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020-1165-65-000 (2)
•N1lisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety 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 Lindstrom, Da I Hudson, Town of ST BM Elev: Insp. BM Elev: BM Description: ion ~~. ~ G5T TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic fir; i n~ +~/ObC~ Dosing ^ i_ Wi Pfi~`~r~ ' `'@.~nJ y~, ~ Aeration 5.5 Fd- 5 Holding ~~ /~ /~~ +~~ TANK SETBACK INFORMATION TANK TO ~~ P/L WELL BLDG. Vent to Air Intake ROAD Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Friction Loss System TDH Ft Forcemam Dia. Dist, to Well SOIL A6SORPTION SYSTEM county: St. Croix Sanitary Permit No: 488Q33 0 State Plan ID No: Parcel Tax No: 020-1165-65-000 Section/Town/Range/Map No: 17.29.19.1011 ELEVATION DATA STATION BS HI FS ELEV. Benchmark 3. $ ~ 03.5 / o~p Alt. BM F'v~ t!a,,~. ,3 • (v~J r! 9 ~ ~ Bldg. Sewer i~~` ^ SUHt Inlet 11 ~ V'~ SUHt Outlet q.3y 9~. // Inlet ~y~ a~ ~ ~~s 9y• 05 Dt$ettem- F; ~~ R . 5.0 g, f b ' Header/Manb`~ q ~~~5 ~j 3.9 Dist. Pipe ei ~~ ~b • io.y5 cj 3 . l S3. cs5 Bot. System ~~ ~ 9Z. ~ Final Grade II II T~ ~ 9 StCover~`~ 3,b5 `j9.8S BED/TRENCH DIMENSIONS Width ~ J Length i CI O No. Of Trenches Z ~e~G~ PiT IME4 NSIONS `~-_ No. Of Pit- Inside Dia. Liquid Depth "~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~~ ~ ~ TION M CHAMBER OR ~~ INFOR A TyGO.n.Jst2.~'rra~e~... 3b J 57' J~'~ 7,JU / A t ~V UNIT Model Number. ~ J` G~ t ~~ DISTRIBUTION SYSTEM 17 ~-(/ = ~S `t` v'a~"a..x~ Header/Manifold J / / Distribution ~ x Hole Size x Hole Spacing z Vent to v In e 3r r ~ ~ ~ Pipe(s) ~_ t- ~ -~-__ ` , ' Dia Length Length Dia Spacing G R(111 C(~VFR ., os~~.•.e c.,~•e..,~ nnr., vY Mn~~nrl nr Ot.Arada Systems Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center / ` Q' (Q (G.~~ Bed/Trench Edges Topsoil \ ~s No ~ ~ Yes ~, No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 940 Mike Circle Hudson, WI 54016 (NW 1/4 SE 1/4 17 T29N R19W) Park View Estates IV Lot 94 Parcel No: 17.29.19.1011 1.) Alt BM Description = ~,,~ ~ CoJ~ C~ t .~.- ~..,pe~5 p ~~ 2.) Bldg sewer length = ~~ ~S ~X~ bQ't -amount of cover = C GX~Sa"i~ Plan revision Required? ?, Yes y~+' l~ Use other side for additional information. SBD-6710 (R.3/97) o 1Z zZ lea Date ~ _. _ _ _ I ___-_ - T -- __ ~~~ ~~ Cert. No. ''! vsm. B ----r- ~ Safety and Buildings Division County ~~ ~. 202 W. Washington Avc., P.t). Box 7162 ~ns~~ Madison WI 53707 7 r~ ~ 5~~~ C , 162 , j De t Sanitary Permit Number (to be filled in by Co.) par ment of Commerce ~ (b(}8) 266-31 ~ ~ Sanitary Permit Applicatia State Plan I.D. Num ~ f In accord with Comm 83.21, Wls. Adm. Code, personal information y pro a "-'-'--, ' may be used for seconda ry purposes Privacy Law, s15.CW(1}(m) Project Address (if different than mailing address) I, Application Information -Please Print All Informs ~ ~ Sam.. ~ 9y1~ /~~~ C; _ PI roperty Owner's h"a me fly ~ y,~ ~ D ~ ~ . ~ ar L t l ~j(f~ ~•~"j'Z c~-Y ~ ~ ° ~~ o Block q ~ ~~ ~ Property net's M ailing Address [~ E ~ Z `~ Z O (~ ~ l ~ roperty Location ~, // ~' ,(J I ~~ ~ ~y./1 G p~ ~ ~ City, State Zip Cade Plto N `ti,Section " '~~ f" ~~ ~ ~~G ~ II T f B ~ ~~~ ~ ~ -- Z~ ` (circ[ea ~ ~~~~ R ~ E T N . ype o uilding (check all that apply) ; or ,~i or 2 Family Dwelling -Number of Bedrooms ,,,~ ~ --- Subdivision Name CSM number ~ L~ PubliclCommercial -Describe tJse _ __Ti __~~ ' _~ I r _ ~~~~'G ~ ~ ~ 1 ---`- :_! State Owned - Bescribe Use ~ ~',•~.1~ ~ _~ ~ t5 ~ r ~~ I ~ _ ~City_(JVillage,l~°Township of~/-~,~,~jA~ 'III. Type of Permit: (Check only one box on line A, Complete line B if applicable) ~~ - ~~~5~( 5 _ Ld0 f - A. - I few System f Replacement System ~ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B. i ~ ^ Penni[ Renewal ^ Permit Revision ~ Befort Expiration L~ Change of Q Permit Transfer to New Plumber Owner Ltst Previous Permit Number and Date Issue~ / (~ /„ b ~ ~ 31~~$ H `C~ IV. ' of POWTS Svstem: (Check all that ap lyp ') Non -Pressurize In-Ground ^ Mound > 24 in. of suitable sail ~ Mound < 24 in. of suitable soil ^ At-Grade LJ Single Pass Sand Filter Constructed Wetland ~ Pressurized In-Ground ~~ Holding Tank [i Peat Filter ^ Aerobic ~^ Recirculating Synthetic Media Filterachin Chamber i G P Treatment Unit ^ Recirculating Sand Filter ^ g t ne rav s ipe V, Dispersal/Treatmetti Area Informations ~ ~~~r~-j,~-~„s ~ Design Flow (gpd) Design Soil Application Rare(gpd Dispersal A Other (explain} ~T -- rea Propas S stem Elevation ~ - ~ y C < <f~d 7 / ~ ~i/3 / ~ ~ ~~ ~ J . e.~a ~ ~ ~'I. Tank Into Capaciey in Total Number `` Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Uttits i Concrete ~ Constructed i Glass New Ex?sting ~ ~ ~ - ^ /~ Tanks TaN[s - h/ ~-• i i / i / Septic or Holding Tank ~ ~~,` A ~ ~~; ~ /GA's t ` ,~e a ~ Aerobic 7rea[ment Uni[ -- Dosing Chamber ~ r - ~ -- f VIL Responsibility Statement- I, thb iindersigtted, assume responsibility for ' Ration of the POWTS shaven on the attached plans. Plumber's Na me (Print} Plumber's Si gnaaire P PRS Number Business Phone Number ~,v~~%Q'-?.k .3ali w ~w ,[ ~e~- ~,t~<,.-~..1 ~7 Q~0 X1.5 ^ 3~G - 9121 ' ~' Plumber s Addre ss (Street, City, State, 'Lip Cade) ~ ~~ -~ VII Count /De rtment Use Only - A roved l pp ~ trrv i R Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ ~ ~~~ 1 Dat Issu d Issui Agent S na r mps} lZ OS ven eason for enial ~. ~,onattrans or Approval~l{easons Cot llisappraa~ai SYSTEM OWNER: 1. Septic tank, effluent finer and disc ?rsal cell must all b~ ttervict+s ! maw as ~.> management plan provided by.pktmba. 2. All setback ragtdrerrtents rrNMt ba trtakttairted as per appN011b1~ COd! / ol*<iralnoas. (/ A plans {to the County oily) rot the system on paper aot less than 8112 x 11 inches in size SBD-5398 (R. 01/031 ~ ~' ,~ ~ iL~f~^~ rn 2 o'I" 9,~ ~~ Y ~ /~ ~' e CiJ ~s ~"" ~u-~.~c~.,rJ f~ij? ~o2fF~~ ~/rSdo;'au D'D'B. .~ ~, 0 ~~ ~ ~ °~ s ~;~ti ~~~ ~ ~~ ~~~ C~~Y r~.Y~ ~ ,~ . ~~,~sf~~ ~ z o ~ 9y ,~~ Yy G~,~G ~ ,~~ r ~~-d~a..~ Sc etiL•~- l `~ Y4 ~ f.~~l ~~1'fFt~ a~s/o~•,u~a. ° .