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HomeMy WebLinkAbout020-1144-30-000 ,..� � . o 72 1 44 §, \ >. • ;• ) az cz t az \ 8 \ k o a k )e z z § §$ - § §}a ! ° ! ® # . E nt ZE Ill 0) _ § @ a. .i a oz 2 = f k ■ — | f # az3 { E 5. a . z 2 . % { •� ) ƒ CC | 2 ! � .. E ! ! » j ( Z ) N 2 _ z - • ~ k $ 0 § B ° a § § _ } - aa1 $ 7oaJ 1 -t- \ tio © ! •Z ` � � j e � \ b § � 5 2 ) f � ! § ! mm ƒ \ ® ~ � ƒ ce \ \ .. Ce % / ; .. 0 ` § � ks ■ f $ ) ƒ / d % 7 } } ƒ ) § 232 a 2 A ca k � ) a 46 2 0 ) s I a • / ) / $ % i ) } } =o \ o Z _ 0 2 5 O . .. aka I Jii \ � r. � / - � � COI k Ja. 2 kw () ku, O Parcel #: 020-1144-30-000 12/06/2005 09:30 AM PAGE 1 OF 1 Alt.Parcel#: 17.29.19.752 020-TOWN OF HUDSON Current X ST. CROIX COUNTY,WISCONSIN . Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-HASLUP, MITCHELL S&L HALVERSON MITCHELL S&L HALVERSON HASLUP 473 MCCUTCHEON RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description '473 MCCUTCHEON RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.600 Plat: 2276-PARK VIEW ESTATES 2ND ADD SEC 17 T29N R19W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 59 ADD LOT 59 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 818/02 07/23/1997 704/25 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.600 60,700 185,200 245,900 NO 05 Totals for 2005: General Property 1.600 60,700 185,200 245,900 Woodland 0.000 0 0 Totals for 2004: General Property 1.600 31,300 165,600 196,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 135 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 • AS BUILT SANITARY SYSTEM REPORT NER 5 ('fr , TOWNSHIP /4 „t to') SEC. / 7 T 1` N. R 1 Y W .0. ADDRESS tl r S` - , ST. CROIX COUNTY, WISCONSIN. • BDIVISION Pp n/,' Ifg pl...." , LOT 51 LOT SIZE 1 . . at . PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ate- Cqr lq • It- : . to - • ). t f 7p . 5•1irr • Ho � sp ) 70 }. � • . G i • • 1.d . I5' • JZ t �'t • • \ /1&) . _ \ \ ` • %��^ • • ='TIC TANK(S) ( Gt, ' nG(R. (A/, . ).-,, . CONCRETE `_ STEEL NO. of rings on cover /f' a Depth 5 DRY WELL 'NCHES NO. of width length area i no. of lines 2- width-727 length 5 2 area ( 2 ¢- depth to top of pipe 3 G 3REGATE .K. RATE 0 S AREA REQUIRED C( T AREA AS BUILT 1 :claimer: The inspection of this system by St. Croix County does not imply complete ' :pliance with State Administrative Codes. There are other areas that it is not possible'/ inspect at this point of construction. St. Croix County assumes no liability for :tem operation. However, if failure is noted the County will make every effort to . ermine cause of failure. .ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. r -INSPECTOR v DATED PLUMBER ON •30- z -- -,5 �-.-1/1-et-a+7 LICENSE NUMBER A/I } 3 2- • `1 ,....+. _,r _:. .,r REPORT OF IJISPECTIO.1--I:7DIJIDIJAL SEWAGE DISPOSAL SYSTEM Sanitary Permit .367 • r State Septic /te 8 "iere J i (7) k-,94) • TOWNSHIP ' / t.roix County SRI'TIC TA'?1; , Size /r(w gallons . ',umber of Compartments . . - Distance From: Well .,.Y L ft. 12% or greater slope ft Building /C,. ft. Wetlands ft • Uighwater — ft. DISPOSAL SYSTEM i/Tile Field or Seepage Pit(s) Distance From: Well r( ft. 12% or greater slope ft . Building /3 ft. Wetlands '— ft FIELD Highwater ft. Total length of lines .7 7--ft. Number of lines 2. Length of // each line `� ;.Et. Distance between lines (p ft. Width of the trench /eft. Total (,i absorption area �• z P . sq. ft. Depth of rock below tile / Z in. Depth of rock over tile 2- in. Cover _ .over .rock., 2 . Depth of tile below grade 2-4 in. Slope of . - trench — in *per 100 ft. Depth to Bedrock - ft. Depth to • ground water — ft. • • PITS Number of pits . Ou di meter ft. Depth below inlet ft. Gravel around pit : ___yes no. .Total absorption area sq. ft. • • Square feet of seepage ench bottom area required - Square feet of Alpeepag t a a required • . Inspected .'• / ��-- Title: • Approv: : e. 'lt Date L 7 197`� Rejected , Date 197 . EH 115 • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH P.O.BOX 309 MADISON,WISCONSIN 53701 ` r�REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:p5AY.,A/AI, Section 7,72.��N, R/7•(or own ship pr Mu�ipality �� Lot No. I�/ , Block No. , ril to !//e%�.) 