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020-1127-50-000
N 4 0 o ~" v h a N C O ti O N b ti d d .~ O ~Nj V .~ U • V r`~i r rn W 1.L Z v z rn ~ z c C7 oz v' ~ ~ (q H m LU o. rn A a 7 O N N J U O RS W FBI 0 0 O c 0 ~~o ti ~ H N C ~ O rn y N -p o ~ _ °~' ~c c. a m ` C 7 c~ a ~ A 9 C 7 lL ~3 0 ~3 O M O_ N O 0 a m v c ~ `m c a d ~ •~ U V1 M N ` a` z° °a z co .. d ~ A a ~ ~ ~ o o a c a 3 3 3 ~ a a a c J d N O ~ ~ rn ~ ~ r m to •y ~ ~, .~ d ~ yy3~ y U N C O) C N O) U ~ ~ ~n o € °' a a ~ C ad+ C Ot~i~U y o of ail 0 N O Z f6 C O a c d E N .~ N N L_ 0 a ~ ~ o a a .~ ~ N } 0 z ~ ~ . 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Q ~ N N N 7 m y a N N C\M (O M I~ ~ ~ N a }gin o O y ~ 7 ai d r OO .- N ° 0 0 l ° a c N t ~ 'O o o N N N N y O m d O O N M N d 'O Z r 'O N ~ (O M f~ + 7 a ~ ~ C L Z y = F- rZ to I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sat~ty and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Luchsin er, Rick & Melissa Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION TYPE MANUFACTURER ~ S CAPACITY Septic t ~ 2,e~~5 f~~~ 2~"~ N d J ~~ '' 11 Holding TANK SETBACK INFORMATION TANK TO n~ ~J., I I ` r w WELL BLDG. Vent to Air Intake ROAD / /6 S ~ !, 3 /L~ `- DLIo 11 ~~ ~ lobo ~ Z ~ i Aeration NJ~d.~-- Holding. PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Li Friction Loss System Head TDH Ft Forcemain ength Dia. st. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length ~,. No. Of Trenches DIMENSIONS ~ S ~ A Z r f~~ SETBACK SYSTEM TO •,Pd/'L BLD IG V~ INFORMATION Type Of System: ~~ ~ ' G an~~.~~r, DISTRIBUTION SYSTEM Header/Manifold ~~ Distribution / Pipe(s) Length ~ Dia Length \ Dia Spacing_ CClll (`f1VFR ., o.e~~..re c,.~re...~ n„i.. ELEVATION DATA County: St. CroiX Sanitary Permit No: 515194 0 State Plan ID No: Parcel Tax No: 020-1127-50-000 Section/Town/Range/Map No: 17.29.19.590 STATION BS HI FS ELEV. Benchmark ` ~ 7 1ot 7 7 ,~ Alt. BM 2~e ( Co1r.`. ~r ZS i~5`. ~S Bldg. Sewer ,~ SUHt Inlet , SbHt Outlet 3 .S /az - Dt Inlet L~(~ ~!j ~b ~ ~ S Dt Bottom C~ , f' ZQ `f /al ~ ~ Header/Man. ~'. S y~, z Dist. Pipe Bot. System 9~~ 96.E Final Grade ~~ ~ I ~ / ~ ~ St Cover ~ , Co l . ZS 1 /6 S~• ~J __ _ ~_~ PIT BHIAENSIONS No. Of Pits Inside Dia. Liquid Depth :LL LAKE/STREAM LEACHING ~- CHAMBER OR 9~ UNIT \ x Hole Size x Hole SI vv Mnnnrl nr AY_f:raria Rvctamc only -_ facturer: /~ r.~ I Numbers C~a ~I / 3 a- / 3 ~ 2(v d Vent to rlnt e 2 .•. ~ r, .~.- Ese_~- C'.~-c~ ~,E ~~ Depth Over Bed/Trench Center I ~ Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched ~~Y N . ~ Yes 0 No es tl o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 498 Park Lane Hudson, WI 54016 (NE 1/4 NE 1/4 17 T29N R19W) Park View Estates I Lot 9 Parcel No_ 1/7.29.19.590 1.) Alt BM Description = Z~' Cap{~' EZ G03~" t,J' ~~ .~ ~ Lam 2.) Bldg sewer length = /-~4 ~oll.~ - amount of cover = X~ 6d`i.- ~U""~' ~ ~'^~ ~ G~ ~ ~~~--~L ~,,j~ ~ I~.t, G OJe,('~ uSe~ e/. A2C~ EweQS SGt~.~; Plan revision Required. ~ Yes No 11 Use other side for additional information J~ I ~ O ~ I~- ~~~ ~ - Date Cert. No. SBD-6710 (R.3/97) commerce.wi.gov Safety and Buildings Division County ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ C 2i i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 ~~ 17 Sanitary Permit Application State Transa~cti)on Number ~ ~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp ' en J unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary oses in accordance with the Privac Law, s. 15.04(1 m , Stats. ~ 4C~j'$" ~q ("~, I. A lication Information -Plea Print All Information Property Owner's Name ,~+ ~ ~ ~t~ Parcel # Property Owner's Mailing Address Property Location ~ ] ~, 1~ ~f ~~~ Govt. Lot City, State Zip Code p Crf~L"L~NG OFFICE ~ Y< 1~j E /., Section ~'~ V © ~ '~~'~~ Z clrcleone) T~N; R~Eor~ II. Type of Building (check all that apply) Lot # ~ ~ Subdivision Name ~1- or 2 Family Dwelling - Number of Bedrooms Bloc R, ~~ ^ Public/Commercial -Describe Use ^ City of ^ State Owned -Describe Use CSM Number ^ Village of ,./ t aa jj ` ~~ Town of 17 V t~7 ~ ~ _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ^ New System ~ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous PermitNumber and Date Issued Before Expiration Owner jilz7 / K~ IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 `~ 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) etreatment Device (explain) V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) '~St~ Design Soil Application Rate(gpdsf) ; 7 Dispersal Area Required (s ~Y3 ispersal Area Proposed (sfj ~ ~y3 System Elevation ~ ~7 VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units .a ~ $ New Tanks Existing Tanks L l ~/ ~ ~ i' w U o y ~ n y p A C7 P /V r y ~ w , Septic or Holding Tank E'Ir S Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installa ' n of the POWTS shown on the attached plans. Plumber's Name (Print) ' Plumber's Signatur RS tuber Business Phone Number ~ i d~ ~~ ~/ a~ tia /6I -?ss a Plumber's Address (Street, City, S t ate , Zip Code) '7/j - ~ ~ ,r ?