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030-2113-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572900 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: E ebmaten, Noel & 79nZ.1 St. Joseph, Town of 030-2113-30-000 CST BM Elev: BM Description: c~ Section/Town/Range/Map No: b~ rr a 1r i 31.30.19.930 TANK INFORMATION ELEVATION DATA 17 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench ark Dosing Alt. B rw~ 73-6 Pvtp Gam /6!•7`l Aeration Bldg. Sewer r a V ~C ~ Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet i( Septic 7 Z5 135 Dt Bottom Dosing 7 Z~ / 3 5 Header/Man. * • r Aeration Dist. Pipe L2 ?/b 95 Holding Bot. System '4 , Le c~ PUMP/SIPHON INFORMATION Final Grade 3 • tr~j 91 1 Manufacturer % Demand St C ver Eel, GPM ~v Cage,` b• ITJZ•tQ $"J~ /D~.7 Model Number ,r ~ er ~ 9`7.63 TDH Lift F ' ' T DH Ft Forcemain Length to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches y PIT DIMENSIONS No. Of Pits Inside Dia. Liqu Depth DIMENSIONS 3 571 3 1 /,/e.1_4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION 11 CHAMBER OR ir. _WX_ Typ~fSystem r~ /t-9 73 /57 UNIT Model Nu `ber: Z" "'t r~ DISTRIBUTION SYSTEM a~ Ae.~ 4-re „t JAA x 3 Z Header/Manifold 1( Distribution x Hole Size x Hole Spacing Vent to Air take Pipe(s) 5 Length5~~ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only I*N Bed/Trench Depth Over Center Depth Over xx Depth of xx Seeded/Sodded xx Mulched /Bed/Trench Edges Topsoil Yes No Yes No [ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 331 White Eagl Road Hudson, WI 54016 (NE 1/4 NW 1/4 31 T30N R19W) White Eagle Lot 13 Parcel No: 31.30.19.930 1.) Alt BM Description = ~v ^^P G ~,y a 2.) Bldg sewer length - amount of cover = , We tt / Z 3 •~a ~7'c Plan revision Required? 0 Yes X No - Use other side for additional information. Date Inser ignatur Cert. No. SBD-6710 (R.3/97) N ~ P~oPoSs-*~ dt5~i~ bwE;v►1 Getl."T~~u(~ ~oe~~ ~a~y E c~ra¢~cn pQ} ~I"c~C,~Er~ ice d,i ~ ~~r►6~ .fai~ /f.~re ee ~ tom 13, p/a~ o{u~k.~e EQ eteeAbt~ a Q. ~9PJ 4. d< --:e- Ssyo~, A 98.37' oo. off' i~•.'~' - s~:ny d; sPusat ec ~5 ys6. elc~'= 9`f. ss~ d • r~ ioi is' y ~Ad o~ L ~„a~ysa/►1'~~ ~(1l ,Zn~e!/~~sr~e v(rv~dld~0%Ctd ir► 'T BaQ. c . 5/tee . d ~ w/ pal7lok srL~ F7{u- ~CSidarcc~. Gar~,y~ t J r~ ~Y v7 r~ • Ha-C ~JY 5~.+ Ecopy .aa~ ~,r; . • County a d Buildin s Division St. Croix 201 W/ Box 7162 Sanitary Permit Number (to be filled in by Co.) F ! iq, Madison, Yfp- 162 Q©D S t -72 APR OF) 201 Sanitary Permit V O1JNTY State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submisslb o i 3'~~htt toteFiatrnmental unit Na is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l m , Slats. Same L Application Information - Please Print All Information Property Owner's Name Parcel # Noel E ebraaten 030-2113-30-000 Property Owner's Mailing Address Property Location 74, 331 White Eagle Rd. Govt. Lot City, State Zip Code Phone Number _NE_ _NW Section _31_ (circle one) Hudson, WI 54016 (651) 353-4949 T 30 N; R 19 E or W H. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms 4 13 Subdivision Name 1 # Plat of White Eagle ❑ Public/Commercial -Describe Use Block Na ❑ City of ❑ State Owned -Describe Use CSM Number El Village of Na ❑ Town of St. Joseph III. Typ of P rmit: (Check onl one box on line A Complete line B if applicable) F z zo-`a- ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A' e m Replacement System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 3 83ZZ IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Treatment Area Information: 42 Infiltrator " Plus" Standard chambers & 6 end caps Design Flow (gpd) Design Soil Application Rate(gpdsf j Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 Gpd 0.70 Gpd/Sq. Ft. 857.14 sq. ft. 870.60 Sq. Ft. 9$.0' VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units u o ti New Tanks Existing Tanks w o 4 U rn v. k. a, Septic or Holding Tank Na 1,250 1V0 1 Wieser Concrete X Dosing Chamber Na 750 1 Combination X VII. Responsibility Statement- 1, the unde igned, assu a responsibility for install tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 11715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIIL Court /De artment Use Only Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ (-,75-0a 44 IIr; Conditions of Approval/Reasons for Disapproval u 1*,W6 47ZOA f~ UQZiFIf T"r S4~ xm 9Z-5V 062.01&) S!G +142/ /V1-w- Sce~ G~ Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size > ABU ~P(a;S of rsr fAe&VJg"J i,U.sf1lM) IeEd°oXT- FgOlfh o?/zoof PaGyGg4 SZS"7P PLO- SBD-6398 (R. 11/11) SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Dose-Conventional POWTS Index & Tilte Sheet Project Name: Eggebraaten 4 Bedroom Replacement Dose-Conventional POWTS Owners Name: Noel Eggebraaten Owner's adress: 331 White Eagle Rd., Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 13, Plat of White Eagle Legal Description: NEya, NEva, Sec. 31, T.30N., R. 19W., Tn of St. Joseph, St. Croix Co., WI. Parcel ID 030-2113-30-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing & Pump Chamber Calcualtions Page 4 System Cross Section Page 5 Existing Septic/PumpTank Cross-section Page 6 Distribution Box Cross section Page 7 Infiltrator Quick 4 Standard Chamber Cross section Page 8 Septic Tank Maintenance Agreement Page 9 Certification for Utilization of Existing Septic Tank Page 10 System Management Plan Page 11 Waranty Deed Attachments: Soil Evaluation Report Mater P ber Re cted Service: James K. Thompson, Dep't. of SPS Credential #30021 Signature: 5--_ Date: o20/S Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ♦ ~X~S~,:,c~ c~.ra.do ~.ltN n ' cam./e~ I = s~ A ProPos~-d d~sfi~ bw~,~vh Cttt.-~~u(~ I~oel~ /~a~y E c~ra~tn d 9 ~~~ei'.%~/fi~.t<<'✓t ~~~te 0~ <0~13, A/,~.~ef'ucs~k,tcE~/e, a 4 tee -66 9S ~v_ 0 o y3rew sue. 9w; 7•r. o< -Y-. rsyo,c, 5&. ctv;g Coil "A 9I xoq 9-'~'P #030-A113-430-4w 99.ds'' 98.3 ` a CIS IV 55" ioi /S- OA awl`'''//ao~y~ ,Z►~~,e/%~e ~!✓tal~0/actd ~n 0 Eyr SE.i [,Jt•e Scr ~ c - ~a'i S~rvJ 4 t/ `a i, ~so~ Scp~E: ~~~Ow.1p -f~,(! ~ 5e.d~'cevv~ IV/ P617 to ~ Gay JG S;d ~ glut, a io s.9z' o S ~ t,c~al/ 2y5pe~~q-,. Emmbraaten 4 Bedroom Dispersal Cell Sizing Calculations 1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7 gpd/Nq_ft. 3. Absorption area required: 857.15 N. ft. 4. Absorption area as proposed: 870.60 N. ft. (42 chambers + 6 end caps) Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.10 sq.ft, EISA 857.15 sq. ft. - (6 endcaps)(5.10) = 826.55 sq. ft. 826.55 sq. ft./20.00 = 41.33 chambers required Number of trenches: 3 A_ 14 chambers per trench (42chambers total) Trench width: 2.83' Trench length: 58.