45 t c p2� J. County is C� Owner's Name: 50,►-L /�'J,`/ /er ubdivision Name Mailing Address: //'42 ler 4- rya, rse,v� L_ ), S. S 27O/6 TYPE OF OCCUPANCY: Residence X No.of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS /0 -01 'i i r PERCO ATTION TESTS /0 'J40-2r (a SOIL MAP SHEET ,02 F1- ' SOIL TYPE 4r.7 B--/ Z -,li)A .441.,isl PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INa.IES THICKNESS IN INCHES `SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P / IT See Fore_ 441 / . N/0 `o 6 6 .S..- P 4 4 -See- Alre 41114 1 NO 6 p 4 e.5-- . P 3 W." See 8cre 611 la_ do 6 6 G .5.." 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) B_ / 96„ /t/641C > 96'f //""T5, 2?.. /L, 63 M ed$ 2-- 96'' Alo,d.- 796-' /c,•7s, d3 'A, 63,, meets B_ y 6" 6 m-e- >2 " /r '7. , .73•4., 6. .. Med s i'' A/41t¢_ >76•' /,l"15, j2",t, 6_2 " /44eS B_ s 96- ,hAd - >76- 00-7-5, 073 `,, 6, Me s ( 96" Alc ce- >p6'• ld •'75, .2; ..4, bed " AIedS PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square/feet, of suitabl areas. Indicate nu er 9f square feet 0 absorption area needed for building type and occupancy. 1GY�pJ ,( QOO " S..a- /`0 � LA ' " indicate sole or distances. Give horizontal and vertical reference epol sp e slope. Sys /�- r tyiiieed4eN' Af i. 6 4-eree . / /////,//t,\C C cilic tory gd, / //b/ o ferFs ,nice / /97' \ q ��res =� °� • It y*Sei - g_o' \ k)a4. �,, • ELev►* i .\ 'toReS:ee,veer• • N ritz' i J >J S)L$,La,, gr'r.A p O 3 a A 6e- ° oas1 ' f N. I, the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my knowledge and -lief f!/ Name (print) D "<< ! ' �`h•� �"�i Sect/ / Certification No. 5 s //f 'q Address ///� 'furL/ t"P• # a'S<.K/ (1t : .�Yivb Name of installer if known � CST Signatur Tom/ - rr/ COPY A— LOCAL AUTHORITY • 'IQ. .__,Kee . KB67 ,.11111 State and County State Permit # u 'DOJO j • Permit Application County Pe j_ s for Private Domestic Sewage Systems County(%�-�-(,{,[ 'DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailin Address: B. LOCATION: 5 G Y4 A/b4, Section 1 7 , T N, R J ! E (or) W Lot# S City Subdivision Name, nearest road, lake or landmark Blk# Village ,a r // , e1.A./ Township H t4/‘•61 C. TYPE OF OCCUPANCY: `Commercial 'Industrial 'Other (specify) `Variance Single family ✓ Duplex No. of Bedrooms -3 No. of Persons D. TYPE OF APPLIANCE+- Dishwasher !/YES NO Food Waste Grinder !/YES NO # of Bathroomsa Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY [000J Total gallons No. of tanks / 'Holding tank capacity Total gallons No. of tanks / New Installation ✓ Addition Replacement Prefab Concrete 1/ 'Poured in Place Steel Other (specify) _ 4 F. EFFLUEfNY DISPOSAL SYSTEM: Percolation Rate 1) , 5-'2) 1 / '3) , 5-Total Absorb Area 4. / sq. ft. New 1/ Addition Replacement 'Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 5 1-Width 1 j Depth Tile Depth 3 G No. of Lines 2-- 4- " Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 2 "' 4 'a Distance from critical slope r---"' 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 Certified Soil Tester, C�L_ /� p NAME p o nn 15 C h t • t p h r i* 4 r f1 C.S.T. # 1 f -/ 7 9( and other information obtained from 5 a _ ! Ter' (owner/builder . Z Plumber's Signatur . ♦ P/MPRSW# /N n - 5.726 Phone #01}7- 3 23 '/ Plumber's Address R 4 ,.4/ i4 t c el c',n PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). I. Q4 CI "< l Y 7' t— , rM G G u f.'c 4 .,,) R 4 A f c re',ter c v R4 K tAA y f-f !OU a d- M ® 5 C /l , ....Jo' , s y 5tivi 4t('n 5-3-4a R„,/*c.' 41,^t 1,A •.,-,,,, V NO ;tits:,/ rt q6/ t 1-1( 2. 7ti Do Not Write in Space Below OR DEPARTMENT USE ONLY O U n Date of Application /7-3 -7P Fees Paid: State% ,D C. Coun / Date - jJ Permit Issued/Agjpcsed (date) /7-3- 76 Issuing Agent Name ' Inspection Yes k No Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT / 7C�j� � / GL Owner M� r rly/� 45 of 38 ' cff, Address 3 /1 e (' ,tJ • City/State �iQ Co") !.[j/ . 5 g10 G Legal Description: Lot 5? Block Subdivision/CW#-• Phi t-U/ �sTi}-TFS '/.