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HomeMy WebLinkAbout020-1125-10-000 i o No od F - ',Ilg C r� c c O �1 n a CD xt c v `�° m m ID 3 m 3 = 3 - 3 - :� w cr, O c C` -. CD CD �i :: O N �D O O 0 O pD � C: O O <1 �V • 3 C: CO O N 7 CD uD 41 O Z CD � (� p O CDL N N N a. ;� N 61 Cn r O J 3 0 0 0 �;'� N N CD N 3 ' (D O 0 0 r O O tD c c :) rnw c� R1 '.I' -4 6 p� c0 °' 3 p H a a o u c ° ° o p A N Cl i 'I O N C C Q !a f -' _ N fD �p a v� y Q a r m vD a CD CO O CA N QJ < N CO o O o- "* (O7i '00 O O N ' S .� N CD O O ci Z o c c\ Ln ! + o ° Co W � W 0 CD 0 (D W W A O c !r N O O 7 n O O O A O O O o p N m �. N O n fA fn N o c fR fA N 2 !j OD - `+ 3 v a 0 Q a O v a CD CD fD N CD (b A r N � :U CD D m °� m m m m 0 a `er o CD CD Ln v A p �.� Z co Z Z m OZ W V iv = D o' =5 D Q =5 CD !y o Q p C7 N 0 0 o ID c ro CD (D CD .� rn J CD ro N (D N ro m co c CD c m CD CL m n CD 7 CD J Cl) �Q CA D D O O " Z C W C Q C CL a i .. Z —I CD CD ( CD co i — Z 0 3 0 3 a 3 3 m (A Z CD CD a w m w (D n co D D 3 0 Q 7 o On a 3 (a CD Q a * ' j -- m fD N O T Q T N N 3 O N c CD O Cr O CL 00 J G N 7 @ N (Q, N v IN - s N s CD N CD a W 7C (D ^^ ch 7 CD j C) S �_ 7 CD N �_. 0� 6_ a 7 N t N I W CD N 3 -� 00 D CA CD � �.. tS > tv N - O C) d (r� O I a ro v ti m m A n o O o C o CD CL CD 4 36 L( sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 4 , INSPECTION REPORT Sanitary Permit No: 420466 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Lee, Doug & Jackie I Hudson Township 020 - 1125 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: t,9, (�' ��� eo.Q' QUC- s cS Tgaw *- ( it ! 5 �? TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 17.4(o I12.-I 0D•v 1� 2� Alt. BM sr. , ` s 1 .6b �8'•6zl ratio Bldg. Sewer I 9Ht I;le z .ZI g3•Z� S t Outlet �{ Z �� �a Q3• p8' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. t Vent to Air Intake ROAD Dt Inlet 9. 1 7 �• aoddAkf I 7 Septic 25 , Dt Bottom m 4Z 06 r �L.• ? S / Header /Man. Aeration 4:13 UZ Y6 - Ups 14 / �' Bot. Syffem 112- •0�/ Final Grade PUMP /SIPHON INFORMATION Manufacturer *� G St Geaer- t vh Lop •$`w S q�.62. r Model Number .�1C Q� ak ,w 'a j PH Lift Friction Loss System Head TDH Ft Force main Length 1 • Dia. it Dist. to Well -v Z / SOIL BSORPTI N SYSTEM `f IRI 6 TRENC Width / Length I No. Of Trench s P:T DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN 10 S SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING CHAMBER Manufarr'oOrFS' INFORMATION Type Of System: 1 UN OR Model Number: e V Z'- y I6 (cI DISTRIBUTION SYSTEM LMo f-cj, (Z.D, tIs . Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Be Center Bed/Trench Edges Topsoil Yes No Yes =, No ,, COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1 C I / 2AU Z- Inspection Location: 364 Miller Road Hudson, WI 54016 (NW 114 SE 1/4 7 T29N R19W) Eagle Ridge Lot 38 P07.29.19.567 1.) Alt BM Description ='(� e�, 3 r �W rl�s ���� � 2.) Bldg sewer length { �i , IZ ;. ' °`f amount of cover n �1 �7 �Z' _ �- ,dY ,C,aA40- L D.T, -- I ° 4c,� � - CO ('� i 3 �'[.a 2 ( zoo - - — - - -- Plan revision Required? Yes No _T - 74,3 �J Use other side for additional informations. _�__ 3 _ R -kh � SBD -6710 (R.3/97) ate G , S Insepctors Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S te. GR �sconsin Madison, WI '53707 - 7162 Site Address Department of Commerce I i o -ii - 34��/9 3 �e ( � 1vi•l�tr Sanitary Permit Application Sanitary Permit Nu ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 2 �� 11 Check if Revision may be used for secondary purposes Privacy Law. 1 m I. Application Information - Please Print All Information a °> $ "'. "'F State P lan I.D. Number Property Owner's Name c, Parcel Number °cp 0`�) Property Own 's Mailing Address Property Location Ile r �' ©a CQ IVC' j4 SE s4,s T ­ 1 q N,R�9 s City, State Zip Code Phone Number Lot Number Block Ilumber y n 1 1 16 - - 3 8 b _ �J Subdivision Name CSM Number II. Type of Building (check all that apply) ❑City X1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use glownship ❑ State Owned n Nearest Road 3 )I ' >( (�Z / +w�c Q�cJlICQ jk6, Ra-*- III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 X Replacement System 3 11 Replacement of 6 ❑ Addition to For County use System Talk Only E)dsting System B. IX Check if Sanitary Permit Previously Issued Permit Number Date Issued f IV. Type of Permit: (Check all that apply)(numbering scheme is for internal useY'4 - 'fv0 _ 44 Ion - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Voiding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 0 Other V. Dispersal/Treat ent Area Information: 14_.