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020-1305-20-000 (2)
Wisconsin Department of Commerce Count Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 430144 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: 1 City Village X Township Parcel Tax No: Van Nest, John I Hudson Township 020- 1305 -20 -000 CST BM Elev: Insp. BM E I BM Descri bon: Section/Town /Range /Map No: / . p / 0/,o � , Z j 11.29.19.1520 TANK INFORMATION EtEVATION DATA TYPE MANUFACTURER CAPACITY STATI0 BS HI FS ELEV. 10 a Septic ' Benchmar �• Q 3 Dosing _ AItM ST Aeration _ Bldg. Sewer . Holding S t In Wt , :�k - S Ht Outlet 7-7 • O3 TANK SET CK INFORMATION TANK TO P/L WELL BLDG. vent to Air I ke ROAD Dt Inlet �- Septic i ` f Dt Bottom 3 S / Header /Man. Aera on Dist. Pipe (I) Holding Bot. System ,� , g ( PUMP /SIPHON INFORMATION Final Grad $5. 3'� Manufacturer Demand St Cover GPM Model N ( / VCA U 411 - TDH Lift riction Loss System Head JDH Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 1 5 I---- SETBACK SYSTEM TO P/1 BLDG IWELL LAKE /STREAM EACHING Manufacturer: INFORMATION CHAMBER OR Of S Typ ystem: > >( ^ o t /l l'U Qvl � UNIT Model Number. � DISTRIBUTION SYSTEM of /I -m pyt;L t d �i - J L� 5 6 Header /Manifol ) Distribution , x Hole Size x Hole Spacing Vent to �r II ake g II L Leng t 21 I Dia h Pipe(s) Len th Dia S p acin g -7 > I ...Jv SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only C �h R6Y l Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched �' Bed/Trench Center ` Bed/Trench Edges Topsoil Yes �' No Yes No l9 � lJ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /—/ / 3 Inspection #2: Location: 1071 Tanney Ridge Hudson, WI 54016 (SE 1/4 NE 1/4 11 T29N R19W) Tanney Ridge Lot 5 Parcel No: 11.29.19.1520 1.) Alt BM Description = sr ' rr L tfl'� , Z 2.) Bldg sewer length = Q,V � S�'t.1� 1 Z,Q - amount of cover S Yes o �- i --- -- - - -- � �— - -- - - - - - -- - - - - -- ,, Plan revision Required? Yes ao i Use other side for additional information. ' � �/ � I �� I S13D -6710 (R.3/97) Date Insepctors ignature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 - r C Ira �)L iseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filWo.) Department of Gommerce (608) 266 -3151 Gf3 / qq Sanitary Permit Application State Plan. Number A ��40 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing a I. A ess) ,__.___m.__. G��i�- Application Information - Please Print All Infort�ia pp o formatlo fion Property Owner's Na me G Parcel # Lot # Block # Yv es f Property Owner's M ailing Address Property Location r - -A,Setion r C 7/ LiYth i! �- E _S ' -A, W OV 11 City, State Zip Code done "NumFier -- — K 4 S 4' v, 'I S 4 0� (circle e) C., II. Type of Building (check all that apply) T� N; R 9 E orV Ltc�a�2c� Sl h Subd' 'lion Name m r �Q 1 or 2 Family Dwelling - Number of Bedrooms 5 b"Y'1�Ci ; 3 S e �o(.(�'a n p �� � El Public /Commercial - Describe Use / f S / Q h Q t 1`► s f e �d ❑ State Owned - Describe Use 367 (N ' I]& y_ ❑Village Township of ►c C.,50) III. Type of Permit: (Check onl ox on line A. Complete line B if applicable) A ' ❑ New System Replacement System7 I ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner # - 2, - 33 IV. Type of POWTS System: (Check all that apply) bq Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sarip Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ grip Line ❑ Gravel -less Pipe ❑ O er (xplain) V. Dispersal/Treatment Area Information: S / C Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) ispersal Are Proposed (sf) System Elevation 5 �► d I c 7 / 119 , sbl 1►�p VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Pl astic Gallons Gallons of Units , , 1/ Concrete Constructed Glass New Existing W Tanks Tanks Septic or Holding Tank 5 C 1 t; C L? �0 ✓ e er C0 4c co( Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the "undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP /MPRS Number Business Phone Number C ax l C, g et s f %� as o j s 7 1 S- 4 s" • a I S Plumber's Addre ss (Street, City, State, Zip Code) VII . Count Department Use Onl V Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued suing Agont Signature tamps) Surcharge Fee) I� G 3 ❑ Owner Given Reason for Denial G / IX. Conditions of Approval /Reasons for Disapproval Jk-e d_44__�' 4v -4 �, Gut- C -41 7 U O o d a c� a d3 3 �'� 3 , n ��� /1� p (to th County only) for e � � �Ot le;s� ' than , ^ /2 / x ll�c h D S -6398 (R. M03) ( �('/ • �`� [,�/ �o / � r b T /ot. o� 2 S C a1L L o7 - inn R` e- ��- �� -��� 5 Oh- C 3 SI TLcn »e7 the gon 3 , Q Al ► t a tq M l E Cud 7 SG a + a Oc 1 Q m Sc�c u; J zab� — W r � S a� ►� ,3A �a� e S Uwe v -92 ,�1.