~ 0 ~y ~ ~ ~ ~~~~ ~ a ~,~ ~ ~~--~~ ~~~ Wisconsin Department of Commerce SOiL EVAL A REPORT Page ~ of DNiaion ~ Safety and Buildings ' ' in accordance with Comm 85, Wis. m. ~Y Attach complete site plan on paper not less then 8112 x 11 Inches in size. Plan ust ~ '' J uxauoe, ous rla nmrceo w: verocal ana nonzonlal r percentslope, scale or dimensions, north arrow, a ~ loca~ta~t*, ea ~ N ~ 6J Parcel I.D. OZd - //(05 ~ E' S - OOd Please print all in rmaBon. Reel by Date Personal illformedon you provide maY tw wed for .04 (1 ))• !Z `~ ~ Property Owner roperty lion 'Ct.r ~ i~-l'~c_' ~ ~'• ~ \ST.CROIX000 .L 114 1/4 S T N R E(ar)W P Owner's Mailing Address Lot # Block # Subd. Name or CSM# City fate p Phone N ^ City ^ irtlage QTown Nearest Road (~ New Constructlon Use: ~ Residential / Number of bedrooms ~~ Code derived desiipl flow rate ~ G o GPD ^ Replacement ^ PubNc or commercial - Descrtbe: `__. _ ~^ Parent material Ou-J-i.,~ f/<,~ ~ ~j~„~ Flood PI~arM elevatial If appAcable .L~/ !~- ft. General oornrrrerlis SY .57 e v~ 2 (~ u . /11 ". YI . ~ ~ • ~ ~b ~~C w ~~c~x end recommendations: _ t ~+ Boring # ~ ~~ Ground surface elev. %S~ ft. Depth to limitlrlg factor rZ ~ " in. . sod Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots (n. Munseq Qu. Sz. Cora. Cobr Gr. Sz Sh. •Eff#1 •Eff#2 4 / // ( 1 ..., ~I ~~ # ^ Being Pit Ground surface elev. ~C~. O ft. Depth b limiting factor ~ ~ 'r•-~ in. Soil Rate Horimn Depth Oomirlant Redox Description Texture Stnxxure Consistence Boundary Roots GP D/fP In. MunseH Qu. Sz. Cont. Color Gr. Sz. Sh. •EtT#1 'ER#2 J . . r( it CIrRRt<n R 1 ~ DW ~ JV ~ LCV 11191E ano 1 DJ ~3V ~ 7.7V rrl9ll. - GIIIVeIn rFL : DW ~ .7V mglt af1G 1.~ ~ A! mgrL CST Nerve (Please Prim Signahue CST Nurrlber Address z- Date Evaluation Conducted Telephone Number llt'~ ~' AYE" -~~. ~'~v 1~~rlioa ~~, ti/~;, 5~/U/~ //- l ~- -O,j 7/S- 71.~G' - c~Z.~S' ProP~Y Owr~ar L~'ru~. S ~~rv w~ ParcellD ~ ~ Page Z of ~~ -+ . ~ ^ ~9 ~ ®Pit Ground surface elev. jG6 d . tt." ~ Depth to krt~idng factor % L ~ in. SoR fcatlon fiats tiaimn Oepfh Dominant Redox Description Texture Stnxfixe Consistence Boundary Roots GP DflP M. MunseQ Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 L, ~ Jam,. , ~l '.. ~~ ~.. ? ~~ S>k i '_r _ c...~~' r- + , G~ ` /' ~/ ~i ^ Pit Ground surface elev. R Depth to limiting facror M• Soil Rafe ~~ ~ ^ ~~ Horizon Deptl- Dominant Redox Dascx~da- Texture Structure Consistence Boundary Roots GP DMF in. Mussed Du. Sz Cont. Color Gr. Sz Sh. 'Etf#1 'Etfll2 Q ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to dmiting factor ln. Sod Rata Horimn Depth Dort~ant Redox Description. Teuton Stnxxure Corrsister>w Boundary Roots G M. Munseq t2u. Sz CoM. Color Gr. Sz Sh. 'Efi#1 'Eff/E2 ' Effluent *1 = BOD, > 30 < 220 rrgrt. and TSS >30 <_ 1SO mglL ' EAluerrt #2 = BODs ^ 30 rrgA. and TSS ~ 30 mglL Tlu Department of Commerce is an squat opportuaity service provider and employer. If you need assistance to access services or seed material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. aw~u3etasroot ply p~ ~~"r1G~-S,~.r +~-~ Parce4~D Ai ~.. Page Z._ of ~ ~g # ^ Boring f Pit Groundsurfaceelev. /~6- d' R '' oeptt, b drt taaor f L ~ in. soi! ir~tion ante Horiaon Depth Dominant ftedox D~afption Tex4rre Stnxsure Cor~istence Boundary Rohs GP O/IF in. Muru<ell Qu. Sz. Corti. Color , Gr. Sz. Sh. 'Efii11 •f8f#2 ~ ~, _~~ _ ~z -~ ~. I ~ i~MS~~c'~ ~ ~-~'~- _-. ~ ~~ ~ ~~ Z ~ ,- -- ' ~, ~.. ~, s~l~. ~ ~- ~. _ a , .-, e~ ~~ I ~9 # O ~~ ^ Pit Ground surface elev. ft. Dspth to Nmiting factor in. SoA Rate Horizon Depth Dominant Cd Redox Oesoriptian Terctuna Structure Consistence Boundary Roots GPOVff in. Mutrsep (lu. Sz. Cont. Cdor Gr. Sz. Sh. 'Etf#1 { 'EfFfl2 Q BorG~g ~ ^ ~~ ^ Pit Ground surface elev. ft. Depth to Limiting factor in. Soil Rate Horizon Depth Dominant Redox Description. Texdire Stnxsure Corrsbtence Boundary Roots GP D/fle &r. Murrsell {2u. Sz. Cont. Color Gr. Sz. Sh. 'EfFtl1 'Efffk2 • PafAuent S1 ~ BtJD6 > 30: 220 RIgIL and TSS >30 <_ 150 IrIgIL ' Etlkrerrt #2 ; BODE: 30 rr1gA. and TSS <_ 30 m9n- The Department of Commerce is an equal opportunity service provider and employe. If you need assistance to access services or creed material in as alternate format, Please contact the department at 608-266-3151 or TTY 608-2648777. i r :~1 PAC3E ~_OF~ NAME ~~rlJ~S~`raw~ LOT# LEGAL DESCRIPTION,~G~(i~/a~~/a,S f~--T ~,N,R ~ 9E(OR~ r SCALE: 1" _ ~~ BM 'I ELEVATION ~~, 0 BM 1 DESCRIPTION~~.-~yV1 ~j.~ s,~~'n.U BM 2 ELEVATION BM 2 DESCRIP710N '~ SYSTEM ELEVATION ~nh~ll ~00 ~tc.~.3 l~r~ SYSTEM TYPE c0/tU~/l:-R'~~'~~ ~. ~. U ~~,.2 r"t I,Z ~.. /~ `+ 6 ~~ q 9 ~' V U ~~.! ,~ SIGNATURE y~~_.w.~...__._~~_....~;"`~~~ DATE / j-- / ~ - c3 ST, CROIX COUNTY SEPTTC TANK MAINTENANCE AGi2EEIvIENT AND OWNERSHIP CERTiFICA:fION FURI'~I Crwner/Buyer _ ~Q.,-• S/~ _ _ -~7 Mailing Address _~~d mil,- `~-~- ~ ,` ~'C ,~ -e. Property Address ,S~ ~ -~ _____`_._ .__T_A ____ _ (Verification required from Planning 8c Zoning Department far new construction.) City/State Pareel Identification Ntunber ~',~~ - l1Gzs.3`=- ~S~-ddd~ LEGAL DESCRIPTION Property Location ~'/a , ~'/4 ,Sec. _~, T r1 ~! N R _~W, Town of ~~~s~.v ____ Subdivision / ~~~ ~ /~,' e ~ ,~S' ~~ ,Lot # ~~ Certified Survey Map # Volume __ ,Page # Warranty Deed # _.~,.~~~ 3,5~ ,Volume ~l ~ __, Page # _ ~ Spec house yes no Lot Lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic taral: every three years or sooner, if needed, by a licensed puanper. What you put into the system can affect the function of the septic tank as a treatment stage to the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.5(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Platuting & 'Coning Departrent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1}the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary}, the septic tank is less than 1l'3 full of sludge. I%we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 3fl days of the three year expiration date. I/we certify that all statements an this foam are true to the best of my/our knowledge. Ilwe arn/are the owners} of the property described above, by virnie of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 ' ~ ~ ' SIG. ATURE OF APPLICANT(S) %~ /%Z/ o DATE ***Any information that is nusrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08!05) - FILE INFOI;tMAT10N Owner Permit # DESIGN PARAMETERS POWYS OWNER'S MANUAL & MANAGEMENT PLAN Page of Number of Bedrooms ~? DNA Number of Public Facility Units ^ NA Estimated flow {average) ~$-d al/da Desig+i flow {peak), {Estimated x 1.5} ~"0 gailda Soil Application Rate allda /ft~ Standard influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/l Biochemical Oxygen Remand {6005} 5220 mg/L d NA Total Suspended Solids (TSS) 5150 mgil Pretreated Effluent Quality Monthly average Bloch®mical Oxygen Demand {BADS) 530 mgdl. Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Conform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y$ in die. ^ NA Other. ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Q'~ Q al Q NA Septic Tank Manufacturer ~'C ~' DNA Effluent Filter Manufacturer (j ~ ^ NA Effluent Filter Model ~ i/'rJ O NA Pump Tank Capacity aI DNA Pump Tank Manufacturer ~ sey ^ NA Pump Manufacturer ~,~~, ~, ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ SandiGravet Filter O Mechanical Aeration ^ D+sinfection O Peat Filter ^ Wet{and O Other: ^ NA Dispersal Cell{s} ^ In-Ground (gravity) Q At-Grade ^ Drip-line O NA D in-Ground {pressurized( D Mound ^ Other: other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Fr®quency tnspect'condition of tank{s} At least once every: ~ ®~Ssj{s) IMaximum 3 years} ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third {Y3} of tank volume ^ NA Ins ect dispersal celllsl At least once every: monthisi {Maximum 3 years) ~ NA Clean effluent filter At least once every: month(s) ear{s} p Nq D monthls} ^ NA inspect pump, pump controls & alarm At least once every: •-- p year{sl !=lush laterals and ressure test P At least once every: ~ D month{s1 "" D ear{s) ^ NA other: At least once every: ^ month{s) Q Year{s} ^ NA Other: ^ NA MA(NTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foNowing 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 Isaks, measure the volume of combined sludge and scum and to check far any back up or ponding of effluent on the ground surface. The dispersal coll{sl shall be visually inspected to check the effluent levels in the observation pipes and to check for any pond'ing of effluent on the ground surface. 'The ponding of efflue+~t on the ground surface may indicate a failing condition and requires the immediate notificatian of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys} or mare of the tank volume. the entire contents of the tank shall be removed by a Septage Servicing Operatar and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. AI! 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 i o days of compleCwn of any service event. Page of " -~- START UP AND OPERATION For new construction, prior to use of the POWTS check treatment rankle) for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cell(s). 1f high concentrations are detected have the contents of the tank(s3 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 wiq be discharged to the dispersal cell{s) in one large dose, overloading the cell{s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a 5eptage Servicing Operator prior to restoring power to the effluent pump or contact a P{umber 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 veils. 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 pumpl 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 ail tanks and pits shah be removed and properly disposed of 6y 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 soli, gravel or another inert sol'~d material. CONTINQENCY PLAN 1f the POWTS fails and cannot be repaired the following measures fiave been, or-must brf taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilised 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 tines and wells. Failure to protect the replacement area will result in the need for a new sail 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. ~~ ^ r s' e d site e tank ^ 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. < <WARNINO> > 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 Name ~~~fl~~cc s~~ s.~~1~ Phone 7 l _ ~ _ ~ ~ POWTS iMA1NTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~-, CCs` K COJ Phone 7/5 ~(o ~ ~' This document was drafted in compliance with chapter Comm 83.2212}Ib1t111d)&If) and 83.5411}. (2} & t3}, Wisconsin Administrative Code. Page of START UP ANO oPERATwN For new construction, prior to use of the POWTS check treatment rankle} for the presence of painting products or other chemicals that may ip-pedb the treatment process and/or damage the dispersal cellis}. If high concentrations are detected liaue the contents of the tankls? removed by a septaQe servioing operator prior to use. System. start up shalt not occur when soli 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 wilt be discharged to the dispersal cells} in one large dose, overloading the celiis} and rraay 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 Ftumbar 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, Oo not drive or park oust, or otherwise disturb or compact, the area within / 5 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. ASANDONMEN7 When the POWTS fails and/or is permanently Laken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 133.33, Wisconsin Administrative Coda: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of aN tanks and pits shag be removed and property disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pits shall be excavated and removed or their covers removed and the void space fisted with soil, gravel or another inert solid material. CC1NTlNQENCY PLAN tf the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: Q A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, tot tines and wails. Failure to protect the replacement area will result in the need for a new soli 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. 9arring advances in PQWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ ^ s' e site e tank ^ 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. < <WARNINi3> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL QASSES ANDIOR INSUfFiCIENT OXYGEN. DU 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 SE DIFFICULT OR fMPOSSIt3LE. ADDlTIONAI COMMENTS POWTS INSTALLER (Name l / i ' /l. ~ G( w-~ a.