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HomeMy WebLinkAbout020-1220-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety anti Building Division INSPECTION REPORT Sanitary Permit No: • 420394 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Haroldson, Tom I Hudson Township 020 - 1220 -10 -000 CST BM Elev: Insp. BM Elev: I BM Des: TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic % Benchmark , Dosing V Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet �• w a TANK SETBACK INFORMATION cif TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' TO ! I Zo r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe . A 16 4 1. I Holdin Bot. System jZ• t Final Grade PUMPISI HON INFORMATION C • tc Manufacture Demand St Cover GPM Model Numbe to �2,•O TDH Lift ri n Loss System Head TDH Ft r � ltd b • S'3 R2-oS" Forcemain ngth Dia. Dist. to Well r SOI B PTION SYSTEM .k RENCH dth Length �No.CiTrenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth i SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manuf cturer: INFORMATION Type Of System: t r CHAMBER OR i am .. 0 �C/ l' 3a 8 Model Numb .,, • D it ^ n DISTRIBUTION SYSTEM Nn�eK��Y6 Header /Manifgld Distribution x Hole Size Ix Hole Spacing nt to Air Intake G� Length �� Pipe(s) Dia Len Dia Spacing 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 Bed/Trench Center a Bed/Trench Edges Topsoil Yes No [� Yes No C M E S. (In lu code iscrepgncies, persons present, etc.) Inspection #1: l� Zc� Z- Inspection #2: �` T � Ac- �I��I �p•c�.. Location: 935 Sherman Road Hudson, WI 54016 (NW 1/4 SE 1/4 17 T29N R19W) Parkview Estates Lot 114 Parcel No: 17.29.19.12B 1.) Alt BM Description 2.) Bldg sewer length = amount of cover = 3� D�Sar�l'a,��•l Q`� �,,,., dr�JCi�•+ Plan revision Required? !': °:I Yes No 12 Use other side for additional information. ______ SBD -6710 (R.3/97) D S Insepctor's Signature Cart. No. 1 (19 Safety and Buildings Division County 201 W. Washington Ave. P.O. Box 7 • G O/' B 7162 7 /p N VIsconns li nn . Madison, Wl '53707 - 7162 Site Address Department of Commerce _Ly Z— 3 pp 3 5 Sff �M4,t7 RP Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21. Wis. Adm. Code, personal information you provide 3 y! G ma be used for second ses Ptivac Law Check it Revision p / 7 I. Application Information - Please Print All Information r'" " A d E State Pisn i.b. Numbe� / � operty Owner's Name 7 A Parcel ,lw / / o L 002 Parcel Number ' _ e r 10 Property Owner's ailingyAdy� Address 3 � i 7/4 �z; �� Property Location w ,VA) 56 17 I f City, State J Zip C Nu Cafe Phone mber u S T N, #() ' P1 R d/� // ,, p Lot .Num r `1�f Btock Number V 4 5 y0 lee 7 l S ' 3 O/ Subdivision Name 7 CSM Number II. Type of Building (check all that apply) 54 - 2 - 7 RI4i X-aleV 697-,+7-Er5 z �y 1 or 2 Family Dwelling - Number of Bedrooms / O `�' L- U Public /Commercial - Describe Use UVillage U State Owned 6Ggt_ I}Gt'S p �, �wnship t��0� Nearest III. Type of Permit: (C on Ine A (numbering scheme for internal use). • Complete line B if applicable) A • 1 U New Replacement Syste 3 U Replacement of 6 U Addition to For County toe S stem Task Existin S stem B U Check if Sanitary Permit Previously issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbe-ring scheme is for internal use) ZZ 44Non - Pressurized fn- Ground 2113 Mound /b d 4T U Sand Filter 30 U Constructed Weiland 22 U PreMItized In- Ground 41 (1 Ifolding Tahk 48 U Single Pass 510 Drip Une -v 45 U At -Grade 46 U 3 1-1 Aerobic Treatment Unit 49 U Recirculating 30 U Oth t V. Dis ersal /Treatment Area Information: Design Flow lg ), Rate(Gals. /bays /Sq. Dispersal Area / Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Y5-0 ,� Required ✓ Proposed Ft.) (Min./hteh) Elevation � / 3 � � _ / �/• /— � VI. Tnnk Info Capacity in Total Number MA acturet Gallons Gallons of Tanks / Prefab Site Steel Fiber Plaslic New Eaistln, r--, �'� Concrete Constructed Glass - Tanks s / C/L Septic nr Iloldtng Tank /b,v / G Dosing Chamber / ( —T W VII. Responsibility Statement- i th e undersigned respontlbWty for Installation of the PO shown on th attached plans. plumber's Name (Print) Plumber's Signature R- � �/ � / G ,� � .MP/N4PRS Number Business Phone Number. Ftumber's Address (Street, Cit State, Zip ode) /r 2 - - -L 37 S 715-. 3 A SS D'v�e�e- ) 2D• !''�"UpSo,t� 41/• S �o Vll Count /De artment Use Onl Apptoved U Disapproved ' Sanitar gPermi Fee (includes Groundwater Dat Issued Is sui t Signature (No Stamps) S711))- r a Fee U Owner Given Initial Adverse . l ' Determination d 3Q Gv U. Conditions of Approval/Reasons for Disapproval AF - praPosed syslt m e�etrct f� 4f e1cJV 1 a,4- skewer uHV be 4v A f � �a tai -fry skmw 3& N � � + F insl to ,Cl -� Rlv o� �, poSS/.b y 0 h ' �,� r► �t Sl n ds f hie_ 3l0 l�, try �tcz,�1 °I fly., • i-� Attach eomptete pia a the Covet t Inv h k net 1 Ila x It in ex e SB - 6398 =05�101) j7r l%�� �� / 'Msconsin Department of Commerce SOIL EVALUATION REPORT 3 ifvision of Safely and Bulldings Page of In accordance with Comm 85, Wis. Adm. Code /Mach cornplele site plan on paper not less than 8 1/2 x I 1 Inches In size. Plan must County - 5 r /�0�•� Inchrde, but not limited lo: vertical and horizontal reference point (BM), direction and Parcel �� •• percent slope, scale or dimensions norlh arrow, and tom ^r +�•� end . distance to nearest road 1.D, d Z Q . Please prinf all lntf, ,• eviewe by D Personal Information you provide may be used for seconds y rimposes (rove 15.04 (1) (m)). Property Owner ,-• It �� f roperly Localf Q / Q !oM �a��so� ovt. Lot NW 1/4 5 114 S/7 T "/ N R `7 Properly Owners Mailing Address �` 1m) W g scP 0 6 7007 k0l N Block !f Subd. Name or CSM# 1y enx lee �s�.�rES , ✓� �9DD� r<o.�. City State Zip Code Pho r AW s � 7 � 1 � ]City ❑ Village ® Town Nearest Road ❑ New Construction Use. Residential / Number of bedrooms Code derived design now tale b GPI) ❑ Public or commercial - Describe: Parent material Nyy 40 Flood Plain elevatlon If applicable General comments n• and recommendations: /`��� �.'