� /o pe . PSR it "' S4_,P" I 3 1, Z• Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rat ystem Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq (Min. /Inch) Elevation I. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber PiAStic Gallons Gallons of Tanks Concrete Constructed Glass t New Existing -6 Tanks Tanks W r w Septic or Molding Tank / _ la4 l 2� Dosing Chamber 8 6 0 / VII. Responsibility Statement- I, the undersigned, asstmie responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number: L0.04e N�k \)i lip aa��ed 7 /s- 7yq- 33�� Plumber's Address (Street, City, State, Zip Code) 9 ld 1, s A " c-3 5 yo,? 3 VIII. Count /De artment Use Onl Approved ❑Disapproved ' Sanitary Permit Fee (includes Groundwater Date Issued issuing gent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse LZ�� V o Determination IR. Conditions of ApprovUReasonsLsapprov� � 4� VIA� �S At( Attaell complete pl (to the Cqunony) for th em on paper not less than 8141 x 11 Inches M she SBD -6398 (R. 0510 OS `_�,►,�,� _ 0 �X s pa �fl OvC. coo �.. r Y�-� / f 90 -� S 10.=- .. ; 1 �.- a J AFARGE www.lafargenorthamerica.com 4 _ o Q / L 103- Joy 9 0 � � � � 5 �.� y o � c�- cat -1/Y l a.,�:,w• � o_ l f �.AFARG E www.lafargenorthamerica.com 1570 Wisconsin Department of Commerce SOIL EVALUATION REPORT p� 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cade A.C.E. Soil & Site Evaluations Attach complete site plan on paper n County ot less than 8%x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. ��. -..._ .. "._..Ma� 020 - 1125 -10 -000 Please print aH nfon �$ . R By Date Personal information you provide may be used f ir secondary purposes (Privacy Law, s. 15.04 1) (m)). Property Owner' „ ; ,a 1 V 1 ,0 0 2 P Location Doug & Jackie Lee Govt Lot NW 1M SE 1/4 S 7 T 29 N R 19 W Property Ownw's Mailing Address )'.� Lot I Block # Subd. Name or CSM# 364 Miller Road _ 8 Plat Of Eagle Ridge 11 City State Zip Code Phone Number City �g Village IM Town Nearest Road Hudson ( WI 1 54016 1 715 - 386 - 2448 Hudson Miller Road & Krattley Lane New Construction Use: Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD Id Replacement Public or commercial - Describe: Parent material Glacial outw Flood plain elevation, if applicable na General comments and recommendations: Dosing required to reach system area. Install system to accomodate three bedroom home using three trenches at 99.00' using 30 leach chambers. Boring # a Boring Jig Pit Ground Surface elev. 101.38 ft. Depth to limiting factor >93” in. Sort Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0-6 1Oyr3/4 none sil 2fcr mvfr cs 2fm,lc 0.5 .08 2 6 -29 1Oyr4/6 none sl 2msbk mfr gw 2fm,1c 0.5 0.9 3 29 -36 1Oyr4/6 none Is 1msbk mvfr dw 1 f 0.7 1.2 4 36-64 1Oyr4/4 & 5/6 none sUls 2msbk /1msbk mfr /mvfr di 1f,vf 0.5 0.9 5 64 -93 1 Oyr5 /6 none strat. s 0 sg ml - - 0.7 1.2 2 H#4 consists of an unsorted mixture of 2msbk 10yr4/4 sl & 1 msbk 10yr5/6 Is. Boundries between textures are diffuse and do not interfere with permiability between textures. Loading rate relfects most restrictive permiability encountered. Boring # ': Boring Pit Ground Surface elev. 103.39 ft. Depth to limiting factor >96" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft: *Eff#1 *E 1 0-6 1O none 0 2fcr mvfr cs 2fm,lc 0.5 .08 2 6 -36 1Oyr4/4 none sft 2msbk /1msbk mfr gw 1fm 0.5 0.9 3 36-45 1Oyr4 /6 none gr.Is 1msbk mvfr dw 1f 0.7 1.2 4 45 1Oyr5/6 none nied. & cci 0 sg ml aw - 0.7 1.2 5 65 -96 1,Oyr6/4 none strat. s 