~~ ~ a - p~'1 ~/ J~ ~t D. J ~I~~J~t~ ~/ i V ~ c~ VIII. Coun /De artment Use Onl Approved ^ isapprove Permit Fee Date sued Issuing e nt Signa e ^ Owner Given Reason for Denial $ + ~" ~ ~ // `G O IX. Conditi~~~it.easons for Disapproval 3\ ~ ~ (~ D /~ 1~~.,~~,~, "/e~ 1. Septic tank, effluent filter and J ~2C31 1y,-/~ V. ~ ' dispersal cell must all be services !be servtces / maintainer ~ ~ ., ~ d-- as per management plan provided by plumber b Cj 7 ~ s l . 2. RII setback requirements must be maintained 1 r ~ Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 ~! '~ l ~. v ~~ -r- ~~- i n~ ,..~! .,v ~ ~ ~~~~ ~~ ~ ~ ~ ~~ , ~ ~ ~ ~ ~ ~~~ ~ ~ ~~~ J -~ ~~ ~ .~ p ~~ ~ ~~ ~~~ ~ '~; ~ ~~ ~~ a1 __ .~ ~~~7 ~~~ COPY w ~ t~ ._ ,~ ~ ~ J ~ LL ~~ t~J ~v ~ ~(c i.~. r~ ~' ry' U ~ ~ ~ ~,; , ~ ~ ~ ~, _ ,, ~ ~~ ~ ~ J t~ v ^~- (`~ C%d v \/ p ~~ !: ~~ ~, ~ ,-~--- ~ ~~ ~ ~ v ,~ ~. ~ ~ ~v ~ ~~ t~ ~,~,, ~ -- ..,3~ ~~~ ~ ~~ ~~ `~ ,,, 4 ~z ~~~ L ~~ ~ . +s C~F,P~IRTMEtiTbF REPORT ON SOIL BORINGS AND- SAFETY& BUILDINGS ItvQUS'~HY, DIVISION LABOR AND . PERCOLATION TESTS (115) P.O. BOX 7869 HUMAN t~ELATIONS MADISON, WI 53707 IH63.09(1) & Chapter 145.0451 ~% w X 9 w/R TOWNSI•IIP/MUNICIPALITY: OT NO.. ~ ~ b Soy ~ LK. MO.= SUBOIViS10N NAME: ,~ v ~~~ ~ MTh ~ ~ 2 ~ COUNTY: T . GRr~ S M f~~'E j`~ ~,1 ~ 2.Ar Z$4U ~NSY LVran111k J4v~ . So, ST, L..aU~ S Pr4,'R_,~t,. M/V, ._.. J... E urwreavaaenvgrw~o.mr+vc ~-r~.~+ O R o ~TC~6E `' Z`'6L1CT ~Residancs ~ ~Nsw ^Replsce ( NOV. 1 ~ I~D1/, /3 5 as I ~. t3 oc~ to P~~ E S8 So 1 t-S : D +41r~.t~7 f*• RATINt3- S• Site witable far system U~ Site urouitabls for aystem O®~ ~~ .~Mp~, a~ iN ~~ ^~ ®~ o~L ~ ~G TANK: ®U RECOMMENDED SYSTEMaoptiona)) ~N V rN T l 0~/~4--t-- tt Percolation Tnh sn NOT r DESIGN RATE: squired It any portion of the tested eras is in the under s.H83.0915-Ibl, indicsta: ~ ~*~ R ;+~4 , Fioodptain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 80RING A P H T R UN DWATER~INCHES A R O S IL WITH THICKN S, COLOR, EXTURE, AND DEPTH NUMBER pEPTN IN, ELEVATION OBSERV D TO BEDROCK IF OB5ERVED (SEE ABBRV.ON BACK.) ' 8- I Iz.O ~o4,5a AItiNE' i~ IZ ; ~N t_t 4"~ gN N1ecD ~` ~ 5, g'~ E3N ~ w M.P,D. Y Mori IG >,~ ~~ ~, UQ ~o• 8u „~. ~,z ~" B- ~ 4 /O/, ~O rCJ /~-I E ,•30 •, ~„~ Li7"J 8N Map ~.~ S~z3•.~ Gy St •-...~ ~~.Pa, ~' ~.hor 3"~ B~/ M ~O LS w./~4 R~-~~ PSe~ CS W ~ 6R- I o"• ~r~ ~vlEt~ 5 w/r R~ 4i , _ ^ ` B- o) (c /02 .5'Fj t,l oit/6 3! •' ~ iZ "' • v.i: L-.F" Zti L~(A"~ sSw 1~.5~ C., ~~ t~3N Mcl:~ S~ 1 °1'~ 8 N C S w EAR. 5 _ '.. B ~~ (~ lby,o) ~UI.IG ~1 @.L ~.~ G.' ~ ~N S; ~~ ~ 3'; ~,.~ L. S, 3"; -6~r ¢o Si !~"; r3N ,.1a"; ~. 5; w P 8r.~ L5 w ~~' (3 M~.p 5 w t~2 4e3 8-~ f!7it7 ~f / ~~ T..CJ ~ / .N +DA.Ii= ~ ~ ~O~ ESC L~ ~p~.; Ui,1 ,:L~ (1~'; ~ LFS~ 3~~; ~~S,f3'~; 3.., LAB.,. ~sr5, ~'j Bi.f {- S fak` / 5,. r; s w ~. ,~ B- PERCOLATION TESTS q1 G A~_ bEPTH WA ER IN HOLE TEST TIME V RAT MiNU E NUMBER INCHES AFTERSWELUNG INTERVAL-MIN. PER INCH P. ~~ 3 Z'~a Z" Z9/ p_ ~ ~1/ Z r3~ ~ s/g ~ P_ Z r / LEI 7 I P- P- P- 'LOT PLAN: Show loations of percolation tests, soli borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what ere the hori- ontal and vertical elevation roterenee points and show their lecetion on the plot plan. Show the surface elevation at all borings and the diroction and perdnt -IhMs~ope. SOIL,. l'1~EaT"E'R.'S fJAT-'~% Ti.~~ MO"t"I'I..-~ UPPERS ~oiG12oNS Wlfl_.I_ g.E SYSTEM.ELEVATION ~~.oo R.eMov~,a QER-rnAat~.n.IT"L.1- wIT"N co/vsr-Z.ucTto~! ' 1J H M ~ i4 C b i= N ~ ~{.~.,AND P~ALb .._. " ~. i ~ I ~ _ ' i _. .. .... I tit ~ Cif-i`I I y i v.d ~' i .. -. I _ . - ~, ` _..__.._ _ ; . _. _. ... ..._.r..` __.. I _ 1 ,.,. _iZ w L ~ I ~ 1 ~ ' ~ ~. i +z.~f ~ N - .~- _....... .. _ ~~>_ . - .-s ._ _..- _ ~ _.. _ .~ ~iij i f I i I '~ ~ I.a ~ -~ N 1 ~, /~~~- I ~ j ~~ S~ ~ I I , ..-~ ,~' '' % ~' .. .i ___ ~--- ~ - ~~ ___ ~, _. ~~,;w ~ . , ~;. ~~ > M ~,~. ..~ :~ -a ski. ,99 Nb'H1 SS 3~ 1C3N H141M 3~8b'lab'A ~0 Od02! ;-._x ad02~ N03#~131~~ ~yN ,.~ 3„0£,£'bo O S e~~.~- -le~Y. ~ ~ ' 8~b'S9£ ,00'092 ~ r 3 8 9 ~ 9 ~ ~~' ° ~ , N M M ~ op M .+ r_,t, ::+ ~ Q z 3 cn w ac 8 cn w ~ o o ~'M ~ 3 p a 0 ' a ~, o ~~ o~ W o ~, ~~ u~ 0 M ~ ~ M ~~ ~ U ~ ~ _ ~ F- 8 N ~ I'~ j V 0 ~ o ~ O m ~ -O c.~ 00 Z I W I F- °s ,££ ,££ z ~ w ,8~'S9£ ,00'092 9 ~ o i o `` ~ 3Nb1 ' is ~i ~t/d ~° cos ~ ~ ~ o ~ a ' 86L ,L9 3„0£,£~bo0 S +~- - ~ a ,8ts'OOZ ,00'002 ,00'SZZ~ ~ , I'0'99 °w ~ v M„0£, £bo 8 N 1- ~ ( 9'Z£L ~°' r~ a ve ~ I 3 W ~ O W O I ~ N a~ ~ a N p ~ a ~ O O ~ l a M M M ~ ~ ~ ~ - Z I ''~S I .p~ °°s 8~ :=OO Z 00'002 , 00' S Z Z I ,8~'SZ9 M„0£,£~ boON s °s~ ----- -- ----------- ~ -- _ .- Sa N tf~ a311b~dNf1 ca z Q ~ ~ ~ W W W m 0 _~ _O N _b M Soil Absorption System Cross Section Leaching ~// \\ Chamber U ~Ul L l ~ft left ~°oZ ft 4" Schedule 40 Final Grade PVC Vent Pipe ~~ a ~ ft With Vent Cap ~ ~ System Elevation ~a ft ft Soil Absorption System Plan View ft ft ft Leaching Chambers Trench 1 Vent Or Observation Pipe Trench 2 Header Trench 3 Leaching Chamber Specifications Manufacturer And Model ~~'~' :~~. EISA Rating ~ sq ft per chamber Soil Application Rate ~~ gpd/sq ft 1~5~ gpd Design Flow ~ '7 Soil Application Rate ~~ EISA = ~~ Chambers rows of ~~ chambers each. Page of vv. r-~i vv aw• aa.vv a~au ~ av vvv vvvv - - - - tEyVVl ST. CRQTX C©UNTY SEPTiC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION kORM OwnerBuyer (~ t~~'~,~ 51 ~1(,~2 Mailing Address ~~O ~R'~ ~^r~ ~'~)fl~N ~'l~~ 's `~~ . property Address (Veciftcation required front Planning do Zotting )~ttment fnr new construction.) City/State __~~~1 ~ ( parcel Identification Nutni~er /~ '" 5'~ "~~ ~~AI. DESCR1PTiQN p~ Property Location ~ ~ ~ , ~ ~ '/ ,Sec. ~~ T ~N 17, ~ -1 W, Town of ~, tl y DDS o IU Subdivision Q~~~~ ~ (~ ~~ ~ - Lot # ~. Certified Satrvey Map # Volume ,Page # Warranty Deed # , .