`Vi4 /O�F'7�I o�v 47" 133 _ �X iSTi�G- f,¢i /i �v(•- S /5 f COf , 1 64! ;f % SDiIS ? ^4j ' /C 1,&'. /v r.4e T A/2 L_'_ Boring # Boring _1 �/� 3 ' Pit Ground surface elev. { b fl. Depth to limiting factor 76 in, Horizon b n. Dominant Color Redox bescriplion Texture Structure Consistence Boundary oots MGPD/fIl. pplication Rate In. Munseli ry Qu. Sz. Cont. Color Gr. Sz. Sh. • f'2 �O � y / E17#1 Eff#2 J m le 2 ,� • Z /a y 3/ SG /7c cs Z f . y YR k-0 Boring # Boring �� 7 Pit Ground surface elev. J ft , . Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots n"Ap SON lI2 Role In. Munseli ry fl Q11. Sz. Cont. Color Gr. Sz. Sh. •EtN►2 •/ 75 '/Y? — 77 7 �- o If Effluent 011 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 02 = BO < CST Name (Please Print mgn and TSS < 30 rnglL R © a g �,� ` % Signature CST Number Address Date • Date valuation Conducted Telephone Number &Associates v , 20 -1 a e L - 71S • 38% • R/gS Private Sewage Consu an s 655 O'Neil Rd. Hudson, Wis. 54016 Properly Owner Parcel ID p Page 21 01 1A Boring 0 ❑ Boring 7 (8 0 / Pit Ground surface elev. tl. Depth to limiting factor 'r1Z in. Soil placation Rate I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff* In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff1t1 •Efft12 / - 0- 5 ,r Yd 31l • 15 /aY,e Z S � • • Z M O • 5U Boring 0 El Boring , L 1 P11 Ground surface elev. II. Depth to limiting factor in. Soil Application Rate ttortzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/4: In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Effg1 'Effft2 r Boring ff ❑ Boring ❑ Pit Ground surface elev. ff. Depth to limiting factor in. S Horizon Depth Dominant Color Redox Description Texture Structure Consist - Boundary ots Still Application Rele In. Munsell h' GPD /1l' Ou. Sz. Cont. Color Gr. Sz. Sh. 'EtfA1 'EffA2 Effluent Of = 8OD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/t- and TSS < 30 mg/- T Uepartrnent of Commerce is an equal opportunity service provider end employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SRp -R)In {R Fftv!) A. I . O YO 1 NO- 3 ,Bepol • i y 2 y zm /�� • ' 3v' a����s T't � f c&E.v7f�') ai Cam -lo d \ i II � I g I I i it 1 Tor �F PE ur e:w i s yST�� SD /-Pa f2iO-o ---- -_ L© i • � J`J�J�� Ma mot/ �� ' O , 1(� U LoT L 34 ' /%v T,�c T AV) /A� f� f lop C�E� ?� 2�\ z� C'P • O Ifj;e CO.v�i T /O•v�i� � T ,1 , av�G7 9a.7s y _ 1L 1, . S T �a(r' g - - �x ? U 5. 15 w • ( 1 1 .� 1 I / 5 * �' ,. , -os I a. l T or of y Sys z s ys7e xf 7 0,50 l CZea_4 'fZ4A 4e SN p,�L ..�►� PAW Kc SY P� MQ ipl IBS � I Ut DHICH T & ASSOCIATES CO. 655 ONO ro • I Judson, Wl 54016 neg..Uesigners of Fngineering System; 7 15 -386 -8185 Private Sewoge Consultants PROJECT INDEX / PLAN ID # DATE OWNER -f,011 �i�J/PDl�OSDN PHONE 3 d'I ' S 7 -7 11DDRESs 133 5 hW114V R,0- TT UOS4 SY01 T LEGAL DESCRIPTION LDf ��y /� �U %�� 45 �� TOWN OC � 4- 01 9 � - d A ST Z/te COUNTY c srrt tf 'ZAKij 4t% P - 3 ?S LOCAL AUTHORITY/ SUPERVISION PROJEC DESCRIPTION: P/11/ WO AP S.ZP iC %7OW 5 -7 1 2 Q� S �� Cam._ 4 d 4-P/,06— 1 11 36 " 12e vfE f Ulbricht & Associalas Private sewage Consultants 3A0 %�� 1 655 O'Neil Rd. U U Hudson, Wis. 54016 Pfd MAWS z�- �s OR} Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pa . 4 it it to -- Q ' yo z y a�f� /mss I p l ;ANT Gv � � ;e Co v�� Tiov i5ep TIC l 11tr 7 7D Z It 13 • \ �X 9r frv + ' ' , 74r of /g/o v.vr Li Fx�sn.�l4• S vt rio ,�s g , sysT�� 3 fA,uce �Gn,r /� i;�rl S r Lv i Z. ;v--e— H A� SY STs"l G HIS pOW TE psfk ZAgE1. A � d � � Q 0 i a y rz kA O l'�llc v to 1'L- /IP pi ve p - f, H.V s ilk -107- �9PP�U h v .v c,4 U'v 1NS�0 77" �1 . -- Iff Cho S� Sic Tiov of Tip��v�s M114, CAI)Acol cv� SQ _ A , j / • � � r� vvZZ) cr�,�lc�� G SAC' TI o.O I . /9 0 ,om tp 1/15 T c,9P T�, U,v iuS�J�c T /ov �i� Iff IN y o An observation pipe may serve as a combination observation/vent pipe providing it terminates in the same manner as required for vent pipes. See Figure 6. Vent cap. Return bend Cap 12 "min.•_. 12" min. rinal grade Aggregate islribotion lateral typ- System elevation Figure 6— Vent and combination observation/vent pipes Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance ? 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. , Water tight cap f r — 4" min. dia. L Repair couplings �— Slot ff 6 "min. Infiltrative surface 4" miry' Water Closet Coiiar Bar(]/B" min. dia.) OWNER 's MAINTAINCE OF SEPTIC SYSTEM G39� . POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic Inspecti servicing is necessary for the safe healthy operationof.this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling,authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ Inspectors: J Y � J 7 �t1 /.0 3 g6 q('-F 1 * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: T * Licensed servIce / inspection agent other than installer: * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1• Winter traffic (sledding, shovekin area shall not be permitted, or frost e can /will into the cell, freezing up the system. Discontinuos use in the winter.(a vacaction trip, resulting in no water use) can also lead to freeze ups. Z• Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This sys�em was designed for a maximum wastewater flow of y56 gals. daily. 3• POWTS are not designed to accomodate wastes from a garbage.., disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload,and destroy this system. •I • 9• If a power o::tage occurs, or a pump fails, it may .'result In a temporary overload of effluen.b being pumped into the cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5• Neglect of the vegetative cover erosion preventive (the cells insulation & traffic also can destroy l t a he t system. It IS REGULARLY WATER TFFE VEGETATION OVER A SYSTEM!! Effluen the system beneath IS NOT sufficient alone to maintain a grass cover. i 6• Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been inr•.,r „.,..,.._� Into the ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I haveinspected the septic tank presently serving the ��,NI YVojj9,-%o loca t_d aut. . 