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HomeMy WebLinkAbout020-1433-05-000 o 0 0 f c 0 O C c 3 1 c (D 3 ,D � A v 3v • T m 3 3 ?. N j Z O W 10 'S 10 7 Z O 0, 1 C N `C O• y , CD S ° d y° W N d 3 fD CD CD > > ry 9 N O y Cp r3 CL CD C O v CD O d 0 S = W 3 S C j o. = �. y d O ,� n f0 O C O O y 3 N O 0 3 m O 3 y 0 ? W O � l � CR U) c W y + c m C d cn z D ° 0 1 0 cn v y a 2 e co Dy a a C I (D h c CD Q : W ° O 4 3 p - c I CL CD I o 0 0 a l CD �. o Q 0 0 n r CA Z 41 y y m P 2 • N 0 c !r � a m 3 D CL g m` M O r o 000 z 000 cn A O 3 cr 3 v CD ID CL CD C CD CD a CD 0 y I 3 z O y 7 d j 0 �� 7 i y.< O o S v o v 7 S m CD CD 7 N O N CD C D X n ;o 7 O Co y CD S R CD C. 7. �. Z -+ d N n N I 3 0 o c Q a W c -P. CL I m A 3 a a 3 = -I N 3 3 -. C6 z �_ `6 Z eD . CD y C y Q C �_ M A C w n a j A C 6 n C p c � C m CL 06 CD z co y? Z ur I CD ? A A y I N 0 ) 0) a vas a CL 3 :1 m 3 CD CD CL o c 3 N o d' c CD 0 CD CD O D. 0 O a 3v O C d CL � sc � p m I � o' � O MD CD y ,-. Sd y L y CD � CD d O L O C CL y cD y o 3 7 0 (n CO fi i : O y O m 0� 6 I a 7 y y] d Q I 0) y N N O 7 a 0 7 VC O-f0 Z O O o 3 p d co c'D�O o - -C o o a A� a', CD : c d (n y a CD @ 7 g. y 2 m CD 'O N 3 O y � ° O v� C/) A CD I CD CD CD p A I I p I o 0 b CD N a tq O O e '° '° f ° o ° 0 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 463208 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Glen Johnson Construction Hudson Township 020 - 1433 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /tic" (�) (\ S 1 , 11.29.19.2693 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic II� { Benchmark Alt. BM 5 Ge. Aeration Bldg. Sewer Holding St/Ht Inlet 7. / te TANK SETBACK INFORMATION St/Ht Outlet 7A L / I g � J TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Tl� 1 Septic Z i y / 4 , � W Dt Bottom Dosing Header /Man. C 2 -7 Aeration Dist. Pipe B C Z S 7 Holding Bot. System 1 ct y , -2 PUMP /SIPHON INFORMATION Final Grade 7.41v 9 11c -341 - Manufacturer Demand St Cover Model Number 't f TDH Lift Friction Loss System TDH Ft Forcemain L Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT DI ENSIGNS No. f Pits Inside Di� Liq id Depth DIMENSIONS ` 3 2, SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR ✓�� 1V-�GZ TypgOf System: � 36 / 7 50 / N JA UNIT Model Number: 4 DISTRIBUTION SYSTEM + ZZ — 4-5 7 Header /Manifold 1 / Distribution x Hole ize x Hole Spacing Vent to Air ntak_ 1 s j Pipe(s) \ \ Ccl Tp Length -I.L Dia `T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of eded /Sodded xx Mulched Bed/Trench Center I Bed/Trench Edges ` Topsoil xx Se / \ Yes No Yes, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1073 Daniel Drive Hudson, WI 54016 (SW 1/4 NE 1/ 1 T29N R1 9W) Mound View Estates Lot 5 Parcel No: 11.29.19.2693 i��� �C,• 7c'�� + �1��.1 �+Js ��+✓. Vic® �: 1.) Alt BM Description `—o = � lavv�, 2.) Bldg sewer length = 33 - amount of cover = Z44 'I Plan revision Required? H Yes �No 11 (o �? Use other side for additional information. — SBD -6710 (R.3/97) Date Insepct s Signatur Cart. No. c� cn p c7 cn O 3an C ' c r > _> n 3 r. w w � N y O O CA co I O O ° 0) � C -' N O• 'gyp CD t�D N 7 N N Q *4 O N N I ty ro N O L O A Q p o cn I CD o °° _ co w CY) A • ° a l ro : rn o I a H n w I Si y ° A CD cn z D cD a rov co v D 0 a 2 D I� a :3 co :L ca a w• C m c� �D I N p zt c� c CD CL O N < O O �1 c0 ro Fh (;D m W O z c a M c n d r CO) O A O d A D 3 w c �• CL Z 000 1 CD °Y Oro ro �* 3 � I 3 v,v,N° I � 3 v, v,cnn c o v v o o T v v 0 :3 CD ro ro °_' I ro a a r. C � S1 H � O1 •• � < g 3 m I g 3 m m 3 rn ti C r z C z 7 CD 0 I O a�.m O S :O: o,= O C <_.� o s I m N m ? O m U) m c y I = X = a ai CD c c n c v0 - O CD Ny � ro s c I yo ro �. m. w N n N �, 0 C Q a O� C A a N 7 N n CD cD 3ro a �'a 3 o p ? n 6 CD ads n I 3� a A o a0 I s� s 0 I Oc n fC/) m CD D - a I v v a z :3 CD m 7 N Z 7 y co ro A A A y I I m N oD pp D D �_ I � I � m N3 v'v a I a O O O a 7 A a N 7 a N C a C CD I CD CD �. O a° p a I OZ a a ro 7 �O D < ro N I w+ CD O ro N O L I N , Br = vii :3 O f0 � ' — O 7 m o I � v,•�NO 7 I m C, P. O I O o o- -a f f O p O I N CD 7 I A I I � O I ° ?� b ` I CD S9 O 69 0 A ° ° g ° o a o a I - _ Safety and Build ton County f������� 201 W • ington Ave., Box 71ts2 n. WI 362.. G kary Permit Number (to be filled D omm ) In by Co.} e artment of C 2 EIV� Sanitary Permit App ppli ___.� Sm Platt I.D Number In accord with Comm 63.21, wis. Adm. Code, personal infor ZDO� mabe used for secondary purposes Privacy Law x130 y iX C;,- Pro t Address (if different than ntaituig address) I -3 Property Owner's Na me Yi Su k k e .� v �� dltiv � Property ne Owr's M attics Address`- �� oc in P v, � City, State ,4 ,b.Secuon i Lip Code P N u. -G� / � � t � - ->l.r //' circle II. Type of Building (check all that apply) C.