~ , Volutnc ,Paso # Spec {wust ^ yes U no t.ot lines identifiable 1.1 yex ^ n~ SXSTEM MAINTENANCE AN~UW.N +'R CERTIFICATInN tmpropcr uxC and tnaintertaru:e of your septic system could result in its premature failure to I)and{e waxtcs. Proper maintenaacc consists of pumping out the septic tank every thrests years Or s~ttcr, if trreded, by a licensed pumper. What yon pint into tht system can affect the function of the septic leak as a treatment stagC in the waste dispoxst 5-ysteam. Owner maintenance responsibilitiesere specified in ~(:omm. 83.52(!) and in Chapter 12 - St. Croix Couaty Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plattniuttg & 7.roaiag ihpartmestt a certification iottn, gigtuxl by tht awncr and by a mastu ptnmbcr, joeutreymaa phnnbcr, tt~rieted phunber or a lietased pumper verifying drat (T) the otr-site wastewater disposal acyxtem is in pmper operating condition and/or (2) altar inspection and pumping (if ~cexcsery), the stptic tank is Less than I /3 full of xludgt. T/we, the undttsiQaad have seed the above reeptircrrrcntx and agree to rnaintairr the private sewage disposal System with tht atandardx sat fordr, herein, ss set by flu. Depattnaertt of t;ommerce and the Department of Natural Resaul'ces, State of Wisconsin. (;~tif'tcatirxt xtating that your septic xystcmr has been a>sintainexl must be completed and returned to the 3t. Croix County Planning & Toning Department within 3tl days a€ the three yrar expiration date. t/wt certify drat alt statt;mtrtts on ttt„s form arc true to the bit of my/our knowledge. 1/we am/are the ownesr(s) of lire property described above, by virtue of a warranty deed recorded in Register of Tkcdro Offices. Nut~tber of bedrooms . ~~;~..~~..,- ~ a ,~ ,~ ~~. SIGNA`TUREyOF AI' tiiCA S) DATE '**Any information that is mistepre~aentcd may result in the sanitary permit being revoked by the Planning & Zoning Department. w"" Cncl»de with this application a reao~ttled warranty dexxi from tlse Regixtcr of Detds Office and a copy of the certiG~ survey map if nfordnct is made in flu: warranty deed. Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file, at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the ln-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: S stem Desi n S ecifications Sanita Permit Number Number of Bedrooms Desi n Flow -Peak d ~ ~ c Estimated Flow - Avera e d v~ Se tic Tank Ca acit al ILL `~ Soil Absor tion Cam onent Size T e of Wastewater Domestic Table 2: Soil Absor tion Com onent -Limits of Reliable O eration Se tic Tank Com onent Soii Absor tion Com onent Desi n Flow -Peak d ~ ~'! ~~ Maximum Influent Particle Size in NA 118 Maximum BOD5 m /L NA 220 Maximum TSS m /L NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Se tic Tank Ins ect and/or service once eve 3 ears Outlet Filter Should ins ect once a ear and clean once eve 3 ears Soil Absor tion Com onent Ins ect once eve 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. 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 continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an Management Pian for a Septic Tank and Soil Absorption Component assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within fhe septic or other freafinenf or holding fank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 Management Plan for a Septic Tank and Soil Absorption Component assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or ofher treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or ofher treatment or holding tank may confain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number II Document Name lillll lilll fill! Illll IlIII Illll Illl Mill Illl lilt * s 7 2 s l s 1~ $~~~~~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/16/2008 01:OOPM WARRANTY DEED EXEMPT ~ REC FEE: 11.00 TRANS FEE: 645.00 PAGES: 1 THiS DEED, made between Ryan D. Hardy and Amanda L. Hardy, husband and wife ("Grantox," whether one or more), Rick S. ~r and as sw ("Grantee," whether one or more}. Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Csoix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 9, Park View Estates 1st Addition, Town of Hudson, St. Croix County, Wisconsin. Recordsstig Area Name and Return Address Wisconsin Assured Title, LLC 1810 Crest View Drive, #IB Hudson, WI 54016 STC-3684 020-1127-50-000 Parcel Identification Number (PIN) This IS homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, and Rights of Way of Record (SEAL) * Am nda L. Hard (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated o ~• ) ss. St. Croix COUNTY ) nv IAMT '~ Personally came before me on April l 1, 2008 TITLE: M S~A$,OF NSIN the above-named (Ifnot, ~ L.i ~ Ryan D, Hardy and Amanda L. Hardy, husband and wife authori ' . Stat. § 7 ~e known to be the )who executed the foregoing _ _~ mstrumer~ d ac ledged he same. THIS INSTRUME 1' `_ ~, Richard K.Y. Lau - Redmon Law Chartered * ~ ry 2217 Vine St., Ste. 204 ~ Hudson, WI 54016 Notary Public, to of is a sin - - - My Commission (i (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003 * Type name below signatures. 