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020-1220-90-000
~ o a~°io° I vo° I 3 °~ °~ ~., a ~., 0 I 0 I o~ o o ti a' ~ I ~ ~ I ~ I I c I I N O I ~ I ~ I _ a I a E 0 _ I a I ~ € I ~ A a rn i I ~ I y N I ~ I I ~ U T N a O ~ C Z C Z C L M C O L d C ~ l O N { O ~ 3 3 I c 3 ~ m I ~ I E N Q -. ~ c I I M ~ ~ et e} ~ _ .. Z y .. I ~' y I W r Z +. ~ a Z ~' C ~ € m «_ c E ,~H~ ', am m I am I I o I o z~ c I c w I I Q E o I in~~ ~ ~ m ~' ~ z I a ~ I .o ~ I v =^ ~ M I N N . O O N v • ~ ? m n a~ ~ I ~ a~ ~ I • N~ I N y I C ~ cif ~ I ao Q °mz °mz ~ ~ I Q z z z l N N Y ~ :: ~ I ~ ~ .. ~ ° I .. I ~ a N I w ` o Q ~ _ ~ N v N N _ y d~ I N L Q G G a .C~ L G G d CO .a v ~ a ~ rr rr 'o o~ 3$ ~ a.m r r r 1 0 3 3 3 I ~ d~ ~ ° I z a ~ ~ I ~ o ~ .. ~ 3 ~ ~ , C W O ° rnrn y N M M I ~° ° y I v1 U , ~ -O ` \ 7 ~ : ,r N ~ o o = N N I y ,n rn C N ~ ~ ~ C~ O ~ ~ 'O I J O O Q T3 ~ j m I ~ ~ m o ~' m I c N 9 ' m Q °' m a I « C N 'p _d Q} fn ~~ d Q Z to O ~ ~+ ~ 3 r~ ~ ~ 7 a~ ai ~ °o ° rn ~+5 I ~ ~5 E I Q ~ ~ O F ~ N 30 ~ ~ O ~ E a ~ c C =a°o I N ~ V 0 N~ C i~~ O ~ I Y N I O 7 d ~ C ~ l c ~ b i..a ~ °~ y ? ~ ! N N ayi ~ F- O N E m N .5 M m y O E y y rn r i6 v • N~ o = I~ ~ o z ~~ I (9 v o co z 5 a ~~ Q ea .. f ~ w = ~ l A ~ € E I V ~ d#t a d I a~a r iao ~ ° i ~ oa A c O c ~ ic ,sconsin Department of Commerce safety and Building Division PRIVATE SEWAGE SYSTEM ~ 4 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information ycu provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gliniecki, Matt Hudson Townshi CST BM Elev: hh Insp. BM Elev: BM Description: _ TANK INFORMATION TYPE ~ 6~M~ UFACTURE`RS / ~ G9PA01TY ~ jJU Septic !~ Dosing r ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO PILL r G G~ 1 WELL BLDG. Vent to Air Intake ROAD Septic / ~ ~ ~ / ~~ Dosing >3 ' Aerat' Holding PUMP/SIPHON INFORMATION ~~ Manufacturer p Demand GPM Model Number /~ TDH Lif I •` Friction Loss System fi c~ ~,l f{ TDH Ft Forcemain Length I' Dial `~ ist. t~We~~! SOIL ABSORPTION SYSTEM /~/GkG'~w-,Coit~/ ELEVATION DATA ~ County: St. CroiX Sanitary Permit No: 430262 0 State Plan ID No: Parcel Tax No: 020-1220-90-000 Section/Town/Range/Map No: 17.29.19.1221 STATION BS HI /0 FS ELEV. d0 ~U Benchmark g m ~j Z j ~6 ~ ~ ~ iaa ~ ~ Alt. BM ~ fl ~~ J. (D• Bldg. Sewe ~ ~ ~ D / O '` ~ 2 • ( L St/Ht nle~~ v £ ~~„ ZS SUHt Outlet ~_ ~~ Dt Inlet / /~ Dt Botto u M'r / . 3 ~ ~ 5~ eader an. ~_ ` •~ 4 l l ~ 4 Dist. Pipe -o ~ , . D 0 ~ ~, , Bot. System , c` • q U ~ `~ ~ Final Grade rYc~t,.d s s st_ ~r,• ~ (o •o y~ •~y ~Z y~ ~ 9~• 3 BED/TRENCH Width ~ „~ Length No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q 1'/,'~ ~ u !/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM ACHING Manu r: / INFORMATION HAMBER OR ~` ,,- I i -~/~' T Of System: ` ~ UNIT tJ Model Number: ~ DISTRIBUTION SYSTEM Header/Manifold Distributi°~j ~¢` / Hole Size x Hole Spacing ~ ! f Pipe(s) IC ~ . ,bp ~ S ~ 6- t • Y 1 f~, ~r 7 ~ f Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Ontv Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center 3 • ~ Bed/Trench Edges Topsoil Yes ~°'-~ No -, [_ Yes No "~ ~/ ~ / 03 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / (~ ((/~ Inspection #2: Location: 459 Jensen Lane H~ud"son, WI 54016 (SW 1/4 NE 1/4 17 T29N R17W) ~Parkvi~ew Est. VI L~22~ _ Parcel No: 17.29. 9.1 1 1.) Alt BM Description = ST''l,0 ~Z ~6~~, ~~~~~'~~~" ~ F ~ - ~- 2.) Bldg sewer length = Q~ ~S~ ;,,u ~Q't~ "'~""~ - y~ ~e S -amount of cover = J r~~~ -~ ~~ G / ~ ~~~G~.Q, Plan revision Re wired . Yes o ~ q 2 Use other side for additional information. _~ _ J ' __. ___ __ _. ` J L_ _ ~__,. SBD-6710 (R.3/97) Date Insepctor's Sig lure Cert. No. Y /r"t/ 1 e~F-4.tti1N - Vent to Air Intake ~d ~'iGllhw (s.OY ~1~i1 17, y9.19'.%22/ `~ Safety and Buildings Division County /' _ , ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 % T ~ ` ~l•Q ~s~ea ns~n Madison, WI '53707 - 7162 Site Address ~~ ~• -r'~~~7 T J Department of Commerce Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ~~Z~~ _ tna be used for seco ses Privac w, s 3 "°-"~•°~----°°-- I. Application Information -Please Print All Information ~ ~ + ~ _-. ~ State Plan I.D. Number N/~ Property Owner's N ~ . ~ i ) MA~tT'' ~,q-7"7"i ~'r/iiviEc~ ~'j~ 200 ~ Parcel Number ~~o ,~Z~.o • y'O • t~ - Prop~e(rtyCOwner's Mailing Address r. ~ ` (; ~ '1 J ~ J 'E/V S~/V ~/1~ ZC _ ` .,...-_.-_.,.~• Property Location p Q .5~ u N >ru• S ~~ T 2/ N, R ~ / City, State Zip Code Phone Number ~(~ Lot Numbe~ Block Number o/C ~ ( ~/) D (D ~ ~ , ~ I V J v S y ~ ~/ , //~~ Subdivision Name ~CSM Number 5 p~;pl~v~~ DDS ~o~ II. Type of Building (check all that apply) ^Ciry ~1 or 2 Family Dwelling -Number of Bedrooms ~~1 bi'i~ '~ ~ ^Vlllage ^ Public/Commercial -Describe Use ovmship ll_ ~ ~7~'U, ~7 i' ^ State Owned Nearest Road J >'~N ~~ /1\~~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 ^ New 2 Re lacement p Syste p 3 ^ Re lacement of 6 ^ Addition to For County use S sum Tank Onl Existin S stem B • ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued Iv. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44~Non -Pressurized In-Ground '~ 21^ Mound 47 ^ Sand Filter ~ i • 1x28= $70.8 3 rGr~ru"~'-~.