0 sg dl - - 0.7 1.2 H#2 consists of an unsorted mixture of 2msbk 4/4 sl & 1 msbk 10yr4/4 Is. Boundries between textures are diffuse and do not interfere with permiability between ures. Loading rate relfects most restrictive permiability encountered. * Effluent #1 = BOD 5 > < < 220 mg/L and TSS > < 150 mg/L * = BOD 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signat — CST Number James K. Thompson - -_ 3602 Address A.C.E. Sal & Site Evaluations Dat6 Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/24/02 715- 248 -7767 property Owner - Doug & Jackie Lee Parcel ID # 020 - 1125 -10 -000 Page _ 2 of 4 a Boring # Bo w Pit Ground Surface elev. 104.40 ft. Depth to limiting factor >101" in. Soti Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = *Eff#1 *Eff#2 1 0-8 10yr3/4 none sil 2fcr mvfr cs 2fm,1c 0.5 .08 2 8 -28 10yr4/6 none sVIs 2msbk/1msbk mfr gw 1 f 0.5 0.9 3 28 -55 10yr5 /6 none Is /sl 1 msbk /2msbk mvfr dw 1 f 0.5 0.9 4 55 -76 10yr5/6 none strat.gr s 0 sg ml aw - 1.2 5 76 -101 10yr6/4 none strat.gr s 0 sg dl - - 0.7 1.2 H#2 consists of an unsorted mixture of 2msbk 10yr4/4 sl & 1 msbk 10yr4/4 Is. Boundries between textures are diffuse and do not interfere with permiability between textures. Loading rate reflects most restrictive penniability encountered. ❑ Boring # 'fit;. Boring Pit Ground Surface elev. 97.17 ft. Depth to limiting factor > 107" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 - 10yr3 /4 none sil 2fcr mvfr cs 2fm,1c 0.5 .08 2 5 -18 10yr5 /4 none sit 2msbk mvfr gw 2fm,1 c 0.5 0.8 3 18-42 10yr4/4 none sl 2msbk mfr cw 1fm 0.5 0.9 4 4248 10yr5 /6 none Is 1msbk mvfr cw 1f,vf 0.7 1.2 5 48 -107 10yr5/6 none strat.gr s 0 sg ml - - 0.7 1.2 H#4 consists Of an unsorted mixture of 2msbk 10yr4/4 sl & 1 msbk 10yr5/6 Is. Boundries between textures are diffuse and do not interfere with permiability between textures. Loading rate reflects most restrictive permiability encountered. F-1 Boring # A Boring -- V�t; Pit Ground Surface elm. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. • PROPERTY OWNER: Doug & Jackie Lee SOIL AND SITE EVALUATION 1570 Page 3 of 4 PARCEL I.D.# 020 - 1125- 10-000 A.C.E. Soil & Site Evaluations REPORT MEMO Residence presently contains two bedrooms. Property owner requests that replacement septic system be sized and installed to accommodate a three bedroom residence. Existing septic tank must be inspected to verify capacity & P structural stability. Effluent filter must be added downstream of outlet. Install bull -run valve after effluent filter to allow future use of hydrollically failed system. Pump will be required to reach replacement system elevation. , Pc��' 1i /S7D �o�.o to "� ,�• +81 � �c�c)1 FvL.r,L� • Top o/' /fZ" S •� - ASSu�+tcd ►off � I a 160'c o WcoWed A g5.4o z /aw radrt bt�wca.► -� PK.r, c��•.��e�- � you, 1�.�►, 9S-; &7 • er /s4; >7; Imc4 a fed: al. 4 ro?os4d pu,*% C-/z.•. { ESf.Q /e a E Ata�E,-�n -,. r� Q U W y JUNCTION BOX APPROVED LOCKING " ". 4" C.I. VENT PIPE MANHOLE COVER AND WARNING LABEL Lt 25' FROM DOOR 12" MIN. WINDOW OR FRESH I GRAD[: 1 BADE AIR INTAKE 1 _g ,, i �• �" 4 MIN. , s j I Sf '�� y is" MIN. let jiOUIT 18" MIN. -.�• .: • , .,. ; . -` ff.'s -''. � •'•• � =VATION I PROVIDE � I 418 ,. AIRTIGHT SEAL I I ••, A 1 1 11 .: APPROVED JOINTS �' 1 I f •' WITH C. I. PIPE APPROVED •JOINT �''• A LARM a EXTENDING 3 WITH C.I. PIPE :1 8 1 ONTO SOLID SOIL EXTENDING 3 I I ON ONTO SOLID SOIL C PUMP I :' �. ELEV. B9a FT. �� OFF D C iCRETE BLOCK jc. };;•° ;. REDDING • ra RISER EXIT PERMITTED ONLY IP TANK MANUFACTURER HAS SUCH APPROVAL FAC URER UJ NUMBER OF DOSES PER DAY .3 S IZE (GAL S DOSE VOLUME INCLUDING BACKFLOW / GAL UFACTURER 0 CAPACITIES '' EL NUMBER vz- t/ A 2� INCHES OR y'1 GAL xCH TYPE - 1 B _ 02 It ACTURER D Q NUMBER 48 NOTE* Pump and alarm are to be CH TYPE A" installed on separate.circuitsf ! DI,SCHA G RATE �/.3 GPM TICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ��' FEET 4 #w�; MI NIktM NETWORK SUPPLY PRESSURE / FEET cl 0..._. FEET OF FORCE MAIN X ', FT1100 FT ` FRICTION FACTOR � 7 FEET TOTAL DYNAIC _ IS , 7 FEET ,�. SPECS: OH I. INCH OF DEPTH EQUALS o GAL I�ZRNAL DIMENSIONS OF TANK: LENGTH /V 3IDTH 1v 4 LIQ D Ll aL H • PUMP CHAMBER CROSS SECTION AND S1 • l� � 6 a 4 15 ° �� r M1, ie ph 3 7/8- — 6 1/4 f4y HEAD CAPACITY CURVE MODEL "98" 4 5/8 k4 x p: 6 s " > 3 5/8 ip i lr_ O i e4 3/16 '�. ;j 1 112 -11 112 NPT f• 1 y ! 