(Od ✓ 'T vf A�iv' �`�C /2 � r C�a�,i �ns' 3 C C A) s e n o � � �a ►, YV � S T � � b � �'" 1 °i' n � q 2 0 � 2" 0 3o5 a d Sc J alp QO L o7 15 I annel je TL-nr(' the "� g�► � 3 0 a by 6Ma �5 93 a /00 fa Q�l��( SC�'►fiC W1Z�` ITC �t� K � n 11 � 5 Qa r �'' ►..11 Wom e 'To ►-F i> Qm a 40.06 �j t►,�` 3 �r X))0 t N 1= Z a`,,r.ran C�aa►6�t � e !� k V Ins I� 3 ��- 11s t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page -- of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S t C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and p LD. 0-;W G S -� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. p 1 7 4� Please print all information. _`—, R ew by Date Personal information you provide may be yse diorsetfn ,tt�ryp�rppStfs�Privacy�Law, s. 15.04 (i) (m)). V J Property Owner Property Location y , + Govt. Lot 1/4 fU G 1/4 S N R E (or)© `�o V 5 e CSM# Property Ownets Mailing Address i Lot # odc # Subd. Nam - 7 id 0.• � � � h a �'' City State Zip Cdoe Phone Number, ❑ W ❑ Village ® own v Nearest Road Iq Jt, 0A 615 ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD Q,Replacement Public or commercial - Describe: „, n Parent material �7 aS Flood Plain elevation if applicable General comments / �yt 5 I 3 C t° it � A o b e � i ca c 4 7o P C e- 0 b c l o W u t S and recommendations: 01- 8 u�o�o �k F7 - (6 a Boring # C] Boring 87 a Pit Ground surface elev. � Z ft. Depth to limiting factor jU in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ECon Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. /1 /. [ `Eff#1 •Eff#2 ©e / - .5�i 1 /l - 7 1 5�C 4 r - 0 "IZ _ y y ,• r , w Jo L — S o q jr �7 Boring #" ❑ Boring ppJ� ® pit Ground surface elev. ©3 S 9 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I `Eff#2 p -/ 10 i'/t — L / msbk m y S f d. 0,S' o Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N (Please Print) Signature CST Number r e AgL 5.5 Address Date Evaluatio Conducted Telephone Number t Property Owner Parcel ID # Page of Boring # C] Boring D .. _ ' Pit Ground surface elev: ft. Depth to limiting factor .... in. Soil Application Rate :Hod= Depth .Dominant Color Redox Description Texture Structure Consistence Boundary Roots. GPD/fF in. Munself - Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicatidn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ! ❑ Boring F-1 Boring # pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L 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. San -8330 (e.6=) r _ a, p �'�b� � � SC ale- L o T , �� 1 c,, n ne,�, e T(twn( to, he n Bm # 3 0 avai 411 _ W tr5ty S ' c h a 5 Qdrrn ly w orb e a'M 4:L 1 'To � s � t'�. 7- Q rn T ° e k 4, 3 . rte t Caml— SL,100. 6 6 04/18/03 FRI 14:15 FAX 10009 FROM PHO FIXTURES F' 1) 04, 10' 09 00: 3 U ST. 08::-" 5/NO. '15, F, i 1 F ) 6,0 ? 3 '.bar -...,, ,.,w, .,.�, HwA'ianlWations _,....«.,......,.,,,, ,, PRIVATE SEWAGE S YSTEM 5stet� and 8Yi1rhs9a Orvraion INSPECTION REPORT S'1' • CY401X C• ", RAL'. INFORMATION (ATTACH TO PERMIT) roeq.Pwnrcrw= P N ' $� O Rv Q N=J cote T MR Ewl• q. eM F arcul Tar RANK IN R'MATION ELEVATION PAT1t TYPE lk"UFACWREA CAPACrTY STATTON 135 ' 1 Hf F5 El:EV:•;, . jeptic Benchmark bosir�g ' lob• � Ar .0 ' - _� 4erati 1 . Bldg. Sewer Holding St � I•It Inlet 8 � ',�, •' �? �> , ' AN1f SETSAICKINFORMATION St /N1 Outlet • 6 TArt+cTO P!� WELL SLOG. a "r L0 ROAD AK Intake Ot Inlet Septic , NIA Dt BOtiW17 " . ; Oosing NA Reader / Mon. 0 �; aeration '� V NA Dist. Pipe -L Ads .& /,. Holding Sot. System PUMP / NPHON INFORMATION Final Grade Manufacturer aemand Model- Number GPM _ TDH Lift ii n S Zara T, Pt Forcert *n Le I1 Dia. Dw, To well SOIL ABSORPT10k SYSTEM BID DIMJ Q L^ t4n9 /cr �u.O�rewshes MT Na Of �a b±ideOla. Lige' DIMENSMPAS SETi/#CK ' SYSTEM Tp P � L BLDG WELL LAKIIiSTREAM L.EAZ(AIG II�FOlIMA7TON CHAMOB 5 m: 4IR� /w , AJX ' A'A OR UNIT ush r DIMIDUTION SYSTEM Ne erI Dtpt►ibuUeR r S ae r HOIWS txngih �_ Dfe, Lcnyt►. brs. enc oaprcnta.4 fpaClnq ,•� SOH COVER �a Pressure sysimms only xa Mound Or Atr&rade Systems Only Depth Over Dvptb Over :c Depth Of AvC Seed4d �fodQe�/ sac iUVkheii , B d1'rre hcarflr fed /trsr,chEdgts Tapsocl Q Yif ❑ No Q Yes Q No COMMENTS: (Include rode discrepancies. persons prtsent, etc.1 C�1T�oI�r: I 11.29.196, SS, ME, Lot 15, Tanney Lane (V 41C Plan revISIM 7 n req�+ire0. El � 11v 11 0 »! U3e ethersidetvradditional information. saas os9,, '� lv d 04/18/03 FRI 14:16 FAX 10010 FROM PHOENIX FIXTUREu (FRI) U4. 18' 03 08: 364'3T, ft: 35M. 160` F 2 STC 104 AS BUILT SANITARY SYSTEM nZ?QnT OWNER S A A'1 171 I AbI?R$SSar W IvTSrOlI / CSMf FAINW- a, EDT I ----- W, Tovn of a 5T. cRorx COURTV WYS r CONSIN Pw Vr SHOW £VERYTHroc wITHYN 00 ECT SYSTEt � 1071 TAAWXE clsK� "Lrr XwT I RSA yaTbM l,ss �� . Ll i I ND I CATL' (+ORTH ARJZOt� Provide SoCback .7hd eLevat' ion information on rever.'s of this roll "M Provide 2 dimensions to center o( Sept i G Cai�� m.)nt ?