~_ SO ^ Constructed Wetland 22 ^ Pressurized In-Grovnd 41 ^ Holding Taiilc 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ~ V. Dis ersai/Treatment Area Informat ion: ester - - O G fp Design Flow (gpd) Dispersal Area d R i Dispersal Area P Soil Application Percola tion Rate S~'st m Elev,,a,,44~~'on ~ • ~ Final Grade ~ U,~vl re equ / roposed ~ Rate(Gals./Days/Sq.FtJ (Min./Inch) .W ~ ~6• ~? J~ . elevation ce~.,~ ~ 5 ~ ~ 70 t 7 ,Q ~ja ~ J~~ so,.~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel -Fiber plastic Gallons Gallons of Tanks ~ , Concrete Constructed Glass New aistin 5 r~~1 ~ _ ri~t'~ Tanks g Tanks . t;Q Q Septic or Holding Tank ~ -i ~,~ O ~/ ' ~ Dosing Chamber / _ b „ O ~ / VII. Responsibility Statement- I, the undersigned, assume respoasibiiity for installation of the POWTS shown on the attached plans. PI tier's Name riot) ~ ber's Si lure MPMIPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) zB~Z /6~ 7411,E • SPR~NIr U S`~7~~ .Count /De artment Use Onl pp ed ^ Disapproved ^Owner Gives Initiai Adverse Sanitary Permit Fee (includes Groundwater Surcharge Fe ~~~ a~ Date Issued I ~ Issuing Agent Signature (No Stamps) , ~ /~ - ~// ~ „ // ' ~ ~ Z , Determination I I ~ ( v r IX. Conditions of Approval/Reasons for Disapproval ~lo~p~_-i ~ ~e"C ~.~ ~~ tJTS POr ~/ ~ " ` ~ C ,,,,,,q,~u~ ~-~,~,.F~Q t~,~; `/ u,1 ~¢GR,t~, ~.~-~~iee~rrn,. ~ (~OV~Iht.E~Ec6. R.p~tt-c-ort~nl'~" ~ ( ~.~ G~t^., ~ `~ e ~- ' w~ l - , ,) , ^,~,~-~- .. ~ c~ ,1~e a. ~ ~/~ ~o o>~ra; n ~e n. ~, ~e~ ~n J 7 l 3. Ykc. Dow~S ~~6o~r S4u~.~ v'e.~.~~t„ ~ S.rrl1 r.h,,tol~~xY-~ ~i ~O . ~ 61rtC6W72~i(, ,l/1.il~t~ •1-k.~ (_=t~n.,l n,._..,~,Gt,.., Attach complete plans (ta the C b on17) ~f)Z~ iP~~(a4. ~- s~~cw- e(ev~lv~t Skou.Q~k ~ l SBDy6398 (R. OS/Ol) on paper not less than 8 > a'~1h9Z~ ~4.c _- 1 • ly ~c ~~ ~~ 0 ~ ~ ~ i o~~ ..nwZ= ~~ ~- 0 ~~ o" ~o v ~~ rvm -v U' ~- ~ -o cn m ~' ~ ~~ ~~~ m r- ~ r ~ 1 s N, - j i D 1! i N j ~ 4 ~ ,, o , , ,, ~'~ ~ ~ ~~ ' ' ' t E_ ~'a-.' + + ' ~ Q l ~ ~ ~ t ~ ~ C.'4------ W -_--.-.... '~- ~ s '~ ~~ ~~ • ~, ~ ~, r ~- ~ , c.- ~ ! ~ ~ ,I ~i~x o ~ ~ i ~ ~ ;,~ i ~i a d 1 ~ I 1 '~ ~~~ `~ ~ - ~' 6y ~°~`'- bi~i f a ~: ~~~ ~t ~~~` tx, ~ ' ~ ,. P c,.~ ~ ~ =c -~ ~ d ~, I~ \1 Y c ~~ ~~ y ` a -~ o. ~~~ /~ ~ ,~ c ~ Z i ~ ode ~ ~ -~ -- w '' a ~~ '''( .~ '' ,`. a d ~ ~ ~ N ~~ ~ y~ 1~ 4 rA ~ ; m_ i `~ WES % ~ ~ o ~, ~ ~~ c ~ ~ fi ~ T w ~ ~ I~1 O Z l . ~, ~ ,- ~ .~ c C ~ ~ rn P ~ `~ ~ .~ ~' ~ ~e ~ ~ ~ p ~ - , ~'t -----~ ~, , i ~ -d _~ ~ ~~ _. - ut~B~~c~-~1 ~ ~SSO~~~T~~ G~. r.. 655 O'Neil Road • FJudson,lNJ 540f 6 715-386-8185 Reg. designers of Engtru!edng System: private Sewage Cvnsuilanls PROJECT INDEX t FLAN Ib ~ DATE ~U~ • /G _~ owNr~ /~j~- 7-1'x' ~~'C~(• ~ (ice i EGt~/ • PHONE 7%S • 3~/• /ll3 AUaRESs LEGAL DESCRIPTION GDT ~ !ZZ ~~U/L~~ ~Sr'if'~~$• S~ }I!'G TOWN OF />~yf~`S'a,~ COUNTY ~~ ~/p0~' x` C 5'j'M ,1 ~lll/~ /~~ ~ ZZ-Ct ~7 5 LOCAL AU'1'IIORI'I'Y/ SUPERVISION ~'?". Gam/ X ~)`~ ~O~ t~~G- PROJECT DESCRIPTION w ~ / ..,e~~ --~--. dl~ SfSr~. ~/ll /~' ~ GYi T~cT I~ ~p~~ . T~(IS POWT SYSTEM COMM. (NCORPOAATE PER 83.44(2}c A PROPER ZABEL. Fy(,TER MODEL ~ f} ' /~ ~•~~ G~~~ ~v~%l ~_ ~ t3~RT ~/`j/~icG,T Ulbrickat & Associates Private Sewage Consultants 2812 10th Ave, Spring Valley, WI 54767 ~~ ' l~ ©3 Pg.l INFILTRATOR SIZ ING WORKSHEET Pg . 2 SYSTEM PLOT PLAN O ~' Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. '~q 1 Pg . 4 ~~ ~~ ~~ ~~ ~~ ~. T----_ r ~ O fi ~ o b ~. ~ ~. ~N III, `~ ~ v~ ~ G ~ C~ d ~ `{'~ V ~~ 1^~' -`~- .~) ~ o ~~ ~ d 'O ~ ~i ~ ~ ~ `~ ~ ~ y ~ n ~~~ y "~ ~ ~ ~ ~°~ ~ ~ ~ y `~ ~. -- _ ~ R -~ ° ~ ~ ~ ~~ \ ~. ~; b ~~ s h m ~' ~` h~f -O C 00 v1 v `~ .; ~ ~ - ~` ~ ~. .. ~ ~ J '~ ~~ ~f 1 ~. i 0 S w~ 'E' .~ ~_ ~ -~ cn ~ !f ~~ - x ~ ~ -~ o v v~ ~ rvm ~ # ~` ~ cn ~- o m u' i _ ^~ m ~ ~ V' ~~ H ~ r ~ ~ r r O -~ S~~,~ ~ ~ ~, ` _ p 3 ~ ~. _~.. _~._.~ _ r ,, ~ ',~ ~ a ^ -P ~ 4. s N f P ~ ~ ~ ~,~ _. ~o ii~ ~~ ~ ~ ! ~ ~ ~ ~ ~~ a !' ,i ~x t ~~ ' ~ .~ ~ ~ ~ ~' ~ ,N~°~ ~ ~~ ~ ~ ~~ .~, ~f ~s~ ~- 3 ~~ cN ~ ) ~ i ~ ~ ,I j ~+,x ~ f ~ ~ ~ ~ ~ ! ~ 1 { '. ` ( ~ `~ ~ V (,\ ~ } ~ ~ ~ ~ s I~ ~ ! ~I , ~' ~, ~ ~ ~ ~ ~ i~ ~ d ~ ~, ~ a a ~ ~ ~, ~~ ~~ `~ `~ ~ ` ~ ~ ~ 1 a 3 ~ ~ ~ ~ N °a .y; , G` ~ -~ `~ 4 /,vas' % ° ~ °~ ``, G ~ C y DoT `~ (~ ~ ~ ~ O ~ Z m ,~ ~ , , ~ c !r ` c ~ ` ~ ~ f a "~' ~°' ?e 7 ~ p ------~ ~ ~ i ~~ ~ ~~ • ~~ ~ h b'' .~ ~ ~ ~ ° s ~~ P ~.p n z ~~~~ i ~ ,~1irv. r~ ,. ~~~ ~ ~1 a ~~.0 ---~. _ !a- `~ ~' _ ~'rflC v Git t~D ~~ g ~r ~~' ~.~~H-~ f~~ ~~ . ,~~ /9Pf'~~~I~ U~.v 7- c,9f /x.11 r,[lS f'Ec T/dc~ ~l~ ~ 1/// Sc~, Qo ~~v~ ~~~~ Cho SS Sic j ~o~ o~ T/r'~"~G~s ?.lS/w ~~ ~~ ~ ~~ v ~ ~E' ~r oR ~~d~/!cam S .S __ ~ y~~~ C,,~~,~ c.1', y ,~.Sir~E/v;,v~;~° ",~lD~i L 3 ~X ~ '~ ~ L O~U~ Lv ~~, 3/ • l SQ. ~T, rfidi°.~ou~ cy~~c,r~ ~ SSG Ti'a ~ ~~ tilirv . r 2 . , ,~r t 3~ .I 1 'y'i ,. i9Pf'~tr~p U~.v T c,¢/° ~,1> r~vsp~cT/ov ~/k,Q, sc~ • ~o ~.