- r N R / , X 1 or 2 Family Dwelling - Number of Bedrooms v � Subdivision Name - CSM Number ❑ Public /Commercial - Describe Use ^ ^ -� �___ .._ — ~ ^ DG r � d � �✓�� State Owned - Describe Use D /s ' Z W 22 Z 3 OCity t.Jviilage Qj�ownshi of t III. Type of Permit: (Check only one box on lin A. Complete li B if : applicable) } Ai X System ❑ Replacement System L Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • Permit Renewal Permit Rev' Change of ermit Transfer to New i Previous Permit Number and Date 1 sued Before Expiration Plumber Owner 3 � 5 - a Qr f I IV. T Ipe of P Sys (Chec all tha apply) Non - Pressurized In - Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable SO ❑ At -Grade Single Pass Sand Filter G Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank Peat Filter ❑ Aerobic Treatment Unit , Recirculating Sand Fitter 1 Recirculating Sytuhetic Media Filter ,Leaching Chamber J Drip Line 7 Gravel -lets Pipe ❑ 0 lain) ` i V 1sD per saUTreatment Area Information: % -- Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersa; Area (sf) ' System Elevation t VI. Tank Info Capacity in Total Nunttxr — Manufacturer Prefab Site �I Stall Fiber Plastic i Gal lo n s Qallons of Units Concrete CoMLM Glass New Existing I Tanks Tanks Septic or Holding Tank Aertalic Treatment Unit !7o sing t Chamber L� -� -- I r- _ VII. Ices tulbility Statement- I, the undersig a ssume respo for allat of the PpWTS sbown one ice attache parts. i ; t3u,i;tess hone Numnet Plumber's (Print) Plumber's Si gnanire MPRS Number ,. / (e `er JG. t�' u 1 lLK`^ .t' � •, plumber's Addre $s (Street, City, State, Zip Code) l 6 7e9 V11I. ount /_t� rtment Use OniY __.________ .-- - -- No Stamps) R pp T Sanitary permit Fee (in es Groundwater i �� / iss suing A rut n ` Aroved C Disapproved Surcharge Fee, .� I O wner Given Reason for mental _ o — - — -- - AINTA" d8t6ons for Dina p ro al Sep tc ust all be serviced 1 maint►�►e� dispersal cell m rovided by plumbr e as per management plan p S� 2, All setback requirements must be maintained CSC / � eyz I r applicable cod as p ,' Iy� � y ` ava e Pp l6f I Q J � Y l � y � EY >YQt 1p„� 1J2 x 11 ltKhar in size _ AltiC� com 9lete plans (to County only) the for the system nn pap N E C /nVt- - 7 6 O tt o ✓ 1 p d •. IF �k , ,eg 1 d vtl Ad (t p, r I S a m �n K v v -1'G. sid.t � D� K COUNTY, WISCONSIN. NORTH LINE OF THE SWIM OF THE NE1 /4 712.82 to 90 0=3 w a��� Jk S csT sca -6 O s MJJ14 FT 0" �t��� ova T4 UN a � L.B.O. FT.) SQ. ,� 917.0 = 917.0 � a We J W F 1' I PE u'S O ' ° • 92 ' < °ql ELEV 1.1 ' S82"1 i 126 "I~';: 285.7a co CC I tr- - 7 6 a no ✓ pf a O y r W 4 i 0 6 q q� k ni l Ad Cc vn �a ►- ��n s a ►-� sfd� a-f s. l y i Wisconsin Department of Commerce SOIL EVALUATION REPO Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wr� County �� r � Attach complete site plan on paper not less than 8 112 x 11 inches in size. Ian must include, but not limited to: vertical and horizontal reference point (BM), dire ion and �p , percent slope, scale or dimensions, north arrow, and location and distance near d. D � aj 'oez Please print all information. by Date Personal information you provide may be used for secondary purposes (Privacy 5.04 (tj�rn RO OFFICE I / U P C mer _ P e n h U� ►� �,' i�trd �� ��' vt. Lot �� 1/4,a `1/4 S %� T ,z y N R / E (or aO Property Owners Mailing Address t # Block # Subd. Name or CSM# City State Zip Code Phone Number City ❑ village ®Town Nearest Road 14 ( ) (� New Construction Use: (P Residential / Number of bedrooms 3 _ y Code derived design flow rate y �U� (n 0 d GPD ❑ Replacement El Public or commercial - Describe: Parent material 004 z S Flood Plain elevation if applicable ft. General comments C^ 7 -e eq e l e V , ? 9 06 and recommendations: > �/ 7 a Boring # Boring 0 pit Ground surface elev. ZOO /C ft. Depth to limiting factor 13/ 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. S h. •Eff #1 •Eff#2 "1 —Zli 1C yl 3�� Z w, 5 P ✓� I VJ _ Ce �• -i j 1 10 ,i q I w. FEI Boring # ❑ Boring / ® Pit Ground surface elev. ft. Depth to limiting factor ! C v in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 tv Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgA- ' Effluent #2 = BOD 1 30 mgA- and TSS 1 30 m g1L CST Name (Please Print) Si CST Number kdL — x.53 30 Address Date Evaluation Conducted Telephone Number o S /.0 Property Owner Parcel ID # �CJ S Page Z of Boring # M PUP ❑ Boring %! Pit Ground surface elev. 7 , ft. Depth to limiting factor � C'r in• Soil APDlication 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 l>'1 jiiy(`�� . (,BSc ti F -1 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # El Boring El 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. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 2648777. Sao-4330(RAW) i I r r 4m L5 PAGE 3 OF Sf � NAME h r LOW LEGAL DESCRIPT N / '/4 S T NR E or W SCALE: BM I ELEVATION-- U ° O BM I DESCRIPTION tvg ±_ky d o ( v 1 � BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION C ALTERNATE ELEVATION CONTOUR ELEVATION nn_ 5a CAI CR 6 0 PS �t'1 ,e e r� r Z- 100- I 6v a P a( f 5 � SIGNA DATE / U ~Z -Oe r - p y G� z v 4 ,1 i 0 z m 0 r Cl) c v z � Do m ft-ft Z � _r O rn $ m M 1 0D ;a �-ftO Cl) m - n 0 X m M i O X �" Z > 4 " o -� CA m --� mn _ CA � m '� rn n M � x v) z c D � z � --� c to 0 X to m X o oz Z Z N O Z c v �nrn � � z Z G) m CO) CO) a _ CO) z �? N m m G) ;u < N r � z 0 rn mn CO) V O m -n I- < ;u --� Z F O m � � O m< � v m Z C 7D Q O C m 1, z a m • O G) M X O T 3 o x.°.• �i z :5 ri rn �� � a Sx - P� r Q° 3 a -I �g r Z N C m �' m �s o OD �. ; B _ m 1 c N z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner uyer cz �T" L4yoS � S�cI p r✓ Mailing Address 0& 0 Property Address (o 7 3 1 (Verification required from Planning Department for new construction.) City/State fS4}'� �iO� Parcel Identification Number 20 - I '� 3 3 — ©CS U LEGAL DESCRIPTION y """ ,(/ I AA '' Property Location ' _ V4 , N 6 %a , Sec. �� , T Z % N R_LjLW, Town o gUDJ Subdivision Y l eZj eSTn -7 � , Lot # S . Certified Survey Map # Aa-;t , Volume , Page # Warranty Deed # - 7 -7 3 U L 3 , Volume a Page # 5 Spec hour yes no L ot lines identifiabl ye o SYSTEM MAINTENANCE 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 every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoruing Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Departure thin 3 s of the ee year expiration date. q SIGN OF APPLICANT DATE OWNER ER M ION U certi tove 11 tements on this form are true to the best of my /our knowledge. a are a owner(s) of the pro cribed virtue of a warranty deed recorded in Register of Deeds Office SIG ATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. U. Z 6 4 6 P 5 9 0 773m43 l � STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX GO., WI This Deed, made between Richard L. Beer and Philippine U. Beer, RECEIVED FOR RECORD husband and wife Grantor, 06/31/2004 09:45AN and Glen Johnson Construction, Inc., g Minnesota Corporation WARRANTY DEED Grantee. EMPT * Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St, oix County, State of Wisconsin TRA 11.00 (if more space is needed, please attach addendum): COP F EE: 218.8(4 F Lot 5, Plat of Mound View Estates in the Town of Hudson, St. Croix CC FEE: County, Wisconsin. PAGES: 1 Recording Area Name and Return Address Qfi - I 020- 1433 - 05-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 1 Dated this day of AVDAq 2004 Beer - - - - -- — � � * * Philippine U. Be r AUTHENTICATION CKNOWLEDGMENT Signature(s) STATE OF ) - - - - -- -- ... — - - - - ... - - - -- — — — ) ss. -•---- --- -- -----•--- _...- -----•--..._ County ) authenticated this _ _ day of � G Personally came before me this day of - - - - -- 5� August , 2004 Mth a bove named Richard L. B eer a nd Philippine U. Beer, husband and wife * ..._... - _..._..._... .._.._. �..- -- --- - ........ .------------------ .................. --- -- TITLE: MEMBER STATE BAR W,)�SaQNSIN (If not, ` to the wn to be the person(s) w executed the foregoing — — - -- -- — '! — -- -- -- authorized by § 706.06, Wis. ts.) inst nt and ackno g safne. I THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland * WStd, -- _ - - Hudson, WI 54016 Nota My Commission 's permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) — — - - - -'- * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, wl STATE BAR OF WISCONSIN 800- 655 -2021 WARRANrY DEED FORM No. 2 - 1999 " -U V , 0 N z x C0 0 � `- - �� CD 0 a an N Co • W a �► - __� wO (� Q A 0 1 � / °DmO� V (� OC V LJ Onm I ■ ' . - - ' • Boma I 3 z l Eg - • . z_' _ - • A w I PD w 8 O �� o $fir' 0 cn0� O m z CD j �� o 0 � O � im m •. / SOO °25'46" W 353.52 m i a m INV cn It 0 0 S70 °12'04 459.04' 37.5T �/2! L EAST LINE OF THE SW1 /4 S00°25'46 "W 147.76 Z OF THE NE1 /4 �O4 0 ■ �Rn� nnnP�pnr�n [L0 7 I n@ o ■ 0) 0 c Lo� k (D M 0) M , 0) 7 . . 2 E_ E 0 & E X� 8 �. 2 # k CD ® - \0 S § t 3 2 § co / A _ _ _ m � Z D 2. CD 0. \ 4 , m Z z § ° k § & cr "". . .. / O 0 0 0 % e } 2 ® ■ ca _ ° / 3 (D I \) K \ % \ m 3 r / \ [ 5 A % / / / S. / , = E , 5 2 § r § I 9 �- 3 \\ m / k � § k 2 \ Col § ■ a Ei CL ¥ §9 J \§ ) \ 2 R{ E■ z § , 2 2 \ k § \ e, U) ( / � K . � 327772E± § ƒL2 w o . CL (CD � E ma@ �f°/ R � § '$$ƒ 7C- ekE m \CD ,oc- 2aq / \} aq --- 0 » \f §\[\ > ED CL ƒ o2 ! � ]k / \�0 ® � 2 k 0 \ CD . � # [ c o $ ? � � ; ■ ° n CD c - � 0/ 0 °& E r B - 2 E k ƒ \ 0 \ o « ;o :3 S - ° § 0 / e 7 \ . % C, § 2 C § o - � _ % Q D / _{ CL § w9 . � ) � z § E n r ca ° § rr �' 0 0 0 / Oro / \ w § 2 k ° / 3 = M o a , CD E k D \ g ( \ � / CD � � _ E r z _ _ � m § $ ƒU{0} § C � FEZ §X n� ƒ';,° =,r( CL \ \)km CD / \\ \ C B / \ D C Z x/ 9 9 = EC + Do T 2 § ;[0)ƒ E® �z 06 ] �m f S§ CL k 7 �z �( $ ® # � 2� = => & (D a m E § , � m � ��k§§ kCL= o \ °° A , @ pa /7\/� 8 } \} R E � ƒ � E)( Tr CD , , k ®0 0 \ � % \� �\ Safety and Buildings Division County Ar , 201 W. Washington