$ '%A/,, Sec. 17 , T,24 N-R/9 W, Town of /(,/.SOAJ. PIN # Oio• 1/954 30 ' °z7v. SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer a-144)2 6 • Size ST/PC / / O' Setback from: House I.7 Well 5g P/L SD Pump manufacturer N01— Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location sub/c/Al-TaR Ce#5 . (. Neu' SOIL ABSORPTION SYSTEM: G3 Type of system: IRIAjaAt Width 3 Len ZJ 74o Number of Trenches Z" Setback from: House 320' Well�g1 P/L>15' Vent to fresh air intake / ELEVATIONS: /00 .4 BoiVo,4. t06-c ,p rn' - - Description of benchmark Elevation Description of alternate benchmark 7? Of o!D PAT/17,'{7t7&S Elevation ?2 YJ U54. 7 G Building Sewer //I ST/HT Inlet Nik. ST Outlet 9�' 7� PC Inlet • PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System ( ) S�E ( l r /0 '59--cJ Final Grade ( ) ( ) ( ) 1141' ya-p Date of installation / / Permit number .9° 51�5 State plan number /1//4— Plumber's signature 1 _l .../.-- License number 2-'2437 J Date / / Inspector /�f�/tl Q Ul N n/ /ol' O o� ((// Complete plot plan ORIGINAL Ma fi r. ,g°° re"- w ll y' (ZC �� � °W 6 ✓ 2e rzl SE0 gg:96 -36) / --I 3 5 w L / IJ I EX1sr/NCr i8 ,� 'f , / 3$ y °" 5 O 3 �� 1 ° CEO zefr I- - - o 1 e0,v.4,ecre� ' 1 , .3K#/ NEW �' \_____,,-• .1'4a6 /O4 ' j 4S4P-dis ,, i _ AlEtz) PP1.5rP 0rr0,J ,v,eo p 0,3X e-4 4" i S 1 I. 8__ 1 1 . 76 ' Loa G- 1011 re . 1 e---- Tar °F 546zz. S 1 I I I I I ioD °rSir�7S i ' I I I K ' I f3• yG I I • . I I i.4 s/Ies f0 1 I I I 1 I I I - 6 : 3 ' L/, 'j X 36, 1 I I I I I TO 731-L 1 I 1 i . SISTEA1 L,P.44s'!'11 3 I - 1 1 �.20' PI ��Ia•8 e ' II - sySr A1 ---i I q a• li, ' 1 I I I 5C44e : / " _ 20 L. As ' Re>/• T PL0 T P/1--,k) ‘4,1°) Ulbrich Ulbricht&Associates Private t Sc', Consultants )64.'o 055 0N•11 Rd. / 3 • G.),0'O Hudson,Wis. 54016 C L • 5 nui4 ) D - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division' INSPECTION REPORT Sanitary Permt No. 405125 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Personal information you provide may be used for secondary purposes tPnvacy Law,s.15.04(1)(m)l. Permit Holder's Name. City Village X Township Parcel Tax No: Haslup, Mitch Hudson Township 020-1144-30-000 CST BM Elev. Insp.BM Elev: BM Description 100' l DU I I�3' • -, tdi.- — s As -(444-6f P/'— TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j/ t- Benchmark / C(ILL1-( L• I DOQ )(? 6M #'1 2. 9 10 2.�q too Dosing k15 Alt. BM Aeration Edg.Sewer v1.ee- �sir.;s-f,i -c. Holding St/Ht Inlet �(f4nNc( et Outlet �� ��, + TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. �Vrent to Air Intake ROAD Dt t� L -1 9 cf- .1 nSP.?'�.t X. Septic Oi_t5 i a� BLr u�I�f Y tl( 9�• Y3. Dosing Header/Man. Header/Man. Aeration ' Di . PPP �„ i 9'f 93 -� I F� 1;r 2 -ss 93. 3y Holding --- C System , /O, Z. r/Z�•- Final Grade reA-r lavg/ 2 /G VS 93,y7 PUMP/SIPHON INFORMATION N•ef T-t .313 9G .4•r- Manufacturer DDigtgand St Co r GPM - (f47)nay Model Num V4A,o i,sc 1 Y, 3V TDH Lift • lion Lo System Head TDH Ft r ` "/" g n( g 1S 9 y• ,(`• Forcemain Length Dist.to Well � SOIL ABSORPTION SYSTEM S-o_. AS - -(-f d BED/TRENCH Width / Length, No.Of Tr PIT DIMIEdSICIO 0,Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 0-4- 7 S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Manufacturer INFORMATION CHAMBER O 5 4 CIA-w,rt d e.r A�}nalot. Type Of System- ,(s/ ,�P? >� ,/ / UNI Model Number: /O e I N DISTRIBUTION SYSTEM I,rf Q �� y� �tid G ,Jsvt itiT- / Header/Manifold Distribution a"TK�fefer Qie- x bole SiYC x Hole Spacing Vent to AiYIritakg .y r ` bb r Length ig/ Dia4 Le gin G2+ 9 5 H "'yispacing 61 -- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BeC/Yench Center 2 .S1 Bed/Trench Edges Topsoil p Yes ■ No • Yes • No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: G I(3 / O Z— Inspection#2: I I_ Location: 473 McCutcheon Road Hudson,WI 54016(SE 1/4 NE 1/4 17 T29N R19W) Parkview Estates Lot 59 Parcel No: 17.29.19.752 1.)Alt BM Description= /"1 A' .t - s/Vi i 2.)Bldg sewer length= aus-Jjti, -amount of cover= 5' ., O Plan revision Required? . Yes otiNo //� / //`�/ /_/'�d G Use other side for additional information. (� 13 a J' ' �{ �,(/f/j/..., l!f! U b `1 SBD-6710(R 3/971 Date Insepct'or's Signature Cert.No. Safety and Buildings Division County ViSoOtiSin 201 W. Washington Ave., P.O. Box 7162 s GHQ X Madison, WI 53707-7162 She Address Department of Commerce .63/Vyt. Y7 3 Mc Ge[fG 04 72P 'V Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21,Wis.Adm. Code,personal