-~-~~c "z_..... ~riv~S~ED 9iP~~~= ~D/~ C TiP~~ c~ ~. s ys r~M ~ ~z_ F/i~// S QED yiP,~~~-- ~ C~ ~ , o T~~~ ~~ ,~~ T +`r ~~ ~~'~ SEPTIC TANK ~:PUMP_CHAMBER CROSS SECTION AND SPECIFICATIONS ~~r~„i' 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ > i,O' FROM DOOR, WTNDOW OR FRESH AIR INTAKE - ~ ~t ~.., - IN. ~~~ ~ INLET qa.o' tt i i 5cD. 4v ` P VG Q i per'; ;'gyp SOLID SOIL a~ 5 SPECIFICATIONS_ g TANK~~~~~ ~y ALM ON OFF CONCRETE PAD SEPTIC / DOSE ~7/~5~~ `T'ANK MANUFACTURER : ClJ.t1~t.C ~ NUMBER DOSES PER DAY - g~ ~e • - TANK SIZES: SEPTIC ~Q'•jfU GAL.'S DOSE VOLUME INCLUDING ~_~~. DOSE ~~~6 GAL. Z5 FLOWBACK: ! ~~ GAL. / ~ yon ALARM MANUFACTURER: G,Q(j,LQ ~/7~M CAPACITIES: A = ~.. j- INCHES _.____ MODEL NUMBER : . L-'r ~ ____ SWITCH TYPE: ~'-!yf}.-~-"- i B = 2 INCHES = ~Z- YUMY MANUFACTURER: ~~1~ C = ~ INCHES = f~ MODEL NUMBER: i _ SWTTCH TYPE: /~,f.T'" ~ D = ~. ~ TNC~IES = ~~ /~~ t~EQUIRED DISCHARGE RATE /~(~ GPM PUMP ~ ALARM WIRING AS PER ILHR I6y2 ~~- ~! ~ C ...~ VERTICAL DIFFERENCE BETWE ATE PUMP OFF AND DISTRIBUTION PIPE S FEET + MINIMUM~TETWORK SUPPLY FRESSURE ----~ FEET + / D FEE`t FORCEMAIN x I~FT~300 FT. FRICTION FACTOR ~~~ , ~ FEET ~~~~~ T.OTAL DYNAMIC HEAD y~~( FEET t t It INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ~~ WIDTH ~ i DIAMETER Vo i cQ Vc~ ~+^"""" ....... lSU X• (l~l =2-`~.~~Q6L-d LIQUID DEPTH ,~~ ~( SIGNED: LICENSE NUMBER: `.~ ~~ 40 ~' i~L/ E ~'; ~ y ~~ ~~~T ~~~ ~, F ~ ~7E7~'- 66 6 PUMP OFF ELEV . U ~' Z' . --1 ,%~ A'WEATHER PROOF JUNCTION BOX -WITH CONDUIT -• i' GAS- ; ~' TIGHT i `, A t SEAL ~ ~ ~ -f-- ~ ~ -; B •~rr i -{--y ~ ~+ c r3.3 , ; -~- I l D j 3" APPROVF,D .BEDDING UNDER DATE P~~ S~ECs ~~~. ~ '~ o~ ~EQ~ /~~- ~-5 ~~.Qs !, n L d~ ~ ~ ~._ ~ J ~t ~~ ZOELLER EFFLUENT PUMP Mt?DEL.'98 ~~vw PEFt MINUtE rout erwu+a Huhrtow rtrt unrure trrt+rn» µe e~vr~trwwa f~ cu>tcnir YMIl~/MtM Ittr MtitRt flrll• lrr+~ io 10! et 2~r 11 1./- 1/ no ~° a is » os ~ 5~ ~ ~/i. it CONSULT FACTORY FOR SPECIAL APPLICATIONS ~ Eleciricat aMerrietors, for duplex systems, ar• sv ~llabie aril tuppNtrd wNh en alarm. • Mercury float awdchss ere avertable for corNrod -.Mt~ilcal a!I•rnatae, Idr duplex syslsms, errs avslieble wnh or • Ares phase systems. ~ aloe aril wAhaA ttlsrm tnvilctr•a, oubts piggyback mercury 11oai awdche• are avertable for variable level brig cycle conlrois. Standard alt medals _ } N l.rb• ~ladst Yyha~Ph Ilodo Amp M_ 9d _ t!d ! uto ' O.E ooe zero `~- f N t Auto ~ !ao i _Non ~ ! .1"~"~ s„_w~.~!!t M-w Iw.e~r err. Ibl. - % f (. p, ersbol 9.LcNoa REIEC~pH OU1bE ' t. N.lrtl Ibet epatl.d 2 pob rw.etnudcar.wheh, to .rMrrul eo+Nrol t+quir.d. ~ !. ftnpq pbpye.ck rr»rcury ao.t ovrNeir a dam back r . h P'i0 h i.t au .K w c y n.reutil. !otl . IMIa b fM011[. !. M.cbarticd dt.rruta f0 001! ~' - ~ a 14-007J~ !. ~e f M0~ t?, br oorgc) rrrodot of E !f. Mercury 1.raor flo.t •wkch id i ~AMarruror, "E•P~', i ~ - dupi•R tai o. (1) do.r.ruan y a eorrirol .erw.tot ,poctA' ~ t .. ~ a / t ! !' f9~to•N- trgt...JPutt", furreUorj pM~ or d'~x oW rrbr~ 10 Coo ~ torrrr.ctto~ a wtnd•N tlm• i. 1ws t~ /a1t'J~P.M",for wwwMO-rf eewt..__...a Np~. - t 1/1 1 6/a -~ r . ~ +,. . PAGE 8 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of 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: 5fi G,'~or ~ G~~ ~ ti i ~G-- 3~~ • yG ~~ *.Licensed installer, responsible for providing an operation/~ ^ maintenance "Users" manual: /'~ * Licensed service / inspection agent other than installer: 3~(0 • X130 * Electrician, for pump, electric controls, wiring units: ~i4/'v ?~U%•t1~ ~~G. 4j -¢.,2., S 7 3 3 Co IMPORTANT OWNER MAINTENANCE RE UIREMENTS ]. Winter traffic (sledding, shove ring, etc.) across the area shall not be permitted, or frost can/will penetrate into -. the cell, freezing up the system. Discontinues use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and desi:royed. This system was ,. designed for a maximum wastewater flow of ~S ~ gals. daily. i 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. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent 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 (the Bells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'PEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. C. T ...~ ! ~ S - t W ~ ~'~~ SOIL EVAIUATtON REPORT Oivlsion of Satery and BuNdings ~ ~~ 3 attach oornplete site - ---- -- -- ----- -_....._ --• --~.. ~.....,w- pfan on paper not less than 8 1/2 x 11 inches in size. Plan must ~, S 7- G~b~ x. indude, but twt firmed to: vertical and horizontal reference point (BMj direidion and • , peroent slope, scale or dimensions. north arrow, and location and distance to nearest road. Parcel I.D. ~ ss,, ~rf~ d 2.O ' ~ Z Z ~ ' /v • rff,~ v P/ease print a// fnformatfon. by ~ te Peraon~ ~itormation Iron P~de may tm used for secondary prrposes {Privacy L.aw, s. 15.04 (1) {m)). Q ~ e- 8 C/J /~J A,~.~.~ / "~ T f ' ~ ?~T~ l ~ / ~ N ~ ~ C.~/~- ~ Propertylocation Govt. lot ,5 W 1/4 ~ ~1 /4 S ~ 7 T Z~ ht R ~J ~ (or} w Property owners M~rit1Q address S J'~',USE,v 5 ~• A ~1~i r~ o Z Z P # k UI ~ ~Y State Zp code Phone Number ffUDSo~ lvl. spa/ 7<~ 38/• //! , ^ c;tY [~ Vif{age ~I Town Nearest Road -~s~ ( o,,, ~e .~ [) New Construction Use: Residential / Number of bedrooms ~•=,~~ Code derived design flow rate ~ ~ ~' ~.