Ave., P.O. Box 7I62 e, f s ons'in Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) 1 Department of Commerce '(608) 266 -3151 2 S Sanitary Permit application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, 915.04(i)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information E C U Property Owner's Na me L arcel N Mcation # ZC le Xxt Jt.A 2 0 21J04 MOL (L. Property Owner's M ailin dress roperty Cit y, State Zip Cade Phone Number ` 1 4 • . , te '4•Sec!?on l� -- J7'u (circle ) II. Type of Building (check all that a ) oa1 S n T L N; R o6 X 1 or 2 Family Dwelling - Number of Bedroo Subdivision Name CSM Number Public/Commercial - Describe Use State Owned - Describe Use C]City UVillage V'ownship of 2 III. Type o Per mit: (Check only one box on line A. Complete li e B 'f a plica ,Zp — )q33 — ps— . ?b 2 New _ System ❑ Replacement Systent I tment/ oiding Tank Replacement Only ❑ Other Modification to Existing ystem a B. U Permit Renewal ❑ 11 Chan f ! L' P ious Per to I.ssu Permit Revision J Permit Transfer to New Before Expiration Plum f Owner i I V. Type of POWTS System: (Check all t apply - Non - Pressurized 1n Ground ❑Mound 24 in. of . itable soil ound Z 24 in. of suitable soil ;* t -Grade ❑ Single Pass Sand Fil r — S � i F- Constructed Weiland ❑ Pressurized In- Ground Holding Tank Peat Filter ❑ Aerobic Treatment Unit Recirculating Sand Filter _❑ Recirculating Synthetic Media Filter AL eachin hamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Informatlon; Design Flow (gpd�I3esign Soil Application Ra gpdsf) Dispersal Area Requir (sf) Dispersal Area Pr d , ysce Elevation 1 VI. Tank Info Capacity in otal Number Manufact r r ue Steel Fiber Plastic ._ Gallons allons of Uni co Concrete , /�- ( Constructed Glass New Existin I g Tanks Tanks Septic or Holding Tank AW 1 - -- � Aerobic Treatment Unit 1 Dosing Chamber -- - - K - Responsibility Statement I, the under signed, assu responsibility for Ration of the POR shown on th attached plans. Plumber's Na me (Pii.nt) P lurnt�r's Si mature _ P - `'- ��- g M PRS Number i Business Phone Number • mod vlt sr��rs� � �— ���stG.���"' %- � 75 'erd (7 /.r °.� �G�- �z Plumber's Addre ss (Street, City, State, Zip Code) VIII. Coun Dnt Use Onl - -- — Approved roved Satitary Permit Fee includes Groundwater Date Issued SSW Signal re (No Stamps) i Surcharge Fee) Pi e n Rea fo ial �. Conditions of Approval /Reasons for Disapproval — SYSTEM OWNER: 3) /�Jp 9 Septic tank, effluent filter and ` dispersal cell must all be serviced/ main gilled - Q- ��-S <i-KAt tg•�. J as per management plan provided by plumber. )))) 2. All setback requirements must be maintained i as per applicable code /ordinances. L AtisMD complete plans (to the County only) for the system on paper not less than 3112 rc ll Inches is size SBD -6398 (R. 01/03) r�,'c'�av�.� .�'ezr .�a Tv� ,l1l �«� U %c'�J ,CS � T �.tJ lJ� /� �.�a. ,� � � Sc�-� t / = yd � — /� � ���,,z�yrP� �Q �d _ ___. ma �.� �� ��'' ,��' �-�� � -, �;1� �. y �� � � e w�`�� �� ; � � _ -? b � � � gdY� a �. �' _ ./ '�- � � r� �i � �,,� �� � s,` �� �4/ � / J /� � �'z`'%' `C YY • �\ / W i O �.�.�-- ,,.����.�_ �� �7�� � /�� /dam` ��`C%�+.alit� ,�c°BY Via/ Jr �f �L.!/� �iC'� C.5 � �.:�Iiff L�� ����✓� 1 �� 2 �y C- V yb�s , 2�j i w I l r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _ Division of Safety and Buildings in accor dance with Comm 85, Wis. Adm. Code Courtly Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.P. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print a _ �/ Persorma information you provide may be used for ecoodally pwfYp09e� (Privacy Law s. t5t04 (1) (m ) u 1 / 1 Property Owner Property Location Govf, Lot S vj 114 M L :: - 1l4 S I I T Z` t N R11 E (or�W� Property Owner's Mailing Address 110a # Subd. Name or CSM# 5d M Du View Esia�s City State city -• - ,c ❑ vifte 5Tow Nearest Road ® New Construction 1 , Use: Residential / Number of bedrooms 3 _� Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: - Parent material _ — wt S ' _ _ — __ Flood Plain elevation if applicable 14- ft• General comments S S vy) V , �r✓uiCr 9 S�ti and recommendation T2y 3•, r ❑ Boring # E] Boring Pit Ground surface elev. 76 ft. Depth to limiting factor _ (I U m• T *EfW1 Rate Horizon' Depth Dominant Color Redox Description Texture Structure Consistence Boundary RooQMf in. Munsell Qu. Sz. ,Coat. Color Gr. Sz. Sh. 'Eff#2 i t 2 c, r�n-�r SiL Zms k i� �r c) �o F2- q Boring # Boring Q �! Pg Ground surface elev. 7 20 - ft Depth to limiting factor C� in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Monsefl Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 '011#2 1 ()-it 10 I Z k Z it -Z 1 0 51 Z4-r.s b1<— nn S Effluent #1 = BOD > W 220 mg1L and TSS >30:5 150 mg/L ' Effluent #2 = BOO < 30 mg1L and TSS < 30 mg1L CST Name (Please Print • Sig ture CST Number o Address Date Evaquation Conducted Telephone Number � >/ Q� ,� d �7'-, �.