4 S - .. 10 20 30 40 - 50 60 70 80 0 80 160 240 FLOW PER MINUTE YV1 Y p� i MODEL 98 60 CYCLE Ea rN feet Gallons Meters Liters + S 72 1.5 273 % ?' �'l 1 A r 10 61 3.1 231 15 45 4.6 170 20 25 6.1 95 12 Lock Valve: 23' 009971 a) 4 3/16 t f g _ ' SKI 102 CONSULT FACTORY FOR SPECIAL APPLICATIONS xe1'atternators, for duplex systems, are available and Variable level float switches are available for controlling single " d With an alarm. and three phase systems. a temmators, for duplex systems, are available Double piggyback variable level float switches are available wx a 46 W{th ' t alarm switches. for variable level long cycle controls. SELECTION GUIDE ta± r 1. Integral float operated 2 pole mechanical switch, no external control required. P ward X11 models - Weight 39 lbs. - /2 H.P. 2. Single piggyback variable level float switch or double piggyback variable level, 1 asrfes Control Selection float switch. Refer to FM0477. 1f01t& -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. H 1 Auto 9.4 1 or 1 & 7 4. See FM0712, for correct model of Electrical Alternator. Y 1 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. 3 d! 230 1 ' Auto 4.7 1 or 1 & 7 — 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. ;+ o- 7. Two (2) hole J -Pak, for watertight connection or splice. 5 t1s1c. 'ra CAUTION * on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, All In,a3 +fat . n of controls, protection dc. , and wiring should be done by a qualified Alternator, FM0486 ; Mechanical Alternator, FMO495 ;Sump/Sewage Basins,FM0487; icensedcir tn6an A,; Bieltrical and e'+, ty codes snouidbe followed including the most ptlad3! �drnplex Pump Control, FM1596; Alarm Systems, FM0732. recent N ti ml Electric Ccwe (NEC) and the Occupational Safety and Heald, Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 6 i N MAIL TO: P.O. BOX 16347 Louisville, KY 40255 -0347 Manufacturers of. . s 0 SHIP T0: 3649 Cane Run Road ( Louisville, KY 40211 -1961 Q 592) 778 - 2731.1(800) 928 -PUMP 4zlry PUMPS sN F /,9M A . la►MrltrW, PUMP `0 FAX(502)774 -3624 alry f •!'h1. � M 4- r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page t of FILE INFORMATION SYSTEM SPECIFICATIONS Owner u Septic Tank Capacity ry 2 !o / + l 000 a l ❑ NA Permit # ZQ Septic Tank Manufacturer, . iman ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0_� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 9-/00 ❑ NA Number of Public Facility Units X NA Pump Tank Capacity E? 00 a l ❑ NA Estimated flow (average) 0 040 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ' 7 ❑ NA Soil Application Rate • gat /day /ftz Pump Model ` $ ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit kNA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) W f ❑ NA Biochemical Oxygen Demand (BODJ 530 mg /L Kin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tanks When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA CK year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA Wyear(s) Inspect um ❑ month(s) ❑ NA Ins p pump, pump controls & alarm At least once every: 0 year(s) Flush laterals and pressure test At least once every: p yea��s)(s) NA Other: At least once every: ❑ month(s) ❑ NA .� tR year(s) . C""V L X NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Z- Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other' chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name (� O� ti Qp Name LO 0,-Q 11 Q11 Phone 7 /5' 7q 7 " °Z Phone 7l .5- - 7q `I - SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORI Name crY.d 5-4-1 Name 54, G C4 Phone - 7C� -- `7 X19 — C7 1 3 Phone � L3 6 — '4 1D 6 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHI P�CERTIFICATION FORM Owner/Buyer D Mailing Address b� R l �►- a-o S y o ! Property Address S �- (Verification required from Planning Department for new construction) City/State A Parcel Identification Number I (Z 37- 10 - GM �• � �� L EGAL DESCRIPTION Property Location /L o V,, -�4—'/a, Sec. . T�N -R 1 f-- W, Town of PA -&4-0 ' Subdivision . Lot # 8 Certified Survey Map # ?