1/9, 5 —_1/9, sec. 1-7 Z , �j T N, R // W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced lwlA -"7.zi SOD Z-�- Did flow back occur from absorption system? Yes No (if no, skip Approximate volume or length of time: f 107-29 next line) gallons minutes Capacity: /0" Construction: Prefab Concrete —_ Steel Other Manufacurer ( if known) : 4 �j %L 4 4W Age of Tank ( if known) : GL /f (Signature) (Name) Please Print (Title) (License Number) (Date) Farm to be completed by licensed plumber (x.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). Nam Signature MP /MPRS Ulbricht & Associates 5/88 Private sewage Consultants 655 O'Nail Rd. Huai Sri. d > 1li s. 54018 } ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSIJIP CERTIFICATION FORM Uwner /I3t+yer & �fe GP .S 10A) - 39/-. 56-77 Mailing Address 9 3- 5 - Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION �i Property Location ' '/., t /,, Sec. 11 , T N -R H W, Town of Subdivision S Al- Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �2 a� 2 3 Volume 1 2,- Page # yy Sec house [� es � Spec Y Lot lines identifiable Xyes O no SYSTEM MAINTENANCE improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc e consists of pumping out lire septic tank every three years or sooner, if heeded by a licensed pumper. What you put into the sysle can affect the function of fire septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joutneyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system Is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 (fie Department of Natural Resources, State of Wisconsin. Certification slating flint your septic system has been maintained must be completed and returned to the St. Croix County Zoning Offtee within 30 days of the three year ex iration d SIGNATURE OF PPLICANf DATE OWNER CE RTIFICATION 1 (we) certify flint all statements on this form are true to the best of my (our) knowledge. I (we) Am (are) the owners) o[ the property described above, by virtu f a warranty deed recorded in Register of Deeds Office. Sf(3NA'IURE OF PPLICANT `_ /.3// o� DATB * * * * *• Any information that is pins tepresented tuRy result in die sanitary permit being revoked by the Zoning Department. * ** r ** ** Include with (Ills Appllcrstlon: a slammed warimily deed from the Register of Deeds office a copy of the certified survey map if reference'is made in fire warranty deed I DOCUMENT NO. STATE BAR OF '.*WISCONSIN FORM 1 -19"s i TNIa tRAC[ R[HRVtD FOR R[COROINO DATA WARRANTY DEED 5206 '' Z3 VOL ���� ?asET4' R :�:j i �R'$ OFFICE �_ _ This Deed, made between ._..James D Fibison� a single I ST: CROIX CO.. W1 man _ Recd for P r,•or4 -••... --- - - - - -- ••- •- •..--- ...••• - ••-- - - - - -- ------------•----•-•--• ••- •- •- •- ••- •- ••- •- •- ••••...... , AUG 2 5 1994 and.- .....- T..omas_- J....Harold **on- and -- Shari L - -- Haroldson I 8t M ..... .................. .. •.... •••...... ......... ....._... .............., Grantor, h husband and wife ...... ...... ................................ .................... ••- •....... •- •- ......_......... ......... ..... .............•- •-- ...- ••• -• - -•- .••- ...----- .._.. -• - -•- - -..... i! IhpdrafONd� ......- -- -•-•..., Grantee, Witnesseth That the said Grantor, for a valuable consideration.... ... .----• ......... ... ............................ ..... •------•.._............ ............................... _ _ ! conveys to Grantee the following described real estate in ...... St Cro x._........ "avuRN To County, State of Wisconsin: Lot 114, Parkview Estates Fifth Addition in the Town of Huesan, St. Croix County, Wisconsin. TaxParrel N-) :.... ............................... F03 p 2 d - / ZZG - �° D� a This ........ .....is........... homestead property. (is) (is -not} j Together with all and singular the hereditament, and appurtenances thereunto belonging; And -------- . JaQI � $..- H• Fibi � 9 R--•--••-----•-•-•------------•-•--•--•..... ......-- •- • ...... ............• ...... ............................... j warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except 'i warranties, easements, covenants and restrictions of record. ';{ and will warrant and defend the same. !' 18 1 Dated this .......--•-•• .. ..............8................ day of .................. August ............., 193.4 - -• C ....... •- • ..................... . .••-- •- -- -- -- - - --• - -- ••-......... .(SEAL) ... ............. ............ ..(SEAL) I !� mes D. Fibison it _......-•--------•-..........• ........ ........................ . .. .... .....---- ........................... 1. - - - -- (SEAL) __ ......(SEAL) ;i fl i� AUTHENTICATION ACENOWL=DOMENT I Sivature(s) _ STATE OF WISCONSIN {{ -------------- - - -• -- -- ---- - - - -- - • - - -- ------------ .._...__..-- -.. - -- - St.._Croia - County. !' authenticated this - - - - -- --day of----------- ---- ---- --- ----- l9______ Personally came before me this .... ------ 18.day of ° - -- -- t _-- -_-- ---- - - -- 19.-9 the above named ;; ----------------------------- -- -- ---- •--- ------ ------- ------ ---- ---- - -- --- amea D. ison - -- ----------------------------------------- - - - - -- k TITLE: MEMBER STATE BAR OF WISCONSIN .. , �.k j (u not, .__._... ...u..' 12 _ authorised by 1 708.08. Wis. Stata.) - - S { to me lOsPw1) 40 tbs y nj.:- :_ - - -- -- who executed the �� folimer�alilli w he same. THIS INSTRUMENT WAS DRAFTED eY r 7 Heyyood � Cari, - _S _C. � b�r - R : _ Cari �� . dib e>r .0, Box - 229 Hudson W11 54016 - -- c� - {� , . ---- -- -- ------- Not: jS.t ..lam ---- _......... County, Wi.. 1� (Signatures may be authenticated or acknowledged. Both My ioa �i permanent (If not, state expiration i are not necessary.) Ash- Ma 14 Te9S % ii �0 a -AD ID iS LQ N 1 l N I *F-.v RX K - I I m , I �-- 4 I I I 6 I N 88* 11' 4 7'E 47• 412.04' .05' . SiT. sse. _.I �� ;�7lA?t�/ �� ?'?tStPt' !?� � ! - _ RK� ,r's W I W 115 I o • �. 1 114 I -°� 48880 Sq. Ft. 6 1 1588 Ac ) - (1.122 Ac.) ( a s I 12 ' I iE NI /2 . 