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Home My WebLink About018-1047-40-100aconsin Department of Commerce ~, PRIVATE SEWAGE SYSTEM safety and Building Division ~ INSPECTION REPORT GENERAL I~lFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s. t5.04 (1)(m)]. Permit Holder's Name: City Village X Township Theis, Richard G. Hammond Townshi CST BM Elev: Insp. SM77~~Elev~ lyy- ascription: r V ( ltu0+~~ ~ TANK INFORMATION la se~v~t PT- cta.re~. ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ •tS~~ l Old Dosing d~~Z(/i.,(~ r ~OZS Aeration ~'' 3 ~ ~ , Holding ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic it ~ ~_ osin Aeration Holding PUMP/SIPHON INFORMATION ~~ ~''`~'~-~ Manufacturer Dema 1 ~ Model Number .yZ ~ w ~o ~ t,.- TDH Lift ~ Friction Loss System Headt T Ft ~O , o (a . Forcemain Length j Dia. ~~ Dist. to Well SOIL ABSORPTION SYSTEM fD n .~ Y ~ ti c°unty: St. Croix Sanitary Permit No: 430493 0 State Plan ID No: Parcel Tax No: 018-1047-40-100 Section/Town/Range/Map No: 21.29.17.331 D STATION BS HI FS ELEV. Benchmark ~ ., AIL BM Bldg. ewer , SUHt Inlet St/Ht Outlet Dt Inlet Dt Bottom / ,/ ~ - ~j t H~t ,/~ p,~-~ / 7 Dist. Pipe pt{.O . ~ , . Bot. System .~ p~_O r _O Final Grade ~ / s {~ ~ 7 ;Mot A* iZtl-f St Cover a'0 • B Width Length No. OfT n s ` PIT IME SI NS o. Of its Inside Dia. Liquid De th MENSIONS / ~ ~ ~ ~ ~~ ~ 1 t7'O SETBACK SYSTEM TO P/L BLDG WEL LAKE/STRE M LEACHING n acturer: INFORMATION CHAMBER O Type Of System: t ~ ~ f r ~_.. U Mod bar: > ~ ~~ , DISTRIBUTION SYSTEM -b,..LtIE'~ °~"- ~ "~' 'a'~~" ~j("~-. I>Joe ani v Length ~•fl Dia ~Z Distribution / Length ~•~~~`~ia i~ lZ Spacing ~ ~ ~ r x Hole Sizep tt / 0 x Hole Sparcing 2 ~ J 3 , Vent to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At.Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Edges Topsoil Yes [_~ No ~r. ~~ Yes Lj No ~C MM N]'S'~(I~nc~d~re~e t ies, pe~SRn~'pr~esent. etc ~~I spection #1: ocation: 813 170th Street Hammond, W1 54015 SW 1/4 SW 1/4 21 T29N R1~W NA Lot 1 ~~~ 1.) Alt BM Description = ~l~ ( ~d~'~'-""`""~C S~ ~-ice' ~ 2.) Bldg sewer length = ~ C~e~ ~ ~. -amount of cover = ~ ~ ~~ ~~, _I, 3) rnow•~~Q n~.suc~c. '~P ~ ~ e'~a • Plan revision Required? [] Yes ~No 2.3 Z4e~ ~ Use er~ .#or additional inf a`ionM _; _x1b+Ja~W~ry~~~ -- /, SBD-6710 7 .. ~'~+'"+4p~+'~/_~u CiwC ~MARA••J'~Y1Q • / Inspection #2: Parce ;No: 21.29.17.331 D o •9S ~ ~~ ~t D :r tA~sw,Y~c. ce•~r ' jQ `~"~+~ t Cert. No. ~~ Safety and Buildings Division County! //~~ ` ' ~ ` ~ 201 W. Washington Ave., Y.O. Box 7162 , 1.../ O • ~ ~scans~n Madison, Wl 53707 - 71 62 Nwnber (to be filled in by Co.) Sanitary Permit 2 3b De artment of Commerce Sanitary Permit Ap lica on Plan 1.D. Num state pers 1 info o}u yqy p vidR1 Code 3 In accord with Conxm 83 Wis Adm 21 r ~Q / ~/~~ , 0 . . . , l(I)(mq ~' LUU maybe used for secondary purposes Privacy w, s Project Address (if different than mailing address) 1. Application Information -Please Print All Information ST, CROIX CO ONING OFFICE ~~ Property Owner's Name - a Z 3 Parcel # Lot # lock # ~- ~.- ~~- ~~,~~~o~ ~ __ Prr~perty Owner's Mailing Address -~ ~ 1'roparty Lor:ation ' .331 ~~"' `~ '"' Section ~~. ~ City, State Gip Code Phone Nwnber ~ _ -- !L//1h1~~ ~f• 5~/n~ ~" ~7rs- / _~~/~ T"~+ t0 T I (circle one) T ~ N; R~3tC4V e of Buildin (check all that apply) ll T -"' g . yp INlI or 2 Family Dwelling - Ntunber of Bedrooms r __~ __-- -~ - ~~ ~ Sub~siea-1 CSM Number l -Describe Us ^ P blidCom e ci `5 ~ ~ ' ~ S u m r a e __ 2 ! U~ ~' ~~'~" " " ^Village ~wnship of ir9/s! City / i0. ^ State Owned-Describe Use c l..~C~~ lU /~ _ lll. Type of Permit: (Check only one box on line A. Complete line B if applicable) :1. ^ New System ~lacenxeut System ^ 1Yeatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Yertxut Transfer to New er and Date Issued List Previous Permit ~u m b Before Expiration Plumber Owner p ~ j ~~J%kj7,(~yj ~/ 0 "' ~ t/l rj ~ ~- 1V. T of PUWTS S stem: Check all that a 1 _ ^ Non -Pressurized hx-Ground ~ Muund > 24 in. of suitable soil ^ Mound < 24 in. of suitablo soil ^ At-Crr~tde ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressw-izcxl hx-Growxd ^ Holduxg Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recireulatirrg Saxxd Filter ^ ^ Gravel-less }:ipe ^ l7tlur (explain) ~ ~ Recirculating Synthetic Media Filter ^ Leaching Chambu~r ^ lhip Line _ V. Dis rsaU'I'reatment Area Information: Cj 1~ ~ ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Arcs ltaluirt (sf) Dispersal Ar Proposed (sf) System Elevation Co~-~~d. O _sf -G_J3 _ __lo~_ {-IE.• __ ~G~_ f'f . 97_~_f • t9G. ~- S l Fiber Pl b Sit ti f ~ e c a as ' / urn cturer ~ Vl. Tank 1'lifo C city in Totiil Number ~6(~ Concrete (:onstructed Glass ~ Gallons Gallons ofUtrits ~ (/v Ncw Exiting ~ ~l ~ ~ . ~-- Ta 'ranks I i~ '~"' ScpticorBoldingTatllc` L~ //_ V ____. Z ~~„fps ~C• w~ ~,/ .4crobic Tn;atmcnt Unit DosingC6amlx;r ,~„ C?A.1 Q~ I ~ (~~e~ ~~ Vll. RespunsibilIty Statement- 1, the Und signed, assn esponsibillty for Installation of the POW TS shown on the attached plans. Plumber's Name (Print) PI 's Signat MPf3atf'If3 Number Busutcss Phone Number oe 5.~. ~ za3 ~ 7~ C~~s ~ s~~ s~~, Plumber's Address (St City, State, Zip C e) VIl oun /De artment se Onl Approved ^ Disapproved _ Sanitary Perxrlt Eee (includes Ciroundwatar~ Surcharge Foe) Q/ 6 a ate sued ~ D 1 mg Ag Signature (N tps) ^ Owner Criven Reason for Denial ~~~ ~--N ' ~~ L 3 ~ C ``,/"' / _~, '~ la. Conditions of Approval/Reasons for Disapproval ~ ~GG y ~ Wl~ yw'c- ~`tR'~- ~'~j`~ " - ;. (~{, O"Yl,o /!A 3 o , _ - ~ 1 . ~t h Ci'~"K-~~t STEM OVER: /n~~. m~.~3STi /I0~2 `-/ ~~~G( -~o ~y ~ ~,~~" Septic tank, effluent filter andl.0 l ~JJ~GvL ~ - > dispersal cell must all be serviced /maintained ~(D ~ ~ ~ ~ i/ ~ ~,, p t~~y as per management plan provided by plumber. All setback requirements must be maintained ~-~ J ~~ ~ ~ ~ d ~~~ ~ ~ as per applicable code/ordinances. Yh/+~• 3• ~3 / ~ ~• ~~?~~ DI Attach cumpletc plans (to the County only) ror[hc system oa paper not Icss man tsuL x r r utcurenn s.zc (/ SBD-6398 (R. 01/03} ' . J /- a i r So~~ ~VR~Cc4fi•or~ P. t ~'/Q FLU On I ~j Qc~: ~ /73/ ,~~ ~d ~-1.,~.i TX e;s Io~co, Skid O.Spka.4~ drlrew°'Y Ew3~'n~ ~ 6 edfoarn ~ y-- lve c f - dwellihJ o .ZSS EX/ Sfinr~ /, czaJ c~ a.P ' " ~, ~ sryf~ P,r ~~ ~ ConCrt te ~ ca.JecKs 1. _ E'yrsfl.~q SG~J ~a.P. ~.uee,t's eo.,c.rcfe -~ Pao os ~~'l~c/ ~'a. 1 A-/w /,4kfiP Gka.., bar. QF.~' ~ce--rE ~; l~~ 9~ ~"~.yo P.~~. ~rcc.xa~ K. ~ _-~~~ B ~ ® ~~ ` ~ , .o ~ ` o ~~ `~ \ ~~ ~ ~ AXIS El^~ rnownd~4 ~ ~ , ~ \ ~ `~ ~ ~s~ ~ -~ be r'~.noveal'> P~la~{o CanSf ~'uLfh~-~ ~ ~ ~ ~ ~ . o.prc~/acc..~~.,E,.1o~ ~~ \ ^ 9. a~ ~ ~ 3 J I~~o po sc,c1 r'e~/a cE.~.~ ~ m ou-,-~d a ~ /~. 9s/;r i/S. ~' o- '~/ ~o~X ~~~ ~:S~OeI-~/ Ce/% T4.7a ~2~ ~Q-L~era.lS a~ ~S /ys.•,z, 9B. 6 7 i.~/f'6' ~~m'; o4''car S~oa c e1 a,E z. S3.' `0 ~~~~fl~ ~.S ~~~~ ~ isconsin Department of Commerce Safety and Buildings 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304 TDD #: (608) 264-8777 www.commerce.state.wi. ustsb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 23, 2003 CUST ID No.223475 ee Town of Hammond, 54015 Con St Croix County ~~ SW1/4, SW1/4, S21, T29N, R17W Lot: 1, DEPARTN FOR: ~ $~~ ~`~~ DIVISl~N OF Description: DICK AND CHAD, THEIS MOUND "'" v~ , o Object Type: POWT System Regulated Object ID No.: 9 77~ /~'~'~ ~~/ ,~.~.~t SE ~°COI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.. A7TN: POWTS Inspector JOE STANG ZONING OFFICE STANG PLUMBING & ELECTRIC ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD WOODVILLE WI 54028 HUDSON WI 54016 ~y3d 3 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/23/2005 Identification Numbers Transaction ID No. 935162 SITE: Site ID No. 667410 Dick and Char Theis Please refer to both identification numbers, 813 170TH Str t above, in all corres ondence with the a enc The following conditions shall be met during construction or installation and prior to occupancy or use: . This plan action is subject to designer comments on the plan. • The existing septic tank must be inspected for structural soundness, size and baffles, and must be brought into conformance with the requirements of chapter Comm 83, Wis. Adm. Code. • * If it does not comply, astate-approved septic tank shall be installed. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. JOE STANG Sincerely, G. Wesley C ube Plumbing Plan Reviewer ,Integrated Services (920)492-5613 , M-r 7:00 - 16:30, F 7:00 - 11:00 wgrube@commerce.state.wi. us Page 2 10/23/03 Fee Required $ 350.00 Fee Received $ 350.00 Balance Due $ 0.00 WiSMART code: 763'3 cc: James K Thompson , A.C.E. Soil and Site Evaluations Leroy G Janslcy, Wastewater Specialist, (715) 726-2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Dick & Char Theis 4 bedroom residential mound system Owner's Name: Dick & Char Theis Owner's Address: 813 170th Street Hammond, WI 54015 Legal Description: SW1/4SW1/4, Sec. 21, T.29N., R17W Township: Hammond County: St. Croix Subdivision Name: CSM Vol. 7, Pg. 1875 Lot Number: 1 Block Number: NA Parcel I.D. Number: 018-1047-40-100 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Page 10 Existing system inforrnation ~~~~~~~~ aCT 1 6 2003 tronally ~~V E D OF COMMERCE cTY A BU1LD1 GS ~-- :SPONDENCE Designer: Joe Stang License Number: 223475 Date: 10/10/03 Phone Number: (715) 684-5166 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) Page 1 of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) _ R Residential or Commercial Design ~_ 400.00' Estimated Wastewater Flow (gpd) r 1.5 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 3.00 Site Slope (%) 96.29; Contour Line Elevation (ft) 27.00!, Depth to Limiting Factor (in) 0.50% In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information _ 100.