� , Volume _ . Page # Warranty Deed # 4 5 3 /0� Q , Volume . Page # ! /` Spec house ❑ yes ® no Lot lines identifiable 0 yes ❑ no S YSTEM MAINTENANCE . to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its premature fa Pe consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a li cense d pumper verifying that (1) the on -ate wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI OF APPLICANT DATE NA OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG OF AP1dMANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE DAR OF WISCONSIN FORK 1 -1962 T"'• 'rAcc RU[RY[O ran RccoeoiRO OATA WARRANTY DEED 453150 r�: S��P "�E REGISTER'S OFFICE This Deed made between ..... ... .. . ...._....... . ...... ... ........ .. ST. CROIX CO., W1 Henry- A.- Zigan and Mary P.. Zigan_ f /k /a._ Mary ... Reed for Record P, - _Rosman, husband and wife _.... NOV 021989 . ...., Grantor, at 10:35 A. M and Aou las._A. Lee and Jacquelyn A._Jensen. Lee.,.. _husband an w re as marital sury vors p... property _ .... _._ .. Grantee, WitilEsseth, That the said Grantor, for a valuable consideration _... Henry .a -nd Mary_ Zigan conveys to Grantee the following described real estate in ..St.. -. Croix...... County, State o`.' Wisconsin: Lot 38 Eagle Ridge in the Town of Hudson, Tax Parcel No: ................................... Croix sconsin. This ..is --- - ------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And .. Henry-- and ... Mary - -Z -gan . - -- - - I - -- -- ._ ................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights -of -way of record, if any. - 01 warrant and defend the same. SEPTEMBER , 1975 V /S87049'30"E REVISED THIS 20TH DAY OF OCTOBER, 1.68 ACRES 1975 87°31 E 470.83 235.0 11 M 36 �i " 2.77 ACRES 18 7.91 ACRES 6 20 ° N 6 9 2 ^� 7 20 b tv 2 ° ot a �3 At ego 08 h X39 2 , 4C • ,.� `ry `ry 26 ,r ? 6 9 . o 5� 6 48' 37 . �, 0 6 s, S z *0 I 0 , 2.99 ACRES \� 38 �E 60'00 ° 1.80 ACRES N / A $ � °�6 SO 46 ,W � M )N PIPE +O cn 9 �A S 6 ° Od) O O �,� 4f4 T 4 0'F O ol� C ..E 292.55 39 "� 117.5 Mq� 40 � CURVE DATA TABLE CURVE LOT RADIUS CHORD CHORD E4TRAL SKETCH N O. NO. LENGTH LENGTH BEARING ANGLE 1- 1942.86' 205.06' N 86 0 37'10 "E 6 0 03' • bb . /�, _� ,�� - ^ 605.96 288.60' N 69 49' 05 "E 27 °33'10 at 2 79.97' N 79 0 48'4d'E T ° 34' 3 It 169.36' N 6T° 59'40 "E 16 NE 4 of 41.44 N 58 0 00'05 "E 3 °55'10" '5 -6 380.25 675.14' N 6 125 ° 11' id' 9 111.66' N 47 16 0 53' Id It 10 33.03 N 36 "E 4 58'4( 11 33.03' N 31 41' 20 "E 4 58'4( 12 " 111.35' N 20 16 0 50'2( 13 162.37' N 0 02'00"E 24 °39'2( 14 33.39 N 14 5 02' ' 15 - " 33.08' N 19 0 49'15 "W 4°59'10 16 " 99.25' N 29 °48'45"W 14 17 208.5e N 53 0 13 40' W 31 0 50 944 24' 1 482.00' N II ° 30'55 "E 161 019'1 0■ o o ca :[ x 03 0 2 � c £ � c ] i ] rt rr / 7 / [ ° ( \ 3 / m ° / $ ( § 2 >& 5 0/ A r z R( g m §@ ■ � Q\ c& $_( m �� & / & ; t , a § § / \ \ § 8 3 G @ :3 ° - 3 ,i o c r / \ ■ I ± % k / / E % \ I \ � k '. o 7 »§ o § 2 I CD g C §§ 8 « G§ n r@ . $ S 8 m w E\ R E — .. z 0 0 0§ 0 o o \_ - / £ ƒ § § 2 § / 3 ) § @ � 0 }_ CD � ° \_ CD � � � CD *` § R Ifm E ƒ § E ■ § D f m — _ \ \ g \7ƒ g /7ƒ O =r ƒ ƒ { ƒ ƒ �. ƒ k r ƒ \ « e \ ; : N % \ a = i : 7 CD CD , § , k / / k k / z o ( P R 0 ■ m ( 0 § d 0 \ 0 A z � m � k \ � k \ § \ D CD CD \ik / / ) \ M 2 =3 z % \ o z % = f \ CD � §3 � \\ � q CD \ ) w % 3 0 �� 7 \ A % $© $r ®% @i @\ 7 � Parcel #: 020- 1125 -10 -000 03/31/2005 03:29 PM PAGE 1OF1 Alt. Parcel #: 07.29.19.567 020 - TOWN OF HUDSON Current X , ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DOUGLAS A & JACQUELYN A LEE LEE, DOUGLAS A & JACQUELYN A 364 MILLER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 364 