~ ~ GPD Replacement ^ Pub6c or commercial - Descnbe: Parent material _ /0~SS ~_(j,~,L, Srav(~y Food Plain elevation;fapplicable ~~~-~ R. General ova w•4- a w and ' ~xrSriiuCr s ST~"~r iS iv svi'T~ l3~-~ Soi/S ~ ~~~ !3-e.. y /~ C Ui A- Uf4/Gu- ,~02 ~ 'fit' ~-~- i3 o Bo~ # o ~ . , aZ . 3 z Gr«a,d susfeoe rev ~~/ ~ ~) Pi D ~ /~~ . . t epth co facror in. soa Rate tioriaon Depth Oomirmrd Relax Desaipffon Texture Shucture consisterme Boundary Roots GP D/fF &r. MunseN Qu. Sz Cord. Color Gr. Sz. Sh. •Eti#1 •Eti#2 ~-I~ iayR 3/ -- Sig i~sh CQS w 3 . Z !a Q ----- sL hF c ~. f • ~ -- ~. I• 1 c: ,ray r .a ~•---•.. ........w v.v a'a}+V I W iw{wwry rO1dN wr. S~ Rate Horluxi Depth Dominant Redox Description Texture Structure Consistence Borurdary Roots GP DAIF in. Murrsep Qu. Sz. Cord. Color Gr. Sz. Sh, •EtT#1 'Efffl2 o• is R3~ /L h S w 3-F • Z •3 a a, ~ • ~ i0 f ~-+~ ot,S , ~. . 3 s s i• l ~~ rams i~r = nw ~ -su < :C1U mglL arrd T55 X30 < 150 mgJl ' Effluent #2 = BOD < 30 TSS < 30 nglL CST Name (Please Priidj ~` ~ C, ~ 2~4 car Address Date Evakratiori Corr~ted Telephone Number ~- 0 7/ •77 ~ - y~L Ulbrickit & ssocla es Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 t ~~ Ld T ~ZZ • ~' CY~i vi~' c • I ~2-d ' ~ o • ~ o ~ , ~ 't~ ~,•O Z 3 0 wrrer # ^ G Paroe! 10 # ~o~•yz page of ,~~ round surface elev Pit . ft. tkpth to 4rtdtlng tailor in. Horim n Depth Don~ant Redox Desaiplion Texture Sod Ra Stnrciure Consistence Boundary Roots GPDA~ ~ ~. Mansell Qu. Sz. Cord. Color v • Gr. Sz. Sh. •Ef~ .E~ I is yp ~ ---- ~G ~ s~~ yes w ~ . 3 `ono s~. Zf ~ cwL~ .s ____ -- Z - i s ~, ~ ~, -~ ~ ~ ~I ` i ~ ~ ~~ ~~ # ~ o:r Ground surface elev. /- ~~! • ~ ~ J ne.,rr~ s,,..,.. / ~ Z :.. Horizor- Depth Dominant Redox Descxiption Texture -~ ---- _.. Stnxdure Consistence Boundary Roots Sod ica6ort Rate GPD/ftr in. Manse!) t]tr. Sz. Cortt. Color Gr. Sz. Sh. 'Efl>V7 •EtTlt2 ~ o • ~ ~o ,p ._.._.-- sip sh.~ w ~ . z ` 3 • z s iL ~,,,t~i' c gar a..s • iv c~. . 7s~ !~!. # ^ ~~ ^ Pit Ground surface elev. ft. Depth to leniting factor in. Sod Rate Horizon Oepth Dorrdnant Coiw Redox Desaiption_ Texture Stnrcture Coruistenoe 8otxxiary Roots in. MunseN thr. Sz. Cont. Color Gr. Sz Sh. •EB#1 `Eff#2 a ^ Pit Ground surface elev. ft. Depth to rirtMing fador h. # ~ ~~ Sod Rate Horizon DorMn2mt Redox Desuiption. Texture Stnrdure Consistence 8ourdary Roots GP DffF in. MunseN Qu. Sz. Cont. Gr. Sz. Sh. •Eff#t 'E1f#2 Effluent #1 = BODE > 30 < 224 rttgll. and TSS >30 < 150 mgll. ' Eftkrent i{2 = BOD, < 30 rtx,1lL and TSS < 30 ngll. o N D O 0 ~~ ~o ~~ ~~ w ~, v\ ~i ~ `~ ~, ~` ~~ ~ N ~ a ~ ~ ~ ~ °Q _ ~ ,~ ~ ~ ~ y 4 ~ 4 l~ ^4~ 11 d • t., ~ ~4 . ~ ~ m` w `.~, ~- ~, - Q- ~' _ ~ I ~'~ ° Oc! i~. U G ~ C9 Q~ 0~ ~ ~ I ~~ was j ~ o T ~.. . O ~ p f Cam' {b,, ~ ~ ") W 4 Z 1 y ~ ~} {v ~ -NS W h N -- .---- ~. ~ o ~ ~ -~ k ~ 9 N fi Q ) `T .~ ,~ d y n f Q ~ ~ ~y __ __ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK phis is to certify that i have inspected the septic tank presently ~ ' , serving the sLiNi E'Ct~~ s residence located at: S~v 1f 4, ~1 /" ~ 1/4. Sec. ~ 7 . T ~` N. R /~ W. Town- of !T v 0 SOn,J Upon i aspect i an, I certify that I have f ound the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced ~u~• ~~ Did flow back occur from absorption system? Yes ~ No of no, skip ~~J/ next line) Approximate volume or length of time: / Z.gallons lid minutes Capacity: /Q'~ ~~ Construction: Prefab Concrete ~ Steel. Other Manuf~c~rer ( if known) : C(j j ~.SE: Age of Tank ( if known) : ~~~ "Z (Signature} tTitle) t i7ate ) (Name) Please Print iLicense Number) F~.ir~~'~ tv be completed by licensed plumber (s.195.Q6, Wisconsin Statutes) or Licensed Disposer tNR 133 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: Iri 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?. Narc~e Signature~~__ MPiMPRS ~--- ;~-z~ 3~S Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 1 52 I~`) / titatc Nat ui w'i+cnmin Funn 2 198: WARRANTY DEED t1^~ ~i1 L fi~ ' 3 DOCUMENT NO. ! ~: , :~. Daniel Keith Ostlund and Kathleen_J. Ostlund ° husband and wife,.-- .. - ___ -- --. pattl ` _. _ __ _ _ A. Velman acx.3 Matthew M. con+rys and wttrants to _ ,; _ Giiniecki , bsjoint _ tenants,- _ _ .. _ ll _ ` ~ .. ._ .... ...... ... .. _. -- _.. - '- $t. Cro1X _ . _ thr following de+crit+rd scat estate +n ~~ ____ County, State of Wiu:unsin; REGISTERS UfE!CE ST. CRQIX C~,,1'Yl Ftec'ti tcr.°.~t:~J APR 3 1995 at a: oo A•tA X.~...,,~t. Regi;terof DecCs i 1111': 'iPACQ HF:~CRVEb i(ln ,tEl:i-'Rr11Nl"~ ilAr~ µi NAME ANI~ t7 i_rtrRN •nnNE S.`: /( ~- iPaccel Idrnti(ication Numbest Lot 122, Park View Estates Fifth Addition in the Town of Hudson, St. Croix County, Wisconsin. ~.;~s~~~ t~ F~~ ORIGI^!A,L This _~_._ 1S __ __ _ _ homestead property. (is) Exception to «afranUes: EaSefttentS, restrictions and rights-of-way of record, if any. 4~-' Dared this ~ ~ __ day of ._._ ISEAI.) • ---- - __ -- ----- ISE:\L1 March ` ,t9 95 n _ 0 ,` ,t ani 1 K h stlund /j ~/ rTEr"t ~ ~ '(It ~ ~{, {~,• '. ._ ISEALI i ttl.t Kathleen Ostlund __ AUTHENTICATION Signawrcls) authenticated this _ day of ______---_------- • 19 _. _ --__ TITLE: MEMBER STATE BAR OF WISCONSIN 11f not. _. _ -- authorized by §706.06, Wis. State) THIS INSTRUMENt WAS DRAFTED 0Y _ Kristina Ogland Attorney at Law (Signatures may he authenticate) ur acknowledged. &,th are nut nrcrssary.) „CKNOW LEDCti1FNT ST:\TE OF WISCONSIN ' St. $t. CroiX County. s ~ Penunally came t,eforr mr this _ ~ day of ~~ amrJ Daniel Keith Ostlund ~ ,F,, - Ostlund, husband and ~. t~_~~~ - _. x ~~ : ~ w =~•r 0 ~ ~ --r-- nun 3 ~ ~. ~ ~ e7t .,ittA~la r to me kno+~n to be the pr foregoing nx•nt and acknowlydg~:.