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e) ('- e~ Center or End Manifold 3.00 Lateral Spacing (ft) 2~ Number of Laterals 0. 2 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in 45.00 Forcemain Length (ft) 89.79 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 6.75 Vertical Lift (ft) 1.04 Friction Loss (ft) 14.29 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 I 1.00 _ 1.25 _ 1.50 x x _ 2.00 x _ 3.00 x Treatment Tank Information 1000.00 Septic Tank Capacity (gal) Wieser Concrete ~ Manufacturer Dose Tank Information 912.25 Dose Tank Capacity (gal) 22.25 Dose Tank Volume (gal/in) Wieser Concrete ~ Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest oint in the distribution Y network? Enter Y or N If N above, enter the elevation (ft) of the highest point. ~_ 7.50 ft2/orifice Does the forcemain drain back? -~- Y Enter Y or N 7.34 Forcemain Drainback (gal) 90.53 5x Void Volume (gal) 97.87 Minimum Dose Volume (gal) 32.95 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 1.50 2.00 x x ~l, 3.00 i Gallons/Inch Calculator (optional) 912.25 Total Tank Capacity (gal) 41.00 Total Working Liquid Depth (in) 22.25 gal/in (enter result in cell B49) ~6n .~ v,,` 3/ to ~ -~ Effluent Filter Information Zabel _ Filter Manufacturer A100 _____ Filter Model Number Project: Dick & Char Theis 4 bedroom residential mound system Page 2 of 10 Mound Plan View 1 - -1/10 B • •Observation Pipe •~ • K • • .,, {ti; Y'5. :'Q?. . .. ; .; ., . •. . 4 ... M. • B - -~ .~ . ~ . . -f J .T A z _~ - L -~ Mound Component Dimensions A 6.00 ft E 11.16 in B 100.00 ft F 9.50 in D 9.00 in G 0.50 ft H 1.00 ft K 7.90 ft z 7.32 ft L 115.79 ft J 5.62 ft W 18.94 ft 600.00 (ft2) Dispersal Cell Area 1332.42 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.83 (ft) --- _, ~`.,,, ,,.... ' . G ~ H ~ . /lflN1 ~ t t / f!/l/11r.: ~~ ft) Lateral I F : ; : ; : Dispersal Cell 97.54 97.04 (ft)-- ~:• Invert Dispersal Cell ;3~. ~ ~ ~ • • ~ ~ Elevation E. ~ D ~ ; ~: • . .. ti 3.0 % Site Slope Shading Key Q Topsoil Cap © ~~~'f Subsoil Cap ©~ ASTM C33 Sand [~ ~ ~"~`-,` Tilled Layer 05 Aggregate d $'. o •a 1.5 ft N O 0.5 ft 0 ~ ~ ..,.,.ti.4.+..•• atera! • .~~'• A --~ (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Dick & Char Theis 4 bedroom residential mound system Page 3 of 10 End Connection Lateral Layout Diagram Laterals cantered over the A & B dimensipn ~ =Turn-up nPball valve or cl eanout plu g P All laterals are Identical ~E X --~ I Hol es drilled on the Gottom of the lateral c equally spaced ~-- - Foreemain connection pia tee or cross to manifold at any point. Laterals & force main of PVC Sch 40 [per COMM Table 84.30-5) Number of Laterals 2 Lateral Diameter 1.50 in Lateral Length (P) 98.67 ft Lateral Spacing (S) 3.00 ft Lateral Flow Rate 16.48 gpm System Flow Rate 32.95 gpm Total Dynamic Head 14.29 ft Orifice Diameter Orifice Spacing i;~ Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity 0.125 in 2.53 ft 40 7.50 ft2/orifice 3.00 ft 1.50 in 3.37 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---- Comm 16.28 WAC ~ ~ 4 in. min. - Disc~ect -!- ~^_ Project: Tank component is properly vented Wieser Concrete Ca acity 912.25 Volume 22.25 Manufacturer Gallons gal/inch A s C D Dimension Inches Gallons A 21.54 479.28 B 2.00 44.50 C 5.46 121.47 D 12.00 267.00 Total 41.00 912.25 ddinq under tank. Alarm Manuafacturer LevelArm _~ Alarm Model Number DLV ~__---~ Pump Manufacturer Goulds _ ~ j Pump Model Number 3885 WE03L~-~`~ Pump Must Deliver 32.95 gpm at 14.29 ft TDH pick & Char Theis 4 bedroom residential mound system E-- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 90.79 Dom se tank elevation (ft) 89.79 Page 4 of 10 Mound Svstem Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS#4819 Phone (71~ 248-7767 POWTS Regulator's Name St. Croix County Zoning_ ___~ Phone 71~ 386-4680 Svstem Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Inspect and/or service once eve z years Should ins ect and clean at least once every 3 ears Test once every 3 ears Should test monthly Laterals should be flushed and pressure tested every 1.5 ears Ins ect for ponding and seepage once every 3 Years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6}(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •.. ......... ............... .. Grade \ , " ' " 6-8" Diameter Lawn ~/` ~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Dick & Char Theis 4 bedroom residential mound system Page 5 of 10 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)j and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present khat could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s, 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, The operating condition of the septic tank and outlet filter shall tie assessed at least once every2 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pume Tank The pump (dosing) tank shall be inspected at least once every years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall lie seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration, Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations {October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continoencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Dick & Char Theis 4 bedroom residential mound system Page 6 of 10 -_. _.. r.... __._ _ _ -.. ._ _. - _ __ _ _ _ ~~'~ - ~ - - - ~ _ - ~ NOD 33f~`,~ ~ \ _ _ _ _ _ - -~ ~ - - ~ ~ °u 1~i Specifications 1 r- _ ~ ~ ~ ~ I~, ~.~~c ~~ _ ~' v'. ( ~ ~ ,r .~ ~ "1~hri ~~.Is n ~ any+.ruciion Features ~~nd Etenefits ®All n,~rl~l f~~~~ silicon carbide mech~n ca .~r,~~l fcE,~ fc ,iipenr,r ;irl8 ;I /F- ~E SISta ~l.l~, ~ Il(. ~- Xil"3 I~~,~g life ~ ~ ~t i n ~ ~ r, ~,.,,~ ~ ir,y '~ f" Cl~~ ~~:.1 F'' .( ~~(ul ~ ~ ~<<p'~he~r~l~. ~~ ~, t~r ~ ~h~n ~ s sF~ei ~i ~~_ • '.1~~rC i~ '~l I V' ~ I'~i ~ ~ h C'1 r(! ~e ~>> I~ 1~c ~ . ~1i7`.IC 'a ~I I ~Q ~ l'~'~f ;'Z '' 1)C~~ iff ~~ll~;lli~'. CSa -IS1CI C107~;1; ~i '-t!l 1~~;. (U~; Undervir'frs Lai~o~~~ai~ries ~,. ~` ~ ~~ r ; ~ ~ 1 ~ I a ~~ it ~'dii na. ~:". i T~~~~. ' ~ _` '~ a~ g ~U s r "~~~,~? 4; y f `r yY r----___._ _~_._ _ ~t-F'P; f 1 _ _._____.__.. ___. ____ ~- _--- __T .._ _ __. __.__.___..... _.____ - 1 ~-•.` ~ ~. -.,. ' _ i ~~ --- f -- ~ ---- -} - - _ _ ~__. - - - [ n 1 E ~f _ -.-... Cr PAC'lY Pump Sf~:ecifications Features and Benefits 'iz Hr' • ~la~~s iill=d. t~,~,~~~~m~;~ias:. ~ ~~=~ up try ~.> >.,1~ ~r~,e!'~r Ih ~t~~ir ~,,~ ~.~f ti'~.lfi('1J~ 1C3~I 1( '~3 fla ~ ~lfl.~ )U ~lil ( 1 .~= fr ~,T I~'lll~l ~ lic f~l~l'~~d S~l' p ~, ,_~ _ . ~ _ f~1ct~i ~r~a~1 ~~E~ ~~ ~ -- a' 1Cf '. ~ 3!. C~ i;l' ~ cr I E ~ ~'I' - ._ ~ 1~E i`c: _\ "~ ~ CI- ~l b ~ ~ it I~ ; `' 1~1~31~~ria~~ iii Goi~~tnic-~Cr i ~ ~~ir<~.hi its - ._tic ~rif ~ ~ ~; c~ f, ~~~ 1~SS C'e 3~:3- • ae~ ~~(J'E it aUi~'~l f , ~if: ~ `~ ,., n ~_~~ I ~ • ~~~ I;:f( ~,~~) i~',i; , '=tip(?I~ ~~~~ ,~~J ~E ~S ,-1/C' 7:-S .jl'PC~ 'O'' ;'Ol'~l!~ OJ" O'C~Ic'i10:1 ~"1/)~. ~ i `~1~ S~clil) ,.; > SSE ('. ~ l~~'~I' c ~E'. ~• i S o;/ EVa /u a~6'm-~ P, t • E/e„taf'o.~ ~I ca! :/`_~~ ~i Q~: ~, l73/ E( Sl.~d aspk.a,l£ dr•;v~ewa.r EXi 3 t,'nJc ~ b ¢alrogn.~ ~-- Wet 1 dwell;h ° ~,4'/ Sfin, q /, ~e,~v aR (/ cJ ¢cKS CanCr< e ~ ~'~~r~ ~r`~ ~ ~ ~.'" S ~ 5epfi•L fa.n~ o e-ylsfin~ ~cn ~~. pro os `OK.,~ p Okay, bar. ~~ ti~~'+£ ~ ff~ ® \T .o x\ ~`o-~ .\ eXiS~ rnownd\~ ~ ~ ~Orlu~ ~Ev C.an SEi'ucklb.~ ~ ~ O~~C~~acG~~-nE ~o _ \~ \Q az h~/'oPo sc.c~ /'~/a Cei„o,~ ~. rn ou,-rd ~z ~ /~. 9s/,+- //S. ~y' ~'~/ ~o'X /G~' a~iSPeis~t/ Ce// TWO (ZJ ~¢terc~.S a~ - /yi~~x 9B.~7i.~/f'B~~o'';°4''c¢.t5,~aceo~a,6z,S3.' ~.„S~.vo P.~~. . -- ~ \~v~'C4ntai~'l. t i 1 \ ,1 ,\ ~ \~\ \~~ \~ ~ \ \ \ ~, l 3 J a~ d c 'D ~S 8d~'!o ~ r_. . _ i 1731 'Wisconsin DepartrnentofCammerce SOIL EVALUATION RE~0~2T„ ~'< ~ ~~ ~ % p~ 1 of 4 Dnrision of Safety and Buiklin~.s ,,.~,,,,,,,,,,e ,.,;~, r,,,.,.,, n~ -ni~ e,~.n r~ t A.C~E. Soil & Site Evaluations ~ Cote Attach complete site plan on paper not less than 8'~4 x 11 inches in size. Plan must '_ $t.,f ;~p~ include; but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale w dimemsions, north arrow, and location and distance to nearest road. . . o -1047-40-100 Please print all information. evi y Date Personal ~farmation You txovide may be used for secordary purposes (Privacy Law, s. 15.04 (1) (m)?. ~ jyN,.~ 1 D ZG/ 03 Property Owner Property Location Dick & Char Theis Govt. Lot SW 1/4 SW 1/4 g 21 T 29 N R 17 W Property Owners Mailirgt Address Lot # Block # Subd. Name or CSMI# 813 170th Street 1 CSM Vol. 7, Pg. 1875 City State Zip Code Phone Number ~ City ~ Village ~ Town N~rest Road Hammond ~ WI 54015 715-796-2423 Hammond 170Th Street New Corfstruction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate Replacement ~ Public or commercial -Describe: Parent material Glacial till Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 97.04' at 9" above 96.29' contour. 