 m .5 .9 5 69-90 10YR 7/6 - fs 0 sg dl - - .5 .9 Boring # --- Boring ~~ Pit Ground Surface elev. 99.2 ft. Depth to limiting factor > 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10YR 3/2 _ fsl 2 m gr ds cs 1f/m .5 ,9 2 10-34 7.5YR 4/6 - fsl 1 m sbk dh cs 1 m .4 ~ .6 3 34-66 10YR 7/6 - fs 0 sg dl cs 1 m .5 .9 4 66-90 7.5YR 4/4 - Ifs 0 sg ml - 1 m .5 .9 horizon 4 has stratified lamellae of ~ 10YR 4/6 fs - 1/8" thick alternating w/ Ifs Boring # -~ Boring ~ Pit Ground Surface elev. 98.5 ft. Depth to limiting factor > 98 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10YR 3/2 - sil 2 m gr mvfr gs 1f/m .5 .8 2 8-44 10YR 4/4 - sil 2 m sbk dh cs 1 m .5 .8 3 44-98 10YR 4/6 _ fs 0 sg dl - 1 m .5 .9 i occasional st stratified @ 40-44" ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. [f 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) Certified Soil Testing ` 1 f 4~ Oh 0. Soh - o tN //,~ ----, `t.~~ wavaJi ~ Ov.h~ ~Jw~+.w..p.. ~, ~ S-~, I ~~t ~ ~ ~~ ~~. yr ` ~S«<< l" . Z~ I ~l O ~5 30 ~ ~,, 1 . ~~ . ct~M~ Lt'L~1-4 ~~:~e Ov. tw~.w CJr Q.K ~ / O't T J~T1 ASV ts~ nn ,,,,., ~c J..,. .n~ui~ C O, ¢Y vaa~ ~ /. i e ~\\`'~ / J /~44~z~'^48 ~3 -1 ~~ ~^r ~-~ ~a~->> /~ i ~~uo,d)~, ~- ,~ \ , .yn v i~ tK g('~ °r~t ~J (f.o o-t e o ~- ~ ~ n S `4` -a$C S ~..~ ~ \` tro . a ~ ~ `O ac~U`~o : S - i. v (j ~ ~s~'~Q.v - N r~ S St~~.~clc a~a~w~ ,~ ~/ ~ ~ (~~1 ` s ~• ''C /~ Wisconsin Department of Commerce Division of Safety and Buildings ~~~~~~~ SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 1936 Page t of 3 Certified Soil Testing County Attach complete site plan on paper not less than 8'/a x 11 inches in size. Plan must i l t li d b t i d i d h ri f St. Croix nc u e, no m to: vert u te cal an zontal re o erence point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 018-1027-00-000 Pleas e ~rin ~ all infQrmation.__ , ' , __ wed Re Date Personal information you provi may be~~nb~ses (Priv Law, s. 15.04 (t) (m)). ~~~ _ _ ~ ~ D w"~'v--~ Property Owner Property Location Platson, Clayton H. Govt. Lot NW 1/4 NW 1/4 S 13 T 29 N R 17 W Property Owner's Mailing Addr Lot # Block # Subd. Name SM# 2017 CTHW E t;>-;~;F ,,; iii~,v'~ ~ r1'1 City tate Z~fJQibl~f~DVoFi8lhlumber ;City ~ Village , Town Nearest Road Baldwin ~ WI 54002 715-684-2443 Hammond CTHW E New Construction Use: /; Residential / Number of bedrooms 3 Code derived design flow rate 450 /' Replacement _,, Public or commercial -Describe: Parent material sandstone Flood plain elevation, if applicable NA General comments and recommendations: install trench system w/ 0.5 gpd/sq ft loading @ system elevation 4.0' below surface contour lines as trench center lines GPD Boring # .mil Boring /,,,,~ Pit Ground Surface elev. 101.9 ft. Depth to limiting factor 70 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 7.5YR 3/2 - sil 2 m gr ds gs 1f/m .5 .9 2 i, 9-19 7.5YR 3/2 - sil 2 f sbk dsh gs 1 m .5 .8 3 19-32 10YR 4/3 - sil 2 m sbk dh gs 1 m .5 .8 4 32-44 10YR 4/6 - sl 2 m sbk dh cs 1 m .5 .9 5 ' 44-53 10YR 5/6 - sl 2 m sbk dh cs 1 m .5 .9 6 ~ 53-61 10YR 4/6 - sl 1 m sbk dh cs 1 m .4 .6 7 61-67 10YR 5/6 - Ifs 0 m dh cs - .5 .9 ~I a Boring # ....