� l �•ovet" 04!18%03 FRI 14:15 FAX 10 008 FROM PHOENIX FlrjREu (FRI) 04. 18' 03 0 :,'7/ST• De: 3510, '5562171650 F 4 iRa�rord wt1l11WR @R,t)5, MfiO_ I1dAf. L"Ltde 4' ✓� ax t S lum (to the County cwy a+h) for on system, on paper not Um Owr' ` 4Ye,/OVerINO.Sfde for na L_J ,rsi.�R�•+�lit+n�yd�Mbn )nse�rudio for ovaiprletlnq Phis spplketion. ti'fATA . L ApPLJGAl�'ir I MRTM - "SAW PRIn tI�011MAT1011, tD. ht1lNl t , • 1 . : i • f'iW/1tytTY LOCATION , , • f 1 X ff- "A, S T t�l1i<JNO IrJ0ii1ES5 LOTS N v ' Wff, brats 3tl60rvmm; OR cam 147 ,' t Q' f Off . 7 -7G? "�' 7 S V �. Tv OFtiUM.D*l& Kuck aw) S400 pyin� "ww {{ p , •ritiblia S 1 or 2 Fam. Dwetling4 of bedroom s' � T N ���� • I in. building t" h tw l% Medk p t lust M" 0Z'0 1'3 4!5--jac, _ 2 r NAtI 8 Mediae!tliry�NUrsinp Hen+a TO ❑ OutdoorAaere@t+oEii) t=sdlilY ' 9 Caw4W* nd 7 Merchandise: affs 17 ❑ Fles�iursittf8a/nlnlp ! 4 C�IUrdv�dfopt @ ❑ Mobils Mloeee PsMc 7 8er alas �tTQNGic Wash' , . �' .CJ . HpesllMotel 9 (] /F Yd tj Others . , OlTips aeDory Spedty , ' �`• ' OR �aNNfT: (iCtwolc onhr vats is furs A. Cl1o�k line S K spDlfeab+el -' � - `j 1. Ifsvr 2 ❑ RepUmmmenl 3. ❑ Reptaaemernt of 4, ❑ Aewsonnedon of 5_ ❑ Repair 91 rfn: , -� Sy�bew S eat Tank Only Exisdnp nig m B ❑• l4 Sas11 perm was prwfiously Issued_ Permit # vane lasued V. 'tTt�E Orvvi 1 m (Cited: wMj ow) MoqPratxuriz4d.fyAribudon PrassufizedDistribution ExpaNmerdal Other 4' A 1t SCepaoet3ed 2T ❑ IMound w ❑ a �vTyce ^ dt HoldhqTefi�C''` �f 0 G"M* Tftnch 22 Q UrOround _ 42 pc" Y3, Pra;sure 43 YauttPrivy i , the O1R1!17CiN d'1 OMW WFOAIMAT": 1, c•341,A.0w PER DAY 2, ^9800W. AREA 1 3 - AB804 . ARFZA 4. LOAMNS RAIV 6.'f'EM- RR a,sr@R @Iw es.ev. T.,�1 ai off► FCWQIRED(sq. ft.) PROPOM (r4• �.) {ftW&iapisq. (L) pAin1•ue0h) r• , f[FSlA�1�ld , 1 TO ♦M. TANK A( i1r' Total ,d Preteb_ f901r Sber. T� a Mln�h►aar►gI'Q Na1rM Car s�eei Pt NC'• �igwer mew � tislfona Tanis zm"ETWA Oo0 �1f " �IRRY 97@►1'E'NIF7/'l• ' . , - t, tlNt +rwpoe rsig"d, assume r spo wim tY bvr tnerialtebl�ri of me wwlee se*TV wywasl shown off+ isa' ettaohsd �• � '"°� Pioa+ele�p llvn•lF!1nq: mod—'& f ro: a" 8wM41 M No - 1 , 401 Oil et T� { •�' r ' ,j i ' owd / Fee ei�r�wm. APP .O d" v"r a.w'1gN(a! ! errawgr ei , r ,r X. DOAPFfMAL• raaf Ofd7t11blJitoN: OreQkMi es GwMbr. One �wr to. 6aleti ! @4tNdGg9 Df.dfaR f7Atnac Ola�updr .. 04/18/09 FRI 14:15 FAX 0 007 FkOM PHUEvIX F XTURE (FRI) 04, 1 03 U':3'VST. U: S5/N0- 3562 P 5 5A M • W CAL Ek- tANnt1 x = 16 7 t T'ANIV EY . LANE LOT I S - Sys'rCm, Et:= 9Z.cp' 54ALL '14� =10� 1M. ToP air z�,. ?IPE 6t M. Tod o� �' �rp� ,4T K9 ccT uE oo Qo -�R asp LE A+A,Z 1 , E f i dQ 7 � ( si /� I I 'i �� •', it ta 7r l�Or1.SF 9 S .tBJ'SO _ v w"rs � 'WEED IN 04/18/03 FRI 14:14 FAX [Noe ?hum rx OIX FIXTURES 'FRIJ 0�. 1r`;' 0:3 U�3:37; ST. U�:'��/N0. s5621?i�aU ? 6 .1 77 'o o CL L IL T i T f , O • ' 04/18/03 FRI 14:14 FAX 005 FROM PHOENIX FIXTt,flES .�562i t l6tiU ? 7 in a=a/d with WIR BUS, Ms. Adm. Coce AM '• ad�e+pl�e rtta p1aA oe� P not less than 812 x 11 inebes is dk., Plan must W d.Nde, but' �}.� - neR it`d tb v erDe:il end Aotbp nkrenae PaM (fir *w0pn wW % of mope, gods a FAACF -: J 1, i rn►heloitad, nerds uraw, and kcadvn and o , '..'•. " . IMP .�WC 1 iltT J�IPQRY�►t10N.PLEASE PRINT M i! eY ATE I LL v4NE ,a 11-F Z9 ,RA�1. ONniER=a wuc , s 4 Lot 8 St16Q ORr.S t _ Moot A R comciiibt use 11 Re WOwrrant Papua a wFonacw C401 1b woo 4* Aow d Raoatttnrer�ded rata: fast,gpidltt ``'`: �'► �. does s� ranch. � �nten badhq raib bn� aae�.,.��;�a!a�.,, . ' �� Fbpo�atendfd deraotfoc+ s R „ , :, ;.R• (� aeleaad b�At (8s l�Mnaik '�t ttsbpt(a1 Pbod L ug edw S Ciu t�s Ou 5 O 3. Ou � s Chu ; C� � v SOIL OESCRtPT'I REPORT "b gp' Huriph ' Dominant Mayles $app' t3PD/f€ a!, Mur"I Teatime cbet9 im &UdN / Root • Qa. S=. Cott: Goior G�: Sa:. Sh. 1 �s •I .12411 JAV it 4 /4 Sit Gum K 3 -11 r ow rh r 4'TAI $► -�t io 4/4- S AL E-1 4 � N Mso 11 4.4 , o v$5aw 04/18/03 FRI 14:13 FAX 10004 FROM PHOENIX FIXTURES A D04. 18' 03 08:W'DT, C 355 P 8 l WT ,M QA- —M It SOIL DEN I:MIP 1 IUM Me wri 1 �OM '; HOf�Z011 , @�l11 L�ft11f1SfK C010f AA�7Ulger i�'p U1. NtT+t5B11 Qt 5�{ C�1C C�71GP �, f. $t. 5�1., •~w w�+n'r� $v 6 7, Q 5 r 1h' �': ' Cc:� t ,SS � 5 f' As tar rC. 41 loyse 44 __aarree.�►► � . low L p-p- . FiYlnairks: ' . 