~7~G~ Y~ Phone 7 ~ _ ~ _ ~ ~ POWTS MAINTAINER Hama Phone SEPTAGE SERVICING OPERATOR (PUMPER} LOCAL REQULATORY AUTHORITY Name Phone Name ~-, ~.Co: sC t~o~ ~ 2,n~n Phone 7J5 - ~'(o - ~ $" this document was dratted in compliance with chapter Comm 83.22t2)lb)t1lldf&lf) and 83.5411), l2) & f3), Wiaco~sin Adrninisirative Code. .~ ~~ ~~ uic 4~ STANDARD CHAMBER Quick4 Standard Chamber ~~_-, ~; ~ - , ~ ~- ~~~ - _ ~; 'y= l l / I~ ~ ~ ~ i t 2" i ~:' I -~ ~ 4 ~~ - L,~ L ~"""~1 SIDE VIEW FRONT VIEW ~~l~Ii'i x ~~ i yr - a ~ I T ~ ~ F R QuICk4 Standard t;hamber Nominal Specifications' ~~~Y,~Mnltipprtk'nd~~ • Size W x L xH) ~ ~ 34" x SZ" x~ 2"~ Size ~W X'C'x~Hi Effective Length 48" invert Height invert Heiyhi g" MultiPort End Cap INFILTRATOR~YSTEMS INC ~NDARD UMIT~j~ WARRANjY (' lFe , t'u[.lu al i to tnly tit eeClr rhamber, enU plat@, wa[ig0 anti other ac ~esSOf {mar [r 1[ IunX1 by Inlillralcx 1 `Urllls'!. wtlen installed alNt ofxu&@d 1 3If aL Mlatl of an C nsM1e Srlplic system In an(pfdarlOH with INYIrat01'S i ,;, ut.llerlu, i4 Wdrranled 10 U'' 1 OriC~lal pumAlaa& l"I'IOklnl ,I aga!rtsl de!@CirvO ' te.r~+r--. anG w xkm. -snip lo, one yua fran th@ dafe lilal 4w septic psnnii r5 r5s[roa I[x U,a :;ppli[: Sfitern cOMaYxnl,f R!p Ura?s. provided, hAwovar. Ir 1 1'~ uaptic nerm t '4 nJl regUlred by eppNCaote 4a W, the warranty pentxJ WA (IOgir' Upon 1110 dale Intl it lslalialinn 0: Ifx, RBpI!o s`/S!e!n Co:l,rnBnGPS. rq rxern:.a iR wana•rty -'glu5 How nwst nollry IntYVatCr ar wrd"u-"J at it9 OaP(Nate HBerkll,.uMr; ur 6hJ Saybrook, CAxIrYX:11GW wilnnt Hlte@n {t5) CR~yo %Jl Ir,e p!leypd CJCI@['1, h111Jlraklr will gUPp!y nyplanam@n1 Units for I)Olfs Dntemlln0(1 by InUiIraRN to be nWfxod by' tells Limllad WJUraolY. IntiUr?ta5lia0iliry sppcilical!y excludas lh@ cost of rernovai arxYOr ingtaNatnm of Ne Units. ii..; 1HF ufvJITED WARRANTY AND REMEDIES IN SOHPARAGRAPri ,ai ARE EXCLUSIVE 1?'~FRF ARC tJ00t}IER WARRAfJ 11ES WITH RESPECT TV LHF UNI fS INIa 1A71tti3 NO IMPL1£D WARRAM;IkS OF MER(:i~ HIH4JT'1BILITY DR f ITW ~ i c3R A FART!i::1LAFi F'URPOSl3. R j lh', I mtiterJ Wa rer ly ,h:,it h[ void it any part of the cnan i~er cyst^r . - ne~nu(a[2ured ny ."ryon~r othar tirap InlNhnlor. Tlfb Limited Warranty does r i c I nd I inr!dc ~tnl, cGnsttiryuon:ml, srecgl or urdnec; darnagee_ :nfk ata shay rwl be IlaLia Iw pc. taifus a 5qukla:ed Damages, including loss of G7l..ti:x. and rxoNls, 41bor and maledals, overhand LOSlS.. Or olhar los es or expans@s xtruued ty Iho Bolder or eny lnhCf party S(xx;ilicaky n.ci„ne,7 Inxn Lim!lai Wa.raNy cuvoraya are [:arnaga ro Iha I}rigs due to [xdinary wear and roar, .'rltardliar, a[:cidaa, misuse, alxxs@ or riegleck of I!~e Unns', rho Unxs Ireiny sub!ocre[I lc w;h"]re IraRrc or alher .;anfkUOns which a@not parmitlM by the inataAation etslnrctials; failure to man Gain the minimum ground -~r,vars set luln'ul the instanRtwn Instructiu"s. 1ny pncnmont W improper malenals ird0 the sysf@m caVaining Iho Units; failure of mp dens or 0,9 septoG :YSt@m aro in improp@i s{tirlg or hnproper RitVng, enc@as!ve water usage. Ingxurer graase dlRpnsol, or knprcK>cr pperatbn: or .any nthur Bvenl not cau:;etl ,~y In`tllrala. 'rhls E;mxa[; iA'aranry small i,e v[,io ;f th@ Holder tails In comply with 4: M tn@ to/R44 set todh in lhls L:rnNpn wanany. Furth@r; ui nc avenl Bhafl Irti'tlaior he rasponyjtl@ to any los8 Ur damage to ti1B HO]dn[ ihp Llnits. or arty Ihln7 {early r@srdlnrg Iroin NlsSaf1811L^rl or shlp- riwnh or pom any ,xodud UaCJ,4ty rlaxns of Helder a ar'y tNrd Parry. Fp itds Limitetl 1Nanarxy to alrfry, the Unns must be hmaNed it accordenco [Mire all site nxhiNurr, required by stole and oral cod@5; all other apPtiWbls laws; and Irdi(lralnr ;9 inslatlation V1sin;CliUnS. iicy No repr@SerAati+a of 9nii4rator !~,as the autlxtdlY to chanyo or extel>;t this l,i;ni;Cr(I Warnnuy No wanany applies to arty party other Nran ".he ai7f- iral 'riold@r. Thn aWva rppre o tt the $~andard L~milen WareniV hPSm'd by !nfilUUlUr. A lirn0.ed Turn ber o} s!a1PS and Gounlr@s have oiltereni w;urpniy requae- n~@nts. Arty Pu U psa of I,ira5 thxyAtl axdarl In}iltnft[x's l'.grporat@ Huatlyuprlers ;n Gld yixrxd., CAnrxiotiwi, tenor tU woh purctuJSU, b Obtain a col;y of teen applicabM wa'ranly and shoulD carefully mad that wanalxy prior to the purG•a;e ul Units. SIDE VIEW TOP VIEW xi6"x12' 8'' or 1.25" '~ i' SYSTEMS !NG ErtWronnrerrta! Onsite Wastewater Safuilorrs'" 6 Business Park Raad • PO. f:3ox 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-221-4436 u t~. Patents. 4,753,6Et; S,GJ 7,(1x1; 5.756,488; 5a36At 7; 5,a0t,1 fE; ,5,401.454) 5,51 f,JOS; 5.776,;63: 5,588,778; 5,838,844 Canadlar, Patents'. 7,32g,rJ5U; 2,DOA,56A Other patents pandiny. InfidratCr. Equalizer and Sidewinder are rei~istered lrada3marK5 U7 In7ilirator Syslelyls tor,. lrrfnlrilor is a IcxJistered 4rariemark in France. Infiltrator Systems Inc. is a rdgisiered iradel-nal'k ut Mexi;q. Contolx. Gontour Swivel Connection, M,ic,oLtJJx:hing, PclyTufl, SnatiL.a:k, Charnb©rSPacer. PdsiLock, GluickCut, c~lJickPlay anq Oui~k4 are trademarks cl lnfiliratOr Sti'$tem6lnc. ®400ii +nklirator Systems htc. prinlod u, U.S.A. RECYCLED PAPER nnr "onoun n SECTION VIEW t ; t .Aa.fll~ ~ I . ~ r « ~+. i `~" ~\ ~~ --° ~ __ t `~ f~~ {{ ~ i~ jj 1 1 f. 4G~S ~ 1 ' ~~~~Q~ 1 ~ '~ ~. ~. ~ ~ ~ i, I CJ ~ 6f3 i @ ~g s~ ~ f'~t, W .W - - - +~~ ~~y - - - - - - - k8~ DOCUMENT NO. - ~• 43'7835 ~ . WARRANTY DEED TNI• a~ACa Ra~awvso ros eecowolwo owts STATE AR OF WISCONSIN FORi~it S<-lYSa; ,...,.. _ _-_~ --* e~ox 812. e~.f 1~~ --~ -==y~ .REGISTER'S OFFICE ` ~~ ST, CR41X CO., WI ,~ .... Ssm .) ...1!'li~lhx.,.. ~. single .man ... ~ Rsic'd for Record ::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::~ ::::::::::::::::::::::::::: ~~ MAY S ~ 188 ........................................................ a~ io:oo n conve s nd warra 4 o a. .., ~~9_.~. Ka~1rS!Il, Ar.......... ':' _.... wi a as survivor^~ii13" Lirlc~atran ~iuabin~ f"" ~ "~ / M ........................c.................................................................:...................... 