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020-1125-30-000
~ f7 N Q ~ n M 0 ~ '9 n d C ~~ C .~i 7 'i 3 C't 3 K ~ 1 I 3 <D N '~ ~ ~ I 7 A fD `~Z ~ ~ '' n A 'p C A7 r' ~~ I 3 3 " I 3 .' 3 ~ ~ ~ ~ ... 1 ~ I .M I M O ~ '..aT. T~ Z V7 Z O W N N d (N!l O °~~~ C O N `C • ~ ~' ~ d ~ '"~ O ~ O O ~ A N ~ n ~ Q I ~ ~ a ~ ~ m ~ ~' ~ ~ I ~ a a y ° m ( o ~ ~ ~+, ~~=3 ~~~ ~ I ~W~ ~ ~~~ o ~ I o o n~ ~~ y m a- a- N lit ° cn w ~ ~ ( ~ ~ ~ ro c ~ n ~ I c~u m ~ ~ ~ ° o ~ O ~ I a o ~ I ° ' ° p ~ c ~ ~ rn sz° , ~ c ~' o ° ~ I ~ I u> Z D I ~ ,~a, ~ I cn ~ D , ~ a ~ m ~ D cn a d ~ ~' m m N C v ~ ~ ~ W Q c 0 0~ W = O' - 0 0~ ~~ I O '-' -' rn I ;, ~ p ? e rn ` ~' NJ1 W~ C ~' A W~ I I I ~ ~ o o h I o ~~~ n r N v' N N Z1 ~ A .Z7 ~'~, N.0* ~ I .. 000 l 000 :.. ~ ° c c ~ I a o W ~ ~ ~ ~ ~' I c'n 't7 ~ ~ ~ a v, N N ~ m ° ~y,,~ ' `~ N ~ ~ I~ N N N ~ I ? ~ N ~ ~ ~I I ~ m vvv I va~ ~vv, ~ m I ~ ? N -. _ ° ~ ~ ~ ~ ~ ~ ~ _ ° ~ A a ~ ~ ~~ o ~~ m I °.: ~ o I ~ °: ~ rn I = 3 ~ .. rn I ~ _ .. I a I o M Z O I ~' I D D D a I °~ ~ ~ I ~ ~ ~ m m m ~ m ~• I I coo I ~ I coo m $ ~ C N m C D N f I w ~ a I ~ a d ~ 7 ~ 7 I ~ N o I N o ~~ ~ I ~ a I a p' ~ ~ I =. I .. I zN., I ~ ~co I a`D I a Z °~ O~ A I I ~: r: co I I y H m~ ~ Z I ~ I F a w w I ~ I I a ~ I n a ~ ~ ~ ' s , ~ I m c I ~ c I o a I f o i v o 'a a I a, I w ~ N I I ~ y I ' y I ~ 3 I I I I a A I I I I ti N p O~ i 1 a O O :~ I m I m de .~~ I p ~ p ~ ~ . O ~ ~ ~ I °o a I o a ~ ,,,, tf- a- St. Croix County Occupancy Affidavit Name - {Owner) Typed or printed being duty sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume t 19 t Page ~ Document Number5'•}~252St. Croix County Register of Deeds Office: A parcel of land located in the N-~'/, of the~~.JE'/, of Section ~' > T~_ N - R ~ `~ W, Town of ~ktxA~+V , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): 6693~~ I~;FITiiLEE'~t H. WALSH hEGISTER OF DEEDS :~T. CkU:I:X CO., WI RECEIVE- FOR RECORD OS-25-200i? 9:3E1 Rtl ZONING AFFIDAVIT EXENa T it CEkT COGY FEE: ~CIPY FEE: 2.00 7kANSFEk FEE: RECORDING FEE: 11.00 PAGES: 1 Name and Return Address So ~tt~t~ P 5fi~t/1e +, 35(p N1.F14'ev- +~. n 20 - 1 12 S - ~ ' t~o0 ~ As owner of the above described property, I knowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flo~.v of L{-S~gpd. The design flow is calculated by assuming 'I 50 gpd for 2 individuals per bedroom. There are currently ~ occupants living in this residence; ~ occupants are permitted based on the design flaw. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that 1 will make this information available to any future parties interested in purchasing this property. Dated this d5 d y of ~~ . z~~. * - - AUTHENTICATION Signature(s) authenttcated this day of ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. t. Cro County. ) Personally came before me this °~ ~ day of cJ°~'` `'` °'" r ~ Ot:.~-- the above named TITLE: MEMBER STATE BAR OF WISCONSINv'' ' • • ' (If not, '~~ authorized by g 708.06, Wis. Stat6.p;, ; ati ~ f; - _ THIS INSTRUMENT W{+S tJRA*Fl~~BY !`^.~ ~- ~~• ~o ~. J ~ ~? Stec- ~ '' : p - - : ~ ~~, i .~;1 (Signatures may be authenticated or acknowledg~d.~.Both are not necessary.) to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. ~Q~+~ Notary Public. State of Wisconsin My Commission is permanent. If not, state expiration date: Date: I - ~ - -~ao'jj `'THIS PAGE lS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submifter: doc menl title. name & return address. end !'I1Y (!f required). Other infomration such as the granting clauses, leagal description, etC. may be placed on This first page of the document or maybe placed on additions! pages of the document. Note: Use of thts cover page adds one page to your document and ;2 00 to the recording /ee. Wisconsin Statutes. 59.517. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety andBuilding Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ~,Q,~e O ~~~ ~-7?'1 , a City Village X Township Hudson Townshi CST BM Elev: t Insp. BM Elev: r B~M+ Description: •c~ G'D . D 1..~ ~~ TANK INF RMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic . i 1 I Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ ~ ~OI ~ ~ ! Dosing Aeration Holding PUMP/SIPHON INFORMATION Demand GPM ITDH (Lift IFn2~t' nip Loss (System Head ~fDH Ft Fnm~rs ai~rannth '\ I\ia_ is . to Well/ I SOIL ABSORPTION SYSTEM } D~ C BED/TRENCH Width ~ Length ~ DIMENSIONS ~ 6~,~ ~~ SETBACK SYSTEM TO P, INFORMATION Tvoe Of DISTRIBUTION SYSTEM county: St. Croix Sanitary Permit No : 39911 X07 5~ 0 State Plan ID No: Parcel Tax No: bo70-'y/Z J - ~`~~ STATION BS HI FS ELEV. Benchmark 3•SZ ~ ,s ~ tsD-c~ Alt. BM Bldg. Sewer ~ ~ SUHt Inlet SUHt Outlet ~ Dt Inlet Dt Bottom Header/Man. ~ (5 _ S~ f Dist. Pipe ~T.aa 3.6 2 Bot. System 2 Z2 Final Grade Jr~S~- 1 ~~~ 1 St Cover ~ °~ -lam ~[ $~`1~ ~,~. 