0 � 6 -M* s4ir. ri; c 4 a t�Cotxld 4 la 0, �- >• a z pA311aft r f !, • , , tyw r 04/181 FRI 14:13 FAX 10003 FkOM PHO ENIX FIXTURES (Ffi1104. !s3' OY:-jW'W'T. 08: 5/ J. J55c AFL �� � � may. _ s , �� � 4 ` . • . M ;i . �E+xraM��ti 2 "Aipt d-r NaQT,.La r J. L.or e o •c�c ; �''- 2e' • wA ^' 04/18/03 FRI 14:12 FAX 10 002 FROM PHOENIX FIXTUREu (FRI) A 18' U1 D8:: yVVIT 08:35/N0. ' HOP IC :I SCE SM - ` •'l1R�F ■�N '�FF1E • ' r �+-� -� FLOA � � 'Ifs7710 1 +, Hov'etober 16 1995 ; P.4_ Box 262 8ud$6A; nisCOnsin• 54016 RE: iR. ptie Zu"ection for Property Located at 1071 Taney IAM*, Hudson, Wisconsin O "r Mr- Killer: An inspection of the septic system serving the ZideiYCe Ierated 'et 1071 Taney Lane, Hudson, Wiaconsin, was C rs tested' .;on 4ctober'.3� 1995- This property is located in the SEN of 'the'' c�.i nk of Seam 11, T29X -R39W, Lot Z5, Tanney Ridge, Torn of ftds�, 9t. Czai�C. co=ty, Wiscorwi.n_ At the time of the inspection, this 'Be�rtic sys+tam. was Pound tv be code Compliant for a three! (3), bedroom ham *... If You have any questions with regard to the above, . please do 'not hesitate in contacting our office. Sincerely Jesskf ass ry as istant Zoning Administrator St_ Croix county, Wisconsin mz P r, POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner N Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer W Q f-Q (- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model - jJ ❑ NA Number of Public Facility Units �KNA ank Capacity kd g al ❑ NA Estimated flow (average) T j 6 U g al/day Pump Tank Manufacturer / se P— NA Design flow (peak), (Estimated x 1.5) - 2 G-0 gal/day Pump Manufacturer ❑ NA Soil ication -Rate g al/day /ft2 Pump Model NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil & G) 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) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L A ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 /100 1 ❑ 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: Z - 'j ❑ year(s)month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2.3 ❑ mo (s) l (Maximum 3 years) ❑ NA (sl month(s) ❑ N A Clean effluent filter S At least once every: / years) ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) NA ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) A Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ 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 (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo ,$ed 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. Page Z of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During 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. he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' if nu ep aiss i s awanabic o ing t ank b e ai D44 1 rrm nR- A/�✓ COIVS77Z(JCTtD^ ❑ 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 �� L Name Phone -� v Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. ( (wj& ZQI�I N Phone Phone '7 / 3W(0- (o 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. , 1 L �. ' FROM PHA. "N . X F "G'm COMM . •1' :r 1'�� FO� i r 4 1 � . , 4 1. r �'� 'Sam' •�', - . , � +` .' ,: .," , • i I low Am br A l ', �'s1�fY�� ; � . ' ','•fir • ,;' . • � � "�`• " 1 voY� ti t � � _ ..rr —� ���''�'1 ^— ,, •. o 7 ' Y . p' nia jd #.ot 13 �& • , �aai�ur�ja� o► w�ow► lroRei . Vim ± .of die aria WW i�►;� "' r� b � w�.ee dim•} ��. � 1. ; 4 .. * , Ohm pp v+MU� ads � • � �t�o: � * , of M riwa�ad � , b� • :i�siri�gpt!�adebs �do�� •. �Q"""'p�t f�'�yy'°� r`�` • ' • ' t1 b1 rind �° oipeeltl�► t r r ' IM �' � • ndm c a p. • • aimmu bot Of my OmWkWOWIL li p �poq� ' . 1t? idYle.i -:;iw ed t�asedrd �a Rsslrle� moods [ iaeo, t , , lip, �-I' Sys[evt Mattagawutnt <. . �Mlatss4ssneat oC'61iis systaiW. S. ciiuca). h1a a co ndi tion a! aDP ravel O f t}►ese t1 alts this system amen; ms�si lyt sitxiti'w+ed e;tl7 h orrx eOwna r, and the 11t1n1COWttEf ittltSL be �? ded'wtth a CO OVl:� F •lttt mating . set of plans inciuding the. iriwiftririt sec t ion. . . • Cfetaaral . . Pro >ritrYCtior�n� 4f stn itC disposal system, "septic iystsm,° is sigpit' "A rly s5 epen dtt+t cm -e �alurnt olwatci wlsish xcaua tatirs'.tiyriem and the level of contamitients in IWM,y'olumo. The ]ow +et the vo1 - of water• snd.dttr lowit :k4t] of coatur items. the beer sad longer oji4ysntrn o n' •(�t:�n. Typical yystt tit cprripna ts;i�sct ;y septic teak or coMPVt rt�clts of tilt same dar�ity g% wsterna La k o►1s a ¢Ilter on th�c outt�t. ri` tkt AiCt to Y ouir arnsl p or corripsMM' Celt to a]law' a : do�at�l'� iice�ar►tulated, a pump !nd controls..and fin�ll,� some h i h. soi! b0iorptiOn Celt to ri;tYcla.hr..w►pt #i; iri : manner to protect ground water quality ttnd public htar+ltt�. or to sheet -rocJc andlor paint ing. pomp the s6oi c•tank berare t'.o'Tta' l• . lt't1 "Pur : teak is• ii:stallilld .'; residerttiil we bt:gins.to�pttuts` Once I o t,Oriuminttnt load desigA erlteria. 2 ln+tgll v�rater�tl�in�.r+YPDii'ysr slid wherever possible, 3. Repair loan stltill watdir.la :tioon as possible. 4. l pouf jns;sc v %oil'•d "w!!tty •drsin or atool. 5, Qorbri�e diepo:ala;�ic that, t±t;►ended; if yon. must have one, use Lt cparinglyi. 