✓� !%fi /' / — 0 7i - 1 ^�^.� j 3 Property Owner Parcel ID # - - -- Page — 2- Of ❑ Borg in. Sol tier Rate Boring # Pit Ground surface elev. �-' ft. DeP� to 9 factor Horizon Depth Dominant Color Redox Desdipzion Texture Structure nsi re Cstence Ei undary Roots GPD111F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#f 'EfW2 2 -ZO 4 ,3 2& 10 plL 3, �� 3 �i F Boring # El Boring ❑ Pit Growrd,surtace elev. ft. Depth to lin)itir7g factor in• Sol ication Rate Horizon Depth pornirrarrt Color Redox Description Texture Structure Consistence Boundary Roots GPDR in. MunseU Qu. Sz. Coin. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. — ft. Depth to Puniifiag factor — in F Pit Sol Application Rate ❑ Horizon Depth pominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff 'Etf #2 in. Munsell Qu. Sz. Cart Color Gr. Sz. Sh. 'Eff#1 I Etli,pA #f = BOD 30 <_ 220 mglL and TSS >30 <_ 150 mglL ` Effluent #2 = BOD 30 mgfL and TSS <_ 30 mglL 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- 2648777. SBD4330 (R.07/00) PAGE 3 OFD NAME: d G e V - LOT# LEGAL DESCRIPTION� /4VE: 1 /4,S /1 T2 NR,, - E(or& SCALE: 1 "= / ELEVATION: /00. C) BM 1 DESCRIPTION BM 2 ELEVATION: q?, q BM 2 DESCRIPTION: 4,, %y 31-e e ( f o cp SYSTEM ELEVATION: SYSTEM TYPE: (G rl y e YN �i o ✓� a. ® SI NATURE: DATE: /- - — o r 914.7 x X 925.9 61. I 7.? � x x X- X 927.5 \ w 4 928.2 U40B 919.3 x \ • ens ''� / LaT (3.00 AC) 920.9 LOT L.B.O \ \ \ ILO. 917.0 922.�, � 271' X•, 915.2 911.8 \, H.W.E. - • \ 915.0 x 919.0 5.0 a' � �14.4 l A) 918.1 x 917. L.B. . s 7.0 I 9 911 x x 2AI AC. 917.3 13.3 AC) ; x 1 7 925.0 i 9186 ' 913.4 , x I Z X' H.W.E. • r 01 A ; 'r , 906.9 x I I ..... / 1 X � • • / AC. 22.2 %• 1 A6 A t 7. V03 %,:70 PM FRC : Fax ro: 7- 715- 3';')..N 77 TAM 60� OF li: 0-F., MOUND VIEW 1 , '114 OF THE NEI/4, AND PART OP THE Set /4 OF THE -WI/4 1 ?54 C' RD A lilJC"' tO . Wf b001a•0912 aK TOWN HUDSON, ST.'CROIX COUNTY; WISCONSIN: % r• .. ., _.' is � ,. / / J' �� �. + 1 /i \i \nl.��. :., �j / ��i., `.\ I r 1 1..,,,_..y` 1 \ •,� \\` \� � � � I i V I J r ^Yesh+t • r.. + �:.�( ` >tl 'S! �- : i�I \.\'\ 1 Ag y \`�•.��..I .rte ' ' te r � � ,,,. "� �( ;` � 1 � h ��'. f�� ! . , r ' -N � -'• "'' �, �: .r ' . \ . !_ A •�^ '� r,ra � + / �l 1 i .' � 1 ." t i - 1 �. i / r ... y Aj � l �� .. f'� i.. 1 '�..w \' / /'•' ..-1�{ {( til 1 o R f + { fir .�\ \• �\ ( sr � a � '�M�a� ` K EiRt 4 l,�. #•� � { VAN s PAN. 7JYUt7Mt- � 4. .. ...._ {• ` f.,,,. r,. - r �� j`.�. 1„ti_;nI` wY.Nt rl7t1 1�+aMMYnyli.l gun { kS •,••••••�•�,•. K < �, .', ,:. , it raAC rrnsrr 1 ,� . �a awwin•u' � �l'•r�':y M.V>YON; 3b7s g f;i � rsey w.t ._..JI ^.t �.yra nw wwWni�efw:+r �".cr i:r ".�s•I,:.,r.. . ; (� I , * �;. OWNEM �� r.•w•..ws OftrC IIrOt FF ` '""o""'r•4 ruab►•�.r•r ! r34 ti,YJi. •A• •rr 7 ` v � •wwwaww ll. oacm,�vA a *at t .►A1AvAr"Im" Mt wry P J[Q11tf E". - DA7►': y\ 1.01 _ _ DIIAYi'}I RYS tY7:1yW .•Lr A4fr tf 3l.O2 �._..._. a �1,�. � �LY�. £ „ �, «. • • n �" CI -VENT �rPE ,1? ".: "�SZN� .ABJV� GRADE b `DOUR w1 1;50 Ca OR 4EATHERPRQOF FRES!i AIR INTAKE - . --,-•. ,y.,, JUNCTION aCx APPRO'JiI 'WITii CO NDUIT `�iA.NP;OLr - OV £ F'HZSHED GRAPE ~ W/ PADLOCK 6 � RTSER WARNINtS 1ABE1 ' M X N LET L l WATER :'IwHT SEALS GAS- 3 TIGHT � { zPROVED �PPROVE�J �.,,.,� ..I_ SEAL ; JOINTS WITH 'IPE 3 0 8 P A,,.N Rppgo RIPE )RTp S,'1i.10 ? -- ON 3 i0 «�• C SOLM SOIL PUMP UMP OFF ELEV. "..'� ►'`Di �� RTS'ER EXIT D PERMITTED CNL' - — - IF TANK - NANUFAC7J.AER S" APPROVES! BEDDING UNDER TAkK HAS APPROVAL O4NCR£TE PAD SPECIPICAT`C45 3 -rPTIC r` DOSE 1 ANK MANU AC Tum : c DA Y: " iS ER DOES PER DA.. gig= SE' 'IIC — GAL. DOSE VOW-hr INC:.JDZNG DOSE Gp "' FLp�r'BACiC; : �� GAL %LAR?� KAWFACTUR.ER: .�.,....�_... MODEL t�'jMBZR: ��=• -- CAPA.I DIES: A SWITCH TYPE: ....- ..A"92!�a........,... 8 s 2 INCHES x ... �...,....GAi. MANUFACTURER MODEL NUMBER, 10- -/�.....�.. C INCHES = r GA. ,. SWI:'CH TYPE: D ,.�;� INCHES s -1GAL. :141;,RED D"SCFARGE RAT r wr ..��.-, G?m P4'MF E ALARM WIRSNG AS ER IL�3R 2b.23 '.,'AC :I ERI +CAL DIFFERENCE BE �NI;�UM nzwoix SUPPLY PRESSURE C' T`phD DZSTP F PE .., ��„,,..•,, FEET I'ORCE.MAIN -*� F"d FT11vv F^', r� ;,' n Frr ' FR. 'I. FA^ TC3R . �{y ��,'� T•OUL DYNAMIC KI'AD �s s I'ZET' � iC Y ".1! �T GF . U.. 1 t W L :GwD IDTFf ; D RGOULDS PULPS Submersible At Effluent Pump �1 EPO4 ,N 3871 EP05 APPLICATIONS • Fully submerged in high III EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • heat transfer. ■ Casing and Base: Rugged Effluent systems • Homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto- resistance. •Water transfer Mechanical Float Switch g� canal an standanls hsoaation • Heavy duty sump ma models include 0 Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps Is ISO 9001 Registered. •Solids handling capability; FEATURES cover with integral handle and float switch attachment paints. ' /a" maximum. o EPO4 Impeller Thermoplas- � power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi -open design with rated oil and water resistant. • Total heads; up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous METERS FEET 140 °F (60°) intermittent. 