1 of 1 s O "N~ ~ ' O 1 3 d ~ ~ I ~ ~ ' I b 2 3 ~ ~ ~ ~ 3 !* ~1 1. ~ ~ ~ ,~ ' ~ eo ,o ~ I ^ 9 3 ^r co B ~ ~ ~ ~ .' I ~ ~ n 3 O y O O~ W O y O ~',, ~ O 9`i _ C V N ~ { `C ~j]y~ • ~ CO rn CO d ~ ~ O N m E O O ~ , ~ Q i p ~O Q "~ ` 1 ~ .. . . C O rn~ O ~ 7 O A co ~ ~ N N n 7 O O s -+ r ~ ~ o ~ C ~ 1 - i c`°c~g°o~~ ~ ~ °' °' n °° ~ ~ ° ~ ~ n ° N N ~ OD H fNll CEO ~''~ ! O• O I'J' I ~ cn -< D C 1 y a m I u> z D C pp m ,Aa, obi ~ ~` m ' ca ~ ~' ~' a ~ cci o ~ a ~ I , ~i ° ~ ~ ' a to ~_ r 1 ~ ° ? m a o° c_ ° ~ ~ p ,~ ~ m I O '" a° ~ I o° ~ ~ o a ao NO ~ I ~ °o c cn 1 ~ ~ ~ ~n o I 0 O o ~ °' i y n r N '~ y o a O o OD rn 7 CO ~ ;~ O C ~ ;'! Q ~I OOOrn OOO '~ ~~ ~ _ Ao A o A ' O ( '' c$ ~ ~ I m ~ to to to ~ °' rn to to rn ; 1 N° o' ,~ m ~~~ I o m ~ v D I < o ~ ~ ~~ 0 ~ <D d ~ <D -, lD ! d ~ I A d n ~ ~ .. ~ ~ N I o I i ~ I o =; D cWO o I D~ 0 0 a~ ~ a~ 0 n~ I ~ ~ I ~ ~ ' • ~ ~ ~ N I ~ N i ~ W N ~ W O7 ~ I C (p ~ C fD ~ I w ~ n I ~ a D. Z _ I '~ p Z ~ ~ C O ~ N C O ' ' ~ M l 9 ~ o, I a ~' ~ I ~ I ~~ Z -1 m , m o n. `'° I c 9 a `D '' c 8 z ~ ~ I o ;: o :~ I z 3 3 I m co < N Z N z N W ~ ~ (D I W ? I a 1 ~ a I ~ I 3 ~ a 0 I ~ ~ I fD. ~ ~ o a I ~ - 0 o • N I N N i d i. yy ~1 I I a j I I f. ~ ye i I ~ 1 ~ b , ~ m ~' a I I ~ ~ i I ~ rn ' ~ I I w -p N O ~ _ ~ A O O b w tv I `~ I CD I O ° nx 2 ~ I C ~ ° a ~ N W o . o ,., ~ w AS BUILT SANITARY SYSTEM REPORT ~~ Form - S T C - 104 OWNER (,~,,~~ ~~~_ TOWNSHIP SEC. 1~ T~_N-R~~W ADDRESS GCCL' ST. CROIX COUNTY, WISCONSIN ~`~©~ SUBDIVISION (//^ C~_ LOT ~ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•T,IiR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~y ~ ~: 0 ' ~-_.._... l d ~i PAC'/ /7 D 1 I l~ C ~ ' --_ _ i ~~ ,~- ` ~i~ ~~ w' ~~~ INDICATE NORTH ARROW I ~~ BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /~~~ ~ Proposed slope at site: ~~ ,~; ~; PUMP CHAMBER ~` '``:; 4., Manufacturer: Liqui~ Capacity: ~ ~' , Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: 'Alarm Switeh.Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYST/EM Bed: V Trench: Width: L Z ~ LenB~h: ,S Number of Lines: Z Area Built:J~ Fill depth to top of pipe: ~ 2. ~ Number of feet from nearest property line: Front, ~ Side, O Rear,~t.z Number of feet from well: ~ s'D ~ ~/ i Number of feet from building: Z ~" (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number .df feet from nearest road: Alarm Manufacturer: DEI~ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR. & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O~ BOXy7969 BUREAU OF PLUMBING MADISON, WI 53707 N~%,N~%,S17,T29N-R18G1 CONVENTIONAL ^ALTERNATIVE State Planl.D.Number: Tawn a~j Hu.cLSaVI ^ Holding Tank ^ In-Ground Pressure ^ Mound llfa,slane~l Lai 9 Pcuch.V~,ew ~~s~at~s NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER M$PECTION DATE: M~.chae.~ ~. B.i,Gv,~s 8730 N~i,ca.P.ee~ r4venu.e Sacith, ~2aamc:v~g~an, MN 554 g- 8- ~.y ~/.'~v ~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELE V.. Name of Plumber: MP/MPRSW Nn. Cnumy. Sanitary Permit Number: ~av-%d B. 1=agehty 3289 S~. Cna~,x 112796 SEPTIC TANK/HOLDING TANK: MANUFACTURER: Q LIQUID CAPACIYV. TANK INLET ELEV.. / / TANK OUTLET ELE V.. WARNING LABEL PROVIDED: LOCKING COVER PROVIDED'. ~ • K,Ci1?.~~ ~ O~ ~ ! ~~ C~ ~ /~~• ~~ YES ^NO ^YES ~NO BEDDING: VENT DIA.. VENT MA71 HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM C v ~ L1N~,~ 7 J J ~ f /~ AIR 1=LET: ^YES NO l~ ^YES NO NEAREST J -e DOSING CHAMBER: MANUFACTURER BEDDING- LIOU10 CAPACITY PUMP MODEL PU MP; SIPHON MANUF AC iIIHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL NUMBER OF PHOPF RTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI"E AIR INLET: PUMP ON AND OFF) ^YES ^NO NEAREST-1. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE ~ I N(;T/+ T DIAMF rEli MATERIAL AND MARKING or excavation, (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continua.) MAIN !`f\I\I\/CNITI AI\IAI CVCTFM• BED/TRENCH WIDTH LENGTH NO OF TR C H S UISTH PIPE SPA(:I N(. COVEN r iIAL INSIDE OIA aPITS LIQUID EPTH DIMENSIONS /~ ~~ EN - E 2.. ~ Z,,~) MA PIT . D GR.ivFl_ DEPTH FILL DEPTH UISTH. PIPE UISTH PIPE DISTR. PIPE MATERIAL NO STN NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES G ~ AROVE COVER ~ E V INLF f E ~}C~r ~/ /~ V. ENU Q p /• 83 9 2 7 __~/ ~ PIPES I FEET FROM NEAREST- -- LINE / ~~ ~ ~ l~ fiJ ~ AIR~T~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL COVER TEXTURE PFftMANf NT MAHKFI{S OBSERVATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH AEU DEPTH OF TOPSOIL SODDED SEE UFO MULCHED CENTER EDGES ^YES. ^NO ^YES ^NO ^YES ^NO PRESSURI2ED DISTRIBUTION SYSTEM: WIDTH LENGTH O LATE HAL SPACING GRAVEL DEPTH HELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH CHES TR EN DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTN DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMA710N HOLE SIZE HOLE SPACING CHILLED CONHECTI V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ^YES ^NO ^YES ^NO~ COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ~ NUMBER OF (PROPERTY ET FROM ILI"E: WELL BUILDING ^YES ^ NO ^YES ^ NO NEAREST----------1.1111 Sketch System on in in county file for audit. Reverse Side. SIGNATU TITLE.