information you provide ❑ Cheek If Revision 4542s/a may be used for secondary-purposes Privacy Law,a15.04(1)(m) I. Application Information-Please Print All Information RECEIVED State Plan I.D.Number N/ Property Owner's Name Parcel Number Mil{ y4S4uP MAY 282002 020• // 15/• 30 • oo0 Property Owner's Mailing Address Property Loudon 41 y73 Afc CGt 1-ado") -RID • H; )'; couv-, • I, C S� 14 14 S / T Z" N R /� tCity,State Zip Codeumber Lot Number S9 Block Number ill(fpSoJ `(J/S Sy0/ Subdivision Name CSM Number S6 •Syro movie-co �s14res 7r II.Type of Building(check all that apply) /�� airy 141 or 2 Family Dwelling-Number of Bedrooms -3 Sot vieSl.�K t-C% ❑Village ❑ Public/Commercial-Describe Use AJd cr? w/// 4 Township yu 125OA) ❑State Owned Nearest Road Z2. (3/X 69 '� �e-cra) ��144-e- 1 "lc Cut�f POAv Ill.Type Permit: (Check only one box on line A(numbering scheme for intirpatritrjle n f applicable) A. I 0 New Replacement System 3 ❑ Replacement of 6❑ Addition to For County me System Tank Only Existing System B. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV.Type of Permit: (Check all that apply)(numbering scheme Is for internal use)S u t�,eb..t, F-4 • -1-x4-1•111e,*-4..) 44 tif Non-Pressurized In-Ground 210 Mound 47❑ Sand Filter 50❑ Constructed Wetland EZ.5/4-,--14Z146 22❑ Pressurized In-Ground 41 0 Holding Tank 48❑ Single Pass 51 0 Drip Line Ai-3'//.-_ /O 45 O At-Grade 46❑Aerobic Treatment Unit 49❑Recirculating 30❑Other o2/Chliyr_E`-c^ V. Dispersal/Treatment Area Information: Design Flow(gpd) Dispersal Area Dispersal Area Soil Applkation Percolation Rate System ElevationFinal Grade Required Proposed Rate(Gals.lDays/Sq. .) (Mtn./Inch) Elevation / ys° ✓ ( Y3 `� 6, RY / Ft • 7 ✓ - 9a •cv 7o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallo Gallons of Tanks W/ze / 7 / .Concrete Constructed Glass - , ' Neww Emitting 0 • T Tanks to/ESE/e Septic or Holding Tank /� /a C.v / �Al/ ' 1� /„ , / Doling Chamber CJ�� ✓K.!- �fJ JL VII. Responsibility Statement- I,the tmderaigned,assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature T1P/MPRS Number Business Phone Number Bold ti/4ri et, i?._/ 1- - Ce 3 7 5 7/S • 3 P‘- PS S Plumber's Address(Street.City,State,Zip Code) - - Go SS' o/ /tieiL )/ . #U1�-Se)....) 4'/. $r/O/ c vm otmty/Department Use Only ULllpproved 0 Disapproved ' Sanitary Permit Fee(includes Groundwater Date Issued gent Signatu o Stamps) Surcharge Fee) G O • � Gftiw+� ❑ Owner Given Initial Adverse �� / Determination Drii Conditions of Ap roval/Reasons for Disapproval &�, bait` S�I lrn.ai u/c- -4 'hl�..) [(I �- �2� l sc..GQ 4z4r ' ?, is t CG!/-dt- . i Afflict' ro lete plans Re comely )f 9a i1n a 144# ii SBD-6398 (R. 05/01) l �,' �. y TICS-aIGa�/ i/ / J . • ULE3RIC1 IT & ASSOCIATES CO. 655.O'Neil Road • I Judson, WI 54016 Rep Designers n/FnpNreP,hig Sysrems 715 386 a 1 F15 Mamie Sewage Consultants • PROJECT INDEX PLAN ID n NSA- DATE ' AY z 5 ' 6 OWN RR /4//d / 5GUP PHONE 3 S26 • e/G✓5—G AuuRP",Ss 17 3 /"Ic (rc 171uPSso.-) 5 'O/ LEGAL DESCRIPTION TOWN OF #0DS0/1) ----------- COUNTY CS'1'M 22437 5 R ul,h/'/ t7 LOCAL AUTHORITY/ SUPERVISION S .'p/'X " C7> ZOO/•Aj �.i-- PROJECT DESCRIPTION: /'gyp/AC E,yb-,) r 614R /N a--is T/Ai G— _3 13eE/4 . hb,4 . 1VA-5 ff f7 eo e/47 • exis r/t) ' D� �o�, /•'1 i 7_ Tit.v/e 70 06- /DADcfa,e . w/"Exz e s 4 z1 -4 /6- w,// / Sri 44, Igo w,) • iCtoeu /Item 50977( / 0 iL/S Ce 27 . �/�r li�� T ,! Z�?/$ !�Si• gu//U/4 /v.L .S 1 tL 5'`4, 7i' /leg .0/D S ys� .�,-` �., 717ce Ulbcicht&Assoolates Prlvats Sewage Consultants THIS POW SYSTEM SHALL 655 O'Neil Rd. INCORPORATE PER COMM. Hudson,Wls• 54016 83.44(2)c A PROPER ZABEL c 0 Z FILTER MODEL# 2 7 MP XS -Tr Pg . l INFILTRATOR SIZING WORKSHEET Pg . 2 SYSTEM PLOT PLAN Pg. 3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg. ') " .. .i .. Pg . 5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg . 6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG. 7 (OPTIONAL) PUMP PERFORMANCE SPECS. [� prsIGN The attached plans and specifications are based on "In-Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems . " (Version 2 . 0) SBD-1075-P(NO1/O1 . e tzl• • t BM. _ 11 k t), N .