10 • Fasteners: 300 series _ stainless steel. 9 30 .. ... - .. . _,..... .. • Capable of running dry without damage to components. 25. _ ..._._. .:... ;...... .._....... 7 Motor: x ~ • EPO4 Single phase: 0.4 HP, '✓ 20 115 or 230 V, 60 Hz, 1550 a RPM, bulk In overload with c 5 1 5 ' ______ automatic reset. 4 - egos • EPOS Single phase: 0.5 HP, o 115 V, 60 Hz, 1550 RPM, ►- _- -- _ ....,..._..w' 3 10 built in overload with EPO4 automatic reset. i • Power cord: 10 foot 5. _ .... . standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 OL 00 10 20 _ 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug - - -- -� - -_�. (standard on EP05). 0 z 4 6 B 10 12 mlih CAPACITY Goulds Pumps 0 2000 Goulds Pumps ITT industries Effective February, 2000 83871 :- =- Quick4` STANDARD CHAMBER -- 52 ,1 Quick4 Standard Chamber I- -- - 48" - - - - -- (EFFECTIVE LENGTH) i�° j K 0 8 "I 1 J- -- 34 " - -- - — - -- SIDE VIEW SECTION VIEW MultiPort End Cap r 34' - "1 SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standara,Chamn , "81168 ; MuitiPart End," ap$I�om1nai Specificatfbns r �` , Ix size (Wx LxH) 34 "x52 'x12' {yk Size(�NzLxH} s* 34'xi6 "x12" Effective Length 48" Invert Height 8' or 1.25" Invert Height 8" LNF9LLRANEL INC. 5jANDAaQ jwiTED WAR RANTY l Tre snuctu a irteg ly of -& .harrlber. and plate, — Iqe and 0100 acn -sdry ?tent uu w,ed by Mitra?ur ('Uri s ^I vmen insta!;ec! and opersled s 1 a..hlieid of i o '.e snpl c vriem ,n .ccordance w3 In!iitratnr's' 1 cJons, is — rienled to the rrginal purchascu ('Holder") against deleClfve raterk3ls and wotkm„nc'3N for a^e year from the date that the soptic vernal is i:sueri fOr t ile Sepik: sYslerr runtautirrg the U+rils; Pro,ded, however, rat rf a sspra: vemril ia; no! reyuka7 by applw Is faw, Iha warranty period wit Begin t,pon tho date that inslalN[,wr M the septic system carunencas. 7� e e sa :!s wa anly riyir ?s Holder mjsl not InNtratw rn veiling at e5 Cr gacrate He90quadc�6 :n Old SayOwk, Connecticut wir.,n dRser, 115) nay of the alleged decoct. infillraiw will auovil roplacomunt :units for U ;s deli. rimed by InnNrator to be. coveod by rhs Urni{atl Warr 1-111" of -xt iiat y 8P-11, My - cU(I s the cast of removal anchor csfallallon of the Unns. b) 1nF UTAT WARRANTY AN) HEME]Ir5 W SUBPARAGRAPH (a) ARE EXi;LU t IHFRF ARE NO OI HER 1NARRANTIES'vV'ITH Hli &P C[ TOTHFIJINIflt NOLLICYNC NO IMPLIED WARRANTIE. OF MERCHANTABUT', OR r rr F FOR A r ARTICULA" PURPOSE. SYSTEMS IN 1 '�` I V () lh L, e r -,r Ws ly n r. t r d if any pa. M the chambe ; ysier'1 s h I la[: IM] IN a - y0ne olha Irian Iri'It 11ur. T-a I - '! x W an,y dune r I u le I , uenral a a n t'a spr.,ral or r d a Ih ., Infal ato sn- a not be to rn 1, a tigu,naled demayec 'r Iift Environmental Onsite Westemler Solutio ns`" P al <I ai ant pots lalx aril al.rials, overhead costa, or Ogler , oSSes n es {;Haar, 3 urraa by l , Hok ?er or any third pally Srnr.Ad;alty e d xlrxt f ronr L I Knoarty caveraye ore damage Ip Ir•e Units due to art nary wear ar J aar, aeemtior,, acudo f, m;yvse airusa a nagier.! u( Ute r n 15, !ho Un 15 e, s sty til'?e;f to vehlele I�dfiC Or other COT tleipr3 w1yCt are nJl paila.hed by the installation ,hslfuct"an% td ore 1, mainlain the 6 Business Park Road P. O. B OX 768 m'nimt rn uJau'd rivers sat Mn» m the msiallatnx3 inslnutru, s', Ina plecHr , Of rmprr per materials in ?0 the system containing 1hn lJnits: lactate W an I rth� ,r'ne se�1`,,. system duo 10 improper soling or imp,ape sizing a "cassve wat Warranty. . er r;aa :j, improper grease disposal, or imprn;er opereliur: a Old Saybrook CT 06475 Y o au ^ ^,etl by ;nlAtralor. This Limited Warranty shall Ue wd 1 113e Ho d r (ails to t Ornfoy w.In all of the terin6 ,otl set h In this 1jitrited 860- 577- 7000•FAX 860 -577 -7001 Inert, ifs nc scent ?o Inliflralor Fie respon6iUIH for any toss or damaya 'o the rI0ld�ir I A Units, p U3) tt kd pa; ty rawllmg from ir,tailaaon or ship - ment, or han a + n: Uucl GeLtil @y claims of Holde codes: r a any third pariv. Fn thin Lir ltwj Wa anly Io apply the U must be Installr r' in xCordarice V V"�G -4436 wi -h all site cavd 1 recp"red by stale anti local er. other aopGcabla laws, and In i trato,:3 installation it"ItaClinns. (dl Nr, ruprnseMa!ive of eor rn!iltr7 has The au {Rnily to cha,,yc or a "tw,n this -I N ok7Hr L!,rdlerl W'ananli, NO weurantY appiras to arty pany other Iha!' the prig, . of Unit. en—lr Co n HI h� Hlx3va re("esW316 1!'a Standard Lirnitai War anty ullaed M Imrlt",dor, A;- number of slates and r:rwnlies ruse reverent wa -anly r"qu Is. Any r,rrui.eua nl"CI I nfllralor's Cot ct*Y of the appecab;e wrr. runty, and slmuld aarwfuliy read thalwanaM�dq; t th ,n Old se of i e k COnnecticul, prior to stu:h pu,clvr.e, to gorarn . i p he V.izha a UrR:3. U.S Patents: 4,759,66 ?; 5,0 ?),047; 5,756,488; 5,336,077; 5, 407, 776; 5,407,4a� +; 5.571,9p3; 5,776,763; 5,5r3&,I78: 5,839,844 Canapian Patents. 