6 Zf e~- vie ~ •~° `? `f- ` 2 PIT DIMENSIONS INo. Of Pits (Inside Dia. ,KE/STREAM LEACHING Manufact (er: ,~ CHAMBER OR .Lv~ ~Y~°'r r ~~~'~ ~., UNIT Mod~IlNumber: Ti! -~4n4 L~ ~^1/ Header/Man'fold ~ l..~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent to Air Intake ~.,. '2 Length ~ Dia i Leng Spacing / SOIL COVER ,. a~o«~~~o c..~rom~ nnl~ YY Mniind Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~ Yes E'! No Yes ~~', No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1c~'k'N/?~/Zt9~~lnspection #2: Location: 462 McCutcheon Lane Hudson, WI 54016 (NE 1/4 SW 1/4 17 T29N R19W) Park View Estates Addn. VI Lo Parcel No: 17.29.19. Sq~ s 1.) Alt BM Description = 1~ljC} , N ~ ~~ ~1. 3,~ /^ ~.~D 2.) Bldg sewer length = ~- I ~ ~ ~ ~ l~ ~ ~Q1 +~y ~ ~ •3(7 - amount of cover = t 1~'r' ~, ~~ ~y(j 3~('s.~~~Cww d~dQ. ~`~5~'~~ Plan revision Required? ~ -] Yes o 12~~ ~ ~, ~ Use other side for additional informs on. ~ ~- _~`__ Date Insepctor's Signature Cert. No. SBD-6710 (R.3l97) Ssfety & Buildings Division • 'Sanitary Permit Application 201 W. Washington Ave. jseonsin In accord with Comm 83.21, Wis. Adm. Code PO liox 7302 Madison, WI33307-7302 Department of commerce Personal information you provide maybe used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(I)(m)] state owned. Attach com fete tans to the count co on) for the s tam on a r not less than g -I/2 x 11 inches in size. County State Sanitary P it Number ^ Check if revision to previous application State Plsn 1. D. Number I. A lication Information -Please Print alt Intormation Location: Property Owner Name Pro p erty Location ' ~ ,~ p d,4f 1 /4 si; I/4, S T ,N l~yE or Property Owner's Mailing Address Lot Number Block Number ~ tXQ~ City, S ~e Zip Code Phone Number Subdivision Name or CSM Number II Type of Building: (check one) - D 1 or 2 Family Dwelling - No. of Bedrooms: ,~ ^ city ^ village ___ ~__ ^ PublicJCommercial (describe use): ~ ~ ^ State-owned ~ ~)( - ~r ~ Tovn' of ~~(~~ (1N III Type of Permit: (Check only one box on line A. Ch. ~ .~,~` , . ~ Nearest Roa r' ~v / • ~ ~ ~ ~ -. A) 1. ^ New System 2. Replacement 3. ^ tp 77~~ ~ ~ stem Ta T ~ r 1 ~..c~CL Parcel Tax Numbe_rss) O 7, Z 9, / , C~,2 Q -/ a~rJ ~d °- B) Pe ~ ©!> ,~ ., " O A Sanit Permit was reviousl issued . _, . ~ "~, ~~ Dale Issued V. Type of POWT System: (Check all that apply) `~ ,,~ t : _~' ' Non- ressuri ed l d ~'-' -` p z n-groun ^ Mound - ~ Sand Filter ^ Constructed Wetland Pressurized In-ground ^ holding'tank ^ Single Pass ^ Drip Line ^ At-grader ~ 1 \ ~~ / p Aerobic' reatment„Unit ci ulating ^ Other: ~ V Dis ersall['restment Area Information: p.S s ', ~' 1. Design Flow (gpd) ~~ 2. DispersalArea Required 3. Dispersal Area Pro po sad 4, it A plicalion Rate (Ga /da ft ls ) 5. Percolati n Rete (Mi /i 6. System Elevation 7. Final Grade i El r - ] (\ y . q. ce n. "~j evat on VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Ga{Ions Tanks Con- Con- glass New Existing crate structed -Tanks Tanks ~oc~o ~ - ~'~ i e~~~ ---- ~ ~- ^ ^ ^ ^ Bp i N ~ t ~~1, ~ .. v ~ ,~ ^ ^ VII Responsibility Statement ~ ' 1 the undersi ed assume res onsibilit for installation of the POW'TS shown on the attached tans. Plumber's Name ' t) Plu bar's Signs ;Ina stamps : MPlMPRS No. T ~ Business Phone Number "" ~ ~~ r ~ ~o ~ i~ -~~~ - v~v Plumber's Address (Street City, State, Z,iGp,Cod) // VIII County/Depart nt Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued [ssuin Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surch a Fee) dp ~ Determination ZZS. '~ qN, Z3 ?~eo IX. Conditions of Approval /R asons for Disapprovalt 5 ~ r t ~ ~14~x~ ~ i5 S ~~ ~ ~ ~Si, ~ ~ / ' l ' ~X ` ~~ s 3_ ~ ~5~~ ~ ~ ~ n ~ /~ ~ ~ ~~... ~p~ or "I~-- [.t IS ~4~a~1 . ~S ~P ``r-~ ~eb~~ ty,.,(.e. a.~ try -~ . ~^ rtnu~.~- CQan-~. ~ ~ ~{att;,,, ~`~'""~ ta~,~C..~/~~I--- -~-~ Cdr oo ~ v•natw~+~~t 1f.,C~p,n.~,tMLI.,,,,t~t~'"S . -~ ~s~ 1 I.~V~ AJ Sr ~~ c (3AS-N w ~~ lfitr~ Vpl~ e -~_ ,,~'~~ i3 6 Qa 3~r . a~ ~~ ~~, u~l _S ~~~1 ~ cvinc~e rs - --~lumh~. _....._ _.._..__ ------. ~~N_!'L--~ . _._. _T:'m. _. ~vu.m~e.~ hex'. .. . ~~ I ~ 7 oa ~ ` ~ ~~' 4 ~____' ~ `~----~lZb' . 2•fl' ~Q~ ~oQ S~ Q' ~~ ~, g~ ~ ~ ____-j- ~' ~- ~ pl y-I~N~~~s 3• 3x ~a.s~ ~ U C~oM}2tn Ptn Tnpa~ ~1, M~, ~~e ~ ~~~ r N T b W in Q~~or- I t~~ ~.. c. l~ S ~a --~ ~~ fi;~~,,~ G~~~e 4C~-~~ ,,. a~ a~ ~~ .ro '~ ~ ~' ~ ~ ~~ o N ~_ ~ N C C = U 'D E C ~ ~'~~ ~ • E ~ c~i ~ ~ o ~ EE'vc ~~~'~ c~ ~ ~ >, ~ 3 ~, a~ .n V c (O ~ •- r') x ~ in ~ .o ti x v- rNi u~C 5 ~~ ~l ~. u~i ncle rs _~1.u~~ _...._ _.._..__. _. .