- ...1 -11„ ,,,,,-1 N- At r -- -(4. -6-`-1 -r- _Li\ . . i i v nail �� `� it - i -O p �� I . HHU 1 ,t . N 1(11111 . s Q nuun M _ I em Jun u t \i• s \ ?Fri min— 1) . .h 11111 — keel wl- Min o Xi II - 4. W(11 :' :\,‘t w L NtN . ,lb 1.6 1 Ni -11/ .* .1' y 3 J W � 1)1 y x 0 . ov/Z11 l eDpe P'o-y/0/14 j piPtcrisr 5&pt/'c T4 "t 95; /l ' I g\A CAK 1 � .1 M coMM. iV,11 PO\0 , s�POpsc IP���' N�, ��R r ,V .�N�o�P�p�P P QP ‘83 aa12.)c, * i 0�S oN .614 42-p- AuP"' 0 ( y I P/ U Cl h:Pries ' °� nH or ��ri sTi�1 . hil,,�, w J� D yam- pRy T. i3o1� ` � V 4 E L � : it l--O , o IS 4 F 3 8 wz�4 I iGT S 5►.4 I /6' i ly i 0 .--- - - Ilil P • it ----Lip �{� - I 0 s ysT /A' I \_34/r/A14)/1/1301/ gol7ni'-1 PENT I 0 V 01 101 1 1 i i ' ( p 5 • -___ 2& ______. 5 3 Io l i \ _�- I I I 1 II II ' fl ul ro I I t x I i --. I NOTE, NO ME4SaA34,6/4._ S/D�,.IS A<,POSS l' J' M ' J ' I sys �Z T t)�°t �f NoN tv M i_, I _I (.0Al"faOA" S ,f,7. 5° S 1,6-57Ez2 /3/ODr f7v5 ? TA9eA1 5y5-77A-/ SNowA) : feDIPSED a ` Fled AT/o.0 S j_ /✓ 647f4 9 - •So , A f0u r, �� sip/rs mil, 71)44 (i L S17 /`M A , ---- 1.11blihl b AsaxlateaU. tants -ki PtIviiiiSowe9e CO l C L 655 dson,Ws. 540 5'i 7 Alv' A) n fr al5r,wc of- der/ 1 ' 6" w P v — i_. , .z �P)& 1't 9 vt 'O T CA jd • P1 P�' ! i v� /NSeEtVOA" / ,'/,V. ,9_ '' )�( (/// Aia I r „ — 54 . 90 yR44f�L 17 N 3 5 && (/f /, fa iX11 a 4) ' 1.—Ilia c I •1II fiee/0 C J•T rir ,am _J —_, W > ma pig _ W rf101 / I Lk veL ,E34erD 7- -b S76TE-I �izv, q , . 5-0 (i A20 J J 3 E c T/o Of 7-43E-4)64(S is 2'5/ti6 /Nf/L7, 447--oe5 •ox /3ioDifrvs-El'S //1 T C4/>/1(/'71 '5 0e wt vpe xl // y OPEL , . 3 ' x G ,a Le.c>G.- Andlt 3/• / 5a, Fr T074 L /14i 5-e T%d.v • _ 1--1 ,� /9PP�'D0tl� UEti 7- CAS MIS/ECT/o v P/ /f// . i '' A/ 2 U( I i/// --- - -Z //N/SNED 40•0 5d. 90 I 1,4P -- 1 i 3•.s At' E if ////7X1ro/E' ,-7—lovc 1 „ l . -_ _- ---- — !-Re,ve-# ......i r. :.Mi... - •a—- am ■ah aaa ..:,— 4.4w Sri air Ng Iliatom W ari am ma 04 Wm: ass eat aic aifi►sac uc,r ,('/t.f' D T/C"& ,...r., S76 TFM PER PLUMBING PRODUCT APPROVAL 1CODES, ALL ABOVEGROUND PVC ..--- •`~' PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCH.40 PVC MEETING ASTM D1785 OR D2665 STANDARDS. ' Wisconsin Department of Commerce SOIL EVALUATION REPORT *Aston of Safely and Buildings Page/of In accordance with Comm 85,Wis. Adm. Code • •Attach complete site plan on paper not less than 8 1/2 x 11 inches In size.Plan must County sr L/P / include,but not limited to:vertical and horizontal reference point(BM).direction and percent slope,scale or dimensions,north arrow, and location and distance to nearest road. • Parcel I.D. 02 O - //yy—�0 0�Z� Please print all lnfonna(lon, by Da1e Personat Information you provide terry be used for secondary purposes(Privacy Lew,s 1504(1)(m)). `7f //ice ,: ///O Property Owner / l`^� I (/ y I— L Properly Location C p /4iiC/, H451VP Govt.Lot 5 . 1/4 A/ 1/4 S 1 7 T 27 N R// S.(or)W Property Owner's Mailing Address lot N Block S Subd.Name or CSMN y73 /plcCufe!rEoN 7212- S9 P/Wle bl'-iv EST -rEs City Slate Zip Code Phone Number (City Village ©Town Nearest Road yjj50 J I of 15Wei, I ( 7/S)399 '('9Sv f/voso,v cedEs r 1 Mc Co t�li.Qa.v [J New Construction Use:L . Residential/Number of bedrooms 3 Code derived design flow rate 5.Sol GPO Replacement ❑ Public or commercial-Describe:Parent material / /z-5 L 0 ' 4' 54,.✓Q)' 01//44 c( Flood Plain elevation it applicable It/.d- n. General comments I `Vl1 and recommendations! pe-R fv,• (e. (i0y 7444 £,C!'ST/ 6- syS'T-ets•t,, ; 5 iAJ CODE' P T / / �O.y li' .v Sp i' s �e C11141-, 4C 4�f% /.v 7:4t'T !//4- /3v/// fa4- 5ycr --,47 FO/? Fu *42 /2e ' 7e p2_ . Boring N /7•o p Et Pit Ground surface elev. / ft. Depth to limiting factor `0 in. Horizon Depth P Boundary Soli Application Rate P Dominant Color Redox Description Texture Structure Consistence Bounds Roots GPD/flz In. MunseM Qu.Sz. Cont.Color Gr. Sz.Sh. •Eff#1 •Eff#2 / 0 •if/ /0YR 7',/2- 5/L 2f5hk 4svife lw 3 f / S • 8 2- /y3g irbyRs/v sic. /fs,6k 4" a S /r` , - . 3 3 . !.>yR s/y ,► • s• — D r sj ee_e --- 0) (' z - ,ma's' 6--, /, r 9() l 1 q p-7 �Z7 12 I &xrlrlg N ❑ Boring Ground G ` / 7 7 l-,''Q, r ® pit surface elev. fl. Depth to limiting factor G In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots " G Non Rate In. MunseM Qu.Sz. Cont.Color Gr.Sz.Sh. 