6. No paper prnduc'[iotlla to should �o into the systatn, 1, No ehemicali.ttl+oul4.gu. :irk: :.system, 8:' Avtiid surge.11ows of :wain tit!' (Q spread laundry tltrougljout the week. p')lairaranancc 1'. The zoptic tank i'nubt br Jft''tP every three years by u properly licensed p�•raon If necessary, this geYit�c ta'tk;xiq>Fist be pumped to t•ernove solids and scum.; p +truing is reotji•rec combined seven •ard solkd:s vtxll -Auals one third of the t%Ak volume. ;• 3, Whiei the. se�tiC tgrik fy. p t td: any solids in the bottom of the pump tank na A be .pumped, e .. t , inter - must be beak d: :ito : �ptic'tank to MZOvt accumulated rn.ateriai; 1, periodic otiatrvatlt+ir pit . i :4 Otions should be made by the homeowrici to $amine the smtc of tl,: situ soil adsorption sell: Qu$;tispections are recommended. ar►d s licensed' ;i��lurnbor should ::: > : ".� il ct[ltiestt.is :colxtisttfnl y'.• . �; the adsorption cd 1. 5, if this aysten+ e0 t>tins : *p :t atmon% components other than those rtstntie�e+ed kart., main!er�ttc.�; . mquirabfents will.aCCpri�pdriy :t .;a�DociftCatlot : 6. 'ihd puntputg tgel�c Mettta; t' ii systaaz include an slwTri which must be i ,SkAlled agd .rrrnain !+c s separate circuit ttia. xi�iip� :'Uihc alarm is activated, MUtitttiZ! Wste use ar iii ao :iFr a licensrd'r�i;;r�er o e;.; - %. a stem allows reserve capacity to aFCUm��'.ittC some ncc.Essi ^� for ser -400 W S004 �s .p 's�sibit • ' , , • Y ,: • nt�tttti!l• salvias cut be �ta�tid;,a#"tss voltatne is srtiniri7 And no mars than one o>F ltivo days should ' S -�: any necssisary repai".Cari re. 7. • Waiiewttter• , ..o vb�iina � quality is not � rtatttstal raquitemtnt fob residantiat systx,�;S; monitoring may .becorttstrc i :'9t•problaras develop. Any ne�isary monitoF n� shall be ache ir► c:.;.,. with this isgtiiretnenitr :cif` vi1��rit � :51(2 ), PUrr+ping and hauling n6wnstev�+ater;t 't-,%y be neceasaty analysis end aid• impiltril Additional testing, designing, and/or i;islatiim of idd :tionr..+ treatment componcnts or C1anv4a' irn.'tu a holding tank tries be t,eeessary. OG�9 oh S C7 ►s.• (r�e- re Z'(a... ov � . :•t`��'� 7 s?` C �. �: 4 . o: ►.;, nr m f fa c. c � . 3 6d, - 4&80 THE EARTH 'i HEISE EXCAVATING ... 10e2 South Main ' • RJR FALLS. WI SA022 CARL P. HEISE x715) Al - 217 Owner T` � • v Ste. c :,c. Z r? �,� r 3$�y 41 p 8l 3�5s ��14e- DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -19e2 THIS SPACE RESERVED FOR RECORDING DATA 53751 _ QUIT CLAIM DEED '! vot 1153Pw_ Vi /J T. C co., W VL Sur cLs� o DEC 15 1y95 t — 2:45 P. P1 quitclaims µ it the following described real estate In, t. County, State of Wiscons °n: RETP NITO� - Pa r i Of SC /4r ►i l ly See . IIJI) N 'IRInW ,helm , ,�.,� ,e ��t� ��r,• � F'ar f OF 10+ 15, l ann� �'iiclt:,� S(� bcd I��k� � t i Orl Tax Parcel No: } anC� �ut-t o{ Lc� ' of ee r4 0 vcy p l r1 0l - I o , ��a �8 30 C�cSo-r1F-6 AS poibwS - 1-01 p� Cer +i�ie �urvcy <aP ,le prJ 17, 19rf I r) 10 I p ace flue AS L7�C , f�10 , 5a h 39 . Y w ri. M N a i s c This_ Is homestead property. (is) (is not) Dated this 15 day of k JQ ( I l ) Y \ / n n �P � `,f (SEAL) — (SEAL) (SEAL) (SEAL) AUTNENT11-A -1— r U'' e \-v V K,4 O—SM 161a9 e y� 4 01? 6 - 130 -?t') l� ad FILED s APR 1 7 1995 ► �3 N ff14 KATHLEEN H. WALSH CS fn 1O�� 90 fo Register of Deeds tea, SL Croix Co., WI 9 52'7'73 ti � .• -; Y � CERTIFIED SURVEY MAP Located in part of the SEJ of the NEJ of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being Lot 15 of Tanney Ridge Special Addition and Lot 2 of Certified Survey Map recorded in Volume 10, Page 2830 at the St. Croix County Register of Deed office. N LOT I LQ I 3 I M C. S. M. IN C \ r 287 +�i�o ? 7713 3 „ ��i�j /C s ' / d c L_ 1 4 L_Q I 13 �. �I - -- -- '°�° I i0 N N c� I LOT 4 2.63 Acres (114,462 Sq. Ft.) of Ct I — l � I o Lpt a �sw, —fI ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road t i "•' Hudson, WI 54016 -7710 (715) 386 -4680 Fax(715)381 -4686 April 11, 2001 William J. Radosevich Attorney at Law 502 Second Street Hudson, WI 54016 RE: Private Sewage System Tanney Ridge Lot 15 Dear Attorney Radosevich: Upon your request, I have enclosed a copy of the complete paperwork pertaining to the private sewage system serving Lot 15 of Tanney Ridge. If there is anything else we can provide to you, please contact our office at (715) 386 -4680. Sincerely, Kevin Grabau Zoning Technician Enclosure KG Am William ]. Radosevich Attor a Law Phone 715 -386 -8234 xllaw @hotmail.com 502,5econd Street Fax 715 -386 -8235 'Hudson, Wr'W16 April 3, 2001 Kevin Grabau 'r CROX Zoning ffice fNGOF g cx�fr:G oFFqc St. Croix County Government Center 1101 Carmichael Road f Hudson, WI 54016 -7710 _ RE: Failing Septic System at Lot 15 of Tanney Ridge Town of Hudson, St. Croix County, Wisconsin Computer #020 - 1305 -20 -000 Dear Mr. Grabau: I represent Mr. Sam Miller of Sam Miller Construction, builder of the house on said Lot 15. I have been provided with your NOTICE OF VIOLATION dated October 12, 2000. Pursuant