16 s NI \ 54737 Sq. Ft. C ZI (1.257 Ac.) I t 1 I C 0 �. ♦ O . � ��� � f': to 12 19 Sq. Pt. s 53651 Sq. Ft 25 Ac.j (1.232 Ac.) w r 118 45474 Sq. Ft." (1.044 Ac.) o 8 117 �\ \ a 44889 Sq. Ft. \ (1.031 Ac.) 105 I 106 1 1 104 I 1 I F �f r r _ r FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER -Sa P-j,'/ ja y- TOWNSHIP C,r Say 1 SECTION - 1 � T G� * N -R of M () I ADDRESS : 2 g Z. ST. CROIX COUNTY, WISCONSIN AIu 0 q ;� 5 .c-s SUBDIVISION r k V,'wz F LOT// 4 LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 11), T 107 fl- �4 I — ;7 6a4gdc L7j It s \A zgrXzy 4s vo, tl Z� yde GS t i I ` � I i to i INDICATE NORTH ARROW BENCHMARK: Elevation and description: /,f {�,y <c�.�a✓ F /. = �Oc), �) Alternate benchmark — 5 2y SEPTIC TANK: Manufacturer: S j - Liquid Cap. Rings used: 2 Manhole cover elev: 5 - •Z<o Final grade elev: (,,,S Tank inlet elev.: �1 Tank outlet elev., g,Bq No. of feet from nearest road:Front Side , Rear Ft. " a PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: , `; Trench: - Seepage i Width: Length 34, Number of Lines: 3 Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: YZ �Nofa. � /o .J No. feet from nearest prop. line:Front Sidej, Rear Ft._jL" No. feet from well: 9 feet from building g 7 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: q INSPECTOR• 4 DATE: ! �`� PLUMBER ON JOB : !1'. r LICENSE NUMBER: ' Q ` 5 2 6 /90:cj DEPAATNtENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 y "J D Sec. 17,T29 -R19 1 4 Stat sgn Town of Huds nI..Number: �1VVENTIONAL El ALTERATIVE ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound S NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tf' �� (I O BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT OM PLAN: REF. PT. E V.: CST REF. P LEV.: ^� Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK /HOLDING TAN o C.Q Cicrr KQ.01 ���� NUFACTURER: LIQUID CAPACITY: TANK I TANK OU EV.: WARNING LABEL LOCKING COR af PROVIDED: PROVIDED: (p u, 60 i e SQ-� . �.� 9G. YES F-1 NO ❑ YES NO BEDDING: VENT DIA.: VE#TMATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: I VENT TO FRESH C • O. y C..O. ALARM: FEET FROM LINE: AIR INLET: ❑ YES XJ ❑ YES ANO NEAREST ­11111- -6,5 + DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCK COVER PROVIDED: PROVDED: ❑ YES ❑ NO [- ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM INE: AIR INLET: PUMP ON AND OFF El YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERI AND MARKING: excavation. (If soil can be rolled into a wire, construction shall cease until MAIN I'"�_ soil is dry enough to continue.) ONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID / TRENCHES: • MAT RIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPT DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. STR. $AREST MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE CO V . ELEV. INLET? ELEV. END: c/4/�cr>C PIPE : ET FROM LINE: r i AIR INLET: d - 9s: • e- _n e-- 3 e ? 9 y� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; [DYES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: El YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ COV NO [- [__1 NO PERMANENT MARKERS: OBSERVATION WELLS: i MBER OF PROPERTY WELL: BUILDING: COMMENTS: ET FROM LINE: El YES El NO I- YES El NO AREST f e /? `�/p 990 ' co--� X,?yt; P c<� a4�n Amax Cp �a a z"Le4 � ' Sketch System on etain in county file for audit. Reverse Side. ; SIGNA RE: TITLE: / f SBD -6710 (R. 06/88) SANITARY PERMIT APPLICATION COUN C:z 1,3ILHR In accord with ILHR 83.05, Wis. Adm. Code . o.,�, S ATE SANITARY PERMIT –Attach complete plans (to the county copy only) for the system, on paper not less than El �3 - /! Ui ous 8% X 11 inches in size. heck i revision application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER FPROPER LOCATION S /� - G' /a, S 7 TZ9 , N, R If E (o PROPERTY OWNER'S MAILING ADDRESS BLOCK # z! CITY, STATE ZIP CODE PHONE NUMBER SY§DIVISION NAME OR CSM NUMBER -74q ArI Ykw II. TYPE OF BUILDING: (Check one) El State Owned 13 VILLAGE: A NEAREST ROAD U! aw '`WG-- -AP 4- ❑ Public 1 or 2 Fam. Dwelling –# of bedrooms a PARCH T AX N BER III. BUILDING USE: (If building type is public, check all that apply) .7— ( 7 1 ❑ Apt/Condo J I 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) ( A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permi was previ ously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 � Seepage Bed 21 El Mound 30 El SpecifyType 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ SysteM -In -Fill 1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION F7­3 Feet /dZI- 8 Feet II. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed tic Tank or Holdin Tank o00 / LcJ�� S m L ft Pum Tank/Siphon Chamber III. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum er's Signature: (No Stamps MP /MPRSW No.: Business Phone Number: A___7 /11 0- 4 f 3 'Z ( 7 V;7) T i .3 3 Plumberts Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e ssued Issuing Agent Signature (No Stamps) rftyr Surcharge Fee) pproved ❑Owner Givenlnitial { ? --� —�/ Adverse D rmin tin �J J [v X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 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 and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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; pump or siphon tanks; 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 113 form; and F) all sizing_ information. '- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Sc- a Location of property � 114 S 1/4, Section Township h`6 44pt2 Mailing address 7 w Address of site - Oa Subdivision name A. rk -- Lot number �� y Previous owner of property AfK 1' - 1 Total size of parcel Date parcel was created ? Are all corners and lot lines identifiable? as _�! Is this property being developed for resale (spec house)? as N0 Volume '15-3 and Page Number 27, as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. Z-177 7 -0 7 - ; and that I (We) p resently own the p roposed site for the sewage P Y a disposal system (or I (we) have P P 9 obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 2' 7z--7 ). 