1 L , i ..._.marital.~ .......................... ~ ~p~ ;, ..... ...... ................................................. ~ 1 '; __. _ _ _~_ _A______,_~~. ................................................................................................................. 11 ........................................................_....................................... ...... ~~' wiTUwN 70 ~! .. ....... ....................................................................................................... l the following described real estate in ...Stc..~~ .........County, ........................ State of Wisconsin: Ta: Parcel No :.............................. ;' - IAt 94, Parkview Estates Fourth Pddition tD the Zbwn of Hudson. ~ 1'RA g ~ FEE is not This .................•-•--..---. homestead property. (is) (ia not) Exception to warranties: ~If~Qi WI'PH and SLIBJECP TO ally Other e3-SP~[teI1tS, COR7endrltS, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recordE~cl enc~amrances beyond the term established by ?aw ar. Date t Is ........................~7tt1......---....... day of ..l!'~y...:............-..:... -- ...----•-•--........-- ----•--•--• 19.. 88 . ~G~ .....:.................................t_...........................(SEAL) ~~..`.~ .......................................~--•---•--........_.._.......{SEAL) a AVTHBNTICATION .. .:- ..--•---~ ........ ............•----.......-•---(SEAL) Same E. Miller --- ----•-- -- ------- - --•-•---...----..........--• ---..-.(SEAL) authenticated this .._.__._day ot ........................... 19._..__ TITLE: MEMBER STATE BAR OF WISCCNSIN (If not, ...._..---°---------------°-----------------......._.. authorized by ~ 706.06. Wis. Stats.) -~-- THIS INSTRUMENT WAa DRARTED BY . Hugh F. C-vin, (tin & Grin 430 Second St.,_Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACRNOWLBDdMSNT ~.,, . , . STATE OF WISCONSIN ~. V ~' ~ ~ , 'sa. ~ ~ •'• '- .....,St....CLC11X---------°---County.•~ ? - / Personally came before me tbie::_ ~ may of ~ ~ "",,~ ~----.. _.~dLOy..~+A_.~.L~.~.~'..__,_19.R4n;T~,..,~,~„v~named to me known to be the person __._......_. who executed the foregoi~ng/instrument andyy~~a:know dge he same. ------ -..1...:~ ~ .-~ ......................... '...._.._.._Marlene..M,._P~Lexson.: ..................•---•-_-- Notary Public ....___.5.t.'...C.x_.O .................County, Wis. My Commission is permanent. (If not, state expiration c7N p' ncn p ~ v nl -~ °' ° ~ ^~ : ° ° 3 5 m a c ~ A m . c ~ `° m ~ ~ ro 3 .a ~ v -o ~ i ~ v v fD •'• -a m st ~ '-° ~ ~ g -~ 2 ~N O -' ~ (n TJ Z N o a r = J O N irn ~ ~ ~. ~ O m O C a C a ~ Z o j~ a :~ o 1 ~ - N~ is ~ { Q m ~ ~" p w `~ ~ !n ~ ~ N N N ((II~ N (D ~ ~ ~ cD UOi 4 cn ~ ~D ~ _ (`.~ N ~ ~. ~7 ~ -~ p ~ ~ IQ o ~ ~ o a ~ i ~ ? ~ f ~ i~ ~ C ~ ~ o y N ~ N N O O d <D N ~ d N O ~ N a n m D ~ a a ~ a ~ C ~p C C a N N W N` C N ` N N N n N '< cp cD ° '~ o o c C7 r to N ~ O ~ N N ~ N ~ .O^. 0- O ~ .. ~ CJ1 ~C ~ Al ~ ~ ~ O O O O (~ iii. ~ ~ ~ _ O) n ~ ~ ~ ~ ? O .O ~ N U1 N c ~ ~ V1 Ul O ~ i -o vq 3 g ~ vv o~ ~ m _ _ o ~ d i ~ 3 d _ y ~ O - __ v y 7 .. pj ~ 3 .. tD N D ~ o D o ~ ~ io a~ ~ . ~~ 13 I~ ~ ~ ~ _ 3 ~ ~ ~ ~ ~ j~ (p fD N v ~ m ~ N fJ ~ ~ ~~ ~ ~ !;~ I~ o- 5 ~ ~ ~ 4 ~~ ~ ~ ~ a ~ ~_ -~ ~ u, ~ rn c ~ n J ~ 'o. ~ a as z o N ~ ~ ~ ~ ~ V O. ~, C 1 ~ Z 0 3 0 3 a ~ o ^' 9 o 3 cn m ~ ~ tll N ~ ~ ~ .d A (.J W N (i fD D D ~ m n n m ~ ~ ~ ~ ~ _ S ~ _ T ~ _ T N N C ~,. N C O Z ~ a I o 3 a ~, ~ CD N ~ N f7 CD ~_ fD ~~ ~ (~ O O ~ O ~~ O N O O Q- _. ZILZ AND ESTREEN ATTORNEYS AT LAW C OO pal 621 SECOND STREET POST OFFICE BOX 359 HUDSON, WI 54016 TELEPHONE (715) 386-5103 (715) 386-8482 FAX (715) 386-6560 DOUGLAS R. ZILZ DAVID J. ESTREEN KRISTINA OGLAND of counsel November 15, 1993 Ms. Marlene Schmidt First Federal Savings Bank LaCrosse-Madison 20Z So. Second Hudson, WI 54016 RE: Daryl D. Lindstrom Dear Ms. Schmidt: Pursuant to your request, I have examined the abstract of title to the following described property: Lot 94, Park View Estates Fourth Addition to the Town of Hudson. St. Croix County, Wisconsin. Abstract of title number RV1529 contains 44 and has been continued to November 9, 1993, at 8:00 A.M. It is my opinion, based on examination of the abstract of title, that as of said continuation date and hour, marketable title to the above-described property i~ vested in Daryl D. Lindstrom and Kathryn A. Lindstrom, husband and wife. There is presently one mortgage currently encumbering the property. Mortgage to First Federal Savings Bank LaCrosse- Madison, in the amount of $69,700.00, dated June 30, 1992, recorded July 6, 1992, in Vol. 958, page 214, as Doc. No. 485547. The abstractor's certificate indicates that there are no judgments, filed construction liens, lis pendens, Federal tax liens, delinquent income taxes or delinquent real estate taxes affecting the herein described property. November 15, 1993 Page 2 Neither the abstract nor this opinion purport to cover: a. The rights or claims of tenants or other persons who might be in possession of the premises or some part thereof under unrecorded instruments or by adverse possession. b. Unrecorded easements created by adverse use. c. Limitations imposed by zoning or other ordinances or laws. d. Unpaid special assessments for improvements to the property. e. Unpaid water bills or sewer service charges. f. Statutory construction liens, if any, accrued but not filed. I agree to indemnify you and your successors in interest in the mortgage opined hereto, to the full extent of any loss attributable to a breach of my duty to exercise reasonable care and skill in the examination of the title and the giving of this opinion. I further certify that I am an attorney licensed to practice law in the jurisdiction in which the mortgaged premises is located and that I am insured against malpractice with respect to the rendering of opinions of title in an amount commonly prevailing in such jurisdiction, taking into account the volume of such opinions rendered by me as such attorney. If you have any questions regarding this opinion, please feel free to contact me. The ab tr ~of title is enclosed herewith. R s eC u , ~ ~ ~ ~ ---- I streen Attorney at Law DJE:mec Enclosures ~ ~ ~ ~ d o 7J n ~ ~ O~t ~' z H ~- ~~ ~ o H R'+ W ~ ay O ~ ~° O H t-' x rn ~ a a z N ~ n r 3 j H to z ro a cn H O D D D `" z ~ m'~°i C1 Z n F-' 6 1 R' ~ ~ n z m to°~N ~ W O Q ~ e> w J -~ ~ .