to the Wisconsin open records law, I ask that you kindly provide me with a complete copy of your entire file regarding the septic system at Lot 15 of Tanney Ridge, including all notes, drawings, memorandums, telephone notes, correspondence, plans, inspection reports and any other documents or records relating to this matter, including all correspondence to or from your office relating thereto. Kindly provide me with a statement for any duplication fees, and my office will remit payment to you promptly. I look forward to your prompt compliance. Please feel free to give me a call if you have any questions. Sincerely, William J. Radosevich� C WJR/rg cc: Sam Miller + t STC - 10 4 AS BUILT SANITARY SYSTEM REPORT OWNER SAM M (t, L E /�'_ ADDRESS .BeX :1t Zg� hv!D w or SUBDIVISION / CSMI 1 h NLL Y LOT / $� SECTION T 2Q N -R Lj W Town of ST. CROIX COUNTY, WISCONSIN FA4TC'par PLAN VI W SHOW EVERYTHING WITHIN 100 EET SYSTE 16 - 71 TAUUE� -40- R nC i RF, A YSTFMI r S CA E 'Iy (v " it V � ,$ r N A b 3� W1:lL INDICATE' E' t4ORTH I Provide setback and elevation information on revel - se of this form. Provide 2 dimensions to center of septic tank m< - jnhole covet ,I BENCHMARK: Tai oV- Z grNF- Le 7 40 3 ALTERNATE BM: If0USr- FO 60 Npl41 /o1Y 6/- -;� .7Z - S PTIC TANK / UMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WS 1 Liquid Capacity: Inoo 6/�L Setback from: Well House Other Pump: Manufacture Model — Size Float seperation Gallons /cycle: — Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches ._. ----- Distance & Direction to nearest prop. line: 58 T J_,4S7 1oTLiN,-c Setback from: well: 3�j' ` House L g Other 24 fo /1�E�d�Cif/ a / -/oy ELEVATIONS Building Sewer - ` ST Inlet . 3 g T q T outlet PC inlet PC bottom Pump Off rH / - 14= 13•(69 =92.61 7 S Header /Manifold Bottom of s / Existing Grade 11.60 Final grade DATE. OF INSTALLATION: PLUMBER ON JOB: , LICENSE NUMBER: INSPECTOR: 3/93: )t Wiscopsin Department of Industry PRIVATE SEWAGE SYSTEM County: Labdrand-HurAan4Iations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: o.: Pjjjit HQ1der s N SAM ag;, E . ❑ City E] a Village �] Town of: State P n I CST BM Elev.: Insp. BM Elev.: 7 /142i ,, p M Description: li Parcel Tax No.: CJ- /U� [' j _A 76 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 f /00 Dosing ` Aeration Bldg. Sewer Holding I St /Ht Inlet i TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic > .SD a) , '2 U NA Dt Bottom Dosing NA Header / Man. ,3 �/� 9.7, 76 Aeration NA Dist. Pipe 6 9 9a. G Holding Bot. System 7 S� PUMP / SIPHON INFORMATION Final Grade //, 9 Manufacturer Demand ",�...� Model Number GPM TDH Lift Lric ' n Syestem TDH Ft Forcemain Le h Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �' �' ° DIMENSION SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O Y�,e. CHAMBER Model Number: System: YU- 5 /8 ' >aS" *1A OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) 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 xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SE, NE, Lot /t 15, Tanney Lane - Q •(/G� X c - '(g= :,Ey�l Plan revision required? ❑ Yes ❑ No Use other side for additional information. J y (o SBD -6710 (R 05/91) Date fhsp tor's Signature Cert. No. SANITARY PERMIT APPLICATION jai iisrs COUNTY In accord with ILHR 83.05, Wis. Adm. Code 5 7 . 6?0 1X STATE SANITARY PE MIT # —Attach complete plans (to the county copy only) for the system, on paper not less than qO3 T 7j 8% x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER - PROPERTY LOCATION Ste' /a Nf-Y4,S TZy,N,R E(o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOC 9 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NU ER v 0 Sri w r o/ A, IZ-L7 T AI R ( J ,, I' - S� s 9 S& II. TYPE OF BUILDING (Check one) El State Owned ❑ VILLAGE: NEAREST ROAD UDso 14 1 7 A _N 1Vt LANE ❑ Public ®1 or 2 Fam. Dwelling— # of bedrooms 3 A CELTAX NU BERG Ill. BUILDING USE: (If building type is public, check all that apply) d 7 _ / 3 O !9 .tpa© 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 7" New 2. ❑Replacement 3. El Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE _ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) , ELEVATION '/Z -00 Feet 96 Feet VII. TANK CAPACITY Site in Qa ons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 000 5 Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: M 1 c -= 38`(0 Plumber's Address (Street, City, State, Zip Code): �oREE H M/LL 4 A N F vp o P11 w t IX. COUNTY /DEPARTMENT USE ONLY ' \wry/ ❑ Disapproved Sanit ry Permit Fee (Includes Groundwater Date ssue I ing Agent re (No Stamps) I N Approved ❑ Owner Given Initial ]� Surcharge Fee) TTT Adverse Determination v X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber f INSTRUCTIONS y :, 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) SA M. , M I LL)_ IL TA N%EY RIDGE T `�'�''�E �' <�`► I D I I TANN EY LANE LOT I S 5 S ?EM EI.