600 GPD na ^ Ong # ~ Boring 1/ Pit Ground surtace elev. 95.74 ft . pepth to limiting factor 27~~ in- Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. Consistence Bourxiary Roots GP *Eff#1 D/ftY 'Eff#2 1 0-9 10yr3/3 none sil 2fcr ds as 2f,vf 0.5 0.8 2 9-20 10yr5/4 none sil 2fsbk ds gw 1f,vf 0.5 0.8 3 20-27 10yr4/4 none sl 2f&msbk dsh cw 1vF 0.5 0.9 4 27-40 7.5yr4/6 f2f 7.5yr5/8 scl 2f&msbk dsh cw 1vf 0.4 0.6 5 40-56 7.5yr4~ c2d 7.5yr5/8 scl 2msbk dh - - 0.4 0.6 Bonng # -~ Boring Pit Ground Surface elev. 95.85 tt. 29° in. Soit hon Rate !~ Depth to limiting factor Apptica Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 DIfi= 'Eff#2 1 0-12 10yr3/3 none sil 2fcr ds as 2f,vf 0.5 0.8 2 12-17 10yr5/4 none sil 2isbk ds gw 1f,vf 0.5 0.8 3 17-29 10yr4/4 none sl 2f&msbk dsh cw 1vf 0.5 0.9 4 29-43 7.5yr4/6 12f 7.5yr5/8 scl 2f&msbk dsh cw 1vf 0.4 0.6 5 43-52 7.5yr4/6 c2d 7.5yr5/8 scl 2csbk dh - - 0.4 0.6 ' Effluent #1 = BOD ~ 30 <_ 220 mg/L TSS >30 < 1 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Signature CST Number James K. Thompson _ = --- 3602 Address A.C.E. Soil i3< Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, WI 54020 10/92003 715-248-7767 SOIL AND SITE EVALUATION 1731 Page 2 of 4 PROPERTY OWNER: Dick & Char Theis PARCEL I.D.# 018-1047-40-100 AC.E. Soil & Site Evaluations T REPORT MEMO Soil evaluation completed to verify suitability of site to allow replacement of existing hydrollically failing mound system. Failure is due to a clogging mat at the sandlgravel interface with effluent breakout occurring near the top of the mound. Excavation into the system reveals that the sand beneath the clogging mat is dry. The interface of the sand and native soil is dry and does not have a developed clogging layer. New mound to be {ocated as near as possib{e to existing system per owner preference. Existing tanks appear sound and will be reused in design of replacement mound system. S o,/ E/a l uct ~i'ori P. • ~le,,af 'o~ c:a.re : i = s~o Q~'~~~si S l.c-d Z SS ~ - E,E'i Sfin. 9 /, ce,~ a.R ~ e c~J 2u~S CanCr< SC'pf.'G fa.ni~ o EYiSfing $0.7 ~aP. `Ou.r~ p Gkan bar. 9,29' Sf~ ~ 61 • ~'~ ~ ~ ~ /~ / ~ ~ 1 ~ 1 ~ ~ ~ 1 o. er;5~ „wk,~d ~~ ~ ~ .noved--1 ~ be ~ ~Or/ar {~ CcM S~kG~i~ az EXi3 fy'n~ ~{ 6¢draw, dwcll;h, -..- ~~~~ -~ - ~t ~~ '~, d~s~ovs~C.~l% f 1 1 ~\\ ~. ,~~ i ~ ~ 9G.z9' y J.~ 3 J v~ c b ~-- wetf 0 3of CEPPRT(+c1L~N T OF INDUSTRY, , LABOR A~!D ~ HUM,aN RELATIONS SW.. cOhr;Tv St. i ~/as.ti 4, zl /Tz9 `REPORT ON SOIL BORINGS ANU SAFETY & BUILDINGS DIVISI(~IJ PERCOLATION TESTS (115) MADISO , COI F3~07 (H63A911) & Chapter 14'.1.045) - - TOWNSHIPI~'CJX1PChPXD1~9C ------ L.~~7 Nc~.: i3,_K. NO.: SLfSi~l VISION NAME: - ~~-~ /R17 ~ Iorl W Hammond rt / a n/ a n J a ~I Croix Gerald Hopkins n/a Hammond, ~1_i . g~New Q13eplace 54015 I DATES GBSERVAI IOf1S MADE _ _`_ PfiOf=1LE DESGRIf'`1-1ONS: I'Ef~Z`~A7IOfJ 1 ESi-S 7-h--87 7-20-~37 RATING S= Site suitable for system U= Site unsuitable for system CO~.VEivT1CNAL: h90UND: IN-GROUND-PRESSURE: SYSTEM~IN-FILL HOLDING TANK R1 ~s~u ~s^u _~s~u asou ^s~u1_ (MENDED SYSTEM:loptional) mound Ir Percolation Tests are NOT regwred DESIGN RATE. If any oortiou of the tested area is In the -.^---- under s.H63.09(51(b), indicate: n ~ a Flood Main, Indicate Floodplain elevation: r1 ~ a decirnal' PROFILE DESCRIPTIONS pale Gl JeB BOEING ~ TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH ' ~ NUtv$ER B-~ DEf'TH I}C. 5.99 ELEVATION 104.28 03SERVED none EST. H'GfIEST 3.66 TO BEDROCK IF 03SERVED (SE(_ AE313RV.ON BACK.) _ _ .92b1.1. .83bn.sil. .83bn.s.1.1..08bns.cl.1l - B- ,, 1 =1 -- 6 Z6 ---- 1.03. ~3 Tzone i - 2.59 --- z-~3-ern-liltr~-~ .-f.`~ .-~------ ---~', .67b1.1_. .t~7bn.:~i:1. 1..25bn.s.1. 3.67bn.mct --------- -- ~ g. 3 h.25 103.53 none 2.25 .83b1.1. .59bn.Si_1. .83bn.s.1. 4.OObn.mot.j B- I ---- - -- --~ - - a. ---- -- - 8. ~ ~ ~ . ~ a l , PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES !i NUM3ER I;'tiil~}-?E% P l AFTER SWELLING none INTERVAL-MIN. F~ERI D t ~- _ _P~F,IOD 2 _ 1 4 _ r _ RTZS ~ 4 PER INCrI P. 2 .00 none 30 3 4 5 ~8 ~ 5 T~^ - --- P- 3 2 .0 0 none 30 -1T-- - 35-- - _--~7 4-- P5 ` --- ---------- -- - f?-- ~ -- ---- ---- --- --- ---- -- - 1 _ J PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitt~ble soil meas. Indicste scale or distances. Describe what are the hur. zontal and vertical elevation reference points and show their location on the plot plan, Show the surface elevation at all t~orings and the direction and pe;car~ of lama slope. SYSTEM ELEVATION 105.2 ~~ ~ ~ ` ~ ~ `q~" ;, . ~, ! ~ ! ~ 1 I ~ ~ ~^ 1I ~ IC ~ I. _ .. I i I ` it I _, ~\( o Q r ~' ~, ~) ~ I i ~I ~ ~. i ~(I I I 1 ^^ i i V 'ern- ~ . ; ~ ~ '~~3~~ ~ ,\ I ~,, I ~~ l ~~ ~I ~ ~ ~~~ ~. I ~ ~ I~ r I .~fti' f ~, ,I ~ ~ ~ sT cxo><x co>_rrv7,~~ SEPTIC T~~NK MAIN7'ENANCL' AGIZEE~ZEN`I AND OWNI:RSIIIP CERTIFICATION, FORM Owner, [J ~'~,~~ C.~ta.f ~ ~'l~-iS Viailing Address p 13 1 ?O `~ ~Ere,et~ ~-~a,,,,,,ond~ i,Jl, S~jO/S' Property Address 5d~r-~~2, (Verification required fiom Ptamling Deparm~cnt for new constnrction) Cityi State Parcel Identittcation Number O/g /05/7- S/O~/~ ~,F:(:AI l~F4C'RiPTinN ~ ~~ Property Location ~~'/4, 5~'/4, Sec. z ~ , T~~ N-R l~ ~V, Ti~~Nn of ~'~+~°''~ Subcirvisiun es~;1 ~~• ~~~~dr 7-s - _,_, Cut h ~ Certified Survey Map # ~9~z9 , Vohu7ie _.-__~______, Page # ~~~'~ Warranty Deed # ~~ ~ ~~`~ Spec house 0 yes ~ no Volume j D`3 1 , Pale # _ ~~ ~Y~TR.I~I 'M 1NTF.15IANrF. h;iproper use and maintenance of your septic system could rsssult ir. its premature failure to handle wastes. f'i~oper 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 al~fe~et the function of the septic tank as a treahnent stage in the waste di~~pusal system. The property owner agrees to submit to St. Croix "Coning Department a ce;-tiiication farm, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (lj 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. Use. the undersigned have read the above requirements and agree to ttyauttain the private sewa;e disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, `Mate of Wisconsin. Certification stating that ,your septic s tem has been n~~aintahted must be completed and retu;red to the St. Cruix Countyloning Uft7ce within 3U diat3-~~f the three year e pir 'ion date. S1~VA'1"URE OF APPLICAN"I ~,~. ~ ~.~ X1~~~~ DATE Q~ u ~>r' "~,~ 1t~~fL I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 ~ we) am Iarej the owner(s) of the p ~rt ~ described above, b vi ue of a warranty deed recorded in Register of Deeds Office. ~S] aNA1'URE 0l= APPLICANT llATE ~"~"* *" any information that is mis -represented may result in the sanitary I;ennit being revoked by the Zoning Department. * ** * ** *'~ Include with This application: a st,unpad warranty deed ti~om the Register of Deeds oi~tice a copy of the certified survey reap ii roicrcnce is made in the warr:ur[y deed SANITARY PERMIT APPLICATION ~ .couNTY . -' ~, ~~~~~ St:. Croix Adm Code Wis In accord with ILHR 83 05 . . . ; ...r,. ~~ STATE SANITARY PERMIT # ~~~ _ -Attach complete plans (to the county copy only) for the system, on paper not Tess than STATE PLAN LD. NUMBER 8Yz x 11 inches in size. ~7 ` Q /8 -See reverse side for instructions for completing this application. ^ ~ O I t. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. NO RIANCE YES V OR PROPERTY OWNER PROPERTY LOCATION ~'~ra1.c~ ?~';. Flot:~ins -- 5't•: '/a S~G~I ia, S 21 T?c~ , N, R17 ~ (or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CIjY, STATE., t O ^ ~Jl ZI~ pp ~rl F` PIigqNE Nut~g~R %~` -73u( CITY NEAREST ROAD, LAKE OR LANDMARK ^ VILLAGE Rl Efi i1ii, ; ~ . J ~ .~ O /l~ ~ : i n lbt~i. Ave. II. TYPE OF BUILDING OR USE SERVED: ~ CCI~~-f(~`t / ` y(/ Number of Bedrooms if 1 or 2 Family ~ OR ^ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. ^ New b. ^ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an j 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. i 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. ^,XGP i In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ^ See a e Bed b. ^ See a e Trench c. ^ See a e Pit ' 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION _ 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): I ~'`' 375 375 7~5•?8 Feet ii-~1 I 1'.JPrivate ^Joint ^Public VI. TANK CAPACITY in allons Total # of ' Prefab. Site C l Fiber- Pl ti Ex er. p INFORMATION New xisting Gallons Tanks Manufacturer s Name Concrete on- Stee glass as c App. '~ Tanks Tanks siructed _ __ Septic Tank or fioidinc Tank j. (J 1 ~t -~' _~_ _~ Lift Pum Tank/Si hon Chamber ?{ f?,(~n ~ `~IE'.O).S ^ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ature: (No S m s ,'bIP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Co e): Name of Designer. ~°..