~ ~ • m ~ p ~ c m 'D D ~ n ~ ~~~ ' z ~ n ~ r y ~ y .~~N ~ ~.~ Z rn 2 m O ~. ~ y O a .~ cn g m O r ~ .'a p 'n { - C31 -~ r $ sum ' ~ ~mi x~nc~ cl-~ox c~oCth O~H~~C z~~cr H~~~ H t+] Cn (Z ~ to ~ x cn r o~Ct-I I-~ tai 7~ Z rnrt~C~ O O m "'~ ~ O n ~ c ~ ~ ~ m O c ~ a 'n a~~o = ~ 'Q ~ ~ a ~ N ~ N .•r W t1 W W t-+ D 'o OD ~, d -_ .s ~ ~ ik n lD N O N J N N • O W N I ~ l9 t-' ~ ~ ~o cry i t-i 61 O Cfi ~ i ~ o 0 0 f Form - S T C - 104 . ~ ~- AS BUILT SANITARY SYSTEM REPORT OWNER S4 /j'7 ~i~/~~r TOWNSHIP /°/4 ~~SO .7 SEC. ~ 7 T ~~N-R ~ I W ADDRESS ~~ ~~ ~®1C # Z 8~ Z_.ST. CROIX COUNTY, WISCONSIN ~ ~~Q / (~, SUBDIVISION~R/,~ .~.~4cccJ ~SI®'f~/V LOT ~ / ~ LOT SIZE ~~ ~ ~ ~~~/3 PLAN VIEW Distances and dimensions to meet requirements of IZIiR $3 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~.~-`~ ~ ~` _ q ~.~. L ~ ~ ~O0-0e _ r Sc° le \~Y ^ ~v /~ , 5 C rG'~ C'D~ K~5 /~~ d \ i 9cr D(~ ~a~'o'y 2 ~X Z-I __---- N,ws~, 3 a~x~~~ ~,~il 7o SS• ~s ',-_--- - - o'---- - - ~y,- - - - ~ r SL 3g /r N a soul ~ ~ ~-~ ~ i ~~. -----__ ~_ INDICATE NORTH ARROW it BENCHMARK: Describe the vertical reference point used ~ ~ot,A~%~~ S~ w, ~/~/dr ,~/ Elevation of vertical reference point : ~~~ ~ ~ { 7 ~ Proposed slope at site: ~~ ~/ ~ ;~ .~ -- -, ~; f ~ ~ ~ ,_ ' ~_~~ ~ PUMP CHAMBER ~ ~, ~ ~ ~~ ~ Manufacturer:- ~~' Liquid Capacity: 4 Pump Model: Pump/Siphon Manufacturer: Pump Size F Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : ~n y~N~i ors ~ l Trench: Width: /$ Length: 3 ~ Number of Lines: ~ Area Built:~Rx-x----; ., Fill depth to top of pipe: ~{ Z i Number of feet from nearest property line: Front, O Side, O Rear,(/ Ft.~ ~ ~ ~1/ Number of feet from well: i Number of feet from building: 3 7 (Include distances on plot plan). `jS~~~ SEEPAGE PIT ~ y'S '~S ~1 ~!. Z ~' 8 o ifo Y» Size: ~ Number of pits: Diameter: Liquid depth: Area Built: Bottom of seepage pit elevation: Has either a drop box ~ 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, ~Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: DEF94FYt'rgENT OF INDUSTRY, ~ INSPECTION REPORT FOR LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 MADISON, WI 53707 NW~,SEt4,S17,T29N-R19W CONVENTIONAL ^ALTERNATIVE Town of Hudson ^ Holding Tank ^ In-Ground Pressure ^ Mound Lot 94 1'arkview Estates IV SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan LD. Number. Ilf assigned) NAME OF PERMIT HOLDER: Sam Mi11er ADDRESS OF PERMIT MOLDER: Route 1, Box 282, Hudson, WI 54016 INSPECTION DATE: '~ Ov" ~i~-r~s S~ BENCH MARK (Permanent reference pon d DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.'. County: Sanitary Permit Number: Croix St 106051 Doug Strohbeen 5432 . r.,~,.,r_.,rr.~ r MANUFACTURER. W (,~ LIQUID CAPACIT V'. ~ Cr[~v TANK IN ET ELEV.. ~ ~ TANK OUTLET ELEV.. ~ /~~ //`~/ WARNING LABEL P~DED YES ^NO LOCKING COVER PROVIDED ^YES NO BEDDING. VENT DIA.: VENT MATL.: HIGH WATER NUMBER F ROAD : PROPERTY WELL: BUILDING. VENT TO FRESH AIR INLET p~ ~ ~ ~ ALARM. FEET FROM V' ~ ~ V LINE w ~`w fL / / 5 /` / ~ ~' ^YES LO1N0 ^YES NO NEAREST DOSING CHAMBER: MANUF ACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF AC TIIR ER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ^YES ^NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) vr.. ..r. s •v...+ " WIDTH' , LENG 7H. NO. OF DISTR. PIPE SPACING COVER INSIUE DIA ttpITS LIQUID BED/TRENCH DIMENSIONS . TRENCHES ._ ~ ~ MAr,~R L: PIT DEPTH GRAVEL DEPTH FILL DEPTH UIST H. P DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPE RTV WELL BUILDING VENT TO FRESH BELOW PIPES . ~ - ABOVE COVER. ELEV INLET ELEV END. " r ~ 2 7 PIPESP ~ FEET FROM LIN~ C S 7 ~ ~ AIR INLET Z ~ 3S 9 . ~ ? . NEAREST- -- J ~~r~ 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 PERMANENT MARKERS OBSERVATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TR ENCHIBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH UISiR. PIPE UIS TH18U ilON PIPE ELEV.'. ELEV.: DIA.. ELEV.' PIPES DIA.'. ELEVATION' AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CC INFORMATION PLAn15 ^YES ^NO ^YES COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. NUMBER OF PROPERTY FEET FROM a"E: ^YES ^NO ^YES ^NO NEAREST ~.L ~ ~ ~ ~ y ~' ~ - ~~,~2,- 3~ Sketch System on Retain in County file for audit. Reverse Side. SIGNATURE. ~' ~~ TITLE Zoning Adm. DILHR SBD 6710 IR.01/82) ~ - _ K ^NO D SANITARY PERMIT APPLICATION uN co ~T'Y ~ DILHR I Code Adm Wis rd with ILHR 83 05 ~ ] ~' • ~~ . . , . n acco ....,..,....o,.. ~ IT RY~PERMIT# SA/N ST T/E~ A. ~ ~ ~ L ~ UC.~W~ -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 ^ Y ®NO 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. ES FOR VARIANCE PROPERTY OWNER PROPERTY LOCATION r'' j,~/'/a ,~. %a, S T , N, R / E (or PROPER WNER MAILING ADDRESS LOT NUMBER BLO K NUMBER BDIVISION NAME CITY, ST TE ZIP CODE G PHONE NUMBER Z ~ ~ ITY NEAREST ROAD, LAKE OR LANDMARK ^ VILLAGE : ~dsQ~ t Cdr II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family - ~ OR ^ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. ~ New b. ^ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an 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/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) , 1. a. Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP I n-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ^ See a e Trench c. ^ See a e Pit 2. PER OLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): ~~ PROPOSED. (`Square Feet): `l ~~•~ Private ^Joint ^Public Feet VI. TANK CAPACITY in allons Total # of N me f t ' M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks anu urer s a ac Concrete structed glass App Tanks Tanks Se tic Tank or Holdin Tank / ^ ^ ^ 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) MP/MPRSW No.: , . ~ ~ Business Phone Number: r k6earn ~~~ ~ S ` %. ~`'~.~~ 2 3 3 Plumbe s Address (Street, City, State Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name ~ Gti /' o CST # / C T's ADD ESS (Street, City, State, Z Code) , . m ~./..