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 21.00'x 58.00' Pump Chamber Calculations 1. Force Main: Diameter 2" Length 95' Flow rate 60.00 gal./min.f Friction loss 10.80' (95')(7.00 ft./100') = 6.65 ft. 2. Total dynamic head: Min. supply pressure 0.00' (forcemain will discharge to distribution box & gravity feed to trenches) Vertical lift 5.80' (P.C. bottom = 90.70',Off float = 91.20', Dist. box invert = 97.00') Friction loss 6.65' Total dynamic head = 12.45' 3. Pump selection: Manufacturer & Model number: Existing Meyers ME40 Pump will discharge approx. 65.0 gpm #a 12.45' TDH (Flow Velocity 6.63 ft./second) 4. Dose chamber: Wieser WLP 1250/750MR - 48" (a-) 16.12 gal./inch ( 773.76 dal actual) Sizing: A) One day holding capacity: 30.70" = 494.88 g B) Alarm setting: 2.00" = 32.24 gal. C) Dose volume: 9.30" = 149.92 awl. (600gal.)(201/o) + (.164)(95') = 135.58 max. dose D) Reserve storage: 6.00" = 96.72 gal. Pg. 3 of 11 i Soil Absorption System Cross Section 98.37= / 60, aD ft 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap IO ft i Leaching Chamber 93d ft System Elevation _ft ft Soil Absorption System Plan View s9 ft 3 ft J- IIIIIA I L. ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leachina Chamber Specifications Manufacturer And Model ~n~~~ ••Q-~ /D~us `.Yno~/cl EISA Rating .20.0 sq ft per chamber Soil Application Rate 0.7 gpd/sq ft X00 gpd Design Flow = 0,7 Soil Application Rate x 24 EISA = S~2 Chambers 2 rows of lie chambers each. Page T of D A 66" AS 86" N D READ A m 53„ K Z z m C A o UP t57" 4" m 3„ 6„ D ?1 N >D D M - 48 I M A D p -0 \ r 1 Cn < Vi ~ fC C7 I N ~ I N J Z7 o UP 50" 4" CAS y z Ln N v ~ c - O m 0 51 m > I D I N rn A r ~ C.) D O D r Z Z 0 -I VCi z r~ z D Z m m m D z m0 C7 z _ rcog rSK:0CD * z AMEN XX A M Z O D -O-2{{Np Nip 0DO-4 7)a::r 1OmZ co va m W m y moo mD0 -~0~ 5.-=.~OA0 (n (n N 8D soN vim 0 n ANC -+~C m20' r- m Ma) N' -p C mZ z0 0 m Ln z j N1z~j 0 I r~ ~,~r,1u;~~.. a~\ M\ z A m y DAm oor771 cn aN N 1N (n :j O OD N M N--1 N 1 0) O s0? n J D- Z OOD = (7 D Nfmr1W I N D r0 W~ O o° n N NZ O N N s N~ V) 0 Dr m' a 0' C~ o a v ~7 -1 O Z mp Z y C7 fmr7 i m rn W N D D o A a -n N rD D o A 0 O H A ~A E zz Acv Wo VDi ;o Z c ;o Dv D -o vo - o0 A n Z o m< rn C) C m r -I m n (f) 0 D Ln 21 o K m O O l!1 m co N n A A D n 70 C A A O m r m O co n v r O I D H 0 r co ;A m r m A m 0 \ = W1250/750-MR DRAWN BY: SME SCALE: 1/4"=I'-O" PRE-POUR: m MIESER COIICCETE REV. V -4 SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2012 DATE:. POST-POUR: \ ° REVISED JAN. 2012 800-325-8456 FILE: W1250/750-NR . 6W 11 1-'4/20/2006 14:21 7156475181 WIESER CONCRETE PAGE 02!02 r.