~ Boring ~ b~Q%ZO`-~- { { Pit Ground Surface elev. 101.9 ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell - Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 8 67-70 7.5YR 4/6 - sl 0 m dh cs - .3 .5 9 70-76 7.5YR 4/6 f2d 7.5YR 513,518 sl 0 m dh - - .3 .5 occasional high chroma s in horizon6; likely residual SS colors; possible redoximorphic features; avoid this area due to this & dense, deep sl textur tmuenr rti = tsVUS> su < 11U mg/L antl TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS _< 30 mgC CST Name (Please Print) Sig at re: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/3/2003 715-233-0398 ~i ,. ~ - Property Owner Platson, Clayton H. Parcel ID # 018-1027-00-000 Page 2 of 3 Boring # _r Boring Pit Ground Surface elev. 100.0 ' ft. Depth to limiting factor > 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10YR 3/3 _ sil 2 m gr mvfr gs 1f/m .5 .8 2 4-10 10Yr 3/3 - sil 2 f sbk ds cs 1 m .5 .8 3 10-38 10YR 4/6 - fsl 2 m sbk dsh cs 1 m .5 .9 4 j 38-69 10YR 5/6 - fs 0 sg dl cs 1 m .5 .9 5 ~ 69-90 10YR 7/6 - fs 0 sg dl - - .5 .9 Boring # -..~ Boring /, f Pit Ground Surface elev. 99.2 ft. Depth to limiting factor > 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ~ 0-10 10YR 3/2 _ fsl 2 m gr ds cs 1f/m .5 .9 2 10-34 7.5YR 4/6 - fsl 1 m sbk dh cs 1 m .4 .6 3 34-66 10YR 7/6 - fs 0 sg dl cs 1 m .5 .9 4 66-90 /4 S _ Ifs 0 sg ml - 1 m .5 .9 horizon 4 has stratified lamellae of ~ 10YR 4/6 fs ~ 1/8" thick alternating w/ Ifs a Boring # Boring /'; Pit Ground Surface elev. 98.5 ft. Depth to limiting factor > 98 in. -- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10YR 3/2 _ sil 2 m gr mvfr gs 1f/m .5 .8 2 8-44 10YR 4/4 - sil 2 m sbk dh cs 1 m .5 .8 3 44-98 10YR 4/6 - fs 0 sg dl - 1 m .5 .9 I occasional st stratified @ 40-44" Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing ~ ' ~\.c. ~oy 1 10.TSo~.- 1~1ot !-~4r. ©l~-1~2~-c9~.- or» !L°~'~ c~Hw k .~ a 46YK -~r4 ,...:fit ~ ?..,r~, ~' S~. E ,~~. ~ ~~ ~ ~ ~w i ~-v a.1\ :... ~ ~ ~-o`~ ~ o.~, w,., cX aFt i M.. w~ ti (i ~~.0.5 C O, ~~ uotit .~}~' ~ ~ ~~~ 3 ~1 ----y . / \ `t"S ~ ~.~~1 v ~ \~/ , .. ~ \yn o \ '~ \ ~r \y % ~'~~ ~ /loo.o~/ / mac. ~ -~ ~ ~~- o~,l~+. (.~4 ~~ -------"-_ s~. ~. ~~ ~ '~- i ! ~a K ~ ~ (~o at G A O~ ~ l u. S `i' "a+X S~"~' C1 ~?~o . a~ ~ ~°Y-"~.o :1. - a. v ~vs«~:~~Lv - d S SE~~.~c a~stw~ (e a ~~}} --;, 0 yr h~ 1 V 0. ~M W O N c-'tl-1 w L ~S«c~. t~~ - Z~~ o ~S 30 ~ .~~ u~H LLZ~7-4 ~e~t Io ¢X.o w ~~~ S-.c ~.,. ~.,,~, ~ l~ 0 ~ ~ ~ ~ LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018-1027-00-000 Parcel Number 13.29.17.1986 OWNER NAME: First CLAYTON H & CAROL Last PLATSON PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 2017 CTY RD E SECTION 13 TOWN 29N RANGE 17W '/<160 NW '/440 NW Line Description Line Description TOTAL ACREAGE 4.280 PLAT LOT BLK 01 SEC 13 T29N R17W PT NW NW 15 02 COM 630 FT E OF NW COR SEC 16 03 13 TH S 490 FT E 380' N 490 17 04 FT TH W 380' TO POB 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit .. PQWTS OWNER'S MANUAL & MANAt~EM~NT PLAN Page / of Z' FILE INFORMATION Owner ~ _ ~ Permit # s.3 0~-~ DE$IQN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated flow (averag®} .36a al/da Design flow (peak), (Estimated x 1.5} ~-r/ gai/da Sail Application fists Q . 