` Ju~ ? Si10re Br . , TTeh/ ~1C}u1100i?d , Ta1j_ , II VIII. SOILiTEST INFORMATION ~ Certified Soi! Tester (CST) Name CST # Cary L. Steei 22~)~`3 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: I G~3~ 2~.. S}vre i?r. New Richmond, t~1i. 54017 71` ?,46-G2(,~0 IX. COUNTY/DEPARTMENT USE ONLY 1 ® ^ Disapproved Sar)itary permit Fee J ~ Groundwater S rcharge Fee ate Issuing Agent Signature (No Stamps) ! Approved ^ Owner Given Initial ,`~ , /~ 1 ~ ~ ~"'L • ~"~• ~,r wC% , „ ,, `~~~~"_' }~ / ,(~%~ l C YC ~ ` '/ ~ ~ ~ ~ < Adverse Determination < j ~ - ! ~ / X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (torrnerly Plb-67) (R 03186) DISTRIBUTION: Original to County, One Copy To' eurevu of Plumbing, Owner, Plumber . ~~ ----..e, ' ' Straw, Mor:h Hay, Or Synthetic Cove,rinq~ 0 Distribution Pipe Medium Sand Topsoil ~ ~ p~~M~1~ pQ 'f4 Slop e ~t~~ ;~ ~ Bed Of !~- 2'2 Co~• • ~~F~~gregate ~~ UMI' .~ AH ~ ~N~S ~~b . ~u R~ EE~~ ~'Np o: Page _,Gf G Force Main Plowed Layer ~~pN F S~ /~: N~~£roas Section Ot A Mound System Using ~ ,.-!l~~,F~~~~~ A Bed For The Absorption Area ~~ v ,o ~ A ~ F t . • ~-` g ~. Ft. License Number: •,~~,~~ i'. ~ !~~, ' ~' "~-J~ K / ~~ Ft. Date: " ~ ~ 0 • ~~_ ~ 1~~7 Ft. I /c^ Ft. W 7. 7 F t . L 0 ~_ F t . E ~,, 3 Ft. F ,79 Ft. G / Ft. H /- ~ Ft . t.:- . ~.. Jbservotion Pipe-~ .-B ._._ ._ . _. _. _..._ .~ . ~ ..~~ K A ~ _~_ ~ Force Main W ~. - - - --- - -- - . -- - -- - -- ~..~ ~~ Distribution Bed Of ' Z~- 2;Z Pipe Aggregate _i Observation Pipe Permonent Markers Pian Vfew Of Mound Usinq A Bed For The Absorption Area PllMP CHA/'~f;~R CROSS SECTIOIJ ANG SPECIFIC~:TIO~~S VErJT GAP y' C.I. VENT PIPC ~ 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE 18"!'11fJ. A IrJLET APPROVED JOIrJ7 W~C.z. PIPE ~ EXTENDIrJG 3' 0-JTO SOLID SOIL ~~~~ ELEV. i u FT, V ~''~~ \\~\ PROVIDE '`. ~ I AIRTIGHT SEAL I ~o,~,~.°Ka~~y I I I FELAT IONS I HUMAN pcflR AN ~ GS 1 ~ TAY' TY ANp UILDIN ' I DF SAFE/~ I ~4~ Gil' _r..~~r ..._ ~__J I I ,y" MII.J. ~~ ~ ~~~~ f~~ ro(~ II I I ~ I ALARM II_ I~ ' VOID' I OFF ,~, ,~~ ~~ (,~~ 18" !"~ 1 tJ . ~.~ `~:: V APPROVED JOtia~ W/C.I. PIPE EXTE-JOIUG ;' ONTO Soup s~ : ~~RISER EXIT Pl=RM1'TrED OrJL~ IF TArJK MAIJUFACTURER HAS _ SUCH APPROVALY SPECIFI~GATi01,.1S ' ~ SEPTIC f DOSE I' 1 ~pn~~ W ~ ~ ~5 n ~~ ~~~ PER DAB Ca TArJKS MAIJUFAC7LJGZER: "" ~.IISMDER OF DOSES: Q TAtJK SIZE; G~0 GALLOIJS D05E VOLUME ~ ~ ~,~ I 2 Z GA~~.o~~ ItJCLUD1tJG BACKFLOW~ ..I ~ ALARM MAtJUFACTUR£R; LL''~c!~ Q ~''r MODEL rJUM6ER: _~~ ~ GALLO~JS 3 CAPACITIES: A-- ~ q'~ IAICHES OR ~ ~~n U ~~q C~~ IIJCHES OR ____~_ GAt_LO}J:; ~ 8 = SWITCH TyPC: r ..__ PIIfAP MAr.IUFACTURCR: µ- ~ ~ C = ~ J ll.1CHE5 OR ~z Z' GAl_40,J5 ~- MODEL UUMBER: ~ e ~~ D= ~~' INCHES OR ~' ~ 7: GAL~O}:= ' SWITCH TYPE: ~ ~"-"'~ rJOTE: PUMP AUD ALARM ARE TO 8E ~~ ALLED OTJ SEPARATI= CIRCUITS T INS GPM MIrJIMUM DISCHARGE RATE ~~' ~ f, ~ VEKTICAL DIFFEREAICE OETWEEAI PUMP OFF AA10 DISTRIBUTIOrJ PIPE.. _._L_"~ FEE•T .~ ~ Z'1 L j ~1/-r' ~- MIrJIMl1M rJETWORK Sl1PPLy PRESSURE 2'5 FEET ,~,, X 2'k'~ _ T,/ FRtCTIO-J -}- y~ Q FEET OF i'ORCE MAIIJ X ~•'~ ~' F/ioo-r x~ ~~ ~~'`~-~ FACTOR.. ~ ~ .FEET --- _ . ~ ~ 3 ._ ~ TOTAL Dy1JAMIC HEAD ~~ ~~~ =~- FEET IIJTERtJAI., DIME 40tJL OF TAr.lK: LEA.IGTN ~ ( ;WiDTN rt ~ ;LIQUID DEP~"H ~' Q MP~ScJ n P C 3 Z.- -~ 1' DATE : 1 " Z y ' , `,~ ~ ,. ,/ SIGIJE at ~ LICEI.IS IJUMOER: _ E ~ i ~-1 A 6 C, 12"M I U. WEATFrER PROOF" JU~1CT10-J HOX r~nc,r c} ~~~~/~~~ A ~-,gPPROVED LOCKING ~' ~MArJHOLE COVER I I GRADE I I co~laulT ~-- CO-.1CRETE BLOGK---{ r ;.n ~I r-..~-,-~, ..,.. ~'~'::~~!= tii,,~ ~ ~c `;~ r :'I~VD Y'~?SCO!~~Sl;b' ni~.'.~i~. v'~ ~ :t. ,Yti vrtrt~5,~P~~sYJq Customer's Phone ~ I Order No. No. ... dote ~ % j ~~_ Nome ~~~ ..- ~ ~' Y^{'~ . ~ w~ _ ao~oer assn ~ i.u.a G:/Ft:l. cn~a.-~~.-_._:~-,.~---~:.a;;,:.7' '--- --- Alta. 1 ~• `JESCRip7i'Nl PRICE AhFOUNT .. ~ ~ r,J~ 1~ / ~ n J ti r' ~~ fJ fi' - a -- ~ ~ l'^ ~ ° ~ ~ _ . o TAX 9EC'0. 6Y TA f n ALL doirc•3 tl"n~ rea,rned Socds NU5T be narmpan~eci by phis blil. , ~. •` F .~ p v' ~' .'_ r+2+C~baa; ~ •Eri,IteC io U ~.A i ~ DEPF,RTt.1ENT °F ~ REPORT ON SOIL BORINGS ANC SAFETY & BUILQINGS ITJD~STR.Y, UIVISIOfJ LaBC~R AND P.O. BOX 7969 HUP~tAN RELATIONS PERCOLATION TEST5 (~~~) MADISON, WI 53707 (H63.09(11 & Chapter 145.045) LOCATIOfV SECTION. TOWNSHIPD6/«CJ?9GC}~J4PS17~~ ~= I.OT NO. 13t_K. NO.: SUBDIVISION NAME: ~ SW., ~~48~ti~~ Ili 21 IT 29 N/R17 ~ {orl W fianunond _ r; / a n / a ti / a _-^_ COGNT'Y: ~OWNER'S,BUYER S NAME: MAILING ADDRESS Sty Croi~_ Gerald Hopkins Hammond, Wi. 54015 USE + ___ !DATES OBSERVATIONS MADE ~1NO BEURIViS.: COMMERCIALDESCRIPT'ON _ P`;OFILEDI=~-Cft1f'~IONS: I'ER~,` AiION1ES1S-j -~ --~ I------ - - ~f?„s~aence i _ ~ n/a g-~New ~~ReUlace 7_(J-87 7-20-87 R_ATI_NG S= Site suitable for s~stern U= Site unsuitable for system CONVEf~'TICNA!_: MOUND: IN-GROUfV(1PRESSURE: SYST ~C~SI~U~~S~ ~S~U D DLDING TANK: RECOMMENDED SYS-I-EM:loptionall ~~ mound I~ Percola[lon Tests are NOT required DESIGN RATE: If any portion of rile tested area is in the under s,H63.09(511b1, indicate: n ~ a Fioodploin, indicate F~~oodplain elevation: n ~ a ~_~- ~ - decimal' PROFILE DESCRIPTIONS page 61 JeB BORLVG TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPT F'. i fJUN'BER CEPTH I?4. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 5.99 1U4..?8 none 3.66 .92b1.1. .83bn.sil. .83t)n.s.1.1.08bns.cl.1 B- ,, 6 26 103.53 none 2.59 .67b1.1. .E;7bn.sil. 1..25bn.s.1. 3.67bn.mctl' B ; h,'Z5 1.03.53 ~ none ~ 2.25 .83b1.1. .59bn.si:1. .83bn.s.l. 4.OObn.rnot .,, B- ~ --------- --------- I ~- ___-_ .-- - _._ .-__._-.-__.__.-_____~.__~___ ~_~.__.~-___~i r: ~ ~ ~ R~ ~ 1 ~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MIfVUTES ~ NUM3ER I~~}Gg r' AFTER SWELLING none INTERVAL-MIN. PFRI D1 ~--~ 2 PERIOD2 -~---- - - 4 - r' R1C~b_ - --1' 4 PERINCI; __i - -- _! P- 2.00 none 30 3 4 5 8 ~ ~ _ P- 3 2.00 none 30 1 37~ -+ j P_ -_ -- _ l _ _ - ' - i `'=----- '' - - --- ~ ------------ -- --- -----1 PLOT PLAN, Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indic<~te scale or distances. Describe what are tree hur 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 pe~c^r of Ian 1 s'~ope. ~. ~ SYSTEM ELEVAYION 1o5.2B ~:~'~ ~` ~ ~ `y~' r , I ~ J i ;din =~~ ~ ' ~ i .~~~~ ,~ ~ I I l `~-~'E f ~; P ~~ ~ 'I '~ ~ ~ ~ ~ li ~ ~~ I ,'; , ~~ ~~ Lac ~~ , ~1 C ~ , ~, ~ ~ ~ ~ ~ J ~o ~~i C s.~,1~ ; ~~p~ 33J ~~ ~ ~ I ~ -.------~ ,c ~ _ _ ~M v l ~ i5 II 'DOCUMENT NO. WARe~ANTY DEED :I ( STATE BAS OF WISCONSIN FORM 2 -~ ts18! ' 1' sos~~s _ ~~~ 1039P~~E ~Q7 , Gexatd t;opkins a/k/a Gerald M. Aopkins and Julie Hopkine,.,a(lc%a-.Julie__R..__fio~itcins,.__husDand ~ and wife...... ...............__.__..-----------.-...----------....................:._........... conveys and warrants to ....RfChard._G-.-•-Theis._and....• ................... ...~h~a>i l.t'n,s..F ...'~heli.~.._. huabiand and x~.~p. k~Q~di,nQ .... I as sur.Y.~:vo?riBh.~P...mari.ta.~..P.roP.e~~Y ..... ......... .............. I~ s TNIf f-A.:[ R[1[RV[D -OR R[COROINO DATA ~I -r.~CSJI E:Z~J ~Ti':vL f..,.~.., t'.I ..:: . ~u,...~ ~i~.. Reo'0 Ibr ReoDTd OCT. 61993 , ~~ • , ,~,,, f {` ............ .. .................................~............_.__.--.......... ... RETURN TO the following described real estate in ...._.-.St~r..~1;Oi~ .................County. State of Wisconsin: Taz Parcel PTo: Part of Southwest Quarter of Southwest quarter (SW~ of SW's) of Section Twenty-une (21), Township Twenty-nine (29) North, Range Seventeen (17) west, .Wore particularly described as Lot One (1) _ of Certified Su>.wep Map recorded in Vol. 7 of Certified Survey. Ma age 1875, office of t e ?teg s er o ee s or St. C*.oix CauZrt~Tfisc-onsin. -- ~"~o mss' This ........., i S ........_.__ homestead property. exception to warranties: Easements and .restrictions of record. Dated this ......~~ ................~___.._.-_____..__ day of _. .......................... _.........._....--------°------------.- (SEAL) ........ ...................................--------•-------------- (SEAL) ~~r .......... .... ................ .•. is93:... -.-...--~.-~. ~... ...t ............................... (SEAL) • ....ilera? ..H... pkitla .................... .--.-..'}. .......... .............. ...C~~d~l}SAL) Julrie K. H pkins / AOTHSPiTICATION Signature(s) authenticated this ......._dsy a~..________.__.._.__., 19.~.. TITLF,: MEMBER STATE BA>Z OF WISCONSIN (I! not . ...............•-----.-----_---------------.... authorized by ~ 706.08. Wis. Stata.) THIS INSTRUMlNT WAS DRAFTED BY Thomas A. McCormack .Baldwin, WI.5400~ ACBNOWLSDdMSNT STATE OF WISCONSIN ss. St•._ Croix ._,_,Countq. /~ ersonally came before me this ..lst'......_day of ..f./~A~IIreGl ...................... 19.83.. the above named __--.,Gerald-_Hop)sins_-...a/kja• Gerald .. __.M._. Hopkins •ancl .Julie .Hopkins, . ......... . a/k/a Julie _R Hopkins -~- .~'".._. ......................................................... • . .4:. to me mown to be the person $.........t, o uted.tlib foregoing i t and acknowled~+ e., ~;'y~ ~ c •- ~. .. •.. . .. ~IC~M'll s ~ ~'p ~ `~") - j.......... .` -a Notary Public ... ~!~7l'r..O~7...........) . -.- : F•e0!lCr:'~V.~a. i R \~ v iiiuiva ~.ca i •• ~.-• ~ . irori'plpe weighing ~ ~ `' 33B 7B 3 I N90.00' 00"E 509.32'\~A7EASTJ -~ 1.13 lbs./lin. ft. set. m ? I 476.32' 3i oo' 4 3~~ ~ 4 , 0 -. 1 Q! ~ 2 ~ ~ Lor i ~ tU ~ I _ ~ ` 3 ___._ ~. W I DI R ~ ( S,DOO ACRES I O ~ ~ N 217,798 S0. FT. (' 1,. I ~ W ~ ~ ~ NET = 4. 