~a~~g ~1.--~~a~. WT~C. DILHR SBD 6710 IR. 01/82) ~,, D~~ R SANITARY PERMIT APPLICATION °OS~ C~0 / X Adm Code Wis In accord with ILHR 83 05 . . , . ^„....,..,~..,~,. STATE SANITARY.PERMIT# / 7q -Attach complete plans (to the county copy only) for the system, on paper not Less than STATE PLAN I.D. NUMBER 8'/z x 11 inches in size. -See reverse side for instructions for completing this application. PETITION ^ ~ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. YES No FoR VARIANCE PROPERTY OWNER PROPERTY LOCATION / ~'j?=' ''" ,s '/a '/a, S T , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOC NUMBER SUBDIVISION NAME ~ o _ ®~tr 9 CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, O ILLAGE : ~ „ ® ~ II. TYPE OF BUILDING OR USE SERVED: a~i0 "" ~~ p~7 ~Q"'~ Number of Bedrooms if 1 or 2 Family 3 OR ^ Public (Specify): OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) III. PURPO SE ~ ~ ^ Reconnection of e. ^ Repair of an ^ Replacement of d ^ Replacement c 1 LYJ New b a . . . . . System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued.. Permit # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ^ The System is shared by more than one owner/bLilding. Attach Common Ownership Agreement to County Copy. YSTEM: (Check only one in #1 and only one in #2) IV. TYPE F O S , -, 1. a. Lld'Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank V. ABSORPTI SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~ ,~ . ~ Feet rivate ^ Joint ^ Public VI. TANK CAPACITY in allons Totai # of N f t ' M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks urer ame anu ac s Concrete structed glass App Tanks Tanks Se tic Tank or Holdin Tank O~ ^ ^ ^ ^ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MWMPRSW No.: Business Phone Number: p ~--b `r~ Plumber's Address tree ,City, ate, Zip e . Name of Desig VIII. OIL T S INFOR A ION Certified Soil Tester (CST) Name CST # C 's A DRES (Stree ,City, fate, Zip Code) Phone Number: IX. COUNTY/DEPA TMEN U E ONLY ^ Disapproved. Hilary Permit Fee Groundwater h arg e Fee Surc ate Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial '~ ~ ~ ~ ] Q ~~7~~~ Adverse Determination ` ~ Pv F l'~~ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT. ~ ~ ,'. APPLICATION TO THE APPLICANT: 1. This 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. Alf°~~visions-to.this permit must be approved.. by the permit issuing authority. A new permit may be needed _. if there is a change in your builc~in~j plans, §yst~m Tiication, estimated wastewater flow'(number of bed- ` ~ ' rooms, etc.), depth of system, or_type of system,,. - _ . 4'' Changes in owners~Mip or plumber requires a Sanitary Permit Transfer/Renewal f=orm (SBD 6399)-t'o be submitted to the county prier to instal)ation; , 5. Private sewage-sysfem~s mustbL properly maintained. The septic tank(s) should'be pumped`•tiy''a licensed ~ ~~, =~ 'pamper whenever necessary; usually every ~ ta3'.years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: I.. Prcperty owner's name and mailing address. Provide the legal description where the system is to be ~ ~~ installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; ~~ V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a!/septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e:~ , MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z X 11 inches must be submitted to the county. The plans must include the followings A) plot plan, drawn to,scale or with complete dimensi;Qns, location of holding tank(s), septic tank(s) or other t'reatrrient tanks;`building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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.. , - - - - -- .~. `. r GROUNDWATER SURCHARGE On May 4, 1984; 1983; Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was.the result of over 2 years pf st@ady negotiation and public debate. Z.fie groundwater bill.; included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on Juiy 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil. absorption system or the disposal -site used by your holding tank pumper. ~ , Grousidwra#e~•~- ~-- WISCOfTSFr1'S buried ~reasl~re /~ The monies collected through these surcharges are credited to the groundwater fund adminis- ° tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (8.03/86) t'~FP~1<Z~'MENT' OF IIVC!US~~IY, ' LABOR AftiD . HUMAN FIELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) IH53.0911) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 ~ '% - i~29 N/R ~~ w TOWNSFIIP/MUNICIPALITY: N ~ o soy OT NO.. ~ BLK. NO.: SUBDIVISION NAME: ,~ v,~,,,/ ~ STS COUNTY: T . GRe~ M l...~E M U ~- Q.,l~ , L84U ~NNSY I~~/WAJ I Ac J4 V6 . Se. ST, Lvu~ S PA,gC~C,.. NIN ~ DATES 095EHVATIONS MADE S~'2Id ~bTTL~~6E PIFF'iC~C ' ~Reaidence ~ ~Nsw ^Replaca -V OV. ! ~ NOV. /3 . . 