'Ertl EfMN2 / 0- 9 /OY/e 1/2-- s/L 2.fsh‹ -wi f/1 w 3+ . •g. 1- y./7 my, 3/4( s/1- /f 54 • 17`. iff w / rc . 2- . 3 3 /J• . /0 YR-s/y SiL /fshk /1=1 f,• q 5 /v74"• . z . 3 36' 5ty/2 ,4 5 ar s, - d,� c.5 _ . -7 I. Z 5 e-ye, 0 yR s'y . mil. _ -s 6, s Le - - . . 1. i 4- '/z s= 53.& V ,/ •Effluent 111 =BODr>30<220 m�l and SS>30< 150 mg& •Effluent 1/2=BODs<30 mg/and TSS<30 mpg. CST Name(Please Print) Signature CST Number ROl3ER T T.1�(3/?/'c.� T zeiL.644._ 2.2-Ce 31 S Address ' Dale Evaluation Conducted Telephone Number tllbricht&Associates AlA y /0 • .2oo Z 7/S•3PG . 43/OS Private Sewage-Ca ra"'5 655 O'Neil Rd. Hudson,Wis. 54016 ORIGINAL R. Ifil s4(1P 2 Properly Owner Parcel ID N Page d I 3 I Boring I ❑ Boring /_ 9 /� Pit Ground surface elev. 7 /lOOfl. Depth to Smiling factor In. Soli Application Rale Horizon Depth Dominant Color Redox Description Texture Shuchae Consistence Boundary Roots GPM' In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •EIINI •Effl2 / o.// /o)R Lit_ /L z-f shk. 414-fi J 3 .74. . S • k 2- //• 2.1- /ol//13/v Sic_ /.f w 5h,e- . t fi? _1 /7L . 2-- . 3 3 22.3/ , /D yje s/y 5/4 /7-51,e ,S 4.s /U7c . 2- . 3 9j.to 7.5Y4 y/� — .,a°• S. o, s d.e Cs. -- , -, r. Z 5 ./' Y,57r9/ . S. D, s d.Q - . . 7 r. z 4+ ‘ia?.6-/- SS--?Z% ?Liz I J Boring S< Li Boring,_. ❑ r'u Ground surface elev. ft. Depth to limiting factor In. Soil Application Rale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIII' In. Munger, Qu.Sz. Cont.Cola Gr.Sz.Sh. •Eff#1 •Eff/2 r BoringN 0 Boring ❑ PH Ground surface elev. It. Depth to Smiting factor In. Soil Application Rate : alorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Mu nseN Qu.Sz. Cont.Color SFs 6Eff11 •EIf#2 • • •Effluent NI =ROD,>30<220 mg/I.and TSS>30< 150 mg/I. •Effluent 12 a ROD,<30 mg&L end TSS<30 mall. ' The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in en alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. !elm,RINDre avrq ov.tu-f 9 eel ro f,/igvi 0 ppPF<4 sr 5e71f<' 7-4't 95-, /4. - I IA eAK 4J N4 qf� t1.0 D� 09 C P �8'9(0 '. (,) o M 41 2-, Ala' ' 3 ,s cam • , of �Xis7i�� . I ��S f/,y, w 0 i i3oT1oH yy. P 5,f, 0 \ , • y) 3 i 1 0 1 \1 ' 11' I '-I X/5I 06- 144 O s ysr 18' • 8 , 4 -ii M Iv. D� e� , PENT 3� __ I 5/P/4) G- V /pO. O I� I I O i ,1 \I 1 , P a • -______ 26 iS \\.,\ -------- k. VI II I sc.f/-e : / " _ .2 O ' ''-- I /o x I i "7E, NO ME4Satedete I s/opts Aeoeoss N f IA) /4 i_ I _I cot)71.06,,es Op • SvyyEs , /3;AD/1f1cLs TXew s/sr-&'Li 44roor 1 /A,6f7/34nR 9 � ,So �,pE,v <.�✓ s // s/11//s F 1 7,eGr at_ molt 6 Associates sunants �j A A 5 O'Neil Rd.�p1_ Si -1 /� 27, t� I.--. Hudson,`ins. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of?-- FILE INFORMATION SYSTEM SPECIFICATIONS Owner M/7T_1a A/ S G /J-X, Septic Tank Capacity /ODD gal 0 NA Permit i 17(0 —/ S Septic Tank Manufacturer Wie-3'E� 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer 2l.L53, --Z 0 NA Number of Bedrooms 3 0 NA _Effluent Filter Model 4 / ac)D 0 NA Number of Public Facility Units 0 NA Pump Tank Capacity gal 0 NA Estimated flow (average) _3C51-. gal/day Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1.5) / .SZ: gal/day Pump Manufacturer 0 NA Soil Application Rate 0. 7 gal/day/ft2 Pump Model 0 NA �ndard Influent/Effluent Quali!t y•) Monthly average Pretreatment Unit 0 NA 1ta4c-Q l-&-GreasT-T OG) 530 mg/L 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other: Pretreated ffluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemica ygen emend (BODs) 530 mg/L 0 In-Ground (gravity) 0 In-Ground (pressurized) Total Su ed Solids (TSS) 530 mg/L 0 NA 0 At-Grade 0 Mound Fecal liform (geome mean) 510' cfu/100m1 0 Drip-Line 0 Other: Maximum E luent Particle Size Ye in dia. ❑ NA Other: 0 NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency �M Inspect condition of tankls) ( �S At least once every: Z ❑ nth(s) ( aximum 3 years ❑ N M-Vearls) fOr Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volum 36N 1- ❑ my mum 3 yea 0 NA Inspect dispersal cell(s) At least once every: earls►nth(s) Ma Clean effluent filter At least once every: ❑ month(s) 0 NA earls) Inspect pump, pump controls & alarm At least once every: ❑ earlsl(s) 0 NA Y • ❑ month(s) 0 NA Flush laterals and pressure test At least once every: ❑ yearlsl Other: 0 month(s) 0 NA At least once every: 0 yearls) Other: 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may'impede the treatment process and/or damage the dispersal califs). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal califs) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the followin measures have been, or must be taken, to provide a code compliant replacemen ystem: ���5 6,1......i L ���J ��j�C�T ��/TZT /v/}J�Ay l rT C A suitable rfplacement 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 required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name e,3ET 7T ()LB2/C/� ? 37cName I Phone ,'S'L — 7/ r� Phone I SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 3-r�.IQe/ c �C.D... rUI/j i.k l C�T I Phone I Phone I 7/�— 3 p. , Ipr7(„ This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)d&lf) and 83.54111, (2) & (3), Wisconsin Administrative Code. i DOCUMENT NO. STATE BAR OF WISCONSIN FORE 1—IOQt TSSPCE """"mo TOR "a°°"°"" DATA '. WARRANTY DEED 439910 j_ a oK 818 i t_ 02 REGISTER'S REGISTER S OFFICE li - ST. CROIX Co., W( This Dept', mad. betwegn Reed for Record David S. Lentz and Janet R. 'Lentz, husband and wife as joint tenants I ,Illi 2$ 1988 I .. Grantor, ,� l sad M1to.he. , J. Haslup and Lynn M. Halverson ii at10:50 A „b ll ee ,.ee . Grantee, Rsparor of Deeds Witnesseth, That the said Grantor, for a valuable consideration David..AO...Janet Lentz - -- *Main TO conveys to Grantee the following described real estate in ..St....crvi..E County, State of Wisconsin: I • Lot 59, Park View Estates Second Addition Tax Parcel No:.._.......... to the Township of Hudson, St. Croix County, _ I Wisconsin. v Z� _//yy— 30 1 UU7 i FEB ;i •i ORIGINAL II This II homestead property. cis) (is not) Together with all and singular the hereditament* and appurtenances thereunto belonging; i And Da.Y.10..and Janet Lentz Iwarrants the: the title i. good, indefeasible in fee simple and free and clear of encumbrances except ;1 easements, restrictions and rights—of—way of record, if any. i 11Ili !I it and will warrant and defend the same. i II Dated this 88° ,µ day of July . t! '1 Q {Ii II t ...,� `�' �— 'SEAL) ji(SEAL) , David S. Lentz eJ t R. Lentz i II (SEAL) (SEAL) q I ii I AUTHENTICATION ACKNOWLEDGMENT i S ,e(a) .-- —' —' Io+43. STATE OF WISCONSIN atr.,....ri.r9.i]l County. /A I authenticated this ' dray of...V'' 1t........, 19`t Personally came before me p '�7 day of ✓�-1 0 oCe�,0k, (tt"AC 4"ed- raett., Jgly , 19 Rik the above named Il 'p 'r,s�,:,rt.(r/A ma'LGihlet.=.t David S. Lentz, Janet R. Lentz �, TITLE: MEMBER STATE BAR OF WISCONSIN ,i (If not, II authorized by 1706.0S. Wis. State.) to me known to be the person .3.... ... who executed the I foregoing instrument and acknowledge the same. THIS INSTRUMRNT WAS ORA/TCO SY Kristina Ogland Lundeen 11 Attorney at Law • Alice J. Fleischauer i, Notary Public St. Croix County, Wis. Ii (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(if not, state expiration 'I are not necessary.) date: ....June_11 , 19.89...) ;I *mans of pinion*alenIus I.any capacity should be typed „r printed h.I,.. their,len.tun.. WARMIITT DaiD STATE BAa OF WISCONSIN Wtenn.i.Lein Wank Ca lac rORM N. 1—usr Milwuhreb WY. S'T CROIX COUNTY • SEI'•TIC 'TANK MAINTENANCE AGREEMENT _-___. • AND , � / OWNERSHIP CERTIFICATION FORM • (r Owner/Buyer / / T ///454 vP 5g(a ' Mailing Address '7 3 /41C Gu f O.t) fU i2J'O, ) (cj/ 5 y 2/. Property Address ` )• /-1.� (Verification required from Planning Departm it for new construction) City/State /f12 �/ Parcel Identification Number d�� •l/yY 3 O •�� LEGAL DESCRIPTION ! / Properly Location '/., N '/,, Sec. / , T 2/ N-R /g W, Town of /711- (4 sr) Subdivision P/Ve V%tom 65rt7 5 , ;met 7f Qn/r , Lot Certified Survey Map II , Volume , Page II War anly Deed N Li 3 0 , Volume $2/1 , Page N 0 '2- • Spec house 1_1 yes l no Lot lines identifiable ) yes O no 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 tank every three years or sooner, if needed by a licensed pumper. What you put into the system can effect the function of the septic lank as a treatment stage in the waste disposal system. 