- �jZ.Op� $G LE �1�� = /D� B -M. TOP of 2 PIPE. Y AT At LOT t Ni. ToP of z t /P� qT ME DoT COP tv F/Z F /. /00,00 row Il S 3S0 7 Z 1 P /V ATF i aa� ARFA � I loan aa� A Y q I a� qo Z 4 / / J NDUSE � � 9 S � a8 XSD e GAK►�t E i 2, � �iYO SCR[E) 1r4ElL o 9-3 a v� �E , r SDUT LoT L/K� 3tos,p�'�ND sc��E W I I I 5 v rn 0 r I z I I I m l I I m l �� W i a) I rn �Q I r 1 I I D --� m �j I I . N I z I � I I I z ,, I I 02 I CA I I I ° w I (' v O I W t z CO EA I -u �' w I � � 0 ��� C O W 0 I I. 0 =i n-4 v m o NO m T z b T m _ o o m 4, m �, o z Wisconsin. Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor &nd Human Relations Jr Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • � COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but - 5 Ck0 (x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne 0 f- f' APPLICANT INFORMATION PLEASE PRINT �,� RMA� - REVIEWED BY DATE � �y'r v W r, PROPERTY OWNER: P TY LOCATION `SAS Iv s " <. GO T S 1/4 NC 1 /4,S 1) T 2 N,R / E (or) W PROPERTY OWNER':S MAILING ADDRESS ' t /1 LOT BLOCK # SUBD. NAME OR CSM # Rl c CITY, STATE ZIP CODE M , ❑. T� V LAGE OWN NEAREST ROAD ( " Cosa aN v LA'j ( New Construction Use Residential / Num ooms [ ]Addition to existing building r r j ] Replacement [ ] Public or commercial des c�tbe Code derived daily flow gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations &,jA� r0'* �rJ& F6't' - r &AlPrni4,VA Parent material Flood plain elevation, if applicable ft S = Suitable for system ENTIONAL I 0 J ND I ROUND PRESSURE A RADE SYSTEM IN FILL HOLDING T NK U= Unsuitable fors stem ® S Cl U L S El IS ❑ U S❑ U E$ S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench — i s la C s 0.4 0.� Ground '2 ! 3 �J r !•1•, C W O 0 d elev. % —9 ft. Depth to limiting Remarks: Boring # JOB 6 - 1 . Z n, - S 04 €0,S iOW 44 5,L I s �;; n', r C w 0.2:03 Ground... +e, S `� r►� CW 1 3 77 d 14 9 j.o/ ft. Depth to limiting for 3 Remarks: CST Name: — Please Print / Q v \ N �� Phone: Address: P. 0 grax U & so ) Signature: Date: l I , n CST Number:� A L—A�a )W2�� PROPERTYOWNER Sidyh &1-6.,e //�� SOIL DESCRIPTION REPORT Page? of PARCEL I.D. # L OT IS l A N , -JEY Raa i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 1Trench _,b ion 4 3 m r C - z-F of s 16 -1Z 7. s Ye, 4 4 S r n►1 Cw T o. o ,p Ground D� -�`6 /b Pe 4 4 n r >h eW 0,7 O elev. /D 13 ft. Depth to limiting factor > to Remarks: Boring # o-/ 1d`/R23 SC r M �r Q7 f Cw 4.... g, -2s J Y� 0 , 7 `D % Ground K- 4 1 6- 41 S C w 1 0 "7 9 e 6. 1b ft. g / -121 6`yje 4 �' Depth to limiting factor Remarks: Boring # ? 3 4 i0� r� 4 3 S: C l m sL k rn3r- w 1 0 71 0 3 ?ii.4 �:ti ?Q ?ivi Ground 52 J p`I 4-1 — 5 C J rn S M C w O . O gglee. 4 4 s m 7 n g � ,� ft. Depth to limiting factor > /d. Z Remarks: Boring # LQ C >G I Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 1 AZ,E 30� 3 • 3 a' � I � I � 1 1 ' I AT Nottu L-4-sr ��eljp�,a�= 100,00' N J � 1 I 1S 4 I 1 i A 20' 20 �, STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S A . AA ��— MAILING ADDRESS B �Z�L / S©(�l G)LJ PROPERTY ADDRESS /4 TA N NY L AuF_ X&JASO A/ (location of septic system) Please obtain from the Planning Dept. CITY /STATE f((Jl>S e j� W I / , - / d PROPERTY LOCATION S 1/4, A/� 1/4, Section TN -R W TOWN OF f L) SO / ST. CROIX COUNTY, WI SUBDIVISION ]2#A Y F / ,J2 615— LOT NUMBER CERTIFIED SURVEY MAP z s9S ; , VOLUME � , PAGE , LOT NUMBER / _5_ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: � lyyl � DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property t\A M I L C Location of property ,L 1/4, Section T_ - R C '�' ) Township 22-50 V Mailing address LOK Ho - D _S N L"' i /<�' Address of site 10 �, f L,tl/1/` /�� 6S V Wl' Subdivision name R!'/S 4,e Lot no. Other homes on property? Yes No Previous owner of property Total size of property Z,9 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? X _ Yes No Volume/ 31 and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. - 4/9 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. S Z/g �m Yk-,/L , — Si nature of Ap licant Co- Applicant (q Date of Signature Date of Signature ST. CROIX COUNTY WISCONSIN - - -- ZONING OFFICE r r N r r ■ Elani ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road --_ Hudson, WI 54016 -7710 J am' (715) 386 -4680 November 16, 1995 Mr. Sam Miller P.O. Box 282 Hudson, Wisconsin 54016 RE: Septic Inspection for Property Located at 1071 Tanney Lane, Hudson, Wisconsin Dear Mr. Miller: An inspection of the septic system serving the residence located at 1071 Tanney Lane, Hudson, Wisconsin, was conducted on October 3, 1995. This property is located in the SE; of the NE; of Section 11, T29N -R19W, Lot 15, Tanney Ridge, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three ( 3 ) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, t Mary Q 7.Jenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz DOCUMENT NO. STATE BA F W 1 - 1883 •04C1 A91•11•0 111 1111111140 DATA AR 504855 _0'L 103iftGE456 'OSTET 701i and .. ICE _ This Deed, made between ... 