~. I N ~ N Q i J ■ m ~ m z { / > N N p 1 C~ tom, ~ w~NO % o ~ 1 Q o rn 0 r ~ '\R\l mmml 0 X yCAM,3' 1• REV NO. DATE \ O 6 HOLE DISTRiBUT10N BOX MEIM taimETE DRAWN BY:SKi SEP= MANUAL Q \o W3716 US MMma. M10001 ROQC, YA 54150 DATE: JANUARY 2005 REV. JAN. 2005 800-325-8456 MLS HOLE DISTROUTM Box STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) e La 112„ T M IN a Flu 14 EE- =s mQ 34" SIDE VIEW SECTION VIEW MultiPort End Cap Q O I 16" I 12" An ~ 34" SIDE VIEW TOP VIEW FRONT VIEW YQuick4 Standard( ombe ominal S ecifications MultiPort End Cap Nominal Specif ci ations - as " Size WsX kXH 34 x 52" 0T-w.,, t ;Size (W ,x L x H) ~~34'x:16 x 12 4 d - Effective engtt 48" ; Ihvert Height on 25 a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Noel Eggebraaten Mailing Address 331 White Eagle Rd. Property Address Hudson, WI 54016 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 030-21 13-30-000 LEGAL DESCRIPTION Property Location NE %4 , NW V4 , Sec. 31 , T N R 19 W, Town of St. Joseph Subdivision Plat: White Eagle , Lot # 13 Certified Survey Map # N a , Volume N a , Page # N a Warranty Deed # 971221 (before 2007)Volume 2845 , Page # 132 Spec house DyesQno Lot lines identifiable ElyesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 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 §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroo s 4; n r ~ A '1-V . q (L"' j V 04 / 06 / 15 SI NATUR PLIC (S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 331 White Eagle Rd., Hudson, WI 54016 located at: NE V4, NW 14, Section 31 , Town 30 N. Range 19 W, Town of St. Joseph , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service March 23, 2015 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,250 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete Tank (if known): 10 years, installed 7/15/05 31censed mit umber (if know 383962 ~ James K. Thompson Plumber Signature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS April 6, 2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 p~9 a~ /r Dose-Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg1L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two--year schedule by use of diversion valve. Effluent to be diverted from new cell to old drainfield at 3 year anniversary of new system installation. Effluent dispersal to be alternated between systems on a three year rotating basis thereafter or as needed to maintain < 6" of ponded effluent within dispersal cells. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 10 of 11 796681 \ ? U 2 8 1 5 P 1 3 2 KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENTNO WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Name & Return Address 06/05/2005 10:35A!! ~~k7 WARRANTY DEED EXEPPT # REC FEE: 13.00 TRANS FEE: 1949.70 COPY FEE: This Deed, made between Joe E. Harlan and Theresa A. Harlan, CC FEE: PAGES: 2 husband and wife, Grantor, and NOEL R. EGGEBRAATEN AND MARY BOWEN EGGEBRAATE N , HUSBAND AND WIFE Grantee, Witnesseth, That the said Grantor, for $1.00 and other good and valuable consideration conveys to Grantee the following described real. estate in St. Croix County, State of Wisconsin: PIN 030-2113-30-000 Lot 13, Plat of White Eagle in the Town of St. Joseph, St. Croix County, Wisconsin. This homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; and Joe E. Harlan and Theresa A. Harlan warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this 51~........................... day of Q'~ ...:.....G2 Joe E. Harlan Theresa A. Harlan JAM CITY of TOKYO sm ACKNOWLEDGMENT EMBASSY OF THE l ~NffM. STATES OF AVEMA ST ;FE