'Sm I ~-. ~ cx~k_ P A~ E S8 So I t-S : D ~Kcrr A RATINt3: S~ Site suitabb ter stntam ll~ Sifs, uerul~ahlr 1m ^wt~... • T O~ ~ ~ I M~. a~ _ IN-G(fi~OUNU~~ S C7U _ Q - -FILL (OL~DING TANK: ® S fit! C]U R~N . `q ( t ~ S V l1~ J L.._.t V hJV TI Q /V l't~' -- 11 PtxcolatianTasq are NOT rttquired DESIGN RATE: if any portion of the tested area it in the untNr s,H83.Q9t5-Ibl, indkNr. ~ ~~ i /~,! , Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING A ELEVATION H T R UN WAT R-iNCHE A R IL WI H HICKNE S. COLOR, TEXTURE AND DEPTH NUMBER DEPTH IN. B RV D , TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) 8- ( Iz©' /o4rSD 1~-oNE / Zip nt I_~ 4 "~ ~N Ntssa ~ ~. 5, 8`~ 8N -- w M,P,D. Y MOT's I!. l g~, 5~- w cme /o~ St.l w UQ e- z oja /o/.go ~~aNE 30., ~.~ L1 7"~ ati Ms:D ~ F 5~ z3"~ CiY 5; ~....~ ~4.RD. ~; ,nor, a"~ ~~ M~ LS w/ Er R. ~"• B>•i CS w 6R- !O"• Rjr.1 9vlr=p Sw/~IC~ 4Z & .~ 9!0 /02 • ~ /~oi1lE I 3! ' p~ r^ _ . ~1~1 L-I CO"~ pj1J L, ~ ~~., j ~N 111¢p S, I I..~ ~n/ J7 W ~T -Y M~ I`~.I N C S w EAR- 5 B-~f' ~/ ~ /OZ.O ~ '~~o/l/G ~/ 3L L~ i-' ~ `3a S1 L~ ~ 3 ; ~.., L, S, 3'~~ b•.i tLD S~ !~"~ N .13"~ !a S; w P "• Snl LS ~v M¢p S w fti2 B-rj lZD I, / ~Y•ZU 1`,.~Otil~ ~ / zv" 8L L ~ Io.,~ Sn~ C~:G, II "~ ~ ~.fS, 3"; 3N~5,8"i 3N Leg"i ~r.~FS, 7 8N t_ f-5 ~e S"• C 5 w .e.. PERCOLATION TESTS NUMBER DE TH IN A IN HOLE TEST TIM V R I U CHES AFTERSWELLdNG INTERVAL-MIN. PER INCH P- ~/ Z t 3~ ~ S/~ ( P- P- P- PLOT PLAN: Show locations oI percolation taste, soil borings end the dimensions of suitsbla soil cress. Indicate scale or distances. Describe whet are the hori- zontal and vertical elevation reter~nce points and show their location on the plot plan. Show the surface elevation at ell borings and the direction and psrant otl.rdslope. $oIL. T1EST'ISER.'S I.1a't-~: TFFi,~ Mo-rrL.ICp V PPER., i~oie.yZaNS W I1...~ g E SYSTEM .ELEVATION 9~,0o R-~ov~p PERMAIJE.~..IT"i~ti- .,v tr-a Co,vSr~.~GT/4~/ I~~ .i~ll~tl ~1rt>(R:P_t~~-t~'.Alc,ts' 6T `t-Q mwlt~.,,c,wrsa~-. .,. __., ., .. , , _,I..AIVDS~I'~'P[K6,+ .. ,....._, ._ , I" 111;01 ~ 1 _.. i ~ I ;~ + l ' ~ i i / '~ ....lo- ~ ~ >~ . . j --tp - ~ ~._ ~_ ~ ~ , ~. .. . ) .. t r ~ t_ i_ ..: , . .' ~_ i ~ ~ ~ t _ ,._ . ~ ~ II ~. , ~~ 1 ~ ~ t• .. .... , ._. _ i .. ~.. `G I 4 I ~~ ~_ ~ . ...~ ~ , s !~ ... .. , ~3 ; . . ~ ~ ~ ~ - i i _C' i ~- ~ ~ i ( _. i.. r •..,, ~ i f i _ .. ~. c I '-_ ?' ~ W N2~~ ~ ~3 f _, -- ~ i ~ 1'N _~ _ _ .a _ . . ~ ~I .. ~~ __ _.~__~_ _ ~~ ~~~- t ~ ~t i~ ,s ,x ~~ ~ u~ ~ ~ ~` v ~ ~ c\ ~~ ~ '~Q ~ ~ ~ ~` h ~ o ~ v ~~- ~„ - J~~ w ~, /~~/ v ~ ~ \~~~\ ~ ~~ ~ ~~ ~ \~-~,\ti ~, ~~~ ~~ A ~ ~~~ `~ ~ ,~ ~, ~ ~'~ ,~ .t ~- r' ~` ~ ~ ~~ ~~4~, -~ i -- - ® i ro I 0 I L ~ ~ ~ ~ ~ ~~ ~ ~ ~~ 3 ~ M ~~ ~~ t1 ~- ~~ ~ ~ 0 ~ ~ ' W ~ - ~ n ~~ ,~ ,< o a `\ ~u R ~ ~ , _ __ ~ "1 f v ,~ IZ? -r ~~ i ~~ ~o iD I~ £~ £~ I S3a0`d Lb'99 SNItJ1N0~ lt1~d :310 N 133 N- 3~VOS OOZ ,001 0 ,001 ,OOZ '~~ 99 Sa3H10 1~9 o3NM0 SoNV~ o311`d'1dNf1 3„0 £ ,£bo0 S Z M,,Ob,ZSo68N ,£9'9b~ ° ~ odoa W_~, 4~ o~ '~~. ~~s ' o N03HO1f10~Ww o`' a sa - mss _ -- -" ,£9'082 ~, M„Ob,z5o68 N o~ '~~~ ,00 ~00£ o`'~ 9 9 C{~ , L£'61 M, Ob ZSo68 N n rn 6 v i~ p ~~~/1~~~ O in p ~ ;~ 0 2.1.1 {~ s3a~d sL ' ~ ~ ~ L~ '" 1 ~b m~ ~ ,z o i~ ,00'00£ -~ ,o Z ,D z ~~ 0 r m N ~n W -i ~ z ~,, s3a~d - s~z ~ ~ 01 _ N O 0 .tD w w 0 m M,,O~,zSo69N w w •~M ~-° _ a o 04. -f ~ M,,Ob Z S o69 N 00'00 's 4 ~,~ N ~ N O u' ~. t7 "O ' ~ ~ ~- S3a0`d 5S' I z 0 0 w W O p c g w o o g m W W W ~ N ~ ~ ~ ~ ~, N O O i i i 0 o`'~ o~ ' N N O O _,00'00 Z t~ s~a~d 8£'I w N Q) 00' 00£ ~ 'b s3a~d e~'- m rn_ M,,Ob,ZSo68N 00' 00£ z o: w.;,. N ~ g O O rn N N ~~ N 8 ~w~ APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/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. ------------------------'L-'^---------------------------------------------------- Owner of property Location of property ~//~ 1y~4' _~/ Section T N-R W Township _J~'~~Sd/l/, ~.-,~ S~O~y ' Mailing address ~ ~J'O /I~lGC7C..L~~-- /g/ Address of site T9 ~ ~Q'/f~.~,. ov, Subdivision name___ '1'r4.~tiC1/1 E1~ l~ 1 ~4'~ES Lot number ~ i l Previous owner of property ~~ f ' 1 ~~2,,Z y~~ Total size of parcel ,~~~eS Date parcel was created Are all corners and lot lines identifiable? 'Yes No Is this property being developed for resale (spec house)? Yes _~No Volume 8/ S and Page Number. ,3 J 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 shal'1 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 (~,am ( the owner~¢ of the property described in this information form, by virtue of a warranty deed ecorded in the Office of the County Register of Deeds as Document No. ~.3 Q' ~ d2.3 ; and that I (We) presently owil the [~ruFC;52(i site fGr the sewage t%sposal system (or I (wet have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the Caun~y Register of Deed, as Document No. ). Signature of Owner Signature of Co-Owner (If Applicable) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER , ' ~~c~/J~L ~• ~~/~jJSS ROUTE/BOX NUMBER ',~/ FIRE N0. CITY/STATE__~~.S~OJ~j /~//~ ZIP SyOI~ PROPERTY LOCATION: ~1/9 ~!~_1/4, Section / 7 , T~N, R~~W, Town of ,l~/U!/S~~ , St. Croix County, Subdivision ~i4/~°J~l//~Gl` GAS%A!ES , Lot No. _~. 