1 ,329,959; 2,004,564 Other patents pending, Irfiltrator, Equalizer and SidaWinder are registered trademarks of Infiltrator Systems inc. Infiltrator i6 a registered trademark in France, Infiltrator Systems Inc is a registered istered trademark - Mexico, C x t4Ur, Contour Swivel Conn cl on, Micro(• aching, PolyTdtt, SnapL.ock, ChamperSpaCer, POSLock, C:uckCU(, QulckPlay end Quick4 are Iradamarks of fnli;ralor Systems Inc. t9 2003 Infiltrator Syster3s Inc. Printed in U S.A. Recn:aE PAPEA f fr � OQa� /CSIJ� e i p LEI h�v oll a ..._ ..... !!!� r t i �• POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of . FI INPO RMATION SYSTEM SPECIFICATIONS Owner Septic Ta Capa city ga i © NA Permit / — Septic Tank Manufacturer Cl NA .r DESIGN PARR- METERS Effluent Filter Manufacturer Z. ig.6 CA O NA Number of Bedrooms y C3 NA Effluent Filter Model ov 0 NA Number of Public Facility Unite XNA Pump Tank Capacity al 0 NA Estimated flow (average) _. d Z ( V& ( ' q0D _11 d4y Pump Tank Manufacturer rrG° j . , 0 NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer A NA Soil Application Rate al /da /fts Pump Model 0 NA Standard Influent/Effluent Quolity Monthly average* Pretreatment Unit Fats, Oil & Grease IFOG) 530 mg /L 0 Sand/Gravel Filter ❑ Pest Filter Biochemical Oxygen Demand (BODs) 5220 m91L O NA ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5160 mg /L ❑ Disinfection 0 Other; Pretrested Effluent Quality Monthly average Dispersal Collie) O NA Biochemical Oxygen Demand (SOD,) 1930 mg /L round (gravity) O in- Ground (pressurizedl Total Suspended Sollos (TSS) 530 mg /L 0 NA 0 At -Grade O Mound Fecal Coliform (geometric mean) S10` cfu /100ml 0 Drip -Line 0 Other: Maximum Effluent Particle Size Y in dia. 0 NA Off A Other: C7 NA Other A "Values typical for domestic wastewater and septic tank effluent. ate A MAINTENME SCMULE S E Servic frequency Inspect condition of tank(s) At le once every: �1;ZZ a (Maxinwm 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y of tank volume O NA Inspect dispersal cell(s) At least once every; 3 ithis) d his) (Makdaium 3 years) ❑ NA Clean effluent filter At least once every: �� O NA earls) Inspect pump, pump controls & alarm At least once every: _- month(M O NA Cl yew(s) Flush laterals and pressure test At least once every: O month(a) ❑ NA '— O ears) Other- At leant once every: 0 year(s) Other: D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calla shall be made by an individual carrying one of the following licensee or certifications Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tani Inspections must include a visual inspection of the tank(a) 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 collie) 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 thr immediate notificatlon 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 disposed of in accordance with chapter NR 113 Wisconsin Administrative Code, All other services, including but not limited to the servicing of affluent filters, mechanical or pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A servil=e report shall be provided to the local regulatory authority within 10 days of completion of any service event. � START UP AND OPERATION Page - of ' For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(a). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to ties. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outag um tanks may fill above normal hi hwater levels. When power is restored the excess wastewater will be 9P g pump Y g P discharged to the dispersal call(s) in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a 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 fail$ 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 63.33, Wisconsin Administrative Code: a All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator, a 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, CONTINENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by wired setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will o m e g P ro p 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. (3 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. site WI T slt e tank Won If nn O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time, < <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 RE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS M INTAJNER ` Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU ORY AUTHORITY Name Name ( ('(' AICL_ Phone Phone. This document was drafted in compliance with chapter Comm 83.220010 1 (dl&(f) and 83.54111, (2) & (3), Wisconsin Administrative Code. I ST CROM COUNT" Y SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSIUP CERTIFICATION FORM Owner/Buyer 1 Cv Mgling Address 15 ?,A �C�� 4, ._ _� Property Address 6 { CA C/ (Verification required from Planning Depattment for new construction) aty/Stsate , . Parcel Identification Nwnber oZo - t 4 3 3 - o S- Mm G 2.b 3 AID DESCRfP "i`ION WIM 91 Locations %., . A. Sec. _ � T ,JN -Rj 7 W, Town of -A �4 &2- .. Subdivision Lot # Cert Med Survey Map # ' a Volume . Page # Volume -- Page # Spec house D yes G no Lot lines identifiable C1 yes 0 no Improper use and utainammo of your peptic system could s rsult in its Premature failure to b=&o wastes. Proper maintenance eeosisb of pu»eping oat the septk tank every three rm or sootier, if needed by a lioensed pumper. What you put into the system csa allfbct the fimctka of the septic tack as a treatment sago in the waste disposal system. 7U property owner mves to submit to St. Croix Zoning Department a certilleation form, signed by the owner and by a MaW phudbarjourneymn plumber, restrictedplumber or a Hcensedparnper verifying that (1) the on -sit@ wastawsterdispoW system is in proper aperatiag condition and/or (a) after inspection and pumping (if necessary), the septic tank is less than In full of sludge. Uwe, the undue *wd have read the above roquimments and agree to maintain the private sewage disposal system with rho standatds W forth, herein, as sot by the Department of Commem and the Department of Natural Resources, Sate of WWoosin. Certification stating that your septic system has been maintained must be completed and returned to the St. Crook County Zon tg Of lot within 30 days of the three year expiration date. ^-2 I� J', .� SMXATMB 4F Al'PLIt.ANI' DATE I (rue) cos* that all staterztents on this form are true to the beat of m our Y (our) knowledge, I (we) m are the owne s of the >m?wty descnkd above, by virtue of a warranty deed recorded in Pe ' } ( } } �iEt+Cr Of �'CCdti a�Ce. 7 SIQN�OF APPLICAN'i` v DA'T'E s �ssss Any Ltformation that is ft'h•represented may resin, in the sanitary permit being revoked by the Z on i ng D epartment. �. � sawsst Include with this appliratlou: a stamped wamaty deed fram the Rt&tor of Deeds affiae a "PY of ties "Wood survey rasp if refer u" is ma& in dw sn maix flood I eooK 47` e� 6 6J 6 � • rt � STATE OF WISCONSIN St. Croix - ___ COUNTY COURT PROBATE BRANCH IN THE MATTER OF THE ESTATE: OF / ORDER OF SUMMARY ASSIGNMENT i I Leonard J. Beer Deceased. VA. N. � PETITION for the summary assignment of this estate having been heard, and the petitioner having appeared. in person and h� attorney, and the public administrator having ,appeared or waived notice, and other appearances t being as follows: I And on all th demo, records and proceedings herein, the Court finds that: 1. The petition :, ),.: on for hearing (upon notice to or waiver by all persons entitled to notice) , r 2. The estate is one properly to be settled under S. $67.02, j Y 3. Forst f-r creditors was made A pri l 22 1971 un � and more than 30 days have elapsed Dance that date. 4. (The l4'ill has been proved and allowed,) ` who -sum W" hUD6 N �l ti h f, f h I� it 6. The decedent at the time of his death had a life estate in the following property: See description attached hereto. shown a4 SchPr9nlo a_ 41 a„ <7 _ •UTSUOOSTM 'AqunoO xTOID • 4S UT PQIVOOT TIP ' pioaaa 3o sAvAq* pus sluamasea og jaa rgng •ISGA (6T) uaalauTN 82UVH 3 'gWoN (0£) AgjTgZ dTgsumOl ' 8 AT3 - A4JTgl noTloeg 3o (IMS 3o IZS) .za4ssnb gsaxggnog oqq 3o aega-enb gseagwos aq�L osTs •gsaM (6T) uaaleUTN r 02ueg 3o 'g4JON (6z) 9uTu- AquaAL dTgsuxol UT p0 49 00T OAOgB ego JO TT (TT USAOTZ UOTgDag VT TTe 'QM 3o JZN) 194asnb lsaxg4JOjj eqq 3o .zagne4 Zssagq.ON 9141 JOAO UOTlDa.zTp AlJO44nOS- dTaa a UT pOTOABa1 xou se /Lexpso.z eg1 JOAO l uOmese9 Aex 30 1g2Ta 9 osTs ! 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Known general creditors and the amount of their valid claims are as follows: Dr. Irving Lerner - $50.80 (Wald - Receipts Filed) i Dr. Zon Miller - $140.00 (t - aid - Receipts Filed) I I I i i I 1. The est,4 - t tr inheritance lax which has been paid)` tQx) • NOW, TNEREFC ?RE', IT IS DETERMINED AND ADJUMAJ) THAT Leonard J. Beer - -- - -- died .. _ testate on June 1, 1970 _ , and the following were the heirs of the decedent: Richard L. Beer, Son Ronald F. Beer, Son ij 69VII CLV X009 eIagojd ul �aIOM 'olla4aS la,eb,c cp +�O to adiLyeyl f f / 35e y w d a _._.. -_ •T � - -- ,..... ti ,. _ � aced 10A ui papl< Uaaq' i' pet... plopi jo puB - g� �:U "o' } rLiauo arll ssa,PPV alit ue.l TUOO y M lnf sl ;uaLugop $l.il �� ;l�,eu fgornl l R.. 'r f t US 6 ': �!• p UO O � - 3S to f4unoo l��. . y O LosIM jo a;e1S 96950E ,cau,ouv lag TUN —ff paw I> c. 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