QF ` ISGGNre1N r. c.... , Geunty. '.P null `s of a me tl~s day o JAN 13 .2M.4 the above named Joe E. -40- a aie is marrle to (rill in marital status) to me known to be the person who i ec e_fo nt and acknowledge the same. , . Notary Seal GonsulaxAssociate lic r... , Cep;-Wis. .S Q IN TE My goni#* ermanent. (If not, state expiration date r ~ *Names of persons signing in any capacity should be typed or printed below their signatures. SOIL PROFILE DESCRIPTION Owner: E-666-9P-A#T~ CST: A - U5C-6 E System Elev. Proposed: ft Syst. Range -5' ! ft to YlY ft Ld Rate: . 7 17055. # Z Elevation: g b # I Elevation: 7 # 3 Elevation: lO~. o Boring o Boring o Boring o Pit o Pit Pit !D2 53 170 s P r4fesej sysAw - ~e Pa, fiv✓~ 93. D / qZ / - - - 4 ~'-r I COPY wisoonsin impartment of Commerce PRIVATE SEWAGE SYSTEM ni sal+etr and Buildings Division INSPECTION REPORT ouk Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanit1839ndro.. Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)). Permit Holder's Name: jaw Vil age own o : State Plan ID No.: Gross, Richard St. Joseph Townsh BM E ev.: Insp. BM E ev.: BM Description: Parce Tax No.: CST T dc, , 3 030-2113-30-000 If F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t' Z ~jJ Benchmark / lA~ Dosing - Alt. BM w.2 n Bldg. Sewer 05 /Ht Inlet J/. QS Hol 2- 2- TANK SETBACK INFORMATION det TANKTO P/L WELL BLDG. Vent to ROAD Air Intake Septic >~op7 / NA Dt Bottom Dosing S ~av i Ll NA Header / Man. f I. n Dist. Pipe a 'r tG•os M r i2, , lr~ Ing Bot. System . g PUMP/ SIPHON INFORMATION Final Grade M , s~ rand k Man rer Model Numbe tqo to G rictio S stem TDH q, 83 TDH Li F LOSS For main Length Dia. Z 1' Towell_ SOIL ABSORPTION SYSTEM 0 d BED ! TRERCff Width Len th Of Trenches PIT No. Of Pits inside Liquid Depth DIMEN'StMS _V DIMENSIONS 3 ZrJ Manu a r: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LH M ER 3 ..r• 0 9 um er: INFORMATION ype System d1nnAJ DI IBLITION SYSTEM ea er Mani o Distri ution Pipets X Ho a Size x Hole spacing Vent To Air Iota e tg9thS Dia./ Spacing A14- 'VA Dia. Len SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Foepth Over Depth over IX x Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil ❑ Yes p No Yes ❑ No In NA: I / COMMENTS: (Include code discrepancies, persons present, etc.) Location: 331 White Eagle Road, Somerset, WI 54025 (NE 1/4 NE 1/4 31 T30N R19W) - 313019930 White Eagle -Lot 13 , Ado( a P C ~cr 1.) Alt BM Description = 2.) Bldg sewer length = It p k- scc~~oY. r -amount of cover = ~yI y uMp Ck1r0 e L1 3,obstru*j%o,% vos r sf5ation. ttO as-st" m 1r46,j.4!,,;y .of ~C 4 -~*wk) tv-dl Plan revi n r u r~ ed?y' es O Nb _ Ow Use other side for additi al inf 1`7 Date Inspector's Signature C No. SBO-6710 (R.3197) . 11 / / k s'~,) Lex&r Oj ~'Omr(,~ /V~4r` Y144 ".Plele al.'a! trr+.~/ I c to WisconSin Department of Commerce SOIL EVALUATION REPORT Page of 3 s Division of Safety and Buildings- in accordance with C ~5, Wis lA~m Code > County ~~Ul)C ' Attach complete site plan on paper not less than 'S 1/2 x 11 inbhes'in size. lan musi Include, but not limited to: vertical and horizontal referenda t B d>lc nd Po'h( i t Parcel I.D. percent slope, scale or dimensions, north arrow, and to ati 'A and di ! rest dad. 3l7 - Zl 1.3 - 30 - UO U Please print all info on. Reviewed by Date Personal infomretion you provide rm be used for seconds iv n y purposes Privacy Law,. 