`••~'(~4 . `ten STA'~ . VoWrv PuM ( S~ ~ ~ ~ ~ ~` County, wi+. ify commis+iun is rrmanent. Ilf not, +ta-c txpiratiuQn drtr- I I I ~ ~ I i ~ ~ ~ ~ i - I ____ J ____ ____I >l _OUT_LOT__t- (PARK) LL ~• ~~ ~ r o 0 z~ SOUTH LINE OF THE NI/2 ~N89~15' 14"E) ~ OF THE SE 1 /4 N 8g'ii'47"E 920.00' -_ _ ~_ PUBLIC STREET ~._ _ ~--- - - - ~o 12~ _ _t24 • _ ~5339T ~1• Ft. ~(1.2Z6 Ac.~ ; I I I I i i~I' ,'T -ice ---3~~.s~•--- 88 ~ ~ 104 I -W l~~pW RIOGE_EA: PROPOSED ORIGIP!AL '~' i'F ;^ i oo S'f C-tOIX CVUN'fY SCP~'1C 'i'ANK I1~IAlNTENANCE AGREEMENT ANU ~.- OWNERSIili' CERTiCiCATION FORM Owner/[layer M/g' J`~ ~ ~14' ~ ~~ • (TG /iV I EC ~~ Mailing Address ys 7 ~ ~~ ~~N i'roperty Ac4dress ` ~`s~'J ~ ~ S (Verification required from Planning Departrent for new construction) city/st~ta Parcel IdentiCcation Number d 2~ '~Z"~ • J~~ ' ~~° LLGAL UESCRiP'I'IUN AA''~ 17 i'toperty Locativrt ~~ ~/., /v '1,, Sec.'.~~ , T ~ N_R ~~ W, 'T'own of (J `sd~ Subdivision ~~}/~ ~%~"LJ r~ST~-TES ,s' 7~1~. Certified Sut-vey N)tip # Wnrr•renty need # S ~- / 2-•c..e •r ~zZ • Lot # ___~_ Vo[ume , Fage # ((__ ~ Volwne ~ % W ,Page # <<2, ,i Spec house U yes ~no Lot lines identifiable yes O no SY5'I'EA~ MAlN'><'ENANCE lmptoper use and maintenance of your scptic system could result in its premature failure to handle wastes. Proper maintena ,.:consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the cyst can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cerii(ication form, signed by the owner and b master plumber, journeyman pitrnrbet, restricted plumber or a licensedpumper verifying that (I) the on-site wastewaterdisposat cyst is in proper operafing condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludt lhve, the undersigned have read tlrc above requirements and agree to maintain the private sewage disposal system with the stands set t'orth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certi[icat sta n that your scptic systtrn has hero maintained must be completed and returned to the St. Croix County Zoning OtIice within d s t e tlrrce-year xpitation date. / ~ I, ~ ~ ~' / S f3NA~ URE OC APPt. CANT DATE .~. t wc) certiT th. all alernents on this form arc true to tht best of my (rnrr) knowledge. t (we) ~m (are) the owner(s) the p err crib ove b virtue f a wacr y deed recorded in Register of Deeds Ot[ice. - 11 ~.~ SI(rNA'I'URLt OC APPLtCAN"C / / " DATE 'r'r' *''' Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ''~•~ "+ fnchrde with tlds appltealtern: a clamped warranty deed from the Register of Deeds office a copy of the certified survey map if refertnce is -made in the wattanty deed S'~'. C~tU~AS [3CUIl,'i'~SANITARY R ~p ~ ~t'1'ME ~~~ . s Vwner M~4'T"Ir ~ T ~T-/ JN/~~ / 3~~ ~ T ~ ~ ~9 1dcl~~ss `f ~v.S~.v ~°~~~%r boo CityiState O.S-D~/ /. y i C~ `~J.~° ~°c,,/; ~ \F .~ 1.,r~at 1)escHplion: I,oi; Rlock _ '/~ '/w ,Sec _ Subdivision/CSM # T N-R W, Town of .J ~ PIN # O2D • /22.a -y'O lldz~ SEP-I'1C 'T'ANK -- DUS ~ CIiAMI3EIt -- BOLDING TANK INTOItMATION: , l,~1~E~'~ilp ' lD~ ~sv ~-~' yS~ ASV' Tank manufacturer Size ST/PC ~- / Setback from: douse- Weil PAL i'unzp manufacturer ZO~'71~=~ Model ~~~~~ , /~-P. Alarm location 1N Siy~= ~U (t1ULbING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location Vent to fresh air intake Water Line SAIL AIZSUit.l' I'IUN SYS'T'EM: 13laoi f~vS~. ~ y Z. 7'ylte of system: ~'~N~i.ls Widllt ~`3 Length Number of Trettcltes Setback from: (louse Weil _~„P/L Vent to fresh air intake > S O ELEVATIONS: llescription of benchmark 'gyp d~ ~~~( L~'S~NUJ llesctiution of alternate benclnnark Td /~__aF _~SJ~ _T" _ __ 5 ~~ __ R~~ ~~G~ F3uilding Sewer ~ ~ ST/ii'f Inlet PC l3ottvm Uistribulion Lines ( ) . Bottom of System ( ) Header/Manifold ~/ !~ ~ ~ . Elevation Elevation ,>! ~'~• r ~ , ST Outlet PC Inlet ~ Top of ST/i'C Manhole Cover .F_ ( ) Final Grade ( ) O ( ) 2 ~ llate of installation / / Permit number ~`~ State plan number ~ ; Phttnber's sitnahtre License number zi'C~3~S Date / / Inspector ~_~`'( ~U% it/,t,/ Sf~?'-• ~ • r>3 ~,~~ duf ~jo O `~ ~~~l~S ~ ~ D~ ~, / Complete plot plan ~ Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Sorina Vallev. WI 54767 ~~~~ j~'Q' cQ ,~ m ~_- ~3~~ ~D~N ~~~o .~ v rn v s ~~ t~ t~ .. 7/ ~- ~i ~ N ~ ~ -•c_ ~ ~ "~ ~ ~ ~ I, ~ off. ~ ~ Oi ~ o~ ~ `- ~1 ~ ~ ~ c~. ~ ~ t ~ i = U. t a ~ ~ I ~ ~ ~ ~ t ~~ ~--=p . I ; I 1 ~' , ~ ~ ~ ~ ~ ~ ~ ~ i I ! ~ !~ 4 ~ _ W ~i I~`~~`~ ~ ~~ ~~ ~ ~ G ~ ; 1 I ~. G ~~ ~ * '.~1 t W ~~ ~~ ~~ a s Sy ° W o. G G -~ ~~ G _~ ~`1~ c M ~ x ~ ~~ _ , 3S o • o---- o ~?' ~~~_ 1 s ~ O ~ O ~. f7d ' ToT~4~-- ate ~ ~' __ - ~t o~ - -~ ~ ~~_ O - + ;' ~ ~ ~ N -~~ ~ A ~ ~7 v D ~ m ~. A ~ c ~~m~ ~ , \,/ ~ ~ D ~ ~ O D D ~ ~ ~ ~ ~ O D s mf - ~ ~ R~ ~ r ~ ~ ,fit? ~ ~ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER y2 Vl'~ I ~` ~~ ~~~-Y TOWNSHIP ~ kb~.. Sa ~ SEC . I ~ T Z g N-R ~ 9 W 1~7. ~. 