- 0~". _ ~ , ~ ~~ ~ ~~ ~ f ~O^ w~ -) FX~ S~~ ^'G L 0(10 A ~ ~ ~ s~~, ~ 3 G~drzao~, Imo' 2.fl . ply e ~' B~ ~' V ~ ~ ~s~ R~ ~~ p3 ~~~ ~ ~.~ 6 ~ ~ ~~ y - i ~,~~~.~s 3'A 3x l,~.Sl ~ ® ~b C~'-nm11R-1 Qa Atn T-tow ~i, J M, ~~e,n ~.~ r~ JqN-23-2002 10:52 AM A.C.E. Sol & Site E~a~l 715 248 7764 P. 02 ._ .. /,~ ~;~ t.~T..~//fin SEe+c,k~ry E,ti3~n, /1~1rS~i ~Sr/ e~~P~iw~ ~~,~. Sir ~Ee,., c lsrt, ~ 92.7$ ~ , ~i4sC~», ter. =~ IIb, dJ.' _ _~ . EX•s~n .. .. r I'es~ i A~rnC , ~~ ~ ,O. Ro/~~ ~s~.b~ep.c.,~ ~~sal a6aer~6t~, sys~.q. ,... ~ ~-~ .. ~' C ~. 3e~3 JAN-23-2002 10:52 AM A.C.E. Soil & Site Ea~ul 715 248 TT64 P. 01 .fl. C..~. Foil ~ Fite EvQxZLUtZ~O'!t8 J'umes K 71eo~sy~aon I'dtsmLi~eg Issr~cctor d~irae #4bV8 Cert~Jfed $odl ?'eater [dcenat #3fiU2 tax Transmission To: ~o r~ Fax #: ~/~ 3 PL' - S<~o Ylo );rom: JjtKLThompson~AL~ R Soil & Site Evaluations Fax #: 17151'.248 - 7764_ l~ eaves including cover sheet' Z if this report is incomplete or illegible, please contact Jim Thompson al telephone #(71 S} 248 - 7767. ~~ ,b~~9 /~,; 2~~ 3~Y pk`I~ 6`~ •9~m 3~ a~b~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division Of Safety and Buildings in ~r-rnrvi~nrc wi4h r`rmm R5 Wic Arfm r.MP. 1488 pie 1 of 3 A.C.E. Sal & Site Evaluations County Attach com late site Ian on a r not less than 8'/: x 11 inches in size. Plan must P P P pe St. Croce include, but not 6mKed to: vertical and haizontal reference pant (BM), direction and Parcel l D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 020-1125-30-000, ID# 7.29.19.569 Please print all lnfonnation. .~ gy Date Personal informatbn you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ '~ Property Owner Property Location Jo Ellen Steele Govt. Lot NW 1/4 SE 1W S 7 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 356 Miller Road 40 Plat Of Eagle Ridge City State Zip Code Phone Number ,.-~ "`, ~• City- ~Ilage ~ Town Nearrest Road Hudson ~ WI 54016 715-386-6 9, ~ Hudson Miller Road ,~j New Construction lJse ~ Residential /Number tse`d '+r ~ ~ ,:' C Code derived design flow rate 600 GPD Replacement~~ Public or commercial ^ " 'be~ ~1`~~.) Parent material Glacial outwas_h ~~~~ __~_~__~__~ ~? _~~~.~ Flood plain elevation, if applicable na General comments ,~.-- u•7 CROI;( and recommendations: Install high capacity infiltrators at le~' - 92.25~Gal9t~lfvalve to allow future use hydraulically failed system. Additional tank capacity and efflu r rt~tit~c~Fic~ "Boring 1 ~~ # ~ Pit Ground Surface elev. ~_ L 97.66 ' --pe{~th to limiting factor > 110° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= *Eff#1 *Eff#2 1 0-12 10yr313 none sl fill 1 msbk mfr cs 2f 0.0 0.0 2 12-23 10yr5/4 none sit 1 thin pl mvfr gs 1f 0.2 0.3 3 23-50 10yr4/4 none sit 2msbk mfr cw - 0.5 0.8 4 50-67 10yr5/4 none s,fs,lfs Osg,2msbk ml,mfr gb - 0.5 0.9 5 67-110 10yr5/4 none strat. s Osg ml - - 0.5 0.9 H#4 consists of an unsorted mbdure of Osg s, 2msbk fs, &2msbk Ifs. Loading rate reflects most restrictive sal condition encountered. * Effluent #1 = BOD ~ 30 <_ 220 mg/L and TSS 30 < 150 mglL * E = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ure: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54 10/20/01 715-248-7767 Baring # ~ Baring N~ Pit Ground Surface elev. 94.91 ft. Depth to limiting factor ' 96~~ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/frz *Eff#1 *Eff#2 1 0-12 10yr3/3 none st 2fsbk mfr cs 2f 0.5 0.9 2 12-24 10yr5/4 none sil 2fsbk mvfr gs 1f 0.2 0.3 3 24-28 7.5yr4/6 none gr.ls Osg ml aw - 0.7 1.2 4 28-44 10yr5/4 none gr. s Osg ml aw - 0.7 1.2 5 44-48 10yrti/6 none tfs 2msbk ml aw - 0.5 0.9 6 48-96 10yr5/6 none strat. s Osg ml - - 0.7 1.2 Property owner Jo Ellen Steele ' ~~~~.~ Parrel ID # 020-1125-30-000, ID# 7.29.19.569 Page 2 of 3 a Boring # ~ Boring /,.,_( Pit Ground Surface elev. 97.55 ft. Depth to limiting factor > 101" in. SdI Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-9 10yr3/3 none is lfsbk mvfr cs 2f 0.7 1.2 2 9-21 10yr5/4 none Is 1fsbk mvfr gs 1f 0.7 1.2 3 ~ 21-30 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 ~ 30-71 10yr5/4 ~ none s Osg ml gw - 0.7 .2 5 71-101 10yr5/4 none strat. s Osg ml - - 0.7 1.2 f-I#4 & 5 contain 1" bands of 7.5yr4/4 0 sg Is at 10" -18" intervals. Banding does not reduce infiltration to a degree that would require reduction of loath rate. Bonng # j Bonng ._J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 Boring # ~ Boring _,_~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ___ GPD/ftz *Eff#1 *Eff#2 I * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS <30 mglL 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. N {~e~. r ~/•~ • ~ •' 17. SS ,0; ~ • E~cd4~'on ...~. 6~~,'cd e le c.