1MI? (m~. , ' ~ f • s D f Property Owner N rty Locatioq G fr_U S S ` ZONING N)~E 1/4 MW 114 S 31 T j Q N R 19 E (or Property Owners Mailing Address Lot # . , S # Subd. Name or CSM# t ~zg S') sr. S00--m 13 - w tiff ~ City State Zip Code Phone Number ❑ City C] Village ❑ Town Nearest Road AsF1UN "N SSOO ( Ste. SLR %t` ti wtkITS I PNGL>~ . New Construction Use: ® Residential / Number of bedrooms L4 Code derived design flaw rate h 0 GPD Replacement ❑ Public or commercial - Describe: Parent material I.0 3Q V NCR. O-U)-Vj h %H Flood Plain elevation if applicable YJ At ft. General comments and recommendations: t ~%TkLLL 3 d L(„ S , tz-,htl•} 3' x 6Z. S ' LI.7ll66 ivt7W 10 uN trS OF ~rp>~eta s/b~wc~w L~Pre~~ e~w-heLs e2 e~zc. $o~~ o~ C.E'u,S 1u a~ boy ~ F T] Boling # ❑ Boring ® Pit Ground surface elev. CH - 3 ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftr In, Munsell . Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EffQ l 0 _ t3 104 IZ 31 4~• - s i 1 z-Fsb tic m `fl- ek, t ~ . s , 43 Z \'Sz7 l~~tiz 31 - s; S Z`(~sbk rr w - • s 3 Z~ So l0`Z2~1` si ~ Z~tsbk »•f.`fi- CS ~ • 5 -S q 91 -1 -5 611- 0 sq MI -1 LIZ ED Boring # ❑ Boring Pit Ground surface elev. 9 6 ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 b 9 1 b`-I,IZ ~ 1 ~ S 11 Z~ Sb 12 ~rv~.'f 1r G.v 1 ~ . , $ Z 5 - t~ lo-c IL 316 S;1 Z --S~~L YWA- C.w - . S . 3 t"1-3o z-s~a.3! 1 s 1c.sblz 1M U'f~- e • •1 t. Z 30-49 ~.s 4231 - S gG~- O s - • '7 Z • Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = SOD, 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ture CST Number Arthur L. Wegerer aAL I "a 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Fiain St. River Falls, WI 54022 y-'Z-LJ-01 715-425-0165 Y Property Owner G S g Parcel ID # 030 • ZL13- 30- 0 Z 3' Pa 0 Boring f>e of Boring # ®Plt Ground surface elev. 1 1 • $ tt Depth to pmiting factor 2 10 6 In. Soil tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eft#2 l o- 1~`tR- 31 - s i 1 Z`~s b lz m-'~►~ Cw 1 . s _ $ Z -Z l ~t2 31 s i 1 Z Selz h1 `F't- djo - • s Z$ S to Ia - s l 1 Z VW S6 YY1` CS ~ 's • $ SS-lv 72. 2i1Z- 0 t Sher. Lek✓,..iT ncnch ~ f,9• t.: C Of Aft Sec e'- i F] Boring # E] 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. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 F-1 Borirt®# ❑ PiB `ring Ground surface elev. ft. Depth to "ling factor in. Son Application Rats Horizon Depth Dominant Color Redox Description Teucture Structure Consistence Boundary Roots GPDW In. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 - Effluent 01 SOD` > 30 < 220 mg/L and TSS >30 < 150 mglL - Effluent 02 s BOD 3p _ , < _ melt 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 608.264.8777. SaD6130tRNODi i . . PLOT PLAIT Cc ge .3 of 3 Scale 1'=y0' ~Pa - ~iD ti O. 030 -Llt3 -3v _ Uop %WY*l - E-00.0 Otv 10 }+1GK,WV -b1A_.PUC...?! PE tYILftTN, ' 7 r + a 00. r"'t' 6w a.z 2" Per ~,Z. s 01 q5 8w1 I Q rwkr s i'"t3 3v ~},.,,bte s.R qtr^►~~s r tw L ~tJ Low e-R.. ~ 4A rt,oC. L4-jq, 0 1 715-425-0165 220254 OI --8~ CST Signature Date Telephone No. CST No. Job NO.