68 / ACRES ) x ~ p ~ 0 203, 89/ SO. FT. ~,~ QI J I p p O ~ vi ' ~ 334.OI ~ ~ ~ ~ p p ~DOWNEO FENCE 2' 2 ~ ' ~ ~..r.~ ..r-- K,.~.S~ 476.48 N 88. 30'2T "W 509. 49' h o ~lNPLATTED LANDS M a SW COR. SEC.2/, T29N,R/7W, /I " /RON P/PE fOtINDJ x A ~ 6 o ~, w ~ xa a J N ~ ~ Q v ~ 4 Z 3 3 M v Q ~.! ~ ? h 3 4 ~0 2 " 41I ~ w p ~ N p ~ ~ ti p I 4 ~~ '~ N p J ~ h li O 2 O to W p a 2y, `N ~ O Q p O W ~ p m \ p 0 3 Qhx SCALE I " ° 200` 0 !00' 200' 400' 600' ___ __ _ 4. Description: That certain parcel of land located in the Southwest 1/4 of the Southwest 1/4 of Section 21, Township 29 North, Range 17 West, Town of Ha~tunond, St. Croix County, Wisconsin, more fully ~escribed as follows; Commencing at the Southwest corner of said Section 21, thence N 00 00'00"E (assumed bearing on the West line of the Southwest 1/4 of said Section 21) (recorded as North) a distance of 430.1' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 00 00'UO"E on said line a distance. of 420.99' recorded as North); thence N 90°00'00"E 509.32' (recorded as East); thence S 00 00'00"W 434.26'; thence N 88030'27"W 509.49' to the POINT OF BEGINNING, containing 5.000 acres, being subject to easement over the Westerly 33.00' thereof for town road purposes and also being subject to easements of record. Dated: July 14, 1987 State of Wisconsin) County oP Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Annabelle Hanson I have surveyed and divided the lands as shown. hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that the map and description as shown hereon are a true and correct representation thereof. OWNFft' S ADDRESS : Route 1 Hammond, WI 54015 Vol. 7 Page 1875 Certified Survey Maps St. Croix County, Wisconsin ~~~~ `~ ~ ~~~+~7 I~6lP?EPI~i:':JVt ?>~{i:. .x.!ll:iN~3 J4t~ iJrllN:i Cvr+~ntrFE6 ~~ ~` SSG O NS/ ''~i, ..4 ~ ••' "••. ,'~ ~- ~ LAURENCE~:,~ ~. '= m ~ W MUR 1( i .. ~~ S 1 N, ': R1 F lS :: w~sc: •.~'J~ ~FD . ~ ANA ~~.~ ~~N~~t1f~~~ Laurence W. Murphy i s to red Laxid Surveyor f~C~~ pus ~8 i~s~ ~ a. ~t ~~~ ~A~~~~ 1 3 y ~ O 7 ~ Z y D o. O Z -~ ~ 3 ~ ~ r O m rn 3 m y 'C O ~ ~ ~G d 'O ~ X ~ N ~. N d who 3 j a m 3 f m ~~~~a~ ~ app nw ~ ~ - N ~ ~ p = D v ~~ Q°' ~~355. cng ao m > ~ a~ ~, v ~, m ~ L~~ °' ~ ~ N N (n y O CD .~. O O ~ ~ d ~ O 7 N to O a S" e ~ ~ ~ ~ W 1 ~i*i O J N S 3. ~ d! G) a w a 0 J ...i Q W ~ J ~_ S d 3 O O O ~ ~~~~ ~ovc %% y o d 'O 1, ~ ~ ~ O .. ~ ~ o ~ n ~ a a 0 3 N C 07 Q m 0 a C'.' f3N Z N W G c a 3 d o ~_• ~ ~ ~_ ''~' ~ ~ O 3 •`° ~ V a <,a b, v Q 0 y O N M Q 3 ;.. 0 ~ 0 v ~O ~ I cn -i us A ? n "~ .Z1 L! A Z O .. ~ ~ (n -{ N J ~ Z A ;p G~ V A 'Y~il• V/ r' C rrr0 0 d O ~• O ~• ~a O °oo- a O W w ~O ~'0 ~ A ~ ~ p~ a LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018-1047-40-100 Parcel Number 21.29.17.331 D OWNER NAME: First RICHARD G & CHARLENE F Last THEIS PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 813 170TH ST SECTION 21 TOWN 29N RANGE 17W'/.160 '/.40 Line Description Line Description TOTAL ACREAGE 5.000 PLAT LOT BLK 01 SEC 21 T29N R17W SW SW 5.00 15 02 AC LOT 1 CSM 7/1875 16 03 17 04 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 Wi`B A' ~~ ~ ~ ~ : 1y1'l6:i': aUpcanfne•nkar.Anodst~ ~~2 2 2 2 P y 9 6 I~rrr++rLn DOCUMENT NO. ? 1 9228 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX GO., MI RECEIVED FOR RECORD 04/29/2003 09:30AK SATISFACTION OF REAL ESTATE MORTGAGE - BY LENDER The undersigned Lender certifies that the following is fully paki and satisfied: Mortgage eXeCUted by gjGHARD G ~HEIS AND CHARLENE F TNElS. HUSBAND AND YIFE AS ,SURVIVORSHIP PROPERTY. to Lender and recorded in the office of the Register of Deeds of sT cROIx County, Wisconsin, as Document No. SATISFACTION EXEMPT t REC FEE: 11.00 TRANS FEE: COPY FEfi: CC FEfi PAGES: 1 Recortling Area 5 0 6 7 7 6 ~ in VOL 10 3 9 PAGE 4 0 8 Name and Retum Iwdress (Vaum•/Pag•/Ete.) THE FIRST NATIONAL BANK COVering the real estate described 2200 CRES'IV1EM DR b@IOW: PO BOX 187 HUDSON, WI 54016 018-1047-40-100 Parcel Identifier No. PART OF SW 1/4 OF SW 1/4 OF SECTION 21, TOWNSHIP 29 NORTH, RANGE 17 WEST ST CROIX COUNTY WISCONSIN DESCRIBED AS FOLLOWS: LOT 1 OF CERTIFIED SURVEY MAP FILED AUGUST 28, 1987 OF VOL 7, PAGE 1875 DOC NO 429629 ^ If checked here, real estate description continues or appears on attached sheet. STATE OF WISCONSIN County of ST CROIX This instrument was acknowledged before me On APRIL 25, 2003 Dated APRIL 25, 2003 THE FIRST NATIONAL BANK OF HUDSON NAME LENDER BY ~ ~ Tide SENIOR VICE PREISDENT by ALAN H YANDENBROEKE and ALAN L KALLENBACH * ALAN H VANDENBROEKE (Names Person(s)) aS SENIOR VICE PREIIDENT and VICE PRESIDENT Attest ~~ (Type of aulhortty, e.Q., ofncer, trustee, etc. a any) ' Of THE FIRST NATIONAL BANK OF HUDSON ~~~,,,trJpL%O rrr,~/~~i Tftie VICE PRESIDENT (Name of party on be of whom Instrument was, ' ' O ~i ~~ ti '~ 'S Any'. * ALAN L KALLENBACH * NANCY~~t:~BSON ~ ~ ~ .jL• -~` r. ' ?'his instrument was drafted by: Notary Public, Wisconsin ~ ~'•.,~-qT ~ • • • ' SGC~.`~~ JENNFIER J SCHMERTMAN My Commission (Expires) (Isj JANUARY 16 , 2 bI4 OF W~ ~a~` (TMPE OR PRINT) ~`~ *Type or print name signed above. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018-1047-20-000 Parcel Number 21.29.17.331A OWNER NAME: First ANNABELLE D TRUST % EVAN Last HANSON PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 21 TOWN 29N RANGE 17W '/+160 '/.40 Line Description Line Description TOTAL ACREAGE 17.845 PLAT LOT BLK 01 SEC 21 T29N R17W 17.845 AC 15 02 SW SW 16 03 EXC PARCEL IN SW COR 300' X 17 04 430' &EXC CSM IN VOL II PG 18 05 353 8~ EXC LOT 1 CSM 7/1875 19 06 ~ PT TO CSM 10/2707 20 07 &EXC PT TO CSM 10/2708 21 08 &EXC PT TO CSM 10/2717 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 of g- ~o~l~ - `fo. l o0 Z ~ . 21. r~ , 33 i ~ V Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT 4 /~ OWNER L~c.~..a Jd ,(~,,,~~~ TOWNSHIP -mod SEC. ~ T ~-R r7 W ,.- ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ,!~ /~Q LOT ,/~~! LOT SIZE c~~a~1'~2.eE.3 PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 5~ ~a \ ? ~ 1~,~, . ~,-pf, ~ . ~c~~i~~~ PK..-,~ . ~©3 \~~ ~ ~ ~~ f ~~, ;cV`~ ~-' ~~~ ~~~ c ' ~~ .1©~ ~ ~~ ~o-~a. ~~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~~~' ~~~/ Elevation of vertical reference point: ` Proposed slope at site:,~~ SEPTIC TANK: Manufacturer: ~,(,'~~ ~~ ~ Liquid Capacity: 1~~~' PUMP CHAMBER Manufacturer: _ ~ ~ ~ ~ S Liquid Capacity: _ ~.-=z„~g/~'~ -----~ Pump Model : (~~ ~3 Pump/Siphon Manufacturer: ~~ f} w ( ~ Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: `~-~(~/~c..aL~. C~r~ Alarm Switch Type: ___~~~~~,~J Number of feet from nearest property line: F.pont, O Side, ~Rear,`~Q"FtJ/_~ Number of feet from well: /t! 14 Number of feet from building: ~~ ~ (Include distances on plot plan). SOIL ABSORPTION SYS Bed : ~'~~ /` Trench Width: ~ ~ Length: r7 f Number of Lines: ~ Area Built:~.~s / s'~ Fill depth to top of pipe: ' Number of feet from nearest property line: Front, O Side,~Rear,O Ft ~~ Number of feet from well: ~ ~~- Number of feet from building: ~Q ` (Include distances on plot plan). SEEPAGE PIT Size: Liquid depth: Area Built: Number,/of pits Diameter: Bottom of seepage pit elevation: Has either a drop box or distribution box O been used on any of the above soil absorbtion sytems? ( heck one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of in et: Number of fee from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Manufacturer: DEPARTMENT OF INDUSTRY, .INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Dlvlslo P.O. BS~X 7969 BUREAU OF PLUMBIN MADISON, WI 53707 SW~, SW~,S21,T29N-R17W ^CONVENTIONALALTERNATIVE State Planl.D.Number: Town `of Hammond ^ Holding Tank ^ In-Ground Pressure ~MOUnd I~~r9n~~818 16th Avenue GeraldRM HDHopkins WI 54015 ARoute P1R, I Hammond INSP ECTION DATE ' , L I~ J ~Q ~ / a V BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber. S l G L MP/MPRSW No.: 3254 County: Croix St Sanit 9111 tuber: <r~ ~IZ~I' ary tee . . .i SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. ^YES ^NO ^YES ^NO BEDDING: VENT DIA.: VENT MAT L.: HIGH WATER NUMBER OF ROAD PROPERTY WELL: BUILDING: VENT TO FRES ALARM: FEET FROM LINE: AIR INLET: ^YES ^NO ^YES ^NO NEAREST DOSING CHAMBER: MANU FACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRES (DIFFERENCE BETWEEN FEET FROM LINE. AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check th e soil moisture at the depth of plowing LFr~r.Tll uIAMETER MATERIAL AND MARKwG or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN !`ll1U\/CBITIl~B.IAI CV CTCM• WIDTH: LENGTH: NO. OF DISTR PIPE SPACING. COVER INSIDE DIA.. #PITS: LIQUID BED/TRENCH TRENCHES . MATERIAL: PI ~- DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRE: BELOW PIPES ABOVE COVER: ELEV. INLET ELEV. END. PIPES. FEET FROM ,LINE: AIR INLET: NEAREST ;: MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE. PERMANENT MARKERS. OBSERVATION WELLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER. EDGES. ^YES ^NO ^YFS ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH. TRENCHES: LATERAL SI DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE ELEV.: ELEV.: DIA.: ELEV.