&~rcul /.'nC ~1 ScR/e: / ° f/p ' 3 SG rrt; //` ~ ,Qd., /off ~o, P,~ ~ af'Ea~/e,~,~e T . of~~ SE.Go;,~ 4',,~Jl. E,rlS~i'ng /,L'x51 ~So:/ abso~~oEi~-i Sy~em. 5~ sEe,,.,pe lei = 9.2. 78. --c,~el w o ~~~ ,~J./ /~ ~ c~:~~ a~° 1ti 8.3 ~~ , ~ .~ G s ~f ~. ~ O, `~ P (-}o~sed yep lacemer,~ .-.~ 50;~ c26sor~~c%, Sy5~n1. _ ~u ~ (~ t« des ~l i a i ~ ~~/,~.fo~,5 toe. tr~nc~h~ E7r~ S~'n ' ant li. S! 6 tdr m ~ ~ /~ ~EXiS~in /, ~ s~~~.~~. elm!- = 95! 9Y,' ~~• Q~QU- ?~ f ~ ~ C~~ ~` ~~` '~ Y` /SyN . ~ ~ Q~ `o ~~ ~/ 3~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 9q (,~- Number of Bedrooms Design Flow -Peak (gpd) ~S a Estimated Fiow -Average (gpd) vn Septic Tank Capacity (gal) U ~~ D Soil Absorption Component Size (ftZ) Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absor lion Component Design Flow -Peak (gpd) p " Maximum Influent Particle Size (in) r 1/8 Maximum BODb (m /L) u 220 Maximum TSS (mg/L) t S ~ 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shalt be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se k and outlet filter shall be assessed at least once every 3 years by inspection. T utlet fil r shall be cleaned as nerpscaty to Pr~.GUrp proper operation. The filter cartridges ou not be removed unless provisions are made to e ain so i s m the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge 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 an 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. 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 shalt be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Cvmm 83.33, Wis. Adm. Code when the tank is no longer used. as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The. inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 . ~ Management Plan fora Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 3 S't' CROIX COUN'T'Y Sf~l'TIC 'TANK MAiN'TI?NANCE A(i1tl?I~MCsN~I' AND OWNERSHIP CERTICICA'TION DORM Owner/Buyer Maiiing Address Property Address CAA ..~ (Verification required from Planning bepattrnent for new construction) City/State ir.~s~~ ~~~ Parcel Ideutiftcation Number Q-,~p~-//~5-3U, vim; GRIPTION Property ideation ~' , %,- ~.~.. %,, Sec. _~, '['~~N_R~W, 'Ibwn of _t~YU~Sn,~ Subdivision Cetrtilied Survey Map # Volume Page # Lot !! ~. Warranty Decd # _ 5 ~ 7 ~~ Volume ,,,_ ~~ % ,Page # __~ Spec hottee O yes~l no f Got lines identifiable D yes O tto .1 nse and maintenanceof your septic system could result in its premature failure to handle wastes. Proper mainteoaraoe comisb of paooping out the sepde tads every three years or sooner, if needed by a licensed pumper. What you put into the tyttem a° ~Re~ the tiurcdon of the septic tank as a treatment stage in We waste disposal system. T~ pity owner agrees to submit to St. Croix zoulug Department a certification form, signed by the owner sad by • masterpiutnber, journeymanplumber, reshictedplurnber or a Iicensedpumper verifyingthat (i) the on-site wastewaterdispoat syslena b in proper operating t:onditioa tuxUor (1) . ~ hu,~ectlon and pumping (if necessary), the septic tank is lea ihsn U3,i1Wi of shrdge. .. Uwe+ the uutdersi `::~~~~~~~ gned have read the shoo ~~ 5 ,,fwd agree to maintain the private sewage disposals ~; ti ~ staodudtt set forth, herein. u set by the Depactntent and the Department of Natural Resources, State of WMcodin. dertiticatloa ~~ that >~ ~~ system ~ been ma nuvst be co leted and returned to the St. Croix County Zodog Opice wlthia 30 d. of the xp on date. ~~~''': ~ ,$I~NATt1RB OF APPLICANT DATB :~~~~~ the I (we) cerdty- That all sbtc ~e a oa ~! arc true to the beet of my (our) knowledge, i (we) am (am) the ownet(t) o[ described shoo + y f a,wtarranty deed recorded in Register of Ueeda O[rce. APPLICANT - • i. ~.''~.-.~I `; DATE '~~,;% •~~**4 Any ioformatioa that is mat-rcpt , , ~ result in the sanila «~~~~~ °!n!Y,~,, ry permit being revoked by the Zoning Depsrtrrtertt. •' include Mth ~t`~'0's""' ' this ippileatlon: a etamped.~rarrrrggr deed tivm the Register of Deeds otTice a copy of the eertlfied ntrvoy map if reference is made in the warranty deed St. Croix County Occupancy Affidavit Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ~ 1q 1 Page ~~ Document Number$`I'~2SLSt. Croix County Register of Deeds Office: A parcel of land located in the N~'/4 of thei_~'/4 of Section ~"' , T~_ N - R ~ 9 W, Town of ~,'~ N , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): ~o~ ~. y~o o~ ~~~ QI~E Name and Return Address p 20 - 1 12 S - 3D " t~o0 ~ Parcel Identification Number (PIN) As owner of the above described property, I knowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of ~ gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently -occupants living in this residence; ~o occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of AUTHENTICATION Signature(s) authenttcated this day of , ACKNOWLEDGMENT STATE OF WISGONSIN ) )ss. St. Croix County. ) Personally came before me this day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public, State of Wlsconsln (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter. document title. name & return address. and PIN (tl required). Other information such as the granting clauses, leagal description, etc. maybe placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recordino fee. Wisconsin Statutes, 59.517. ST. CROIX COUNTY 7.ONING OI'FICE CERTIFICATION STA`1'EMEN`i' FOR UTILIZATION OF AN T'XIS'I'iNG SEP`.l'IC `l'AIdY. This is to certify that I have inspected the septic tank presently serving the _t~o ~ f ~efti ~t~L~e residence located at: /v~~'r, ~~, Sec. ~_, TN, R~_W, Town of ~~~~~___ St. Croix County, Wisconsin. Upon inspection, I certify that I leave found the tank and baffles to be in good condition and it apl~ea.rs to be functioning properly. Last time serviced ~~ (~ Did flow back occur from absorption system? Yes___ No~ line. ~ Approximate volume or length of time: `~~ gallons Capacity: ~8~ _ ~-~ --- Construction: Prefab Concrete _ Steel Other Manufacturer (if known) : ___ (, ~~ r_ ___ Age of Tank (if known): (if no, skip next minutes (Sig ture) (Name) Please Print (Title) ~ (License Number) v~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wiscunsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name ~~ ~e~_~~ Signature II DOCUMENT NQ .! t =1 Sc ~~\er~ quit-chime to _ ~ I STATE 8AR OF WISCONSIN FORM 3-1fJAY QUIT CLAIM DEED PA~~Q[~ /~Iso~~ 1~Kla. ~T ~"// r, ~~f~~~ 1~.,~ ;tee ~~e, 5CN _ 4511__ 5''EvI~+ the following described real estate in J! . C + n ~ x .County, State of Wisconsin: TMi3 SPACE RESERVED FOR RF :ORO'NO DATA S..~:::...:~:~, , ;.~ ... - , .!UL ~ 4 136 ~ 4.4 5 y >h~ y' `'K:,~ri...,. 'fit ..~ 1 \ I RETURN TO ~'~ ~lrG 1L 5 FJCI~ VIS~O~: `•t0 EIICH ~ I Lot y~ I-~ E~~te R,d~e, a r..~~-~I u .~sb ~t1'1)t~ ~t i looted ~~~ -4he JE % o-~ SCCttc~~ `l, u ~OI,L'v~ S~~ ~ p ,~~ !~ Q f ~~,\ ~ ~~C-l~~ci L'. ~~ ~,V CS~t Tax Pa: ceI No: _ ~"~~i'r c-F N~~ Sc4~~ 5i- C-~ otx Cou.~•~' ~, k'ts~c~~.s~ •~ t This ~ S homestead property. (ie) (ie~Jnot) o Dated this__ ~7~, roc yd~~ day of ~ ~c ~T , t9,1~2,. /-~_-~~.Q-k~ ~=/"''..`-c^'c,~ (SEAL) (SEAL) .mac E~1eh P S+eel~e. .(SEAL) AUTHENTICATION ACKNOWLEDGMENT AL) ~TeTE OF WISCONSIN se. ~; -~ TED IN THE SE I/4 OF SECTION 7. ~,b~ ~ A .RURAL- SU6DIVISION Is~CA , ~~''Lr{.f,.,.Ll. ...°R ~Iti'yRf•r'.n,4 .*~.n~ ~j••~ ss y; !'"1 ~ ~~A'~ 1~ ~~~.~,1. {3~ ~i '.. `'` • ' SCALE '°,{' ~ T~ wo o ao ~~ ~~.~ 4. +v ~ ~ ~ W R+v ~ FRANCIS H . Ot;OE $ •882 REGtSTEREO I,ANO SURVEYOR DATE TH19 30TH OAY Of TEM8ER.19T537 __, ~~ ~;~. ,.: Ron ~ :'x~d~''~ uoN Prc ''a~~~~. ~ cn; ... .. -, ., . Z~ ~`~'' . ~ ~ T[M/011ARV TURN tttKMID TO flft AUTfY ; ~' W ATIC~11 VACATLC -~ON s!jllL[T IXT~IfaON~~ n~~~w'41L~er,.• II e~fM, .i Y .1? i... n, ,. . ~ ,,n., ~~~. .y ~' 1 , ..,a•,~fr~w+ 1 .}h . ~~ ~'°', ~RtiNtl[0 T~kF4 ZOTM OAtt of aroeEtVa'rs ~) ;s !3, •`~. .oo. ~ Q 47 ~.~~~s ' \ "51. ~. i \`~ 50 I. ~p ACRt '3 _ ~°, .+ ~~~ 1.823P1~;f 27 k669303 H FEGISTER OF DEEDS ST. CFiOIX CO., WI Document Title RECEIVED FOR RECORD St. Croix County Occupancy Affidavit Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ~ 19 ~ Page •17fl Document Number,S`}~25ZSt. Croix County Register of Deeds Office: A parcel of land located in the N~'/. of the~_'/. of Section ~" , T~ N - R ~ `1 W, Town of ~~ N , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): 01-25-2002 9:30 AM ZONING AFFIDAVIT EXEMPT ~ CERT COPY FEE: CDPY FEE: 2.00 TRANSFER FEE: RECORDING FEE: 11.04 PAGES: 1 Name and Return Address To ~t~,t/v~ ~? Si~~te ~~ Mt'~~~~ ~d. p2o - )125-30 ~ Oo0 ~ Parcel Identification Number (PIN) As owner of ±he above described property, I knowledge that the septic system serving this residence is sized for a 3 bedroom ttotTte, or a design flog/ of 45~gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently ~ occupants living in this residence; ~ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that t will make this information available to any future parties interested in purchasing this property. Dated this oC~ d y of Ja ~l~(c3tl"V , .2P~,Z A _ w Signature(s) AUTHENTICATION authenttcated this day of ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County. ) Personally came before me this o2 ~ day of d~ `'~ °^'T a oa ~- the ab J o E ((e-h ~ ~ P. Pe e TITLE: MEMBER STATE BAR OF WISCONSII~'ti • ` ~ • to me known to be the person(s) who executed the foregoing (If not, •' • authorized by § 706.06, Wis. Statp.