7 gal/da /ftZ Standard Inffusnt/Effluent Quality Monthly average' Fats, Oil & Grease (FOGI 530 mg/L Biachemicai Oxygen Demand {80D6) 522a mg1L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOOS? 530 mg/L Total Suspended Solids {TSS} S30 mg/L Fecal Coliform (geometric mean) S ' 100mi Maximum Effluent Particle Size ~ in die. ^ NA Othef: ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECiFICA'1'fONS Septic Tank Capacity ©"dLy al ^ NA Septic Tank Manufacturer ~rC.S~ ^ NA Effluent Finer Manufacturer (` ~ ^ NA Effluent Filter Model ~ ar4 ^ NA Pump Tank Capacity 4 al ^ NA Pump Tank Manufacturer Sev J NA Pump Manufacturer ~jd A ^ NA Rump Model ,E,~jd ~ $~ ^ NA Pretreatment Unii ^ Sand/Gravel Filter O Mechanical Aeration ^ Disinfection 1 ^ Peat Filter ^ Wetland ^ Other: / Dispersal Gellls) n-Ground (gravity) ^ At-Grade O Drip-Line ^ NA ^ In-Ground (pressurized) O Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect conditian of tank(s) At least once every: ~ month(s) {Maximum 3 years) ear{S O NA Pump out contents of tanks} When combined sludge and scum equals one-third tY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years? .~ ~ earigi ^ NA Clean effluent filter At least once every: , r monthta) eartsi ^ NA inspect pump, pump controls & alarm At least once every: ..~. ~ month{s) ^ yearlsl ^ NA Flush laterals and pressure test At least once every: ~ ^ month(s) •_.. ^yearlsl ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS inspections of tanks and disperse! 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 tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to chock for any back up or ponding of effluent on the ground surface. The dispersal cell(s) steal! 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 felting 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 {Y,i or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of to accordance with chapter NR 113, Wisconsin Administrative Gode. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized pomponents, 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 4ocal regulatory authority within 10 days of completion of any service event. Page 2of y 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 celi(s}. If high concentrations are detected have the contents of the tankls) 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 cellCsi in one large dose, overloading the call{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 Saptage 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 fast 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 pumpl 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 Saptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized far 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. ~~ ^ T site h d site tank O 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. < <WARNINIi> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDJOR INSUFFICIENT OXYGEN. DU 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 ~~`11.'u `~ - ~ r ~ ~ 1~ Name Phone 7 l -- ~ _ ~ ~ Phone SEPTAC3E SERVICING OPERATOR (PUMPER) LOCAL RE(;ULATORY AUTHORITY Name Q /~ Namd ST. /L Q~ ~x ~ / / l~l PhORe - - . Phone 71,5 =3~ - ~ This document was drsited in compliance whh chapter Comm 83.22121{b}{11{d)b(f1 and 83.64(1), {7) b f3j, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK' MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~Ryrd nJ ~ a Q C'~32a L ~ , ~//~ 7S ~.~-~ Mailing Address ~~ 17 ~ ~ Q~ ld ~,' +'`l~ ~ ~ v '~ ©o ~ Property Address 0/7 c.a g 8.~/dam,°N, --cyz ~~~ oa (Verification requited fmm Planning Department for new City/State B~ ~~+~ ~ •~~. ~ z Parcel Identif cation Ntunber ~ l3. ~~. /7 . /9~~ o~~- ~o ~.