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 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 HAY be eligible to receive a grant for a MAXIMUM of $3000 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 Auqust of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED Q © p- DATE / -' ~/ ~7 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address • DOCUMENT NO. :, ' ~4~9~28 - . _._ __ ._ __ M_ __ __. liUUl~ U1U PAvE ul STATE BAR OF WISCONSIN FORM 1-1982 WARRANTY DEED This Deed, made between --• .............•--•------.----•----....._......_..---.... .. Lee_ D.._Murray~ a single person ..............................•-•----•----...._..---••----._...-•-------•-----.._..-•---•--...._.., Grantor, and.._Michael__E,___Bihs s_,__.a--single---person_-•-_____._••_____________ ...--•-----•-•--•---•-•---...._...-• ................•------•-•--•---•--•-------..__.....__.._....., Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... ... Le~..D ~__.Murray.------....-•--•--•------------------------••---.........---...:-----.......... conveys to Grantee the following described real estate in St . Croix ,___ County, State of Wisconsin: THIS BPACE RESERVED FOR RECORDING DATA II REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record .111.2 91988 a~ 8:45 /A QQM Register of Deeds RETURN TO I Lot 9, Park View Estates First Addition to Tax Parcel No: the Town of Hudson, St. Croix County, Wisconsin. ~0 FEE is not This ............................ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And----•_Lee__D. MurraY .........................................•-------....----............................................................. 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, r if any. and will warrant and defend the same. ~ Q Dated this ..........~/..~ ......................... day of .........JUlY. ~ ... .. , ....................., 18:8...... ........................•----•-------........._....--•----.....---... (SEAL) .....................----................._.................--------. (SEAL) r AUTHENTICATION Signature(s) ..................................•-----•--_._.............. authenticated this _.......day of ........................... 19.__._. TITLE: MEMBER STATE BAR OF WISCONSIN ~.......... . G~~~r~ .........................(SEAL) ................. ................................... (SEAL) ACKNOWLEDC}MENT STATE OF WISCONSIN as. __St_:___ Croix ,County. Personally came before me this ~.......Jday of __Jul_Y ................................ 19........ the above named _Lee D. Murray .......................... ~~ ~. DEPAEi'fMERit'Of IyDUST1~Y, ' LABOR AND . HUMAN RElAt10N5 REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) {Hti3.09(11 tL Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 TOWNSHIPlMUNICIP LITY: OT 0.: 8LK. NO.: SUBDIVISION NAME: COUNTY: • T . f/~+r~ 1_.~'E M V ~ R.h L84U r-~a.IwN•aY LVA1J i l~ /~V6.'aD. ~T. LACJ~ S Plrli'~~ N1Al, +x DATES OBSERVATIONS MADE 42 (o ]Residence ~ ~Nasw QReplaq N ~. ! 3 -V D~/. J3 sm i ~... g cook.. f~ P~ ~ S8 So 11--5: D A~1c.crt A RATINO: ~ Site WIla61a fef avM~nn Ilu l;tif~ ueruifa6l. Ins ewf..n O ' MQ~ ~ • IN L G . RECOMMENDED SYSTEM:loptional) ~ ~ a~ ~ a~ ' ~ ~ Q~ ~ ~ ^~ a ~ ~~ If Percolation Tats are NOT required DESIGN RATE: If any portion of the tested Brea is in the J~ under s,HS3.081511b1, fntiicate: ~ i~/l I N ~ FloodPlain, indicate Floodpiain elevation: ~ i~ PROFILE DESCRIPTIONS 80FiING A ELEVATION P T R UN ATER•INCHE A A R I I H 1 KN SS, C LOA, tEXTURE ANO DEPTH NUMBER PTH IN. B RV D , TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK,) B- ~ ~ 2.0 /04.50 ~J~oN~' ~ Z#' n1 I_t 4"i ~~~ Ms;.o ~ ~• 5, g"i BN I_ w M,P.D, Y. Mori Ja'r i $r.l rjL w Gr ¢ /O • .g r.1 W U ¢ B' Z ~~ JO/.~O l`~bNE ~0" B~ La ~"~ Bn~ MgD ,~ •G' S, z3"i cav 5; ~... A~I.P•C. Y r.nor, 3"i ~na Msrp L.5 w/~fra2. °l B~~CS Wi 6R. to"~ 3N >'vtE() Sw~~^~-~ 4L B- 3 9la ~OZ . s~ r J~,/ o,Jt/6 r 31 ' $n1 Li(o"i ~N ~... ~ C~" j Dina MGr~ S, J°/.,i SN 5; w F~ Y nn Of; iZi N c s w G,s•. 5 B-~ ~~Q /OZ.d'~ ' / '/V O/~•/C ~~ gL ~~ L' ~ $N S; L! a i3`; ~N ~, S, 3'•i 8~r e:D - lCo"i N ~ i3"i &, Sr w P $na LS w " M¢o S W cSR B•5 /ZO / o5/,ZO ~ / N oA,lfa ~ /zv" gc. L, io'•i Sr./ 5,~, tl", l~na t_fs, 3"; B..~tS,S"; 3M L,8"; gnaFS, 7 i BN ~ S ads S"• CS w ~ 8- PERCOLATION TESTS NUMi9Bi DEPTH A IN HOL TEST IM V RA7 I U INCHES AFTER SWELLING INTERVAL•MIN. PER iNCH P• ~O G Z ~~Q Z q Z, q/ p. ~ Z ! S Z s~8 p- ~ / Z.~ 7 ~ P- R CLOT PLAN: Show locations o/ percolation tests, soil borings end the dimensions of suitable soil areas. Indicate acele o- distances. Describe what en the hori• :ontel and venicei abwtion nfer~nce points end show their location on the plot plan. Show the. surface elevation at ell borings and the direction end percent otiandslope. $p{L ?"l~ST'1ER•S NoT~: TFE~ MOrr1..t~ UI°pER.. f4a1CIZONS VK(L.t. gE SYSTEM ..ELEVATION 9~.0o RCMov~~ PERMAJLI E JLIT'Lti- w I rr+ ca ~/srl2.ucrro~/ ~~ )J H M .e :. R EI d 2. N ~. _ ...-I , .. ~ ,1,-AwrD f Pr!~t~. _ _.._ ) i of .., "~1 • u t N ir.4 ~ I ~ ~ ~. _... _ ~ , 4 ( _ __.. L ~_ Z -I ) i ~ ,~ _.._ ' ~ I _.._ 1. ' _ _. - -- ~_ I I _ i w.. .. .. ,. I a _._ _.~ _ _ _.. _ ~ ~ ,. J 1 .. i i I .. ... _. .. _ .~--_. _ , .fl. ~~ I .. ~.__. _. , ._. .i.. _ ~ , 3~. t x ~, [~~ _. _. _, ,._. ,. .. _ _. ._ . ,,.