~ Phone Numberxx v~~/~ IX. COUNTY/DEPARTMENT USE ONLY Approved ^ Disapproved ^ Owner Given Initial S Hilary Permit Fee / Groundwater harge Fee ate Issuing Agent Signature (No Stamps) //~ ~ /~U ~ ] "" ~ ~~ [h~'1 ~ " ~ Adverse Determination ~ . /t - X. COMMENTS/REASONS FOR DISAPPROVAL: ~ C ~ f~~V ~ ~~ lrnc.~~ ~,~.e.i•, k ~ ~S 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. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 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. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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 all 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.g. 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'h X 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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. ~ - 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 of steady negotiation and public debate. The groundwater bill Groundv~a#er - included the creation of surcharges (fees) for a number of regulated practices which Wiscor~,irt's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption ~ o system or the disposal site used by your holding tank pumper. 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- 1 water, groundwater contamination investigations and establishment of standards. Groundwater, ~. it's worth protecting. SBD-6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC- 100 Thin 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. Omer of Property ~4 sy! ~~ ~~~/ Location of Property ~~6,~~~, Section , T .,.2'I' N-R /~,~ Township _~tr!/~O !'1 . nailing Address /~~ ~ ~ ~OX'~ Z~~Z._ ~4 r1 So s~ ~/ i Address of Site ~ ~~ U i cc ~ ~S~7~S~ ~~ s ~~~/ c~° ~ Subdivision game /mow r ~ yi ~Lrc~ ~` .S ~.e ~O' 3 . Lot Number ~ 9y Previous Owner of Property ~/rt ~ Gyar~ Total Size of Parcel /~ 03 ~L¢ /S _ Date Parcel wee Created G -/ y ' b~ . Are all corners and lot lines identifiable? X Yea No Is this property being developed for resale (spec house) ? -~ Yes No Voluse s and Page Number / Z as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY O(VNER CERTiFTCaT10N i (tVe l ceh.ti.6 y that a.Q~ bZatementd on ~h,i~s onm cute hue .ta the be~s.t o 6 my (oun) knowledge; zha-t I (we) am (alc.e) the owne~c(~~ 06 the pnopenty de~schi.bed ~.n .th.ia -f.nl~01If11Q.t~COn ~O/uf1_ hu viht-~o nL n u~n~.hn~,.t,i .I.,..,! MnwwM.J...I .._. 1.-__ .tiir__ _i ~~__ i 1, ' A~ A~±S1Cf~ ~ _1TE~31N .THE ;~'A-~_~4 ~ t~iW1k~S^c t~+, ;~G77C;V !7, T29N. , R19 tN , s C'r!d!'V Ct~ fit[, aT. ~~tX ~'.~QUN~"Y~ ,~1~~Gf~'~3N `crstY272CATL' or ^'o"MZ•7 TRTr4SIJ1tIR s:azs or ~zsccrss>•r) ~. 1, BevrzlyA. Solsaaoe..A.rtayl tlta adq elocird, qua.tiifad`aad aetirig Town Tsaaruzas of il+a Town of Hudroq, do Asesp+t ctsztity t+~at Irt seeosdaaea s rda in mg oiile•, these u+ tw unpaid taxes ar ryroistl arrnsrrsteata as oi'^y,~~~~~ ~" oa ang LttnB inatr+ird to th• :'Its of $zk V3o+w~ Yatstao Fourth 9ddttioa. ~r~~d~ g . .+ohns o~spaorer T01r!1 BOARD Rs,SOLL:TLON Ite.SOLY]<D, t'•at the PIa2 ~ Psak Yie~. Estates ~'austh Addition in the Town oC Hudson, P.arral ~, 'N art aad 13eve A, tV rrt, c:wnex!+, 3r hereby npprov¢d by the 'Toe.n Jvt~:d i rr 1~_ r. iY f.'aia ryozovpedlL own zman ~ D ignxd 'own t,nairman {/„I a aarebv a artiiv that thr foregoing :a a espy of .. r¢svl cation adopt cad by the Town I)oazd of iha Town of F[udron. fr :/ , ~ ~ ~ , r, Ddte ~/ •L)•-~:-_ Town Giark OWNIA3+ Gr`RTZrIC,AT'E OF DEDICATION. As ewnera, we hnrebg trrtifg that we caused the land described nn this PlaO to be su.-vs lad, ?;•.~3ad, r..apa2d SttE dodt~ated as repravnnted an this Plat.. Wo ~+Iao certify twat t`.is Flat is required by S, 23b.10 or 5. 230, 12 to be submitted to th¢ foStowing for spprowsl or obj¢ction: Dspasttneot c.f Dovelopsaant lie wtrtmrnt of Indurtzy, Labor and I'{uman Ralatio•tr, Town of t{tsdron, City oS Hndron and St, Croix County. ~+;: ^tES,S the luxl Arad real o! raid owners t1ilr,./- 't day of _.~~~ ,~ /''r`-• ,~ -Darrel ~ CrY ~ `-"-~ ~` ~ rt ' Aevezly ~+. W rr4 STA?E OF WISCO~iSIN) 53 • ST, CROIX COU'Y'fY ) Pnrsenxlly cams before me thin ° day of // :t.. / ~ •• _ the above taraad Dartel E, `Nest ind Beverly A, W erL, to me known to be the pnrscna who executed the foregoing instrument nad aoknowiedgnd the rime. Notary Publlc:S,_'~~,t• '~,~4r wiseonrin My commirrton expires G~y'~/BT S~tar~Rrec/~ h, 1Tota~ iblie ~CERTZFLCATE OF TOWN CLERK.. -~.3'TATE OF WISCONSIN) ST: CROlX COUNTY ) I, Aita ;sores, being the duty :ppointsd, gttalitiad and acting Town Clerk of the Town o! ;t;+dson, do hersbj'c~tily that copse of this Ptat wets forwz:•ded r.r srquired'ty .a, 23b, 12 on tha~day ot~z~ 198, And shat within the 20.8ay titnit set ry s, 233:12 (3) tno ob)ecti ne to the plait have been Ciltd) fail ~hj«c1.<+n7 to •h.n diet have bete met), r i/ Date Rit Horne, Town Clerk ' ~Y!7~~t~Hil '~,~ v ' -~-ms,y...t . ,~Jo . ~ r.' .~ , - a ~- r r ... -. 1 _ .. ~ i I I .~.~~~~'~ ~~TIFZCkTS': 1. ~4_=~f Lt4eQi~. lte83ete~rad Wtaeoauia I..aatd 9~rYYeyOY, hexsby crrtlfy to the bfet of t>yy' pzolsfsiovsl krsasl.dge, twdezettadan; and t,altaf: atbat t brags rasvfywd. disidod sad mapped Park V3e+. Estates <Faurth Addition,. locat•rl b-tha NS1/i fir tba SW it'l and the *i`?Yttp4 of th• SE1l~ t1t 3ectl.aa 17. T24N, R 19Y, Tovs.aS EiaAson. 9t, Crfi:c Coaety~ Wiacaaein: Tbat I hsw n3ade loch euarsy~ iasd diirinion sad plat by t!e diao~ctioe of IIazzsl £. 7fszt aarYH•wezSlr.R. t><ozt. a~sttszs of said land, dssuibsd a^ [ellf~t: Coeaircmaeia~ as.thf St/4 tsozaes of acid Section ]7; theees• S89~dua78'^N (aasamed bffria8s za[esfae+d :a the ttwaumraded tSR3'f :t £S'I I /• Sfetios Ilaf si.' 3eetioa l T, beesif~:saaavaad 339-?rttCi•'N} {zfaozdsi se 31iSs'ZI140"At oa flat Csrtift•+d Swtrrey llar scot:,tat to Y~ l; Pats tSb). 1312.9 abet; aald F.A37-W L' T" 1}.t ~ttoa lines ~ ~ s' ' " s t x ~312,30 eheoeo30 f0'! 40 : theaef, Oi tF.237.t3 tgtbf pwiei oL be~minR: thftrc• Ns>tSt NO'OLs30"L II2,tIQi is th. Swui•:lY ziiM-oi.+nr 1J.af o! Gr«e 1~[ii~ Lees: thooc+r %d39-S2egC'N 6L,QCs aloetg said riitk!•ol~r-sy liaa: eheate• SO°Odi110"'ip 253,.~A1; !bane. ~ S79"36LSZ!'41. 