1 ................................... ............ Randall W. Syp��!� Patricia E. Synan, R ------- ...... ....................... ...... ......... I ........ .... .......... �ec*d for Ro husband and wife . ................................................................ I ...................... ..... ....... .......... 9 1 ...... ----- Grantor, SEP T 1993 • .... kil. ... * a .... sn p ------ ---------- ................ I ................ — I ..... ..................... ....................... of 10-45 - A. M .............. ..................................................................................... .. ..•..... ... ........................ .... .............. I ............................................ ....... �.U_` It, ........ 1_ .................................................................................. , Grantee, L WitlieSseth, That the said Grantor, f a valuable consideration Randall W. Synan and Patricia E. Synan convoys to Grantee the following described real estate s, ........ St ........ C ISTURN TO .............. County, State of Wisconsin: Tax Parcel No: ----------------------------------- The SEI/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the S91/4 of NWI/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. as AND ' A A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1 /4 corner of said Section 11; thence S89 30 along the North line of the SE1/4 of said Section, 1212.32 feet to the point of - -eginning; thence continuing S89 30 along said North line, 66-00 feet; thence SOO 28 500.00 feet; thence N8q 30 along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence NOO 11 150.00 feet; thence NO3 58 351.07 feet to the point of beginning. This ........... 14L.AlPt homestead property. (in) (in not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ..... R.a.r%dAj.j ... X .... $y .......... ...... .................. .nAn ... .................... .. ... .. ... Patricia ................ 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. and will warrant and def the same. Dated this .............. ..................... ......... day of .......... .... August .................................... ^ ... (SEAL) Q. . 1 ,:J ............... ... ........(SEAL) Randall W. Synan Patricia Synan .................................................................. ........... ...................................................... ........ ............................ I ............................. (SEAL) ............................. ....... .... (SEAL) --------------------------------------------- ---------_ ------ • ..................................................... -- --------- AUTHBNTICATION ACKNOWLEDGM]INT Signature(s) ............................................................ STATE OF WISCONSIN a& ----------- I ------------------------------------------------------------ ------- St. Croix aty . u . ....................... Co authenticated this .__.....day of ........................... 19.._.._ Personally came before me . ✓. ........ day of August ........................................... . 19 ........ the above named ..................................................................... ...... .............. I k - a' n --- 1 - 1 ----- W ------ S * 'y" n ... n .. .....P atr i cia *' , ... E. ..................... --- ---------------- * --------------------------- * ----------------------------- ........................................................ TITLE: MEMBER STATE BAR OF WISCONSIN Synan . ...................................................... (if not, ------ ................................... ....................................... 4. authorized by 1 706.06 Win. Stats.) to me known to be the person 31 ------ 844y x , he go ing� instru nrt ;and cfn)wIe*x*eI - - RSM THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland ------------- At'corneyat--tav .................... Ali y oA ors Alice -- ------ •----- • - -.... st cr ---------------------------- - - ------------- --------------------------- --------------------------- 'Notary Public .......................... ........... --- County, Wis. (Signatures may bo authenticated or acknowledeed. Both My Commission is permanent. of not, state expAation Q W 0. O Z I J -- 2 2 $ ~ 60 � arm glo a l z 6 j a e o _ aj I f i / ' I ; h 3 b� � �eF • FS �� M Y Y M r � I ' f � _ M 13 .$ o a Il• b ti! ..... yc 4 V. 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