1 ~.1~-~-I ADDRESS ,~~~z~SZ_ ST. CROIX COUNTY, WISCONSIN ~ ` ~~ ~ S r~ ~- v D ~ C, (/ SUBDIVISION ~~ (k u,'R,,,,~~ E s'f', LOT I Z Z LOT SIZE ~ ~ Z ~--s /9C . PLAN VIEW Distances and dimensions to meet requirements of IT.HR 83 SHOW EVERYTHING WITHIN l00 FEET OF SYSTEM ~ ~ __ ~ °`~-- -- ~a.v ~ Y~ ati,V ; Est l..o~" *~ 12 Z s y ~fi~ E ~- 9z-7s- 3Ys" z f A T ~E Nota._ N 5~ ~s ti ~ izo IS. ~ I~H~ 2~ o~~ ~ ~ .T. L aSt ~et I..t~ R E ~ is r N ~--3c u E yo 5 - - - - - T ~,: L iS# D ~ S 3q~ T ~~ - - o g L fi T 1 . ~.. N E ~~as~ No ~ To o£ Z~kzV" zta xtia" L~bc,K. , E I- = I Od.o ~s INI ~ . will 1 1' INDICATE NORTH ARROW SUkI ~ IO~ ,i K~~ BENCHMARK: Describe the vertical reference point used~~ ~~k ~ouuQa~~o~ ®~S ko~SC Elevation of vertical reference point:/9,y 3 Provosed alone at site:3-~l't CIF PU1~ CHAMBER Manufacturer: ~ y Liquid Capacity: ' pump Model: Pump/Siphon Manufacturer: Elevation of inlet: Bottom of tank elevation: Pump Size Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Number of feet from well: Ft ._ Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : (e y, U~'ri a.~w~ Trench. Width: / ~~ Len$th: G ~ Number of Lines: 3 Area Built: Fill depth to top of pipe: y z Number of feet from nearest property line: Front, O Side, O Rear,O Pt.~/ Number of feet from well:,~_ ...--- Number of feet from building: ~9 ~ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: ~~~ Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt._ Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: pEPA'RTMENroF INDUSTRY, INSPECTION REPORT FOR LABOR ~ HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P,.O. BOX 7969 MADISON; WI 53707 CONVENTIONAL ^ALTERNATIVE SW 4 , SE ~, SeC . 17 , T29-R19 ^ Holding Tank ^ In-Ground Pressure ^ Mound Town of Hudson Lot 12; MI ADDRESS OF PERMIT HOLDER: INSPEC71 am Miller Box 282 Hudson WI ~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. Name of Plumber MPIMPRSW No. County. Dou Strohbeen 5432 St..- ix _ __ SAFETY & BUILDIN DIVISII BUREAU OF PLUMBII State Plan 1.0. Number . (lf assigned) IATE. I~O ~O ~a~ ~,: CST REF. PT. EL Number: i7Cr 1 fV 1 e.tv n/nvwrr.v r rr..~.~,d~, v~-- -.+ MANUFACTURER: ~ wer I ~ ~ - LIQUID CAPACITY: - - TAN E LEY.. T ELEV.: WARNING LABEL PROVIDED: -~ LOCKING COV ER PROVIDED 95!3"~ / 93' YES ^NO 9.x ^YES C ~ . FRI BEDDING: v~Ea1J DIA.: MEFfF MATE HIGH WA7E NUMBER OF ROAD: PROPERTY WELL LINE' BUILDING. VEN ~ AIR INLET: ~y ~y iv /1 ~ ALARM FEET FROM / ~~ / ~A , _ ' ^YES NO ^YES NO NEAREST' D DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMV MUDEL PUMP; SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP ANU CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING AIR NLETR (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) YES ^NO NEARESt SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH UTA ME TEH MATERIAL AND MARKING or excavation. Ilf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN ONVENTIONAL S rsit=m: WIDTH: LENGTH NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA. #PITS LIQUID BED/TRENCH: -.. DIMENS{OHS $ ~ ,~ to TRENCHES l ~ MAT RIAL: Q„ t"` PIT DEPTH. GRAVEL DEPTH FILL DEPTH UISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAU NO. I TR. NUMBER OF PROPE TY WELL ~ BUILDING / VENT TO FR AIR INLET BELOW PIPES ABOVE OVER ~ II ELEV. INLE f ELEV END I PIPES FEET FROM LINE: , L~ E ® /~ 3y : yd~ ,~ 3 NEAREST 7V . ROUND SYSTEM: r ~ ld '~ ~' ~ ~ ' '' "~`` ~'~ Mound site plowed perpendicular to slope Check the texture of the fill material for and furrows thrown upslope: mound systems to make certain that it meets the criteria for medium sand. ^YES ^NO 501E COVER TEXTURE PERMANENT MAR ^YES 7EP7H OVER THE NCH'BED DEPTH OVER THENCH~BED _ IiEP1H OF TOPSOIL SODDEU ;ENTER EDGES ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPF. BEDITRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD UISTR. PIPE MANIFOLD MATERIAL: NO DISTR. ELE V... ELEV. DIA_ ELEV.: PIPES .ELEVATION AN ISTpIBUT10N D J111FORMATION HOLE S12E HOLE SPACING DRILLED COH RECT LY COVER MATERIAL. COMMENTS: PERMANENT MARKERS: OBSERVATION WEL ~ ^YES ^NO ^YES ~•~~,(~. c~lQ ~ dG- ,rc~.,c.r ~ ,.,~..,~ ~ ~ •~~~ Sketch System on ~ Reverse Side, i DILHR SBD 6710 IR.01/82) i N PROVIDE A DIAGRAMOFSYSTEM ON REVERSE SIDE. SHOW ELEVA- TIONS MEASURED. OBSERVATION WELLS ~NO ^YES ^NO p MULCHED (-1vFS ~INn ^YES ^N( A: PLANS ^YES NUMBER OF CPROPERTV WELL: FEET FROM LINE: @AI-IITADV DCDwA1T ADDI Ilf'_ATIIA111 HR ..