~ ~ { f? •_ instrument and acknowledge the same. s ti .. . L ( THIS IN~S7TRUMENT WPIS gF2A~~BY `-+' ', t, ~~ .. ~ ~ O 2•F' ~ f~ ' ~ Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledg~d.l,Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: i - a - .~o0 3 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter. document title. name & return address. and PIN (if required). Other in/ormation such as the granting clauses, feagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note; Use of this cover page adds one page to your document and $2 00 to the recording fee. wsconsin Statutes, 59.517. ~ a ill"' " ~" , AS BUILT SANITARY SYSTEM REPORT Form- STC- 104 OWNER J~~fJ ~J/~~~~/ TOWNSHIP .d SEC. ~ T ~N-R ~9 W ADDRESS~~~~ .~~~' ~ ~ Z_ ST. CROIX COUNTY, WISCONSIN /-~Gc-~S c5 ~'! ~f 5 SUBDIVISION ~~~~~ ~/~~~~ LOT ~ ~b LOT SIZE ~°`Sg ~G~~5 PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~~ „a e A INDICATE NORTH AR OW BENCHMARK: Describe the vertical reference .point used ~ ~~ ~!'o~„~`,~~- a`~ ~ ~~~_ Elevation of vertical reference point: ~•-]~= f~,(~ Proposed slgpe at site: ~~`~ u SEPTIC T~1~TK: Manufacturer: ~~~~~' Liquid Capacity: ~'QQp~~L~ ,~ Scci ~a. ~(~ = 1D PUMP CHAMBER ~~~- Manufacturer: Liquid Capacity: a s ,"'~ ~~ Pump Model: Pump/Siphon Manufacturer: Pump Size. Elevation of inlet: ~ Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed. ~ ~ x 3~ Trench: ,~-_-_~ ~ , Width: ~j Length: 3 ~o Number of Lines: 3 Area Built: Fill depth to top of. pipe: 4 Z Number of feet from nearest property line: Front, .O Side, O Rear,( Ft. 3 i K~/ Number of feet from well: ~ ~ ~ Number of feet from building: ~ J ~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtioq sytems? (Check one). HOLDING TANK ~ ~ ~ + Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Number of feet from well: Number of. feet from building: Number of feet from nearest road: Front, O Side, O Rear, (~Ft. Alarm Manufacturer: ~ [' k ~ rn ~ e yc DERARTMENT OF INDUSTRY, LABOR'AND -(OMAN RELATIONS D REPORT ON SOIL BORINGS ANb PERCOLATION TESTS (115) (M63.09(1) & Chapter 145.045) SAFETY & BUILDING DIVISIOt P.O. 60X 796 MADISON, W,1 5370 Soy'/ ~t/,~P' ~9 o B RATFNti: S~ Ske suitabtr fw system U' Sits unsuitable for system ,u, rG v ~, `~ r/ ONVEN :MOUND: IN-GROUND- TE -I - ILL HO DING TANK: RECOMMENDED SYSTEM:loptional) ©$ DU ®S ^U ®S ^U ~ ^ S ®U ^ S ®U cam ~.~1 '~ ~ `• If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the `,/ under s.HS3.o91511b1, indicate: I Floodplain, indicate Floodplain elevation: /~//9 PRpFII,~ DESCRIPTIONS BORING 4 ELEVA"fION 'F R UN OWATER-iAJeM1`g CHARACTER OF S IL WI H HICK SS, L X URE, AND DEPTH NUMBER PTH Ili; OBSERVED E T. H GHE TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B- / ~,.5`' /c~,S : /' o,~~. ~ 7.S' " . 6l .3 B., / , 6 Bn s . 3 eh /S B ~r 1 S B-.z >s' r/as;r a ~. ~ ~s• ..~ ~i . sB ~ si y ~ ids B- `~ ?.S' /p ,3' /t,lo~re- 7 ?. S' .B • 6 B~ / . S/ . s ..Z s B-s'' 7.s'' oS r'~o,rte.._ ~' '7~S' a . 6 /3/S,`/ .S ~ / •3 ~ s/~- 3.6`[x` /.S c, B- f ~n PERCOLATION TESTS N M OEPTN~ A F=R IN HOLE EST TIME DROP IN WAT R L V - RA E UT U BER {'S AFTEtiSWELLING INTERVAL-MIN. p U 7 P RI PER INCH _ p. 2. . ~ p S' ~ ~ 02 a~ .~ P_ _ P- p_ PLOT PLAN: Show Iocatiorrs of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hoi 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 parcel of land slope. ' / , SYSTEM ELEVATION /o% a- ,~ e G QK ~ _.. _ _ _ .__ .. .. ,_ . _ r _. __ -- - 1_ -.__._ . _ .. `~ i f~ I I I a ~ ~ T- 7~' Ali t BI ~ I _ ~__ I_.._.~ _ . L ~ i . ,~ _ ' SS4.~:, `< ~..._... 'y6' fi~ __ ~ ~~ N~ ~ ~ _(~/dam ~a~~ ~ ! ~~ i ~o~i ply _~ ~ _. 1 Q, ,L3vres ._ _. ~. P.~ r I ~ _. ~ .. _I.0 . ~er'c~-- .~_ _.~_r ._~____f~_._~ ! i ~ ~~ I ~ Su i ~ . ; i.: i ~u ~s'atyl~; s-/~~/ F~,~~~ per: ~ . _ .. l ~ i ~ I f DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIO P.O. BOX 769 BUREAU OF PLUMBIN MADISON; WI 53707 • CONVENTIONAL ^ALTERNATIVE State Plan l.D. Number: ^ Holding Tank ^ In-Ground Pressure ^ Mound (lf assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: I NSPECTION AT Sam .Miller R. R. 1, Box 282, Hudson, WI 54016 ~~ ~ Y ~' BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. EL V.: CST REF. P .ELE V.. NW SE, Sec. 7, T29N-R19W, Town of Hudson, Lot 440, Eagle Ridge ` Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: Dou las Strohbeen 5432 St. Croix 49429 SEPTIC TANK/HOLDING TANK: ` MANUFACTURER: LIQUID CAPACITY. ANK INL T ELEV.: A K OUTLET ELEV.: W ARNING LABEL LOCKING COVER •~ , P ROVIDED: PROVIDED: , i ~ YES ^NO ^YES ^NO BEDDING: VE I .. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERT WELL - BUILDING VENT TO FRES '1 ' ALARM. FEET FROM LIN ~ ~ , AIR INLET: YES ^NO v' ^YES O NEAREST J DOS NG CHAMBER: MANUFACTURER. BEDDING: LIOUID 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 the soil moisture at the depth of plowing ~Era~,TH DIAMETER. MATERIAL AND MARKING or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN Cr1NVFNTIDNAI SVSTFM~ BEDlTRENCH DIMENSIONS WIDTH: rn !1O! LENGTH: ~ ~ NO.OF TR ENC HEFf-~ ~/'T DISTR. PIPE SPACING. / / ~/J!'" COVER M~~`L~ PIT INSIUE DIA #PITS LIQUID DEPTH: GRAVEL DEPTH BE LOW PIP ~~ FILL DEPTH AROVE°~OVER. °'~+ UISTR. PIPE ELiE~V.INLET /~~+~` DISTR. PIPE DISTR. PIPE MATERIAL: ELE END. ~ ~ V .~~ NO. DISTR. PIPES ~ NUMBER OF NEARESTO- PROPERTY ,LINE ~/~J - '7oC WELL: BUILDING: V NT TO FRE: AI INLET: MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM 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 ^YES L DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED. CENTER. EDGES. ^YES ^NO ^YES ^NO ^YES. ^NO PRESSURIZED DISTRIBUTION CVSTFM• WIDTH: LE NGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL'. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL $ MARKING: ELEV.: ELE V.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ^YE ^NO ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ^YES ^NO ^YES ^NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 IR. 01/82) ~~ w~scons~r~ ~~DILHR ~ OEWiRTTEnT OF ~ InOUSTRV,LRBOp 6MUTRn RELFiT10n5 APPLICATION FOR SANITARY PERMIT (PLB 67) l/~'~ rOUNTY UNIFORM SANITARY PERMIT # ~~ ~a 9 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER / MAILIN ADQRESS~ / r C^ ~ o.l 2 ~2 I~~cdSs~ t~4 PROPERTY LOCATION qq qI --~-F~~ D /~~i/4 ~~1/4, S 7 . Tz !N. ~ / ~l~l? Tov wF: ~~ ~c. c/ s a LOT NUDMBER BLOCK NUMBER SUBDIVISIQN NAME NEARE`T~ OAp,~L~KE Obi L~ h ARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED i~"1 or 2 Family Number of Bedrooms: ^ Public (Specify: THIS PERMIT IS FOR A: New System ^ Tank Replacement ^ Repair ^ Replacement Soil Absorption System ^ Revision ^ Privy ^ Alternate System ^ Reconnection ^ Petition for Modification IF TH,~IS tS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. '~4J'Seepaye Bed ^ Seepage Trench ^ Seepage Pit ^ Holding Tank System-In-Fill ^ In-Ground Pressure ^ Vault Privy ^ Pit Privy ^ Existing, For Which A Previous Permit Is On File, Permit # issued ^ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total Gallons # of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity ~ d d ~ 1 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ~~ 1 f 5 t Q IF THIS tS AN ALTERNATIVE SYSTEIdI COMPLETE THIS BLOCK: ^ Mound ^ In-Ground Pressure Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inchl: REQUIRED (Square Feetl: PROPOSED (Square Feet1: G ~ ~ ,~ ,~/ LS Private ^ Joint ^ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Printl: Sig ture: MP/MPRSW No.: Phone Number: Oou ~qs S7`,.o~Gtzt~ ~ z ,~~~~-~ ~n-s~3z (2g7-323j Plu~mpber's Address: Na of Designer: /t ~ '¢ ,N ~ w ~rc~j ~fc~ (i(i~ S ~ ~ Uf ~ ~ou S 7~~ oft ~9~c COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: ~ / `/(,( Fee: / /_' ~ (s~ (9 Date: ~ /~~ %`~ /Approved ^ Disapproved ^ Owner Given Initial Adverse Determination treason rot visapprovai: /ice Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5182) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town; 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.-; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T- to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. Anew permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER; This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Form - S T C 100 Owner of Property ~~,~ ~~VUx~ Location of Property~~ ~~~~, Section~_,T ~R N R j~ W Townshlp_-H i.~~, ~~ Mailing Address ~; ~ ~Vl ~~ ~ ~~ ~~ ~~ ~ ~~, - - ~..._____ o Y ~ SubdiVlalgn Name toG~~ r~,'~i_.o . Lot Number yQ Previous Owner of Property~~o~~ ~~~ ~ /~ S~ Total Sixe of Parcel_ %.. ~ 7j >~~r~ ~, 5 Date Parcel was Created ~ (~ ~'~ - ~ ~~ Are all corners Identifiable? ~_yes_-_TNo Include with this application ane of the following .Certified Survey Map .Deed .Land Contract,, or , .Other hegal Document which describes the property PROPERTY OWNER CERTIFICATIpN I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (wel am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ~ ~ ~ ~ q and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an basement, 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 Oeeds, as Document No. ), SIGNATURE OF OWNER SIGNATURE OF CO{-WNER (IF APPLICA9LE) `3~ !D/ ~ ~ DATE SIGNED DATE SIGNED ,~ r DEPARTMENT OF N D~JSTf~Y; LABOR A[VD HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) L,'CATION: SECTION:~~Q D'Q TOWNSHIP/""""""'~,.