19•i.35s; ihroaa ga9'1St14"W x3&.73it; ebsaes :V?S'37tOS"M :i?..17t; theeee _ I ~ ~ 314q"s'Stt4'"if S3d,.80a;:t9eree i~itT06i30"£ 10i.t)01.1 tbssas Say-15s14" rd-3t~J.AOs; ehenes . ~ xtl°!vt3of1zs3§,oas:thesco Ssi's3tld"M +66,oltt theaasso'ob'sti"7i~ 3I6„a3~; eh.atf . sb9•istl~~+a;1sl,rlo~; th.~f xm37t3I•'s ~a, lay; ttt..~f sa9'txto9»w itr..',~Ot; thence. ~> 2db.~r; t~afes Di89'I311{"8 154,0~01:.lhamt Stttiis30"M:321L971; fleece ', N09'!lSsL~L"= 1SO.QQ~i-thanes 3oa3Lr-stasiy b6.25= alAUa~~ thsl sza-ot s:3it3.~1)s radiu.t cusw'<wttease-Northeset•rijr wheer chard baars'.34'SOsSQ"F 66.77s; thteca `tE~7'iS111'•E u7,6dtyilMo~s Sotztheaaterly_136.Sbt aloaQ the arc of a 3L7.CQ~ radius evr~~e eooeavs :~matbftstfsiiyy irhoea-chard bears 824 U3=d2"E 13'.S,Sit; thence 8>~23t30"'.L" 1~]. 141: s ~ ihauties H'1P'33 ' p"1:' tb0,%~; thwres N69~13'14"EZ43.00+; thattef SO'06130"N~ t0it,00t; tbetses ~33!36t30^![ 239.161; tttfoee Soutb+astfziT 96.141 aion= t[rf sec of a 217.00' i " ' t tb ; Lhettc• E 4S.3E sfrti~f:evtsaseneave IlartIIe[atarlp olifas attosd t>sfie 373 03 NJp!' .'~~'~ 9ZO.ti9r; theses ttertheiatfssy 91.21R' along the ara'of a 300..gc1t radius • t:+aa:wtara+ttro Nortlta•sesrly wnofe alwzd baarf ti80'3214f1"1w 40.35 tbs+ml- North. vreetarlp~ 91'4St a1o tlu era of a 30.00' rsr}fua ¢tesrf eanefre AToztkeaM+esly rhoso c1wz~E-irenis ~7'3'fdib"79 41.09r: thaasf NO"Obt3A"ly' iSO.e4': LMencf IiA9'lSrl4N-~ 47s,03*t ttwttro piG`04t30"]C ti,34,55t to.ttw point of h•giattit+g, T'Ta~.stcat- p~ift if a eazzeoe rapnesorsttatiaa at sU the exterior boundlcaiaa of this latttd pe+.rroyrad's+ud ttto anbdi+ieiof thereat made. and ZDee 2 0ia+f 1ett717 foraylisd with fire psovition+ of t:bapter l36 of th• 1'.liseofela Stattrtos~ ta-f SoDdi+islen anel Zoair•g Itagulatiat~a of St, Crcla Coatnty. LSe : awo of 1?rtlfaa 9ahdirtelorc CtraSuaaae+. ae3 tAe G'ST ~t Hvdwa f.+~tbdiwlelan ands'iatrins S?s.ii- nrettofr ft1 farreyillg. eitvleSfsd snd mapping the e3ttu, 9 t7atfd talc i~} day of M~w-t 198q R~vlfwt 1 13th da o! April, 1984. '~ `~ t ~~ ~"trtes 11:, ~ifrt:h - ~~.~. ~ t, pct. des ffic:aud Stro•t qt- .. -trt liadfop, 6laaconain 5441b S tip ti COUDCiT TRICASUtl1EA1S G£1iTIFiCATT • 'f 1 ~~ "` 87ATE 04 YdtSCQSl 5.3 1, ~'+"Y Saes Livoxs»orf~ being duly. elesteA, qualified and ae:ing Tsrt-surer of St,. Cso6s CaautY~ de horobp certify that the rfomrde in my ofAef chow tie unrfd•emed tau aa3es sad ao nupaid ta,~tas fz epscial aaseoemeote as o! /.t- 3/' ~~ afifet#ws taro 4tada taalteded is tttf Plat at Paark Viser L+'etales Fatxth Addtion, ,~~,~ ~) .. _ _ natf inky Treasures ?.dM.NG Gt?23E.iIT',I's•:F., bts::-3D1.UTI+Jpd This past is hereby approved by the St. Croix Gounly Comprxhr.nyivn Park ' , ?'anoing and Zoning Cur:imitt~e. F .,. , ~ ~ _ .~~ ~ ! __.__--_ ~ _.. Jatr G1~3:~ rb 44_ ''~ _ _..~~.r~Pr_~._.-- ~• AdmtaietratOY t y~ 4 ~..r .it.$~S~L~1 S a'~.;~ . ~ : SXAI !11 IlY, i A STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S~rlj j~f'~~~ld~ D~- ROUTE/BOX NUMBER` ~~ ~p~~Z"yZ--~ Fire Number ~-•~ CITY/STATE ~14`/Jo/7 ~~ ZIP ~7 ~!7 ~L PROPERTY LOCATION:~'~, ~~, Section, T~N, R ~~ W Town of ~lr!/.Sori - St . Croix County, Subdivision~j,,~~l~~~~4~- Lot number_1~• Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St. Croix.County residents m_ay. a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receives a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County 7.oning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior [o 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 'l.oning Office within 30 days of the three year expiration date. St. Croix County Zoning Office P.0. Box 9$ SIGNED G' ~~ DATE 3 r ~ ~ - H z H a r r a H H 0 z d 9 H ra H 0 E z x H b Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AN D INDUSTRY, LABOR AND PERCOLATION TESTS (115) HUMAN RELATIONS ' (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION:s ~ ~/ ~/ SE TIONr ~ /T~9 N/R19t TOWNSHIP/ ~ d LOT NO.: BLK. NO.: - SUBDIVISION NAME: ~ , ~ u to ~ K p , COUNTY:. C/ i ~ OWNER'S BUYER'S NAME: .MAILING ADDRESS: +~ J/ ~/ ~Y~/~ ~ c` ~ ~' `t~Ld 5~ / 'f ro . c . / er oc~ ~ USE DATES 065ERVATIVNS MAUt NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PER OLATIO TESTS: Residence ~ ~ / ~ew ^ Replace I G~ ~~ ~r r/~ ~~~ ~ d /y Sd. / ~A~ ~r .~'/n Q 1 4 R~TW(:eS=Sitseuita6lafnrcvcfam. 11=Sifauncuita6la fnrcvctam .~/ ~p K•..~~~d4.1T .~dil~1/ ~VA'/y '--'--'--- - ------ CONVENTIONAL: QS ^U ---- ~--•-----. MOUND:: - ®S ^U - --- ----'---- --- - IN-GROUND-PRESSURE: ~S ^U •----- v r SYSTEM-IN-FILL HOLDING TANK: ~ S QU ^ $ ©U ~ - - - - -- RECOMMENDED SYSTEM:(optionaq C'o~ry~~:a~~/ ed f/~ `x 36 If Percolation Tests are NOT required . DESIGN RATE: It any portion of the tested area is in the under s,H63.09(5)(b), indicate: ~ Floodplain, indicate Floodplain elevation: PR~QFIL~E DESCRIPTIONS BORING TOTALS PTN TO GROUN DWATER- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHi?d'! ELEVATION .OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK) 6- ~' , (? ~ . ~ ~ ~i~ e- 7 .U ~ ~ O a'lS/, /.O ~, S~, . ~ ~~~ r S/~ ~ .2 BiT S~ B-.' ~" t (y ~ ~. 6 ~ /I~Gii/.rEi 7 ~~ ~, ~S . d , s .S:'S" r S g- PERCOLATION TESTS TEST DEPTHS WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1AMGL{,GS AFTER SWELLING INTERVAL-MIN. PERIOD ~ PERIOD 2 PERt D PER INCH P. r , Y~ d .~- ~ ~ ~ L ~ P- ~- Y 3' ~ Z. 6 L 3 P- ...3 / ' ~ oZ ~ L' -3 P-. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM -- •~ a fl ~, ,,,~- _, -. ~vf ~ o, SC.c ~+C. __ -'} D ` fi R~ ~~ ~ 1`~r - ~ ~ S2 ! - c ~- , , ~, Y ~ k SZ N1~~ o -,~ c C ~, ~~`~~ P 0 ~» ~, ~r ,i ~ ,~ ~ ~ ~ ~ ~ ~ s ~~ ~ ~ ~ ~ U1 '' a - '' ~-~, ,. ~- ~ ~ fi" ~ ~ r ~~'~ ~ ~ ~ ~~ ~ ~~~a~~ ~ ~~~~~ ~, ~ ~ . '' .~ t`e o~ s ~ ~ ~ ~ ~• ~` H Y N O • P ~ . P ~~ 6~ P P ~- P -a -v P ~: ~. .j~j, N~ i I t i ~~ ~{ ~i r~ I ~1 L. •1 -t _-C S~ -c ~~ _~ ~, In ` -f- P ~~P ~E '1 ~ ~ o G G Pr n 0 P ro -o~ . I ~ ~ ~~ ~~ ~~ ~ ~ C i J~ „~ ~ . ~~ ~ ~`~ va ~~s~: ~~ ,~ it .! •.y ~,~ ~~ ~~ ~ r _W. 4 5 d P r s ., ~ P - -, - - - . s s j .P ~ W. "n 6: ~ ~• ~ ~ ~ . P -d .o . . r . .~ :,~,. . ~ ; .: . . ~~f.; . ~ ~ . ~.~ ` ~. .I~• ':: ~.,~ NH 1 ~ '.. ,, 5 " , 1 ' ;4' wl. r J ~ .C ` . ~ ~ ~ . , t .. ~~ H L F .. - s p ..} ~ 0 . '~ - 3' , H ~1 o