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. ^YES C COMMENTS: PERMANENT MARKERS: ^YES ^NO Sketch System on Reverse Side. DILHR SBD 6710 (R. 01/82) )EPTH BELOW PIPE. ITERIAL: NO. DISTI PIPES: E _~_ ^YES ^ NO UILDIE ~~cav ~I~~.~o~~ ~' NUMBER OF PROPERTY WELL: 6 FEET FROM LINE: NO NEAREST Retain in county file for audit. SANITARY PERMIT APPLICATION •COUNTY ~' DILHR Wis Adm Code In accord with ILHR 83 05 St. Croix , . . , ~~ ~~~~- STATE SANITARY PERMIT # ~~~ -Attach complete plans (to the county copy only) for the system, On paper nOt IeSS than STATE PLAN I.D. NUMBER 8h x 11 inches in size. 7~ Q ~8 -See reverse side for instructions for completing this application. PETITION (f~~I - ^ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. i~l No YES FoR VARIANCE PROPERTY OWNER PROPERTY LOCATION Gerald. M. Ho ):ins Sod '/a SW %a, S 21 T29 , N, R l7 ~ (or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME K.i2./'~1 n/a n/3 n/a C Y, STATE 4~fftand Wl 21 Qp ~ ~~E11 Py~~ Nt~p~~R /ll /~Jb-~30~ CITY NEAREST ROAD, LAKE OR LANDMARK ^ VILLAGE , . / : ~ 16t)'1. Ave. ~,,~ / //,~~/ II. TYPE OF BUILDING OR USE SERVED: ~ CJI~--fU`~r 7 ~!V Number of Bedrooms if 1 or 2 Family ~ OR ^ Public (Specify); 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. 0 New b. ^ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an System System Septic TankOnly 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. ^ GP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ^ See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 4S 375 375 105.28 Feet ~ Private ^Joint ^ Public VI. TANK CAPACITY in allons Total # of t 's N M f Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks ac urer ame anu Concrete . .glass App Tanks Tanks structed Se tic Tank or Holdin Tank 1. 5d ~L Lift Pum Tank/Si hon Chamber X 800 1 Ede@E:.S VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installatio of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's atwe: (No S m /MPRSW No.: Business Phone Number:. (~ ~ 715 46-6201) Plumber's Address (Street, City, State, Zip Co e): Name of Designer. '-~u8 F. Shore Br., Neva Ric)u~~ogaid, ~di. VIII. SOI EST INFORMATION Certified Soil Tester (CST) Name CST # Gary L. Steel 2288 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: 988 N. Shoe }fir. New Richmond, Wi. 54017 715 246-5200 IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved S~ary Permit Fee Groundwater S rcharge Fee ate Issuing AgenYSignature (No Stamps) A roved pp ^ Owner Given Initial ~~G j C;7r) ~r ..~ ~_ . E ~'~~ ~ ~ , ~_ ~ ~ C' Adverse Determination ~'v• U~? • `- c f_~ c_ ~f t i iii 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 INFORMATION & INSTRUCT'10NS 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 anj~ 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 ne~N 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 wheriever 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: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; 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 experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all infoi-mafion requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or ex'sting tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed arn~ tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental 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 designer 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. Complete plans and specifications not smaller than 8%z 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; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufactureri D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 forma 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 r~~~ result of over 2 years of steady negotiation and public debate. The groundwater bill Groundy>}ater -`1-~ included the creation of surcha~ ges (fees) for a number of regulated practices which Wiscor~s`rn's can effect groundwater. The surcharge took effect on July 1,-1984. All of the water that buried treasure is used in your building is returned to the groundwater through your soil absorption ~ (~ } i 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) Mound System for Gerald Hopkins SWk SW4 5.21, T29N-n17W Town of HamQnond, St. Croix, County Pages ~~1-----plan approval application ~~2-----application for alternative system X63-----St. Croix Co. on-site ~~4-----115 4~5-----plot plan-plan view ~~6-----work sheet #7-----system cross section ~~8-----pipe lateral layout 4~9-----dosing chamber #10----pump curve ry L. Steel ~?-~'-~ 98 N. shore Dr. New Richmond, Wi. 54017 MPRSW 3254 7-20-87 ~ ~~ ,~ • . July 20, 1987 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMONO) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 An on site investigation for the Gerald Hopkins property located in the SW 1/4 of the SW 1/4 of Section 21, T29N-R17W, Town of Hammond, revealed suitable soils at a depth of 2.25 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator rc ~ `, ~ DILHR PRIVATE SEWAGE SYSTEMS PLAN APPROVAL APPLICATION STATE OF WISCONSIN DILHR DIVISION OF SAFETY i BUILDINGS BUREAU OF PLUMBING 201 E. Washington Avenue, Rm 141 P.O. Box 7989, Madison, WI 53707 808-266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., P.O. Box 7840, Madison, Wisconsin 53707, Telephone (608) 266-3358. 1. PROJECT INFORMATION (Type or print clearly) Revision To Plan Number: ~;,~ 6 ~ ~ ~ ; ®9,1r~ Name of Submitting Party (Plans returned to same) Project Name Ga L. Steel mound Street 8 No. or Rural Route Project Location - Street i No. or Legal Description 988 N. Shore Dr. SW%SW% s.21 T29N-R17W City or Village State Zip City ~ County New Richnmond, Wi . 54017 village oF: Hammond St .Croix Town Telephone No. (Include area code) ' 715-246-6200 Designer. Telephone No. (Include area code) Owners Name Telephone No. (Include area code) Gerald Ho kins 715-796-2366 Street 8 No. Street 8 No. City or Village State Zip City or Village State Zip Hammond, Wi. 54015 2. APPLICATION FOR: ®New Mound System (3a) U Groundwater Monitorinig (7) ^ Conventional System -Public Building (1) ^ Replacement Mound (4a) ^ Holding Tank (2) ^ Replacement Pressurized System (4b) ^ System in Fill (1) ^ Petition For Variance (6) ^New Pressurized System (3b) ^ System in Flood Fringe (1) ^ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50.00 3b. 1,501- 2,500 gallon septic tank - 60.00 3c. 2,501 • 5,000 gallon septic tank - 80.00 3d. 5,001 - 9,000 gallon septic tank -100.00 3e. 9,001 - 15,000 gallon septic tank -150.00 3f. Over 15,000 gallon septic tank - 250.00 4. FEE SUBMITTED FOR OFFICE USE 4a. 4b. 4c. 4d. 4e. 4f. 3g. 3h. 3i. 3j. 3k. 31. 500 - 1,000 gallon dose chamber 1,001 - 2,000 gallon dose chamber 2,001 - 4,000 gallon dose chamber 4,001 - 8,000 gallon dose chamber 8,001 - 12,000 gallon dose chamber Over 12,000 gallon dose chamber - 30.00 4g. ~G - 50.00 4h. - 70.00 4i. - 90.00 4j. -110.00 4k. -150.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 -10,000 gallon holding tank - 55.00 4n. 30. Over 10,000 gallon holding tank -100.00 40. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal 80 3r. Priority plan review: walk through 4r. Submittal of plans in person, by appointment, with double fee 3s. Petition for variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee 80.00 NOTE: Fees pursuant to Wls. Adm. Code, Chapter Ind. 89 SBD-6748 R. 8/85 ( ) may be subject to change annually -0VER Eflectlve July 1,1984 ' f Location: STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLIC,4TIOP~ FOR TfIE USE OF AN ALTER~~ATIVE SYSTEM Township/Municipality: SC,~ ~ 1.11 '~ S ~ T ~ N/R ~ ~(or ' /-// ngw,~;..f ~~ S'I~- C' ~ v. 1 Street Address: Subdivis~~i99on: County: IW~~ Name: Mailing Address: k~' I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I a ree to have the system installed in conformance with the Bureau's approval of plans. and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. $ ~ Q I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. ~ ~~~~~ ~~ ~ ~ ;Ci _ ~~ i ,~,.;a Signature of Applicant Date ~nnnrrrrh STATE OF WISCONSIN ~~'~ ~•• S/FBO++., Subscribed and sworn to before me ~~'ARr '- COUNTY OF ~ ~~ This ,~ ( day of~~1~19~. ~'118LIC ~ r ~•• p Bpf ~fjgCO~,~- Mary u}}~~lic, State of Wisconsin vrrrru~~~N>> 'rur y L. .J.~l, l ~ T1TT[1D-CRTI-~/ 19 r,,r nsin~~ ~~ My Commission Expires: !7 -~_ J' 1 _ ___ (~0 Q. Q~')`yk~ \' I ~~ ~;~~ ~n~E~-s ~No~- -}v 5 e. ~ l ~ ~--- ,~u~g1Na \ `t~~.~~~ ~~~ ~ iflNS FJ-A aN a 1 ~,gpR ~ U ~Ditd6S i V~S10C fl~ SAF ~ Aµ~ ~~~ ~~~ ..~ ~~ Q i Q ~e; ~~o ~~ $~°r~~~iP g~.a3C~~C6)a7. - /fit YEflicttt~k 7~PAFF/~ PRoN~4~T~~ iv T.Y•E' ~tRFA ~~ rHii~l o2S 'OF' Tif/~' ~ ou.~US~C cy~,E ,E?JC~ oc'nrov.~11, g'~ ~ ~ .~ 3 ~a i~~~ S ~ ~ ~~ ~~ ~ ~o'~ ~~ k ~ PiP~~u~ ~ ~o~,~rs As PEA' ~ ~, o ~ ~b \ ~, ~o ~~~ \~d ~y tia i ~ ~ ~ ~~ ~~P / ~~ /V o 1~ Y~v ~' c? n 1 ~. 5,~~~ }moo--~ ~o ~- 5.~,1tF S a~' ~ ~~~ .~ OPTIC,NAL Vi~ORKSHEET 1. MOUND SYSTEM ``//~~-~~ II. IN.GROUND PRESSURE SYSTEM{ontinued- i. Wastewater Load, Total Daily Flow= ~ pl. 10. Fore Main: ~ ~ ~7 ` Use s. ILHR 83.15 (3) (c) Minimum Dosit-~ Rata' ~s-• Tf` Adm. Code and PROVIDE A DETAILED Dlamear = .