~1D,^~' f-; : LOLT~O.: BLK. NO.: SUBDI/~ COUNTY: OWNER'S BUYER'S NAME: MAILIN A DRESS: iE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~esidence ~ A//n New ^Replace RATING: S= Site suitable for system U= Site unsuitable for system , DATES OBSERVATIONS MADE PROFI DESCR PTIONS: ER ATION TESTS: ~ -6 -6'3 6- - .3 ~B CO NVENTIONAL: ©S ^U MOUND: ®S ^U IN-GROUND-PRESSURE: ®$ ^U S STEM-I - ILL ^S ®U HO DING TANK: ^S ®U RECOMMENDED SYSTEM:(optional) Cou ~ ~ /cf'X36` If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(51(b-, indicate: I Floodplain, indicate Floodplain elevation: ~/~ PRpFIL,~ DESCRIPTIONS o~ BORING TOTALS D PTH TO GROUN DWATER-GPIehhE3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IAd; ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B" ~ ~~~' /ate/' 6.u~ ~ 7.S' 8l .3 B~/ , 6 8nS . 3 e~ /s . ?B inedS B-3 ~S' /03,8' ~ .S' Ql/ / o a s /s s: ? s B- `( 7,S' /v 7.3' /Clo,~r ~ ~ '~• S' F3 / • 6 g~ / . S/ . s ..ZB s B-~ 7.S' oS,6', ~,(o,~e- ~ '~~5~ a . ~v B/S,`/ •S n/ l.3 ,~3h 5/,~- 3.,D"[s`/.S B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1~16+lE8 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERI002 P R PER INCH P- / Mo .~ ' / / S P_ 2 o S o2 ~ Y o2 ®'L .3 P- 3 0 3 6 ~ 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 hori zontal and vertical elevation reference points and, show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ' SYSTEM ELEVATION /o% ~-' Ge s ; I ~ ~ ~ ~ ~ __ ~.. ~~~~~.~ _ ~ : , ..i -__~~1~.,?.a.- ,_.,~~ i _ ~ _ ._ ~~ P _._ .~ -~-~_ ~..~ -~. ~ ~- ~ ~ _ ~r ~ __ m ~9~_.~ ~~ _ __ - -- -C .~ << ~ ~) ~~ }-_-~~ ~ ~ Q c~N"~S ~_~~~1L I ~~ . ~ ,/w- _ . ~ ~ .. _ .._. i ~ i~ f / i t ~ z i I/~ ~ 3 I i 3 ~ i.. _~T if c ~ ~ 1 ' is ~r i. Su , ~e ~~~ __ f~~ _ _~ 1 1 ~~~ ~c,1 ?0 5l ~,~ ~ c~r~q~G __ _ _ ~ ,E TN x ~ ~ d '3 1~ ~T (tJN~ . : ~ C~MPL.~Tl FCiRM 1 °~ - ~~ - ~~ ~• To k~e a cex .. r '~u ~ your ,,~ inclUcae: ~ r. ~. Cc~~r~~~l ,~r. ~Z_ The use se- .~~ ~ ~~rty te7dieate w(~e , crr c 3. i ',~}"IhlUt . ~ ~dr<sr~n~s or ct~rr? £- ~~~d; r _ ~t79LCCJ". 1`° ,~ ,~ r~~rc~fiil~~ ,f3(atplan; . ~ ~ ~rrec~. A ~~cr~t; .. l"l, {'I 'f' i'l{~3`~, "' ~~"l E?r1 ~„°3Jt i3j7Ytii~E l1Q K.i r,ertif' ;~, r. ~,RL ~(~~ ~ u?S ~ ~ST B~ I~C~ ~ViT T~~~~ ~-IIRI ~C~ CLAY C). 'L'"TlC~~J. ': ~ 1 ~ . .C?~hee ,;~4s ~, _. E3h -- , 5 5 -~ s f: ,z, 1- _ ~- ,, 5 ~- ~> sl ._ - ` iii - C `( ... v...a yi~ }Z - \ _. L.~arn ~~~ot ~ ~~~ >,. ~ #1t fE - { ~ r .: ~ ' (c,~, ~ ~~, ~ ;4 __ ~: s ~ , ,, _ - ,> _. ~ ~~= - ~. 3 F>~ S s ~ _ . ~ -~ ~ ~ p c~ r ~~ A i1 PT i 0 _V ~~ i ~ ~„ ~ ~cl ~jd vi _ rt ~ F 0 ~^ ~~. P rP or ~~<~~~ ~ ~ ° ~ ~ S ~ ~ ---tj ~ ~ D :'P ' P ~ o/ ~ ~,- p ~ P I ~ ° ,+> --rJ ~ ~ ~ o ~ ~ -St' ~, y~ ~ r' ~ l/1 c~ ~ ° ~ ~. 3 ~ #~ ~ r ~ 7v ~ ~ ~ ~- ~~~ ~~ ~ 6' ~ - o_ ~.a N i~' . ~ , ~+ w 4 ~~ b~ ~' l/~ r ~ ~ ~ rn ~r r ~ p_ ~ ~~ w ~. , i 6, ~ ~ < ~ ~' ~- r 0 d ~ ~ y ~ ~ a. ~I STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~~~'"~ N~ ~ SE9-V~ ROUTE/BOX NUMBER ~~~ °z ~p ~ 3rd'' ~ Fire Number CITY/STATE ~~~~'~~ 1i,~ (~) < <.~ ZIP X5/0( ~ PROPERTY LOCATION:/~~ '~`~ ~ ~, Section ~ T ~-~"/ N, R~°)' W, Town of ~~ S r-,~ , 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~ 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 Zoning 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 9 r r a H H 0 z Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractpT,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property S c ~ ~ ~ ~~ C~ v~ Location of Property ~~ ~'~, Section ~_, T ~ N - R c W . Township ~~ ~ ~, ~ ~,~ (x~,, , Mailing Address It ~ ~ Z '~~ r, ~ '~~ '~ . Subdivision Name ~~_ ~ i ~c,• co~_ ~ i ~+ Lot Number ~ ~( Q Previous Owner of Property ~„ ~ ~¢ ~ ~ ~ ~~. ~ ~ ~ ~., ~ ~ m "'f Q Total Size of Parcel +.~(~ Date Parcel was Created ~~ ~~"'] srs Are all corners and lot lines identifiable? ~ Yea No Is this property being developed for resale (spec house) ? Yes ~_ No Volume ~ ~ ~ and Page Number ~~ ae recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract .,.~ 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OGlNER CERTIFICATION I Iwel eehti.6y .that aP~ e.tate+nenta on chid Bohm ane fiie.ue .to .the bes# 06 my (owe) , know.P..edge; xha t T (we l ~ (~.e) ~J~.e owne~c (d) o ~ ~h.e pnopehty des en,i.bed .i.n .th.i,e ~.n6on.mati.on ~onm, by v.c~.ce o~ a wct~.anty deed neeanded .i,n xhe 0~~~.ee o~ the County Reg~.aze~c o~ Deeds a,e Document No. c~ ~ ;and .that I (we) pnea en.tPy own .the pnopoa ed d.cte ion the a swag-~~ od a yd.tem (on I (we) have ob.tai.ned an easement, zo h.un wtith the above deeehi.6ed pnopehty, bon .the cons,t~cucti.on o~ sa.id system, and .the same has been du~.y neeonded ~.n ~h.e Ob6.iee 0 6 .the County Reg.c.s.teh. 0 6 Deeds , as Uo eument No . 3 ~ 3 o.Sr3 )