11re property owner agrees to submit In SI. Croix 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)rifler inspection and pumping(if necessary),the septic tank is less then 1/3 full of sludge. , 1/we, the undersigned have read the shove 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,Slate of Wisconsin. Certification • staling that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of e threeeef year expiration dale. SIONA1URE or rrLI 'ANC DAIS OWNER CERTIFICATION • I (we) certify that all statements on this town are true to the best of my (our)knowledge. I (we) am (are)the owner(s)of the properly described above, by virtue of a warranty deed recorded in Register of Deeds Office. i% . Z.4.,,2—ee SIUNAIURE OF APPLICA �/ /C� C� DATE Any information that is nth-represented may result in the sanitary permit being revoked by the Zoning Department. �• Include wltlr this eppllcriflou: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • ORIGINAL • I I o 1.38 ACRES N Ts Z 1.30 ACRES 51°Z.1.. -vN,Qs `�'O 28.13 tO 09„WO•4 300.04' 296.12' co cgd1 ' N 89°52'40" W N 89°52'40" W N ;NEON ® ©` \5°27055„ d IE II 1 \ 3 '0 9" E k , .© o v� L is.. °o° �' \ \ 50 N 0 49 0 `�� ... 4 \ 1.36\ ACRES N 0Z 1.53 ACRES N 53 \ \ 0 • \ ° 103.17' 275.60' �b�-6 \ © N89°52'40' W 378.77' - T 030' R=20 V McCUTCHEON T:19 ,2 T=2008 to 1g 20 R=20` 10.E S89°52'40"E ,.� ° 4i 'ES a 197.23' .� ° Nt O �N0 0.- /0,, a . c) 6I6' ti a �0` 3 3 h 58 .o _ o - M t` es M 2 1.65 ACRES o h 59 a oo 3 0 1.60 ACRES 2 2 'lb N I?N CZ 0 WCC to N N 325.00' 275.00s $ N N AN 300.00' N 8 9°521 40 W 300.00' to 6 fi m 61 60 MATCH LINE — SHEET 2 :pect to Secs. 236.15, NOTE ALL LINEAL , MEASUREMENTS ' HAVE BEEN MADE TO Stots., and H 65 of THE NEAREST ONE HUNDREDTH OF A FOOT, ALL ANGULI 36.12 (6), wis. Stots. MEASUREMENTS HAVE BEEN MADE TO THE NEAREST TWENTY SECONDS AND COMPUTED TO THE VALUES SH fir 19.a A BUILDING SETBACK OF 100' FROM THE CENTERLINE C ESTABLISHED FOR ALL LOTS IN THIS SUBDIVISION. THIS PLAT CONTAINS 7437 ACRES, MORE OR LESS. elopment s9 ST: CROIX COUNTY ZONING OFFICE ORIGINAL CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that{�I have inspected the septic tank presently serving the LJ 11 4 1t4 'P residence located at: S� 1/4, NG 1/4, Sec . 11 , TZ? N, R "9 W, Town of /fUDSo.�J . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. L)50+0b1 ? 2 )2e ) Last time serviced a11aGt` O C Did flow back occur from absorption system? Yes No_( 1f no, skip ,. next line ) Approximate volume or length of time : M gallons /S minutes Capacity: /OD �� / Construction: Prefab Concrete Steel� ,/ A /4 Other Manufacurer ( if known) : /ii-S A" Ca ,-e co ' Age of Tank ( if known) : /d'/epac Zy 1/ 4-i- 5 X � - / ( Signature ) (Name ) Please Print (Title ) (License Number ) (Date ) Form to be completed by licensed plumber (s . 145 . 06, Wisconsin Statutes ) or Licensed Disposer ( NR 113 Wisconsin Administrative Code ) Plumber (applying for sanitary permit ) Certification : In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis . Adm. Code (except for inspection opening over outlet baffle ) . 15 Name T-2e/b�� (O signature 11P-/MPRS �� n 5/88 Ulbricht&Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 1.77 r ........ L \� N lik 1 N EG {0 Tom' .13 CO '_ �p 296.12' R� 0, 9'24 ' 300.04� 09�W • e ►� N 89°52'40�� W N 89°52�40�� W z Q ;HEOK ® © 502705�28 ,. 0 IE 11 \ \ - • w_ .•T O G Q W\ O - ' 09 E �, ® 50 N e 49 a �N • 1.53 ACRES °o ti N1.36 ACRES a Z a �, N 1 \ \\ \�0�103.17' 275.60' 4,� \\ Q N89°5240'W 378.77 R• y — T=1992' T=20�08 tO a. McCUTCHEON -_ 2 R=2o • S99°5240 E r . • t - � 197.23 °\,.4) 'ES 4/ o`ti� aj� 6t6 k p N p 3 i • M M O .Z _ m 3 ii M � 59 .41 �o m 1.65 gACRES o N 1.60 ACRES art a O N W Q'Z Z Z 1 N pp N 275.00, tto p a in cq 325.00 0' 300.00 N 69°52'40~ W '- •� 6 6' tmo 60 61 MATCH LINE — SHEET 2 - NOTE: ALL LINEAL MEASUREMENTS H HUNDREDTH OF HAVE BEEN ALMADE� :pest to Secs. 236.15, THE NEARESTBEEN MADE TO THE NEAREST Stats., and H 65 is MEASUREMENTS HAVE 36.12 (6), Wis. Scots TWENTY SECONDS AND COMPUTED TO THE VALUES a A BUILDING SETBACK OF 100' FROM THE CENTERLINE 19.70• ALL LOTS IN THIS SUBDIVISION. ' 0_ ESTABLISHED � MORE OR LES! ,.i THIS PLAT CONTAINS 7437 ACRES, elopeent .,) C j