~.... ~.... ~....... ~.. ---- - - ---- 1I cou C ,L In accord with ILHR 83.05, Wis. Adm. Code ~~ .a.,~,,,,.a-,..,..,,~,,,o. STATE SANITARY PER T # -Attach complete plans (to the county copy only) for the system, on paper not less than h i i ' ^ ~pZ~(~ ~ / n s ze. /z x 11 inc es 8 c eck if revision to revioue application wee reverse Slde for If1StrUCtIOnS for Completing thlS application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION a. ~ ~ w'/a ~'/a, S TZ~ , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # /~ /Z 2- BLOCK # ~Z Z CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ^ State Owned ^ viLTMLAGE ~ NEAREST ROAD f/ice~Sa J' a a , ~ , ^ Public ,~ 1 or 2 Fam. Dwellings of bedrooms-3 PARE TAX U R( ) III. BUILDING USE: (If building type is public, check all that apply) 2 _ D ~ ~ Dd 1 ^ Apt/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recrea):it)nal Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ ChurchlSchool 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 Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 11 ~ 12 Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill Vt. 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 ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) g ~5 D `lS G ~~ -D7y ~ 3 9 Z.7S Feet /'S'7SFeet VII. TANK CAPACITY in allons Total # of rer's Name f t M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks anu ac u oncret glass App Tanks Tanks structed Se tic Tank or Holdin Tank 060 ~ ~~ ~ ~- Lift Pum TanWSi hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum 's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: S~r~~6cch d " ~ ~~_ 5'~3Z ~~7 3~ ~ o ~ Plum~be1r's dAdress (S,tr/eet, City, Stadte, Zip/Code): -/ Q ` ~~ ~ / ~ / ~ ~ ' 7 t~ 70 ~ 1~ 'J~ N f w f 1 ! G ry I IX. COUNTY/DEPARTMENT USE ONLY Approved Disapproved ^ Owner Given Initial Sanitary Permit Fee (Includes Groundwater Surcharge Fee) i / 06 ` a e ssue /U' J~ '~ Issuing Agent Signature (No Stamps) Averse De min tin ~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 8 Buildings Division, 60&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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. 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 it 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 a/! septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DIIHR. 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 8X 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 115 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) -:~:: E r~ ~ - ~~~~~ . ,rt APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be the property being developed. the permit issuance. Should owner/contractor,(spec house), completed when the property appropriate deed recording. ------------------------------- completed in full and signed by the owner(s) of Any inadequacies will only result in delays of this development be intended for resale by then a ,second form should be retained and is sold and submitted to this office with the ------------------------------------------------ Owner of property SQ ~ /~li/~~ Location of pro/perty ,~~,1/9 S~ 1/9, Section ~_, TAN-R~ Township /t!v`~e Mailing//'~ address ~ ~z~ Z~ ~GcilSo+~ (,V~ ;C~p~~ - Address of site ~,-,,~ V~~~ ~SI'c~~~s ~ ~~-~sa~~+- w-~ S'~/~~1~ Subdivision name_~~e~,~ ~/~m.~.~ ~s~-~¢~ Lot number ~~~ / Z Z Previous owner of property ,]~f/a. / (,f~vv'~ Total size of parcel /-o/ t4«y5 Date parcel was created S-8 ~8~ Are all corners and lot lines identifiable? _~_Yes No Is this property being developed for resale (spec house)?Yes No Volume Viand page Number ~ Z as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUM88R, 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 recozded in the Office of the County Register of Deeds as Document No. ,3 ~ 3 ~s ~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of tt~ounty Regi~t~er of Deeds, as Document No. 39 3~/S L_) . S i nn~f-nrp n F (ltunor Q i nn~ En~e n F !~n-A..,ner f T F 1n.~1 i n~hl 0 1 /± • ~ 1 r. ~ .. .. •• - 4: ~~~K !,f ~F'v~Y ~ST~TES F~UR'1~-i: ~ ADDlTft~N ;'1 ,t~RAC SV'~GtV1SiCN I.QC,ATt:D.'iN Tt~ ^~Ctr1-SV'~s4~rrw~--S£t~4, cCTtCN t7, T29N., Rl9tN., '!'G'A1N:CF-W. a7: C.RGX CAUN7Y, 1Ar9SCA'~S1N `r- . ~, ••Y CSRTIYICATE OT ?O'Mt~7ftYrtStTfIZR aTATS ar ~-tsccNS~ ss:,:~;~,:r.::.:. tr, caonc co4~Y .-..~ . I'r 8evesl7r A, bM.oe,. be4R fire dslp eleclad, qua1111ad•'aod actla~ Taws Tstasurer al tits Town of Nulsoa, do bsreby eeatity Mae !n ueosdame • Gorda la m7 oflleer t3ea^ ar• tto unpeid taxes or ayaa[aI aaeesentsata -a of ''" " ,,,_. on aey land laotuled bt the .7lat oL Ark View Ietatae Fourth Addition. i ~- ,~ ~te BeV..Ohnea of FO 1Z.aeOT.7 ' TOtUSI t30ARD RSOLtiT10N H:SOL'/ED, that th• Plat of Pz:4 V!•w E.wtes ~ouati- Addition 1n th. Towt- of Hudwn, P.arrsl N, ;V art and Hevje~~j~A,.~IY~st, awnerr, it hes.ay npprov.d by ehr f ~' r a • ppsov.dlt own sman ~ ~ T Y~~-- --7 D tined owo t,.utrman i ierebv errtliy that tb+ forertomq ;e a copy o[ :. sarulutlon adupt.d by the Town Doard o/ the Town o[ Hudson. Dite otrn Clesk , OtM.itASt Ce'RTiSICATE OE' DEDICATION Ar o+ner~, we hareb* t:estifr that we eauaed tba land d.sesibed an thi: Plat to be eusveyati, ::ai3rd, rrapoed and de bated ae rovre+ented an this Plat.. W+ ~.lso eertily tSet ;kte Piet is :egalsed by S. Z36.1o or S, 230,12 to G. aubmlttsd to tier following tos :tppsu•nI or objection: Drparttttret t.t Devslopmeot liruarimrnt o! Industry, Labor sad Human ltelatloae, ?own of iludsans Clq of Hndeoo and St, Croix Coanty, Y.'aTN?.SS the load and real of said owners title ~/^ 't day of ~~!f r ~• 1n~usncr o[: a~ ., e n:~e:ly ~, w,,= STATE OF WISCONSIN) SS ST. CROIX COUNTY ) Yeteonaliy carne before me this '• ~" .lay o[ /~,+~ /'.