~_ ao -asp Property Location ~ '/,, /J~ '/., Sec. /~ . T~N-R 17 W, Town of f~A~ m o ~'~ Subdivision y 2~~~~~ ~~-a y ~4L~n~ .Lot # N ~. Certified Snrvey Map # /"~A .Volume .Page # Warranty Deed # ~3~~~ .Volume S~v2 . Page # ~ Spot house ^ yese~,no Lot lines identifiable ^ yes ~ no SYSTEM MAIITENANCE Improper use and maintenance of your:eptic system could result is 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 is the waste disposal system. The property owacr agrees to submit to St. Croix Zoning Department a certification form, signed by the owner snd by : masterplumber, journeymanplumber, restrictedplumber or a liceasedpumper verifying that (1} the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is ices than 113 full of sh~dge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the s4ndards set forth, hereiq as set by the Ikpattment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three y~e/ar expiration date. .~ fY ~~~ D51 /~i d SI~ OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that atl 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 deed recorded in Register of Deeds Office. ~s~~~ ~ ~C~'~ SIGNATURE OF APPLICANT 5 i 1 ~ ~{ DATE ssssss Any information that is mis-representedms~y result in the sanitary permit being revoked by the Zoning Department. •*ss•• ss Include with this application: a stamped warranty deed from the Register of Deeds ofTce a copy of the certified survey map if reference is made in the warranty deed DUCUM[NT NO. -w 3438~U vQ=_ 562 ~a~~`39~ • ~ B1~ This Ueed.....A1.an...8....CarnerQn...~n~..M~l^y...Cam~rRli...a.~.S.o .....kno~ln.--as_..Mary„ B.,,_Cameron,,,,husband,,,4nd,,,w~,f ~..,a~...~R1.rlir........ tenants„„ ,,,,,,_„ Grantor conveys and warrants to......Cil.dbl.~Qll...i')......P.I~tSflll..llll(i...lwa1:II1...~....... . -P1.ats.Qn,...h.~sband...and...r~~.fe...a.~..~a1.Rt...Henan.is.....- ......................._ ......................................................................................._.............._.................., Gantee...~.., for :valuable consideration .................................................................................»..........._...._ the following described real estate in.....S.t....~rA.ix ........................._.........._... County, State of Wisconsin: T[ fiAR O/ WtSCONf~N - -URM ! W~RRArTT DEED NA.:a h[a[wvaD -Oh R[COwOiNO DATA ', REGISTERS dFFiCE ST. CP.OIX CO., WtS. Recd, for Record this ],3 _~ day of October A. 19_y? ~at 8:'~0 A. , M. /) Rp4far of oiALa- RfTYRN TO Tu Key ~..._.._.._............_.._....~.»... This is ..,.LtQt._... homestead property. Commencing at a point 630 feet East of the Northwest comer of the North Half (N~) of the Northwest Quarter (NW;) of Section 13, Township 29 North, Range 17 West thence South 490 feet, thence East 380 feet, thence North 490 feet, thence West 3R0 feet to place of beginning. ~~Y~i~ ~ 40.0 r ii u Exception to warranties: ~C' Executed aL..~L~..l•-71-...~:r.~:~.. ths...........fj..,...._... da of. .. ~i(~..._..._....._...._..., 19.1... BIOYBD AND BEALED IN PF.ESE~ICE OP ~,~fk.~~-_~,,,~„_........~ ...... .......~........._... ~"~~._........(SEAL) Alan B;Camer~n - *,~.••''~wy'_~r• Mary BcCameron •. ' Signatures of ....1 d~Q~~-..~ ................................~fA......, authenticated t day of .........: .............._........_................................................(SEAL) ......._~..........---..........._ ......................................._....... (SEAL) ~ ........ ...... s~.........A...-.ref-....... ... .................._.._... ~~J~..._._.....19..