MILLER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.800 Plat: 1925 -EAGLE RIDGE SEC 07 T29N R19W EAGLE RIDGE LOT 38 Block/Condo Bldg: LOT 38 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 855/516 07/23/1997 801/192 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 48657 192,900 Valuations: Last Changed: 10/2612001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.800 37,400 111,800 149,200 NO Totals for 2004: General Property 1.800 37,400 111,800 149,200 Woodland 0.000 0 0 Totals for 2003: General Property 1.800 37,400 111,800 149,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 124 Specials: j User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Whin Street, P.O. Box 526 Colfax, Wisconsin 54730 kt� 715 - 962.3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.S 34687/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 10/09/89 COURTHOUSE DATE RECEIVED; 10/05/89 HUDSON, WI 54016 ATTNS THOMAS C. NELSON 7. z 5 OWNER! Henry b Mary Zigan LOCATIONS 364 MiLLer Rd., Eagle Ridge, Hudson COLLECTORS Henry 6 nary Zigan SOURCE OF SAMPLES COLIFORMS 3 /100 ml INTERPRETATIONS BacteriologicaLLY UNSAFE NITRATE -NS i ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE LAD TECHNICIANS Pam Gane WI Approved Lab No. 19 �. \NOEVE/rp J V H SA < Means "LESS THAN" Detectable Level Approved by'* PROFESSIONAL LABORATORY A RY SERVICES SINCE 1952 ® L BO O AL l �J` dq G ST. CROIX CONY ZON P OFFICE f' 1 St. Croix County C rthouse -- �.. -. 911 4th Stre t �n Hudson, WI 54016 �f %,9 a/ G Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is ess so that the-property _ c an be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. �( WATER TESTING-------------------- - - - - -- --FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION - -- -- -- -- --FEE: $25.00 ✓�' (Determines if system is,'prop6 -ly functioning at time of inspection) Property owner's name ' j�l/ y 4 ,e)� Z Property owner's address /L LE1e Legal Description 1/4 of the 1/4 of Section , T N -R Town of � J 0-90 Al Lot Number Subdivision Name IR � Col N Color of house LOCK BOi y n by house? CIf so, list firm PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e, PY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY'OF'THE LISTING SHEET. Testing of residential water requires a sample that is fresh.' If the home is vacant, and has been so for some time, the water line must be purged by running the ,rater for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry nay be gained. Firm or individual requesting services: Telephone Number 3t REPORT TO BE SENT TO: 0 I Closing dat .. .. Signature r ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET •HUDSON, WI 54016 (715) 386 -4680 October 4, 1989 Barb Avery 700 2ed St. Hudson, WI 54016 Dear Ms. Avery: An on site investigation of the septic system on the property of Henry and Mary Zigan at 364 Miller Rd. Eagle Ridge of the Town of Hudson was conducted on October 4, 1989. At the same time I also obtained a water sample and submited it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. 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 is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. sincerely, Mary Jenkins Asst. Zoning Administrator TCN:cj g3 AS BUILT SANITARY SYSTEM REPORT WNER S pi 44 , ((e , TOWNSHIP l7 Li Gf S On SEC . 7 TZcfN-R l W ADDRESS riyaq t 8 toy' /l RF ST . CROIX COUNTY , WISCONSIN . SUBDIVISION rdy/ l ' ,),0 LOT 5 / LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 54 (7 C7 , tc / l , 4.' . . / / C/f ° • Indicate North \rrdw SC.AL1 : BENCHMARK: (Permanent reference Point)' 'Describe : / ap a ( / ,/ L` / / 1A, Elevation of vertical reference� point :_ ( 06).,, (� _Slope at site : 1% SEPTIC TANK: Manufacturer : �.r(e ce`t Liquid Capacity : t G' Q- 6 Number of rings on cover : Tank manhole cover elevation : Tank Inlet Elevation : t 1 f,K( Tank Outlet Elevation : ` , F 6 M a1 Aa(e r( i .