-, ~ in LIST OF SIZING ON PLANS. ~~ 11. Total Dynamic Head: T. Depth to LlmitinE Factor ^ ft. System Head = 2.5 ft 3. Landsbpe = ~,~,~,_ % Vertk:al Lift = ~~ `^~ ft 4. Distanu from Dose ChamMr to Frictbn Lose = ft Oistrlbutbn System ^ ,~y~ a ft. TDH = ~ ~ ft S. Elsvatbn Olfftnnu setween ~ s0 ~ 1 Z. -ump Sekctbn: Pump end Olstributbn System ^ Pump wQl discharp at Mast ~ ~ SDn+ 6. Absorptbn Area SizinE: at ~ tt. total dytutmk heed. Area Required = ~ `f tq. tL Pump modal and manufacturer: ~ ~' '~ ~d Bed or Trench LenSth (8) • fL ~ ~ ~-~ L _ - Bed or Trench Width (A) ^ ~ It. 13. Doss Volume: Tench Spacln5 (C) • ~=- fL 10 Times Void Volume of 82 , ~n 7. Mound HelSht: Olstribution Lines ^ 4 Fill Depth (0) _ ~_.. tt, Daily Wastewater Volume +• ~ Flil Depth DownsloDe IE)' -~ ft. 4 Doses in 24 hrs. ^ ~ S~ = L Bed or Trench D"epth (F) _ ._..ZL_ ft. Backflow J2 2 CaD and Topsoil Depth (G) ^ ...~. fL Minimum Dote = Cap and Topsoil Ospth (H) _ /, S ft. 14. Dose ChamMr: 8. Mound LenSth: Volume = ~ End Sbpa (K) ^ -.1.12- ft• Total Mound LenSth (L) ^ ...L. iL 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: ~ 9~S 1. Wastewater Load. ToW Daily Fbw ^ ' ' t Upslops Correction Factor= Use s. ILHR 83.15 (3) (C) , is. Upslope Width (1) • 1t. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = ' ~ O LIST OF SIZING ON PLANS. Downslope Width (I) _ . _L. fL 2. Required Septic Tank Capacity' i Total Mound Width (W) _ ~1 ft. 3. Percolation Rats ^ --- n 10. Basal Area: 4. Absorotion Arse Sizhu: infiltrative Capacity ot, Refer to Table 2 in h. ILHR 83 Natural Sofl =~~~~ pl./sQ.tt./day and PROVIDE A OETA1 D LIS7<' OF Basal Area Required = .1Q=SZ sq. ft. SIZING ON PLANS. , Basal Area Available = ~'~~ sq. ft. Required Area = t-•- s' 11. If Standard Tables from Chapter Iifjjt 83 _ ~ LenSth = .J~--- f~ are'~~used~, indicate Table # ~ `"'"' width = ~ '~ +---- f' 1T, For the Distribution Network, Use Numbers S•14 in Section 11. Number of Tronchss = ---- Tronch Spadt`iS ^ --- f~ II. IN•GROUNO PRESSURE SYSTEM, 2~ S. Distribution System: 2. Lateral; LenSth = -- f 1. Depth to UmitinS Factor = ~_.~ it. 2. Landslops = % Numbi;r of Laterals = ~-~- 3. Percolatfon Rate = min,/in. Lateral SDacinS' ~----~-- it 4. Proposed System Elevation = „(O`S•~ ft. Dlstanu from Sidewall to Pipe ^ ~._~.~ 6 S. Wastewater Load, Total Daily Flow: ~~Q Sal. ~ 'System Elevatbn =' --- } Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVtOE A DETAILED IV. SYSTEM-IN-FILL ~t"l o LIST OF SIZING ON•PLANS. FIII in All Items from Sec 1 Required Septic Tank Capacity = 0 ~ D Sal• 6. Absorptbn Ana SIzInS: V. SEPTIC TANK D D O Percolatbn Rate = _ '-A min.~in, 1. Capacity = y~ I 2. Manufacturer: ~ F F ~ ~ Cv'n ~ ~'" ~' " ' C - Area Required = ` ` sq• ft. System LenSth = it. 3. Show Site Constructed Tank Details on Plan System Width = ~ >`t• 7. Distribution Pipe SI:InS: ~ VI. DOSING TANK OO ' Hole Sise = In. 1. Capacity ° I : ft. ~. Manufacturer: ~'~ ~ ~ ~~ G Hnle 5paclnR ~,1 Lateral LonXlh • '~~ ft. !. Pump Manufacturer: ~ ' ~ l.atrra151ie • ln. 4. Pump Mudci: ' I~~ Lalcrrl 5pacinK ~ fl. S. OPcratfnR Hsad= Uislantc from tii~k~w,riidn I'ilx 2 ~•-° in, ti. Flow Raic= 1 11. Uhlrlhutlrxt Pipe Dlsch.trKo Role: // // 7. Show Slte Constructed Tank Details on.Plans Number of ltelex Per Pipr ._! .S~ 1 low Par Pipe ~ /~~. Kpm. VII. HOLDING TANK' ~ '*~+..... ~,,. 4: Manifold Sbtnlt: 1. CapacllY = i ~""" 'fypc (center or anti) .. ~ r? L~ Z: Mmula ~ ~•• LenK11- _ ~_ It, 3: -flits r~5 to Constructed Tank Details on Plans Diameter = ~_ in. -SHOW ALL INFORMATION ON PLANS- ~c, . Page , ~' Straw, Morsh Hoy, Or Synthetic Covering, Distribution Pipe ~, Medium Sond Topsoil . _____~,~__ F ~ E .. p . ,,.''~ P~,~M~t~ 'Y. SI o pe •~~r~.~@~~ Bed Of ~= 2 ~ Force Main .. ~ ~ c~~ ~ ~~,p,'t~ e g o t e MP°~ AN 41U 1N~S ~ ~E~v p` `g~pN ~~NC~ro:: Section Of A Mound System Using ,,, ~,~,~~~' ~ A Bed For The Absorption Areo %~,, Signed: /,~, ~..' r~C ~ ":~ - ~. License Number: •,~~~ /1. ,s ~~J, ' ~ ~-~° Date: `~' Z D ---~ ~ ._ ~- .I ~~ L - A ~ Ft. B ~r~ . Ft. K / D Ft. L X0`7 Ft. ~ ~~ Ft. t ~ ~ Ft. W ~ Ft. Plowed Layer D _L Ft. E /, 3 Ft. F , 7 9 Ft. G _~ Ft. H /• 5 Ft. 8'~0 5 8 z ~ ~ ~--- Dbservotion Pipe ' -- B --------------~ A ~ ---~ '~ Di:tribution Bed Of '?+- 2 %Z Pipe Aggregate Observation Pipe Permanent Morkers -K ~. Forts Main Plan View Of Mound Using A Bed For The Absorption Areo Meat Te Ee0 Cop ' Oittribution Pipe Lorout Si ned: ..~Q~ 9 • License Number: ~YI/J/Z~S~J .7.~ S ~ Date: ~ - zo - ~ > , ~,_, PIU~l~lNQ ~o~~~~~~ AN HElMAN AE{.At10NS I OF IND TAY. LABOR ~IS~ ~ ~5AFET . AMD ILDINGS ~ Page ._.. i~ NeNe Leeete~ Oe Bolton-. Ivt Egeepy sMeee~ .~ 8~O ~~ swa .~ , P ~.~ Ft. - S 3" X ~3 ~ Inchf!c Y ~ Inches Nole Diameter ~ Inch Lateral 1 y2-. Inch(es Manifold " z- Inches Force Main z-. 'Inches ~ of holes/pipe ~8 Invert Elevation of Laterals l0$ `fit. Perfo-oted Pipe Oeloll • PAGE (;F } PUMP CHAMBER CROSS SECTIOIJ AIJG SPECIFICATIO-~15 VENT CAP ~s~/~~~ 'i'~C.I. VENT PIPC A F,gPPROVED LOCKIAIG WEATHER PROOF ~A (I • JUNCTIOIJ BOX MANHOLE COVER ^/x" ~ 25' FROM DOOR, 12"MIU. W~~~rr~~5 ~-O~aE~ \ n,~ f, •, WWDOW OR FRESH I (1~SP AIR INTAKE I ~ . ~w,,r n GRADE I IB"lMIAI. CONDUIT ~-- ---------- 18"MIIJ, ~~\ INLET PROVIDE. •'` .~ I - --'- AIRTIGHT SEAL I ~ I ~ED ~ /~ pia I W \/ PLV~ I I ~ I h~l~ APPROVED J011JT. APPROVED JOINT ~ A W~C.S. PIPE Cp,~tao~a I I I W/C.I. PIPE EXTENDIAIG 3' I III ALARM EXTENOItJG 3' OUTO SOLID SOIL ~ ONTO SOLID SOIL a p1tON~ I 1I. Rol I I UMAN F,pa Ate kl S RY, lA ~,p,NG I I ON , t u- z$ ~ o q° s;o° F SAFETY ~„da ~!• i I qq44 ~ ~_J ELEV. ~ F'f N`0~~~ OFF • H -~ D I GOAICRETE BLOCK RISER EXIT PERMITTED ONLY IF TAIJK MANUFACTURER HAS SUCH APPROVA~jL S>=PT-c E SPEGIFI•GATIC~t~1S "~ ~ ~`' DOSE ~ ~ (~ ~~ ~ w ~ ~ ~ 5 : PER DAS I TAf.1KS MAAIUFACTURER: L~ ~ JUMgER OF DOSES TANK SIZE: ~C~Q GALLOfJS DOSE VOLUME IRJCLUOING BAGKFLOW: ~ 2 ~-- GA~~ONSi ygLARI'1 MAWUFACTURER:. y'~'~1~ ~~~^P~ ~ ~ ~ g'`~ IAICHES OR~ CALLOUS : MODEL NUMBER: . ~ ~ A= CAPACITIES ' , ~ ~ , ~IIJCHES OR _L_ GALL01J5 g = SWITCH TyPC u f ~ _ C = `5.5 IAILHES OR ~ Z Z GALL0IJS; PUMP MANUFACTUR><R: ` ~ 7 ~ MODEL NUMBER: 1 , l -^~ C(~ ~ ~" = GALLONS " D= ~~' INCHES OR SWITCH TYPE: '"'~/A, l.~.N~ NOTE: PUMP A1JD ALARM ARE TO 6E • INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE ~ GPM ~~^^ VERTICAL DIFFERENCE 6ETW7`EIJ PUMP OFF AIJO OISTRI6UTIOIJ PIPE.. "~U FEET -}- MINIMUM NETWORK SUPPLY PRESSUR~~E/~.. .. ~2.~5~ FEET -}- ~_ FEET OF FORCE MAIN X °7• ~ ~ F/oo F~FRICTIO-J FAGTOR..1'11! _ FEET _ TOTAL Dy1JAMIG HEAD = ~ FEET ~ •Z , Z ~ G ~ a -/S-, X -2 ~X ~ l3 s 9i~, ~~ 13 ~ IIJTERNAL DIME tONS: OF TANK: LEA.IGTH ~ (-;WIDTH `~ ~ - -;I-IQUID DEPTH ~- M ~O r~.S c,1 SIGNED: Q-A LICEi~lSE NUMBER: 3 Z'S~ -DATE: ~ Zt> ~~~ in 1 -b ,. ~ 1 ,• ~ f• ~ ~ Or Of Cy1 n ~~ Y, N C ~~ ,~,~ mn Q 8Q ~ ~$ f Lv 1 TOT/LL HERO ; ~ ~ ~ ~ ~ ~ ~ o ~ ~ g o ~ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT ' St. Croix County B U Y E R Gerald M. Hopkins ROUTE/BOX NUMBER Hammond, Wi. CITY/STATE Fire Number ZIP 54015 PROPERTY LOCATION: SW ~, SW ~, Section 21 T 29 N, R 17 W, Town of Hammond St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or•sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_ay a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 7.oning Office within 30 days of the three year expiration date. SIGNED ~. ~~/'" •,~ DATE~//~ ~~ ~~ /~~ St. Croix County Zoning Office P . 0 . Box 98- Hammond, WI .54015 715-796-2239 or 715-425-8363 H z H a r r 9 H N 0 z d 9 H r~ H 0 E z x H ro Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC-100 hie application form is to be completed in full and signed by the owner(s) of the roperty 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 end submitted to this office with the appropriate deed recording. (Owner of Property Gerald M. Hopkins Location of Property SW ~C ~ ~, Section 21 , T 29 N_R 17 W Township Hammond Nailing Address Hammond, Wi. 54015 Address of Site R.R., Hammond, Wi. 'I 8ubdiviaion liaae ~/a ,Lot Number „/a Previous Owner of Property Annabelle Hanson Total Size of Parcel 5 acres Date Parcel was Created 9-4-87 Are all corners and lot lines identifiable? x Yea No I, Is thi• property being developed for resale (spec house) ? Yes x No Voluisa 791 and Page Number 34~ as recorded with the Register of Deeds. -_..,. INCLUDE WITN THIS APPLICATION THE FOLLOWING: A Warrantq Deed which includes a Document number, volume and page number, and the ~I 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 refer- i encea to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY 0(VNER CERTIFICATION 1 (wel ceh.Li.6y .that a.CC 3tatemen,t~s on zhv5 ¢ohm cute ~lcue .to .the be~s.t o6 my (oun) hnowCedge; .that i (we) am lane) .the own2~c(~51 opt ~ko_ nhnnohl`u aoA..h;-,,,a ;.. fc.:. ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 20, 1987 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Gerald Hopkins property located in the SW 1/4 of the SW 1/4 of Section 21, T29N-R17W, Town of Hammond, revealed suitable soils at a depth of 2.25 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, ~,t Thomas C. Nelson Zoning Administrator rc DEPARTMENT OF INDUSTRY, LABOR AND HUMA~iV RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.0911) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: ,~ ~~ SECTION: T ~ N R W TOWNSHIPk6lEQXIQC?P7~)81~4C LOT NO.: BLK. NO.: SUBDIVISION NAME: ~5 SWr. 17 lor- 21 ~ / 29 Hammond n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croi Gerald Hopkins Hammond, Wi. 54015 1 ISF NO. BEDRMS.: COMMER IAL DESCRIPTION: Residence 3 n ~ a ~ New ^ Replace RATING: S= Site suitable for system U= Site unsuitable for system DATES OBSERVATIONS MADE PROFILE DT~TIONS: E A ON TESTS: 17-6-87 7-20-87 CO NVENTIONAL: ^ S ©U MOUND: ~ S ^U IN-GROUND-PRESSURE: ^ S ©U SYSTEM-IN-FILL ^ S ~U HOLDING(T~ANK: ^ s uU RECOMMENDED SYSTEM:loptional) mound If Percolation Tests are NOT re wired DESIGN RATE: Q If any portion of the tested area is in the under s,H63.09(51(b1, indicate: n~a Floodplain, indicate Floodplain elevation: n~a decimal' PROFILE DESCRIPTIONS Da>?e 61 JeB BORING TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I~, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 5.99 104.28 none 3.66 .92b1.1. .83bn.sil. .83bn.s.1.1.08bns.cl. g- 2 6.26 103.53 none 2.59 .67b1.1...67bn.sil. 1.25bn.s.l. 3.67bn.mo g_ 3 6.25 103.53 none 2.25 .83b1.1. .59bn.sil. .83bn.s.1. 4.OObn.mot. B- B- B- r1 ar i ma 1 ~ PERCOLATION TESTS TEST .DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I~~~ AFTER SWELLING INTERVAL-MIN. PERIOD 1 ERIOD 2 P R PER INCH P none 2 4 4 P_ 2.00 none 30 3 5 8 5 P_ 3 2.00 none 30 1 3 P-. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~:~. SYSTEM ELEVATION 105.28 ~ ~~- ~' ~ , . _,- I , ~ i r .._ _ ~ , ___: . ;__ _ " t1~V _ , _ ~ a_ ~ ~ ~~ - - ~ I I ( ~m -ice ~ i ~~~~ , ~`. ~, ~ ! I ' ~~ I 1 ~~~r ~, ~~Y)')rf-v~ k~ ~ ~~ ,)b ___ a ~ ~ i l fi ~. _ i ( ~ i ~. _ ~ ~ ~ ~ ~ ~~ i i i ~ r ~ ~ ~ 'TN DOCUMENT NO. 43U31~ ,, WARRANTY DEED *N,8 SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCgONSIN~~FORM 2 -1982 BOOK ~~1 FACE •,~1 Annabelle D. Hanson, a/k/a Annabelle .. Hanson, a single person conveys and warrants to _.- Gerald__M. Hopkins _arid -•--.__Jul-ie-_ K .---Hopkins--_holding__as_- suryiyorship_______•__ -------mar i_tal._propertY ........ ......... ...•---•----•-- the following described real estate in ._.__$.t...__CS01~C .....................County, State of Wisconsin: REGISTERS OFFICE ST. CROtX 00., Wt$, Recd. for Record this 21 s t day of Sep_~_q,p, 9 at 9:00 A ~ RETURN TO Tas Parcel No- ------------------------------ That certain parcel of land located in the Southwest Quarter of the Southwest Quarter (SW4 of SW4), of Section Twenty-one (21), Township Twenty-nine North (T29N), Range Seventeen West (R17W), Town of Hammond, St. Croix County, Wisconsin, more fully described as follows: Lot .One (1) of Certified Survey Maps filed August 28, 1987, in vo~C:er~il:~ie Survey Maps at Page 1875, as Document No. 429629, office of the Register of Deeds for St. Croix County, Wisconsin. S 0 0 a ~~~~ This ._....._iS riot homestead property. ~~~ (is not) Exception to warranties: Easements and restrictions of record. a Dated this -•------•--•---•---•-•--~-----------------•-- day of ...........--•'-=-•F•~.----•---•-----•-••-•------•-- ----..._....---~ 19._.87. ....----••-------•-•---•-•-----•--...-•-•---•-•-----•------•-•-------(SEAL) _..~at~-eev- .8 --•---•--....(SEAL) •-----•-----•---••------------•-----•----•----------------------•--- (SEAL) AUTHTNTICATION Signature (s) ----------------------------------------------------•- authenticated this ___._.__day of___________________________ 19..._._ TITLE: MEMBER STATE BAR OF WISCONSIN ^ _Annabelle---D.....H~ans.Qri ................•-- ----------------• •---•-----•---•--•----•---------•-•------..._...-- (SEAL) ACBNOWLED(IMENT STATE OF WISCONSIN ~ ss. -__-_-,__St.___CrOlX--_.._.County. ) Personally came before me this ________________day of ------------------------------------------~ 19 8 ~--- the above named _Annabelle D. Hanson ~~~~~ ~zss~s ~~ ~3/ ~ •. ;; w ~- L;d'/a-cJ i ~,> >iy~ . ~2T~F'IED SURVEY MAP ANNABELLE HANSON Part of the Southwest 1/4 of the Southwest 1/4 of Section 21, Township 29 North, Range 17 Weat, Town of Hammond, St. Croix County, Wisconsin. SOT / C_S. M. ~\ w Ji4 CDR. SEC. 2/, T29N, I VOL. 2, Pq GE ~ UNPLA TTEO LANDS R/7W, /BfRNTSfN CA P1 I 353, DOC.'# O Indicates 1" x 24" ~ _.__ ~ 1 i iron pipe weighing 3 339 79 3 N9O. 00 00 E 309.32 \~R/EASTJ ~ 1.13 lbs•/11n• ft• '^ k O O 1y W Set• ? ~ 1 476.32' 3{DO' W ~ 2 , v yl 3I ~ O '~ y -' - ~m ~ ~y N yI ~ y ~ QI 12 T I ~ L~( ~ 2 3 3 WI J I~ ~I3 ~ M ~ Q r . ~ CI I ~ I ~~ O 3.000 ACRES I vl = Q W ~ 1 N O p/7, 798 S0. FT. 7 ~ T = 4 B 3 fJ ~ 2 ~ I ~ W 4~ I . 6 ~ NE / ACRES ~ {V I ~ p~ = ~ O Q ( O ~ O 203, 89/ S0. fT. O ~ ~ ~ ~ ~ ICI +! I p O O O ~ to ' O Q I W ~ h I I ~ o ~I 33I.O/ ~ ~ ~f li .l O I DOWNED FENCE 2' p Z ? ~ +u ~ ~~~ 2 Imo. ,~.~,~ 476. 4B' H , ~ '~ o ~ O N88. 30'27"W 309.49' W a O ` O ~ o o UN PLATTED LANDS ° " ~ 3 o ahx SW CDR. SEC.2/, T29N, R/7 w, //"IRON P/PE fOl/NO! SCALE / ~~ a 200' O /00' 200' 400' 600' I ~ -- Description: That certain parcel of land located in the Southwest 1/4 of the Southwest 1/4 of Section 21, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more fully gescribed as follows; Commencing at the Southwest corner of said Section 21, thence N 00 00'00"E (assumed bearing on the West line of the Southwest 1/4 of said Section 21) (recorded as North) a distance of 430.1' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 00 00'00"E on said line a distance. of 420.99' recorded as North); thence N 90°00'00"E 509.32' (recorded as East); thence S 00 00'00"W 434.26'; thence N 88°3b'27"la 59.49' to the POINT OF BEGINNING, containing 5.000 acres, being subject to easement over the Westerly 33.00' thereof for town road purposes and also being subject to easements of record. Dated: July 14, 1987 State of Wisconsin) `,,~~~~~11~~1~~~~,y County of Pierce) ```~~ww``\SG ~ NS/ ~i~~ `~~ V` •........ • /~/ ~ I, Laurence W. Murphy, Registered Land Surveyor, do hereby ~ ~~ T,~ :••'' • '••. '~i certify that by direction of the Owner, Annabelle Hanson ;~ ;'LAURENCE ~~y' I have surveyed and divided the lands as shown hereon ~~ m W MUR ~~•/~ in accordance with official records, Chapter 236.34 of " e~ S ~ the Wisconsin Statutes and the Ordinances of St. Croix ~ i/N ': RIV F LS:•r• County; and that the map and description as shown "~ ~ ~ ••. W~SC. •..•' JQ Yiereon are a true and correct representation thereof. ''~ 9~~•~AN $ ~• i 0 • l~l.Th TT:fI ... ....~.~. .-..... eOMMERCIAL TESTING LABORATORY, INC. ,,,, •514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 ~~~w 3T. CROIX ZONING REPORT NO.: 40023/41 ST. CROIX COtJPlTY REPORT DATE: 4/26/93 COURTHOUSE DATE RECEIVED: 4/21/93 HUDSON, WI 54416 ATTN: THOMAS C. NELSON .., ~, OWNER: Gerald Hopkins LOCATION: 1313-174th St.F Hammond GOILECTOR: N4..1enk i ns DATE COLLECTED: 4-20-43 TIi"~ COLLECTED: 3:40Pm SOURCE OF SAitPLEt Kitchen faucet DATE ANALYZED:4-'~1-93 TIi'fE ANALYZED:2:04pm COLIFO~i: 0 /100 mt INTERF'RETATLON: Bacteriolo~ieati.y SAFE NITRATE-N: 10 pprt~ Above 14 ppm exceeds the recommended Public ;" , ~Dt- i nk i nq Water Standard. Coi.iform Bacteria/144 mt Nitrate-Nitrogen, a-q/L ~t.INDECFNOfNT, ~~ v A A ~d~~ '~h 9 ~ po ~ ~ ~ ~~ cfl ~ ~G y ~ 02~~ u S ~~ A LAB TECHNICIANI Pam Dane ~ ' - (.£ ~'~ `~~ WI Approved. lab NoF 19 means "Lii:SS THAN" Detec+able Levet Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 RAGE 1 °>Zlfs ~ 11 ,~. ~'~,~o ~ '.+AA~ Q 5 1993 ^~ ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ST~gah 911 4th Street ~- zONfN~C,p~OE w Hudson, WI 59016 'q Telephone - (715)386-4680 WATER TESTING----------------------------FEE: $-5.00 3 S. 6 O (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 h~t. Croix County Zoning Office offers the service of septic ~/ nd 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, ?long with form to the above address. Testing will be done as soon as possible after fee and form are received. (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at inspection} ~~ P Property owner's name_ e- Q'-h-~ ~ y <<-~ "~-~ . C / ~I ~„ ice, ~ ~~~ Firm or individual requesting services: ~~I~JZJLSL~ ~~r' Telephone Number ~~~0 -'$ ~ l ~ ~ k "" `~"' R E P O R T T O B E S E N T T O: `C-~A. ~~ ~..D '~ N C~-~-i ~m Cs~A ~-t~k. CS~ ~'~C~.DCI~--~ _ _ 3 C~'-l S~-~.c~~l 5 ~- . j Closin " Signat Property owner's address,'' p~R` l 3 Legal Description ~~/4 of the Town of ~ Lot Number FIRE NUMBER Color of house ~a~--~3 ~..5~ o a time of '~9to - Z3 ~ ~ 1/9 of Section 2"1 T ~-5 N-R 1~ Subdivision Name BOX NUMBER ealty sign by house? 1J oIf so, list firm; PLEASE IN DE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LO ION SHOWN, AND A COPY OF THE LISTING SHEET. Test'-tg of residential water requires a sample that is fresh. If the ome is vacant, and has been so for some time, the water line m t be purged by running the water for several hours before the est 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. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 21, 1993 Doreen White First National Bank/Hudson 307 2nd St. Hudson, WI 54016 Dear Ms. White: An inspection of the septic system on the property of Gerald Hopkins, located at 813 - 170th St., Hammond, WI was conducted on April 20, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator c~