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' ..graittt'G" f o 5 �� . «.r. r•. ..•1 • u. . .• « »r«r«ruw•.rr••ru« r.w ' »� 9t. 'r...County, Wisconsin for the'sum of - - - i 1•�r _�?4.� Rn�.. qnd r od he r . gopd and « v„a linable,_ � " ".�' ° ,congi�erationt............. / . «•• «» » «rrr...«•»r «..................... » r.». »«•••.r » +^ � ..« _� _ ..-J_ -- � /�, the following tract of land in...r..... ....►�.�_.�xu.i.. « »......_.. County 1 . Wisconsin:..r....._.. ...w.._ «.._.._..._..r The Southeast quarter of thb Northeast quarter (SEINSI) of } Section 32 and the Southeast quarter of the Southeast quarter (SEJSSJ)'of Section 32 and the West half of the Northwest i' quarter (WJNWJ) of Section 33 and the West half of the South- west quarter (WJSWJ) of Section 33, and that part of the ;.: Southwest quarter of the Southwest quarter (SI 0 SWO : "of Section > 28, lying south and west of that body of water called'Perch ! j' Lake except part conveyed to Arthur,Ti Kerrick and Agnes >•' �i i; Kerrick by deed recorded in Volume 265, page 493,'and subject to the buyers interests in those land contracts: entered into., !' < by the grantor and grantee (and his wife, Beverly A. Wert) n with Theodore L. Mackmiller and with Kenneth D:,.Wert and aifei ; all in Township 30 North., Range 19`West. 11 . I a �.I a+ Itnev Whereof,'the said grantor•..._ hLA.. «. set der hand . and seal this !� « ;; !r day of . ..Ju>xe.r....r.. ._.r:., A. D., 19� . , ; , ... t sto APiD 82ALM IN om Os ; + rFyt�i A 11A T y t { " (SEAL) ! �, .•N .......... .» •wrr.•r«•._.•w..•.r••_ru .• - j Hu g h S Gwi� {" ... ... r(sw.i i , ...._ .. . ... ..... ,...... . ..... Marlys oumeester i. .. ............. r.• r .•.••r ....... .•.. .r••r.(S&1L) t} ; . U»r»•. ...Ir St wain, ».. a.. F4 1 4... , ..County. P came before me, this...11`3..ray of , A D ,19 9 .'�.. e of wisp .. • J 6 Ri XJt. }«.X �r... •• ................ «»»• the above named .:. _ ...._ i i STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER .S et , i1'1 /t"l /�'" ROUTE /BOX NUMBER 1S'a,� 'Z 's Z FIRE NO. �— CITY /STATE � �-s °' - u1 ZIP_ /6 PROPERTY LOCATION: _ 1/9 � 1/4, Section 1 , T j:? N R Town of St. Croix County, Subdivision , Lor No. ISID A A 0 � � � result in its tic s stem coo& res p remature p Improper use and maintenance of fo r sep y failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 0 with the re uirement that owners of ALL NEW SYSTEMS agree to keep their 198 , 9 Systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification m signed b the owner and by a master plumber, journeyman plumber, form, g Y restricted plumber or a licensed pumper verifying that (1) the on _ site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNE DATE 2 -- - St. Croix County Zoning Office. St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, REPORT 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.090) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP /�i : B OT NO.LK. NO.: S NAME: �/4 S �/4 /V? N1R1 (p O (o /l��cc� ro�v // I / /`'Ai 40 JFZA AV . COUNTY:: OINNER'S BUYER'S NAME: MAILING ADDRESS:� / rc l.i i� �� � a.�- d / I� /` d . dl.� B.0 L S . ryuvro USE DATES OBSE VATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: N JPROFILE DESCRIPTIONS ER A ION TESTS: ' Residence � 1 � �IVew ❑Replace_ I i ll /� I RATING: S= Site suitable for system U= Site unsuitable for system ' .� �� I Jy ©g CONVENTIONAL: MOUND: IN-GROUND-PRESS RE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) !Zl)c ft� 119 ❑U ®S ❑U © S ❑U ❑ S DU ❑ S U Cox; a.&,, t >OW,4I `x36 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: WA I Floodplain, indicate Floodplain elevation: PP FILE DESCRIPTIONS BORING TOTAL/ DEPTH TO GROUNDWATER CHARACTER OF SOIL. WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHAft ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBS ERVED (SEE ABBRV. ON BACK.) B- 41 B- Z- , V' o /. /' /s �, f !3n -r B- 3 7 An S/ 4 2 CS B- Y 9.0 /vo . 7 e - 7 � O f S " 6 n. Sf . 3� Bn /S ?. 7 n t , `/ Bh C 5 B_ PERCOLATION TESTS TEST DE PTH* WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER HdeHI!B AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD P R PER INCH P- .3' AAj 3 G 6 3 P. . Ado .3 6 6 P o < 3 r 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 ELEVATION 9 1 7. 3 `�/� / " y�' e G eAd Ad tN I _ C i - 1 i I T � L�J to �- v 36- z o °- 3 Lu M d �fC i 1 ft ` 1� w o i ° a CA i ♦ ' Aw- "m _ I O � c M j � a o I.�� ♦" 7 •r 1 X M Ae O � � 3 e d lid IA rrl �1 P i t. 1. LT- - �� i ' F'{ •• ':fir : =�� ��� �.� °, s . ST. CROIX COUNTY WISCONSIN l � ---- - - -�~� ZONING OFFICE r r e N r g r x ■— """.e ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson WI 54016 -7710 (715) 386 -4680 August 19, 1994 /�'LQ 220-0 Allan Cowles / 706 19th Street South Hudson, WI 54016 RE: Water Results for Residence Located at Jim Fibison - 935 Sherman Lane, Hudson, WI 54016 Dear Mr. Cowles: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions regarding these results, please do not hesitate in contacting our office. rSiceely, j . Ja s Thompson ` ssistant Zoning Administrator js Enclosure 6( `COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 -962 -5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 68268/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 8/17/94 1101 CARMICHAEL ROAR DATE RECEIVED: 8/10/94 HUDSON WI 54016 ATTN: THOMAS C. NELSON i OWNER: Jim Fibison LOCATION: 935 Sherman Ln., Hudson 9 1p COLLECTOR: Jim Thompson DATE COLLECTED: 8 -9 -94 TIME COLLECTED: 1:45pm� I SOURCE OF SAMPLE: Kitchen Faucet DATE ANALYZED:8 -10 -94 I TIME ANALYZED:2:00pm COLIFORM,MFCC: 0 /100 mt I INTERPRETATION: Bacteriologically SAFE NITRATE -N: 7 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coiiform Bacteria /100 ml Nitrate- Nitrogen, mg/L I i I LAB TECHNICIAN: Pam Gane f ` OF .,NCEVENQ FN `I WI Approved Lab No • 19 t Means "LESS THAN" Detectable Level Approved by: d q" PROFESSIONAL LABORATORY SERVICES SINCE 1952 f � r ST. CROIX COUNTY WISCONSIN - ZONING OFFICE 1 x x x x x x■ rMr�b ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 =- (715) 386 -4680 August 19, 1994 Allan Cowles 706 19th Street South Hudson, WI 54016 RE: Water (VOC) Inspection for Residence Located at Jim Fibison - 939 Sherman Lane, Hudson, WI 54016 Dear Mr. Cowles: Enclosed is the original test results from SERCO Laboratories for water (VOC) inspection of the above property. If you have any questions with regard to said report, please do not hesitate in contacting me. cerely, mes Thompson Assistant Zoning Administrator St. Croix County, Wisconsin j Enclosure cc: Pat Collins SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7176 LABORATORY ANALYSIS REPORT NO: 46039 PAGE 1 of 3 08/15/94 St. Croix County Zoning DATE COLLECTED: 08/03/94 1101 Carmichael DATE RECEIVED: 08/08/94 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WELL WATER Attn: Mary J. Jenkins CLIENT'S ID: Cowles SERCO SAMPLE NO: 119284 SAMPLE DESCRIPTION: Cowles 08/03/94 ANALYSIS: --------------------- - - - - -- -- - -- Benzene, ug/L < 1 0 Bromobenzene, ug /L <0.2 Bromochloromethane, ug /L <0.4 Bromodichloromethane, ug /L <0.2 Bromoform, ug /L <0.5 Bromomethane, ug /L (Methyl bromide) <1.0 n- Butylbenzene, ug /L <0.3 <"�f sec - Butylbenzene, ug /L <0.4 tert - Butylbenzene, ug /L <0.5 Carbon tetrachloride, ug /L <0.2 Chlorobenzene, ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 2- Chlorotoluene, ug /L (o- Chlorotoluene) <0.2 4- Chlorotoluene, ug /L (p- Chlorotoluene) <0.2 Dibromochloromethane, ug /L <0.4 1,2- Dibromo- 3- chloropropane, ug /L <1.2 1,2- Dibromoethane, ug /L <0.2 (Ethylene dibromide) Dibromomethane, ug /L <0.2 1,2- Dichlorobenzene, ug /L <1.0 (o- Dichlorobenzene) 1,3- Dichlorobenzene, ug /L <1.0 (m- Dichlorobenzene) < means "not detected at this level ". 1 mg = 1000 ug. y V i N pyj� S L abo r ato ri es 1931 West County Road C2. St. Paul, Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 46039 PAGE 2 of 3 08/15/94 SERCO SAMPLE NO: 119284 SAMPLE DESCRIPTION: Cowles �- 08/03/94 ANALYSIS: ---------------------------------- - - - - -- -- - - - - -- 1,4-Dichlorobenzene, ug /L <1.0 (p- Dichlorobenzene) Dichlorodifluoromethane, ug /L (Freon 12) 1.5 A 1,1- Dichloroethane, ug /L <0.1 1,2- Dichloroethane, ug /L <0.2 (Ethylene dichloride) 1,1- Dichloroethene, ug /L <0.2 cis -1,2- Dichloroethene, ug /L <0.1 trans -1,2- Dichloroethene, ug /L <0.1 1,2- Dichloropropane, ug /L <0.1 1,3- Dichloropropane, ug /L <0.2 2,2- Dichloropropane, ug /L <0.2 1,1- Dichloropropene, ug /L <0.2 cis -1,3- Dichloropropene, ug /L <1.5 trans - 1,3 - Dichloropropene, ug /L <0.9 Ethylbenzene, uq /L <1.0 Hexachlorobutadiene, ug /L <0.3 Isopropylbenzene, ug /L, (Cumene) <1.0 4- Isopropyltoluene, ug /L <0.5 (p- Isopropyltoluene) Methylene chloride, ug /L <5.0 (Dichloromethane) Naphthalene, ug /L <1.0 n- Propylbenzene, ug /L <0.4 Styrene, ug /L <1.0 1,1,2,2- Tetrachloroethane, ug /L <0.2 1,1,1,2 - Tetrachloroethane, ug /L <0.1 Tetrachloroethene, ug /L <0.2 Toluene, ug /L <1.0 1,2,3 - Trichlorobenzene, ug /L <0.2 1,2,4 - Trichlorobenzene, ug /L <0.2 1,1,1 - Trichloroethane, ug /L <5.0 < means "not detected at this level ". 1 mg = 1000 ug. C M SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (6 12) 636 -7178 LABORATORY ANALYSIS REPORT NO: 46039 PAGE 3 of 3 08/15/94 SERCO SAMPLE NO: 119284 SAMPLE DESCRIPTION: Cowles 08/03/94 ANALYSIS: ---------------------------------- - - - - -- -- - - - - -- 1,1,2-Trichloroethane, ug /L <0.1 Trichloroethene, ug /L <0.4 Trichlorofluoromethane, ug /L (Freon 11) <0.7 1,2,3 - Trichloropropane, ug /L <0.2 1,2,4 - Trimethylbenzene, ug /L <1.0 1,3,5 - Trimethylbenzene, ug /L <1.0 (Mesitylene) Vinyl chloride, ug /L <1.0 Total Xylene, ug /L <1.0 See addendum to report. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Carol A. Kuehn Project Manager < means "not detected at this level ". 1 mg = 1000 ug. SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 Addend= to Report #46039 St. Croix Co mty Zoning Augu.St 15, 1994 This sanple's analytical results are below the U.S. EPA's cZWA Maximum contaminant level of 01/30/91 for those requested coVout -ds which are also on the SDW& MCL list. A: This coagxxr was observed in the laboratory blank at a concentration of 0.6 ug /L. lv5 g �- q� ���►�� ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. J4 Water (VOC's) $185.00 4 Septic $50.00 I& Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria I retest $15.00 Owner: h ; SUr4 Requested by: 0 S_ Address • S e ✓ dll Lg µe- Address • O S - ,S d ZIP ZIPS Telephone N (715 ) 3SCO ' 3a YU Telephone N ( 3 - X 0 7 Property address (Fire W & Street) • q35 she✓'IU,t 6w., e Location: ;, ;, Sec. , T N, R W, Town of cc Sa --► Realty firm: N -N/ a1 Lock Box Combo: kF Closing Date: 0 ad �`I �o S TO BE COMPLETED BY PRO ERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: ' Age of septic system: S ri 0 Septic tank last pumped by: _ p�Ck �� Date: Previous Owner's Name (s) : Have any of the following been observed? ❑Y N Slow drainage from house. ❑Y N Sewage Back -up into dwelling. ❑Y )4N Sewage discharge to ground surface or road ditch. ❑Y XN Foul odors. X comments relative to system operation r ^ / .G✓ � e S �J L�/ h_ ._ Ce '`• `' °I ?cery y that the above information is compl to a d true to the best ciE - -•ipy knowledge. }� LJ� OWNERS SIGNATURE: TE :�� OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCA�'ION {p/ TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd ❑At -Grd OMound Approx. size 'X ' ❑Gravity ❑Dose ❑Pressurized Ft.I ❑Bed ❑Trench ❑Dry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: []House ❑Well OProp. line OOther Dose tank Setbacks: OHouse OWell OProp. line ❑Other ❑Locking cover ❑Warning label ❑Pump /Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: OHouse ❑well OProp. line OOther OPonding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title U8/18/a4 U9: 53 0715 U62 4030 COMM. TEST LAB COUNTY CLERK 10001/001 CONNERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 - - 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST, CROIX CtXtm ZONING OFFICE REPORT NO,: 68269/01 PAGE 3 ST.CROIX CTY GOV.CiR REPORT DATE: 8/17/94 1101 CARMICHAEL ROAD DATE RECEIVED: 8/10/94 HUDSON, wI 54016 ATTN: TO MAS C. NELSON OWNER: Jim Fibison LOCATION: 935 Sherman In -, Hudson COLLECTOR: Jim Thowson DATE COLLECTED: 8 -9 -94 TINE COLLECTED: 1:45pm SOURCE OF SAMPLE: Kitchen Faucet DATE ANALYZED;8 - 10^94 TIME ANALYZEM240pe CM1FO MtMFCC: 0 /100 at INTERPRETATION: Bacteriologically SAFE NITRATE -N; 7 P pm Above 10 pps exceeds the recommended Public DrinkiN Water Standard. Conform Bacteria /100 at Nitrate - Nitrogen, mg/L LAB TECHNICIAN: Pam Ga ne WI Approved Lab No. 19 vV ` �S < Means "LESS THAN" Detectable Level Approved by: ST. CROIX COUNTY WISCONSIN ZONING OFFICE I IN IN if r r■ ■� ■.` ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 ` (715) 386 -4680 August 16, 1994 Mr. Allan Cowles 706 19th St. So. Hudson, WI 54016 Dear Mr. Cowles: An inspection of the septic system serving the Jim Fibison property at 935 Sherman Ln. was conducted on August 3, 1994. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. Most septic systems consist of a septic tank which traps the solids and greases from the sewage stream and then allows the remaining sewage effluent (liquid) to drain into a subsurface drainage area. Once the liquid reaches this point it seeps away by percolating through the soil surrounding the system. Failure results when the soil surrounding the system becomes plugged with microscopic bacteria and sludge, which form a clogging mat. As time goes on, this clogging mat becomes progressively thicker, allowing less and less liquid to seep away from the system. When this clogging becomes severe enough, liquid sewage is trapped in the drainage area, a condition known as ponding, and results in backup of sewage into the structure or the discharge of sewage to the ground surface. At the time of inspection, this system appeared to be functioning, but not at full capacity. I noted that there was approximately 1 of sewage effluent ponded within the drainfield. This indicates that the bottom of the drainfield has begun to clog and has reduced the ability of the sewage effluent to drain away from the system. Because the failure of a septic system is a progressive process, I cannot predict how advanced this clogging is, and therefor how long this system will continue to dispose of sewage effluent. Neither can I predict how soon the system will fail completely. I want to stress that I cannot guarantee or warrant that this system will continue to function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and /or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a full load, use a washing machine with a suds saver feature, etc. I would also recommend that the septic tank be pumped at a minimum of once every three years. Please feel free to share this report with anyone who may have an interest in its findings. Should there be any questions or concerns that I can clarify, I can be reached at this office between the hours of 8:00 am. and 5:00 pm., Monday through Friday. Si _erely, _ J mes Thompson f �_ Assistant Zoning Administrator cc: file i wW V,) ct-� OJV- a IvS- �►�►� ST. CROIX COUNTY �' WISCONSIN ZONING OFFICE I N r I N II Nn' ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. JR Water (VOC's) $185.00 ,® Septic $50.00 R Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria JJ retest $15.00 Owner: ly scm Requested by: 14 11afL , 0 tlAj Address: 5 -S ep ✓mdA µe- Address: 70 lQ S - sd ZIP ZIP / � Telephone N (Z) 360 3aYU Telephone N ( o?o Property address (Fire W & Street) • 6735 sbe�'�a� Lq� e Location: ;, ;, Sec. , T N, R W, Town of H C4 JS I Realty firm: w M a) Lock Box Combo: Closing Date: 0 ® $ I k stake - r'ct lle Sai �e A10 x,,._ Obit S � B�YPR%ER � TY TO BE COMPLETED OWNER *PROVIDE A SKETCH OF -HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap logation: A Oe & Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: Age of septic system: s rs o ld Septic tank last pumped by: CCk N/-e Date: Previous Owner's Name(s): Have any of the following been observed? OY j�N Slow drainage from house. ❑Y N Sewage Back -up into dwelling. OY )4N Sewage discharge to ground surface or road ditch. OY XN Foul odors. 110! comments relative to system operation: °./ C!5 c vt ficc7Cr5� S'��1Ce � �~ El f! cer that the above information is compl to a d true to the � " o knowledge. w OWNERS SIGNATURE: r OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCA'T'ION a Vey 5 C �'4uk TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system K=Av7ty grd ❑At -Grd ❑Mound Approx. size 'X ❑Dose ❑Pressurized Ft. umed ❑Trench ❑Dry Well Molding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank ��/ Setbacks: ❑House OWel1C ❑Prop. line::! 0 her Doae tank e ❑House ❑Well OProp. line ❑Other ocking cover ❑Warning label ❑Pump /Floats DAlarm ❑Elec. wiring Soil Absorption System Setbacks: DHouse We Prop. line ther OPondin — //" g : .� U 2 ODischa ge : flarc General comments ° ot c r INSPECTORS SKETCH OF SYSTEM LOCATION N I Inspector _ Title 08/18/94 11:44 FAX 612 636 7178 SERCO LAB. COUNTY CLERK 01002 r M 7 sER�U Laboratories 1931 Nteat Cmmty %W C2. 5t- Qaui. Nfn*Mta SS113 Phone (612) 636 -7173 FAX (612) &- LABORATORY ANALYSIS REPORT NO: 46039 PAGE 1 of 3 08/15/94 St. Croix County Zoning DATE COLLECTED: 08/03/94 1101 Carmichael DATE RECEIVED: 08/08/94 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WELL WATER Attn: Mary J. Jenkins CLIENTfS ID: Cowles SERCO SAMPLE NO: 119284 SAMPLE DESCRIPTION: Cowles 08/03/94 ANALYSIS: ------- ------------------- -------- - - - - -- --- --- - -- Benzene, ug /L <1.0 Bromobenzene, ug /L <0.2 Bromochloromethane, ug /L <0.4 Bromodichloromethane, ug /L <0.2 Bromoform, ug /L <0.5 Bromomethane, ug /L (Methyl bromide) <1.0 n- Butylbenzene, ug /L <0.3 sec- Butylbenzens, ug /L <0.4 tert- Butylbenzene, uq /L <0.5 Carbon tetrachloride, ug /L <0.2 Chlorobenzene, ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 2- Chlorotoluene, ug /L (o- Chlorotoluene) <0.2 4- Chlorotoluene, ug /L (p- Chlorotoluene) <0.2 Dibromochloromethane, ug /L <0.4 1,2- Di.bromo- 3- chloropropane, ug /L <1.2 1,2- Dibromoethane, ug /L <0.2 (Ethylene'dibromide) Dibromomethane, ug /L <0.2 1,2- Dichlorobenzene, ug /L <1.0 (o- Dichlorobenzene) 1,3- Dichlorobenzene, ug /L <1.0 (m- Dichlorobenzene) < means "not detected at this level ". 