- yg, ,o PUMP CHAMBER / Manufacturer : // 4 Number of gallons /V Number of gal . pump set for a cycle /V/1 g,,allons ; Total capacity of distribution lines /V4 gallon : size of pump /(/ n head ; gallon per minute i/4 ; horsepoiaer ,{j` A- ;brand name of 'jump and model number A/ - ; Type of warning device HOLDING TANK: Manufacturer ,iv_ 4- _ Number of gallons ,/ A Elevation of manhole cover ,/t/4- ; Type of warning device N 4 SEEPAGE PIT SIZE; /A/4 Number of pits it/4 feet diameter /VA feet liquid depth A/4 seepage pit inlet pipe-elevation 4/ 4 bottom of seepage pit elevation .. v 4 feet . SEEPAGE BED SIZE : number of lines 3 width ` 4- length f G tiledep_�h 3 �/ A� s SEEPAGE TRENCH: width. � length PERCOLATION RATE 3 AREA REQUIRED (� ( 4 AREA AS BUILT C / O INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER Al - S_ 1 y ( 07 tA <5 -/ P /3: 7/ :7_ Vnnfi 0 \ eo ,? � \ \ � 6 Go l—f � u7 � lV tq 5 E f f n L DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINC +� LABOR & F{UMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIO P.O. BOX 7969 BUREAU OF PLUMBIN MADISON, WI 53707 ®CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Ilf ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound assigned) NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller TroutBrook Rd., Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. EV.: NW SE, Sec.7,T29N- R19W,Lot 38,EagleRidge, Hudson Town. Name of Plumber MP /MPRSW No.: County: Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 38458 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. ITANK OUTLET ELEV.: WARNING LABEL L Nz� Ll �� PR V ED: PR lJ q' YES ❑NO BEDDING: VENT DI .0 VE MATL.: HIGH WATER UIU1131FR {�1'w 'F ROAD: PROPERT WELL BUILDING: I V E T T RES ALARM. LIN I AIJL - ]YES NO DYE ONO Enka' DOSING CH MBER: MANUFACTURER: r ING LIOUID CAPACITY. PUMP MODEL. PUMP IP N MANUFACTURER WARNING LABEL LOCKINPR YIDEDPROVIDED: YES ❑NO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIO L: U PROPERTY WELL BUILDING: VENT TO FREE (DIFFERENCE BETWEEN FROM LINE' AIR INLET' PUMP ON AND OFF) OYES � O ARS SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plow0 LE TH A DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cease the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH J NO,OF DISTR. PIPE SPACING: COVE '.INSIDE DIA. - . .1ITS. LIQUID ;mow s °s' .A TRE NCHES. M, RIAL• I DEPTH: fN GRAVEL DEPTH FILL DE DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N0. DISTR I�1(�M�I`. ('�F - PROPERTY WELL: BUILDING: VENT TO FREE BELOW PIPES ABOVE COVER. EL V INLET. E V. END PIPES LINE: A NL 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- OYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE P ERMANENT MARKERS: OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER. EDGES. DYES ONO ❑YES ONO DYES — 1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: MIT CH TRENCHES: IE MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV. : DIA.: ELEV. : PIPES. DIA.: 1 f5 RI 11 Willi, HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO ❑YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: 11#lr11Il1OIcROF` PROPERTY WELL: BUILDING: EE1T LINE: ❑ YES E] NO ❑ YES El No �fEAi�S>' X "►� X73.61 1 ° � q.s� T�0 b 0 �0 pip G Sketch System on a In in unty file for audit. Reverse Side. .- SIGNAT TITLE: DILHR SBD 6710 (R. 01/82) 1 8,% BLflLDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AN eDii"‘ S• �NfaOSTI?Y, DIVISION LABOR AND PERCOLATION TESTS (115) q �c B°" 7969 HUMAN RELATIONS \ / jr j�� tDl'l,� ,WI 53707 LOCATION:[ SECTION:T�C� p ?}�TOW#„,(50,,, NSSHIP/! UNICIPAL-41 YT SLOT NO.:BL. �'v,: S To rs10N NAM. COUNTY:,��C,� OWNER'S/BUYER'S/ / N/11 M (o� ) ING ADDRESS: , �� � ,4�4 �'`e- < /,r� C�yy� /E /�j�/ //yam Jy`t._ // .�+7 C 4;x. ✓�!