~~ .................._............................ ~ C N,1 -.. N/A ~'~•'*i+~y~.~ ~tf~,A14S Tide: 1ltember State Bar o: Wisconsin or Othet Pary cll •~ ' /~ ~`"• ~~V~ ~ Authorized under Sec. 706.06 viz. r : • • i ss. s. s..= x /n ,.....::s:..~- j'-.......County. rf Persc~n~Th`. ' ~ b!T ~' au. this .........................................~7 .. day of........--•-- 19........ the above nam~./...A,.~l.a.(1...$....CamerQ~.. a.nd..Mar.Y....13,....G.amenon ... ........................ ........................................... .................. to me known to he the person...... who executed the foregoing instrument and acknowledged the same. T IS NSTRUME T WAS DRA ffD BY .................................._......._.. .................,.......... -.................................. Anderson-r"rei tag, nc. New Richmond, WI 54017 ___ _______~_ ~_____ The use of witnesses is optional. Notary Public, t<..'i~~~:~...j~7`j~,,...S..ILl..... County, Wis. A _ _ .man ~ ~ ~ ~ State of Wisconsin ss County of St. Croix ,F1 ;<, - "~ ~-'tf'r >~ THE ST. CROIX COUNTY ABSTRACT COMPANY hereby certifies that-ihe foregoing abstrgct._consisting . .:. ., t .~, ,~ ,. of entries No. ~_ to ~-, both inclusive, is a correct abstFact of title since e ~ ~ f ~~ ~ ,~, October 16, 1935 at . 10:00 o'clock ip the `_;; A M Hof fond{~ '~`'~ik~d~~1rz . . , ~ {w $ •- .he Caption at ATO.-51 hereof, to-wit: ~~ R ~ a~a~ '`~~ t ~~ Part of NWu of NW,-~ of Section 13-29-17. That, for the period covered by this certificate, said abstract correctly shows all matters affectins or relating to the said title which are recorded or filed for record in the office of the Register of Deeds of said County, including Federal Tax Liens and Old Age Assistance Liens filed therein against the parties listed below. For the period covered by this certificate, except as shown by this abstract, there are no unsatis- fied mechanic or material liens affecting title to such lands docketed in the office of the Clerk of Courts in said county for the past two years. That, except as shown in this abstract, there are no unsatisfied judgments, including delinquent In- come Taxes, docketed in the office of the Clerk of Courts in said County within the past ten years, as and against the following named persons which affects the title to the real estate above described to-wit: Donald Zignego Alan Bart Cameron Mary Bridget Cameron Clayton H. Platson or Carol D. Platson. That for the period covered by this certificate, all instruments appearing in this abstract contain the necessary number of witnesses and acknowledgments unless otherwise noted. We further certify that for the period covered by this certificate that we have carefully examined the records in the office of the County Treasurer for St. Croix County, Wisconsin, and find no record of un- paid taxes or assessments standing as a lien on the real estate described in this abstract, except as shown herein. Such examination covers up to and including the taxes for the year 19~_. That this certificate and annexed abstract and also any prior certificates, if any, made by the un- dersigned, covering the same land, are furnished for the use and benefit of any and all owners of the land described in said caption and their successors in title, including mortgagees and guarantors of title. Dated at Hudson, Wisconsin, this _ ~h day of s1c~t~hPr A.D. 19~_ at .8.30 o'clock in the ~M. SEAL