= i I I ~ 4 ~ ~ i 4 i f~i~ ,; _ ,. ~ I i ~~~ n ~ I ~ I Liar ~ E .~ r ~~ ~ . I I C~~ ~~ v v `~ I i h I C Q 0 u ~ N U ~- q b~ ~ ~ Z Z ~ ~ 11 -1 ~ p ~ ~~~ ~ Z n ~ ' d f o I` al ~1 h 1 rh ~ ~ n ~~ e ~ ~ M i, \~'' ~ ~ ~ n ~~_ _ ~ ~ ~ _~ \ _--~1a, -- __-._._._ __.._- ~ ` ~\\ -- __ _-- ~ is ~ ', >>-. Ic\ y ~ , ~' \ ' ~'~ ~ ~ ~ ~~ '~ ~ ~ ~ ~ ~~ ~ ~~ ~ ~~ ~~ ~ / \ \ E't" / t ~ \4 ~ r _. ___ ~..( _ ~~L' , wr ~ ~° ' a '. o \ ~~ ~; ~ ~ ~ ~ F ~ >~ ~i ? e ~~ a ~ ~ ~ W ~ C~ v ~~ ~~ ~ ~ ~ . ~ ~. ~ ~a 1 }{ ~„ ~ _},, . a` - ~~ ,~ ,~ ~! • - ~ 1 w ~~ ~ < ` I~ w_ .., ., ., °~ ~.r;~~ • '~ n i ~',' ' ' ~r~r-- . ~ 1 ' ~! ,.~ ~, ~ '~ ;. .~ r ,.,1- ~. i i } i r r_r J r' `c _ .. .-,-.. j i ~~~ _, .. 0 n __ ~ ~1 ~ ~~ ', '~ .. ~, f` I w, W ;+~•'I~ ~ ., "i 1 • ~. ,,, \. ~ n ~ _ I ,, -~ ;~. ~.~ o ~~ - ~_ ~ _ _. ~a ~~ .. ,j • ,i ~ ,, '' ~) ~• '1 ;i • 1 ' ., ~ .. ,, r ~ w ~ I~ ~ ~ ti 1 O n P R _^ ~ ~1 ~~ ~, Z REPORT OP INSP~CTION_INDIVIDUAL S1:GIAG~ SySTFM San~.~any Penm~,x-~~ S~a~e Sep~~.c~ NAME ~ ,~. ate/ Tawn~h~.p c~~~~~--~'~~ S~. Cna.bx Caun~y ;r ~ ,~~ %' _ ~~~;;~~,1.aca~~.an~Gr% a b,C~%, Sec~~.ar~/~T~ N, R /~C1 r p-~ - S~PTIC TANK -. S~.ze ga.2.~an~s. Numb en ab Campan~men~~ ~.c..s~anee Fnom: Ule.~.2 ~~. 12 % on gnea~en d.2ape ~~ DISPOSAL SyST~M U.%b~anee Pnam: PIFLD VIM~NSIONS: Bu~..2d.~ng ~~. Gie~.~and~ N~.ghwa~en ~ ~~. ~~- We.~.2 ~~. 12% an gnea~en a.2ape ~~. Bu~..2d~,ng b~. Ule~.~and~s 1:~. N.i.ghwa~en_ ~.t. W~.d~h o ~ ~nench ~~. D ep~h a ~ na ch b e.~aw ~~.2e ~.n. Length o~ each ~.~.ne g~. Depth ab nacFz avers ~~..2e ~.n. Numben~ a~ .b~,ne~s Depth a~ ~~..2e be.2aw grade ~,n. Ta~a.~ .~eng~h a~ .e.~.ne~s ~~. S.~ape a~ ~neneh ~.n pen 100 ~~. D.L.a fiance b e~cueen 2~.ned~~. Depth ~a b edna efz ~~. Ta~a.~ ab.a anb~~.an area ~ ~~2 Depth ~a gnaundwa~en ~~. Rec~u~.ned area _ ~~2 PIT DIMENSIONS: Numb en o ~ p~.~d_ Ou~~.de d~.ame~en Ta~a.2 ab~sanb~~.an area Area nequ.~ned INSPb'CT1:D By APPROVED ,~AT~ R~J~CT~D ;DATA g~. Gnave.2 around p.i.~d ye.a no Depth be.2aw ~.n.~e~ ~~. 2 ~x . ~~2 TITLE 19 7` 19 7_ z rn EH 1,15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: ~~/4,~/4, Section ~, T~N, R~~~-(or-~fownship or Municipality ~~~5~ Lot No. ~, Block No. /'~'~ !/glt'~ ~~'~ is County ~ ~"~-~9! Subdivision Name Owner's Name: s / Mailing Address: ~ ~' l ~ - ` ~ r `~~ TYPE OF OCCUPANCY: Residence X No. of Bedrooms ~ Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITIODN REPLACEMENT-7 DATES OBSERVATIONS MADE: SOIL BORINGS ~~ c3~ ?a PE COLA(TION T ST/S /'~~ ~/~ SOILMA~SHEET ~~~~~~ SOILTY~E 7Y~`~ ~~~/~- `~~"~ SO~~(S PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN E AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED HOL ING SWEL IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER P / ,r J ~e. ~li't ,~ ~ ~ L /ti~ ~ / yL Y/ 1 P " e ~. /~JYY'1C /~ V ~ / SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) / 6" oc~e- y 6« ~-.a ~ .~/'` . ~t'" ~Y~ , 6r1~'CaNte ~d-Cr. B_ B 3 Q ~" ,t.~~ ~P6° `` ~3"E°~~Srt=~-. ~ a =as, Y ~ ~fvys,C~ $ "'~s, ~ d' " s _ L , J ~ e ~ 6'[~ am 7~6~`' 3Yf`~~b~.S,~G Y ~ ~ Y ~/ (~ " S~~ •2 Y" ~ c~tt~t~S ~ - 6 ~j L ~j " ' J , ~~f~c~- ~ ~p !r f It ~ 'r ~! a ,~~ ~ ~t-S ~a llrf aC " ~OI~/`~C sYw' PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the Ian the location ands uare eet o suitable areas. Ind'cate~uf ~?r of s uare fee of absor tion area needed for building type and occupancy. ~/~~-~~ Ek3 ~ `~i~..'t+o'~-[Lty /~''"~.9 ~ Indicate scale or distances. Give horizontal and vertical referenc in .~I 'ate slope. ~~ ~ c • E • ~ ~ Zln-nl~ ~r ai i P 1 { I I { I ! ! 7 I =~. 1 I 1 I ! I I 1. • 'l U llll ~/ State and County Permit Application for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required A. OWNER OF PROPERTY State Plan I.D. # State Permit # 3 County Per t # _ ~ -3 Count; ~ ~~- Mailing Address: ~~~`~ ~X lY•~~ B. LOCATION: ~~'/~ uF~'14, Section ~~, T,~ N, R~ $1 (or) ~Lot# ~__City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. T PE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family ~_ Duplex No. of Bedrooms ,,~ No. of Persons__~ D. TYPE OF APPLIANCES: Dishwasher ~ YES NO Food Waste GrinderYES~VO # of Bathrooms. Automatic Washer x YES NO Other (specify) E. SEPTIC TANK CAPACITY ~~~-~ Total gallons No. of tanks / *Holding tank capacity Total gallons No. of tanks New Installation k Addition_ Replacement- Prefab Concrete kr *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ~ 2)_[_3) Z--Total Absorb Area, 6 ~,/~ sq. ft. New Addition Replacement *Fill System ~f f ~" ~ /~~ i~ar Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length 3 ~ Width Depth ~! Tile Depth ~ `~ No. of Lines ~ Seepage Pit: Inside diame er Liquid Dep/th Tile Size ~~~ Percent slope of land ~ <,~ /~z/ Distance from critical slope - I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the C 'fied Soil T ter, NAME .. Ste, C.S.T. # ~cr=/f~~and other information obtained from t owner Plumber's Signature N~~P~/MPRSW# ~/~j Phone #7/r -3~6 3613 Plumber's Address - G.•- ~/ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). o ~~ _ ~ ~~®~as ~ ~ ,o ~©o' '~ ~~ CoruoN- _ ~~ ~ ~ l~f e ~iq-ram- t _ ~' "~`~°' ~.~~',' _ ~ ~ ~ '~ °a ~ ~ ~~~ _ ~ o os~ ~ r ~, ~ , ?s"' .... ~. ... __ .... _ _. _..../~ f.... _.. _..... ..._ ` 'ov