/(1 / •,'/6,- �e"..1- , r 00k /del , //(�Z.a f '_ll� , ,-VL• p USE l DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 �/ ,,New ❑Replace s,-/&.y e3 /y,c,_ s0:7itl,o,.J 'e - , 7 B RATING:S=Site suitable for system U=Site unsuitable for system ®d t'y AI,t 4'6 0 S;`/rt /,51,-1 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:loptional) FA S U KS LJ U (S ❑V ❑S Z U ❑S lxl.0 'o ci ti -o r,l ,9��1 (/#, 3 E') If Percolation Tests are NOT required DESIGN RATE:SYSTEM ELEV. If any portion of the lot is in the fr/At s.H63.09(5)(b),indicate: ,(f/ ,�/ Floodplain,indicate Floodplain elevation: /`��///�j ` PROFILE DESCRIPTIONS eer BORING TOTAL, ELEVATION DEPTH TO GROUNDWATER I?JCIICC CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B / o ' ?7? ' goat-- 7 9L ' I /3/ c,/,.arg,,/, /Mgn/+ S// 3. ? Sn � B- ,Z 7 ©' ��,/' A A4.2__ 7 ,.'© f r rg/i 6 ,.z,o B„6 /,0 0-7/ i-s i, /.S"Bi,/sl o B.,s i B- 3 Fe) ' V 3 ' /(h 4.c e 7 7,0 /0 a/s,`// z.e B,/ /.g•, /4-57- / Y 1, /s/ 3, / s� S B t d ' 99• 9' e.- _ � F C ' f e/s;i,2. Bei/, / le if /*.r/, y, ci Ais. B-4"-- f,of /CC.61 Ale?, 2 - 7 9C ' /fif/3.1 Rd B /`/84/ �S/� I, /enisr 3,c inr _S B- PERCOLATION TESTS TEST DEPTH r WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NPUM� C ER S AFTER SWELLING INTERVAL-MIN. � O iOp 1 PERIOD 2 PERIOD 3 PER, INCH P- .2- s 7' A10 3 C 6 3 iF3 si ?, Aid /0 - /�/i. /At i` er 47 PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 742• Y e te 6 40 d , 1 4 B.M. is r-Ze t/ewt. 4- ii/oe�i. tk eF. /o, ..fi A- , , S, uJ, ,f �ry3 ` �a o f COI-octet" Ch., 1-op o F /9 ‘ 0' N Nik N,.p? Q.3 , 4 J t r' kd 'ry.e... l 1.-f•FN /1,4) A. ►. sb. k\ Ass �cme4 et, /odic ow 8 / a- N.P '� �' �L /,i A , e.���s CB4cLI ce) 9N �� \ \i\%al,1' /L° `� / Q Peecs re f <o EL 9 ?.i(' 4 Ne -7 .. - -/ , , S'o..: ita d/- frba eh f l rc 4.e C B /.,t I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): / TESTS WERE COMPLETED ON: Qe iiir� Y ' Cie; yc� 5� ei i -2 ADDRESS:/ ,� / `, r CERTIFICATION NUMBER: PHONE NUMBER(optional): /P/6 /440-e( /9-u�r /j� he l.� cotes , �,47,6 C /sa,TUyE: 7/f—,i f SIP/ c DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. R-SBD-6395(N.03/81) DEPARTMENTOF APPLICATION SAFETY &BUILDINGS •INDUSTRY„ FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, W1 53707 Attach plans for the system on paper not less than 8 /Y x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner. /44 . [ Ma i l' Addre S 1 fr 13 tG ok Hu a so4 t4/ s .5 ors Property Location: U N�ity�M*llege.or Township: County: C /✓lt 1. �R %s 7 �T - NiR l wor W o l Gro I)( Lot Number: Blk No.: Subdivision Name: Neares Road, Lake or Lan mark: tate Plan I.D. Number: g �� r a l r t �' l/ Q F U r! f assigned) TYPE OF BUILDING Number of ❑�"blic El Variance* El Other (specify)* Bedrooms: V1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBE NEW REPLACE- OTHER RGLASS GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ooc HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: 4 ♦+ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): L'f New ❑ Replacement ❑ Experimental (� epage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Wat er 5pply: Owner's Name as Listed on Soil Test Report (If other than present owner): , L� Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP /MPRSW No.: Phone Number: 190645 1 14/° -511 (.2 f7_ 313 Plum er's Addres : Nam of Design r: COUNTY /DEPARTMENT USE ONLY S na re of Issuing Aent: e: „n Date: pp Al Sanitary Permit Number: O O " w `�o� DISAPPROVED �� Reason for Disapproval: Alternate course(s) of Action Available: i Change of ownership, building use or plumber. requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) Form - S T.0 100 Owner of Property 5x VI /?1f, & e Location of Property 4, Section T�_N RAW Township � ` P _ � .� rrti, Mailing Address , r, ;d- '_ T _ � �s n LA J-3 '� Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel — Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following .Certified Survey Map .Deed ' .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deeyl recorded in the Office of the County Register of Deeds as Document No. ,,fT� -J -3 ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. -1 Id > ► ). SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED T-J) � d' 'b � Q 4 � r r `t 4c z o . h it R .rt Sam�� e n of 1 .2 4- � ©, � iy 1 - 4 e v. ri f -t l L o, 1 ./ !' 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