1 mg = 1000 ug. 08/18/94 11:44 FAX 612 636 7178 SERCO LAB. 4-+4 COUNTY CLERK Q003 sERCU Laboratories 1931 WeSt CGUMV Road C2. St. PauL Minnesota 55113 Phone (612) M7173 FAX (612) 636-7176 LABORATORY ANALYSIS REPORT NO: 46039 PAGE 2 of 3 08/15/94 SERCO SAMPLE NO: 119284 SAMPLE DESCRIPTION: Cowles 08/03/94 ANALYSIS: ------- - - - - -- -------------------- - - - - -- -- - - - - -- 1,4- Dichlorobanzene, ug /L <1.0 (p- Dichlorobenzene) Dichlorodifluoromethane, ug /L (Freon 12) 1.5 A 1,1- Dichloroethane, ug /L <0.1 1,2- Dichloroethane, ug /L <0.2 (Ethylene dichloride) 1,1- Dichloroethene, ug /L <0.2 cis- 1,2- Dichloroethene, ug /L <0.1 trans- 1,2- Dichlotoethene, ug /L <0.1 1,2- Dichloropropane, uq /L <0.1 1,3- Dichloropropane, ug /L <0.2 2,2- Dichloropropane, ug /L <0.2 1,1- Dichloropropene, ug /L <0.2 cis -1,3- Dichloropropene, ug /L <1.5 trans -1,3- Dichloropropene, ug /L <0.9 Ethylbenzene, ucl /L <1.0 Nexachlorobutadiene, ug /L <0.3 Isopropylbenzene, ug /L, (Cumene) <1.0 4- Isopropyltoluene, ug /L <0.5 (p- Isopropyltoluene) Methylene chloride, ug /L <5.0 (Dichloromethane) Naphthalene, ug /L <1.0 n- Propylbenzene, ug /L <0.4 Styrene, ug /L <1.0 1,1,2,2- Tetrachloroethane, ug /L <0.2 1 Tetrachloroethane, ug /L <0.1 Tetrachloroethene, uq /L <0.2 Toluene, ug /L <1.0 1,2,3- Trichlorobenzene, uq /L <0.2 1,2,4- Trichlorobenzene, uq /L <0.2 1,1,1- Trichloroethane, ug /L <5.0 < means "not detected at this level ". 1 mg = 1000 ug. I 08/18/94 11:45 FAX 612 636 7178 SERCO LAB, COUNTY CLERK 1@004 SERCO Laboratories 19191 %%W Canty %W G2. 56 ftul, WIMOSM 55113 PWM (612) 636 -7173 FAX (612) 636.7176 LABORATORY ANALYSIS REPORT NO: 46039 PAGE 3 of 3 08/15/94 SERCO SAMPLE NO: 119284 SA14PLE DESCRIPTION: Cowles 08/03/94 ANALYSIS: ----------------------------- ----- - - - - -- -- - - -- -- 1,1,2- Trichloroethane, ug /L <0.1 Trichloroethene, ug /L <0.4 Trichlorofluoromethane, ug /L (Freon 11) <0.7 1,2,3- Trichloropropane, ug /L <0.2 1,2,4- Trimethylbenzene, ug /L <1.0 1,3,5- Trimethylbenzene, ug /L <1.0 (Nesitylene) Vinyl chloride, ug /L <1.0 Total Xylene, uq /L <1.0 See addendum to report. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Carol A. Kuehn Project Manager < means "not detected at this level ". 1 mg = 1000 ug. n (1)O n0 g 3 ry^ m 7 A A 'p C% • C A 3 - 3 S sa O NO Cll 3 O Q t3ti d N C> �... O N a. p CD O. 7' CD v O N r < co W p@ C A O O N CO NO O o> 3 cn 3 cn i C 3 3 N N � 'O Q 0 0 - 0 m o rn � cn � (D co g ° W c con 3 c n 3 B o a Lnn p o 0 N N O N UC O o m m L d m O .. CD Cn C 7 N O C 3 C O N 3 O N ( j W O N C) (D CD O. O O S N N 0 { C CD Z1 0 0 00 d !� fD (o O y N O C N N N S (n O O O .. a C C CL 7 a O O O O O O �• cn 3 N t/1 N 0 3 to fA Vi p v v o 0- A I v q e� I ID T m N o CD CD Lo o (D v (D CD ° _' m F a 3 v 0 o CD N p o Cs Z co Z Z m o O N n o 3 D a ro z� O p O N m 0 3 cn ry • O O Q C CO @ CD N CD M D CD m CD C CD C COD C. CD CL 2 co R o A Z CD D o R W CD (D W A 0. , i G Z '0 3 '0 3 p O rr o c o m y y z CD CD ? 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CROIX COUNTY ZONING DEPAR r EIV ED AS BUILT SANITARY REPORT it 3 G Owner �D/" f�ff'/POL/i✓ 7 /s• .3��• S' 7 Addres S !r� c� oFF�cE City /State 5YO /6 / Legal Description: 4A91 7 A--' Lot Block Subdivision/G&M -# A10— /4 � ', See. 11, T ILN -R aW, Town of fjL(/ SOnJ PIN # 0 20 • /L LO •/O • ejay SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION iv 6x 15 r 6-- earl-- 60 v Tank manufacturer �I • Size ST/PC � Setback from: House 2,/ Well dos P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location /3i�0•'FFvS�� '" $ S!;)IL ABSORPTION TEM: Type of system: Width 3 Length 7y Number of Trenches Z Setback from: House !/I? - Well ' P/L Vent to fresh air intake > 2 5 ' E LEVATIONS : e c v r&R) 0, F i ,c, Description of benchmark T � � � � � Oi•r Elevation /00.0 Description of alternate benchmark 7'0 R ge y 4/4/ • Elevation Building Sewer N / ST/HT Inlet ST Outlet 1 1 ' 30 PC Inlet 11-� PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System Final Grade ( ) ( ) ( ) 56P P-r ?'er° L 10114— Date of installation i I Permit number o 3ly State plan number Plumber's signature License number 2" S Date Inspector � � C + zf /Cek S - -- Complete plot plan ORIGIiIAL I , fv y I 30 aAfj /,ts Al I El /w T ic T: pp C�E.v ?ft'� 1/ cop Cis T Gv J c� a , 1 O I 1 36 I i 9 5 .'IS '� 5 1 i i i i ' ► � o� 1 I � M i i � I I it .9 /�►i:vvAA . T��''� � / •P U11 Tio.JS � � � � j 5/' 7� S ST�� �_ yS 9/ 7 AIG�� of 1/'07/ A)Lar 130 GO � 0 Properly owner Q Zd ` /Z?-� • /�' J L/ Parcel 11) p Page of 7 T hrning p U Boring �� �v y W �. Pit 1pround surface elev. _ T fL beplh to Ilmitino Victor �/ y M lorizon Ucplh Uorninanl Ior SON Vcallon ate R Texlure Structure Consistence Boundary Rrtple U/flr in. MunseN Qu. Sz. Cad. Colpr Gr. Sz. Sh. 0.// /oy/l I:Irat ��mr� 3 � �•s y� � s�. rf �ti c s � , y . � Bo►tng ff Boring U Pit Qround surface elev. Qepth to 8milinq feclo► � M lo► Iron t)eplh bominnnl C SON Ap Ilcallltxt Itele Redox Uesc►ipllon Texture Struclure Consistence Boundary Rood GP011lr In. MunseN qv. Sz. Cont. Cola Gr. Sz. Sh. 'Ef(g1 'EfM2 -------- ..__ r ' U Boring 0 U Boring r u Pit 13 fot►nd surface elev. Ueplh to OmINn r. g laclor In. t ! Iolizon Oopih homtnanl Cplor Itedox Uescripllon Tezlure Soil /lpplfes" l e In. Mun §ell Structure Consistence Boundary Rook GP r Qu. Sz. Cont. Cl Gr. Sz. Sh. 'E11�1 'EI11� ' Effluent fit = Bpp > 30< 220 mgJl and TSS >30 < 150 mglL ' Effluent 02 - Bpb < 30 mglL and TSS < 30 mg/L The bepa►Inre►rt of C'onnnerce is an c oal o ► h pporlunily service needmalerial provider And employer. Iryou need assistance to access services or in an alternate formal, please conlac( the depattment at 60 8 -266 -3151 or'1TY 608 -264 -8777. (/ `,r ♦)' S s :c o,) A*¢l ©w i v �'