~ • •• the above tumel Dartel E, Mert and llevesly A, Wert. to ant icnow~ to be the perst.ne w:to executed the fos.SoinR lnrtrurnent asd ackttovrfed3ed the earns, Notary Publle ~'. i,,,.. • ~ „~, ,Wisconsin My eommlarlon expires _.tt~::_SP~ 1~Iar~R~ech, `tot tbile ~ ~. ~~~- C!'ti TIFICATE OE' TOWN CLERK, .=.STATt OF WISCONSIN) _ _ )SS •, ST: CAO1X COUNTY ) I, Rita lfaene, being the duly appolntad, qualtffed and setinF Totvn Cierk of the 'Town o! I!:•dwn, do harab~ ce,~ ~tt[yy that eopie of thin !'tat wore torwasdad a• required Dy .t. 21b, i2 on ehet.L~day of ~ , 19(14, and that within the 2~•day llinlt rot Fy e. 236, 12 (3) tno objectl ne to the plat have been tiled) (all n'nJ..c:innt to •he riot itava been mrt), • 1 ~. t • I I ' 4 I i 1 i i 1 Date tilt Horne, own Glerk ... 3:;t.:ir:r:.: r ~s c ~ , ~~ ,. . ~ I ~ ' s i, ~.}~i d r i ~a • . ~ t ~'sY 4. A t ~ ~ J .. .. ' t. . .. .. , ' JVA .1l N{a~ C~TK NMZl~.: ~ '. i. at,~ r. 81asa1+ Aojdawrod Wtxwria La,-d ]asvyor, barrl-y e•rtify to th. . 1•ot oat my psol..siooal kno•.I+dj•, twd•srtaodur; sect bd+r[t Teas I LOSV nttsverr{, dfndai and na•ppw4 Park Vtra £ustas;Powth A{ditfo0,. loert.d 1>• for NS1/i tJ tLr SW t!4 and tit. N'M:1! 4 0! tA• 51/4 0! Srettoa !T, ?29.`i, !t l9ttr, Tottraof Hadroa+ 9t. Crof~tCoaaty, Wi.teearfa; TLar I haw mania srcA rwrYey, fa,d dlriulos aad plat by t1a dluactlon o! 13rrrd S. Ifest aaJ Dav>irty.A. W•rt, a«raasr o! w!d la,rl, d.reslb•d as toiimn: ' co~aaaselrQ .r thr t1/z ..:~ •! ,.,~ s..tloo 17; tk.se. S89•L:Me'~r (rs.t.ta,•e b.«f.f;,.:.raat~.a !e :b• t,.araowatad s:/-sT :r esT t / z S.ot!•a ua. •+: s«tt•. t 7, b~wlas saaaurr•d sa9-xxwr'~v) (:aoora•ai a, 3aY z t'{o'^x ea ta.t c.rtYt+d Sarray >+.~ r•o.nlai to Yadrma i~ Prfa 184). ls32.98' aloes aaLB EAST-W L3T' 11i S+ettoe !la•3 '~ ' » ' ' .r 4u,0o . th.a.. sresno {o ; eh.as•.. +r-22?.7 s mtb. ~.trs o[ , ta.na. Na!!z ~ ~ s ' No~os'so»~ zu.oo' to tit. s..w:tr Inc-. r il.. of c:«. wu L.r~.::s.a.. ' lryru+4o" it a4,oc' aloe-8 rrla r! ht•o.l++.sy lia.; ih.ae. so'o~,'30"1r zs~.~o+; tk•nes ~ 5+14"N 236.74'; eh•ac• N7!'l7WS"N~ 142.17+: sh•eea _ , :i7lr'I6+S2!'W 194.33'p tLaaco S39' 389"1S'L{"'f/ 53d',00'l.lh.ac~ NO'06'30"L 104,00+; tb+aea 38y'15'14"1K 3r4>.80'; t>unea .. N0P!v-30"E~ 1!3,00'; th•ece Si9']3'1{"1Y b6.0f+t tLawce SO'06'!0">«' 116.33'; tb•aee . . sse-lsai~n' 1sl.eo+= ti,.,a<• NO'37'sl^1f 54.1a~; tf+..t• sa9•zzw9'~ti- 1{r..so'; throe. 30'06'!0~'Yf. 204,48'; t5+aea N09'1!'li"lt 150.00'; tSrma SO'06'30"'1/.312.97'i !J•oe• Nd!'.1Ss14!'L 1S0.OO~;.th.aea SoatLawrta:lr 66.25' aloac~ttt thr ara.of.3a3,ao' rrdlw " r " ' ' ' t4 t curvy eoneaie Norttt,rart.rljr xtwu eh~d Dsasr S•4 SO lO i thatac. %!8`rlS E 6it77 ;,7.01'f tlteaca 3oetha.trsly.136,l6' aloes i1r atta of a S17,00''radier t:vvr coreav biastfwsrtari1yy nho•a elwrd brar~ 9x4 Os+02"S 13Cf,S1+; tLrau 33023+30'r: 143.141; tbrwes N9P36'30"L' 160.%'; three. N8li5'14^SZ43.00'; thoase 90'06'3r"i~ !08,00'; tb•ace SSl!36']O^1-. 239.Ibt; tltracs Southrut•:iT 9i. t{' aloe= too arc d r 217.00' •. ' a'i ati+aer rtr~tl~sstrtia.oeoeaw Nortbsirtorly. where chord seasa S7f 037.16"E 45.3 ' }d~81~!IStIN'>r 4z0.00't th•ace Netshwatwrly 9 i,x 1'' aloes tAe atte' o! a 3001113' radlw + f tnrsco North- ess:weowe-r+o N~osthttnrtorly trsoae c4ord braze N{Or32'40"1e.90.8l wrtarlFl3;{isactor the arc eta 309.00' radlu:s curve eooeeva Nesthrastasl r~+Ror~ chordf bare T7C37's~" W 91.09'; tbros. NC~'Obt14"L' 1!0.00'; tltrsc. N89'1S^I{ ~. {78,05 trtaato !i{f06'30"! 83{.56'to.tbr poLtt oI b.st.alry.. Tltw~Na~ ~LtK lFR correct Y•psr•ryatatloa Of au tba ataRKlbr botmdsa4•• O! the aad r+tfT•yast asd tn. aabdlvlsloa:n.:..a a~.e., t,re ZDoe I twee four oonapilyd vritlt ttta p*ovlrioa. o[ Cbwptrr E]6 of tt.. Rttreowrln Statalas, tAe JoDdlvf•Loa twf Zoafns ReXalat4ans of St. Creis Cataty, iSr : owe w! littdsow ~lubdlrtrten OrdLtaoca, aad the C!!7 n! Hadsoa JrbJivlrlou aad S'1rtt:ias t3sAf- ... -' aonca„ L rarva~lns. tWYilSaS a»d marplns for ramr. Dat•d tlls.~„ dry o! m98Y~ct3-_, 1983 '~j ~ ii vlrod t f lath ds e! April, 1984. '~ ,.~ 'JlAR1tt ' . tta•a t, osch ~ . {2I dt:ond tftrwt ~ .., Ifidrow, Ylloconrla S{0 i6 !' ~ ~ w p ~ ~~ , COfM?T Ti1RAltlltlAtS CE3l?IlICA?t A~ aTAT E Ol* p19COHSi! } ~; • ST. CRO C O3INTY A G f ~. ,, ,, I. ~-+.~.r ~a LIYS?aior•, brlaS dtdy •lectsd, yusllllyd and re.ie0 Ira-artur! Of st. l:solr e•oat~, do borrbr e•>Rltr tbst ehr rroordr !n my otAee chew ro tutsatd«m•d tas aai~e atd ao nupald taxis •r rpocta! arrorrmaMr a• of ~~~.!!•JI a/frcilas tiro lawds lo.l+dsd fa thr Plat of 3'ark Vl•w Yrgtrr Toarih Addtign. ~- P-1! 7r ~.a~ . . • '• D++fa Doty Tir:tsur•r . xONING CO3A?.fITTt6 AL60LUTI~JN ?hla plat !r hsr•by approrod b~ thr St. Croix County Comprrhan.ly Pwrkr, Plaaolns and 7.on1nR Commlttwe, ~~ + I>!tr Gtulr'}r,y 11 94~ ~ ._ ~ .-... Aat• Admldrtrator ' +~ ,~ .. .... .tfatTTE~'i !~~lt~ 1 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~,-;,' ~i~,~i/w/" ROUTE/BOX NUMBER ~1. '"" %~ ~' FIRE N0.'~-""~`- CITY/STATE ~/'~.'%;~r'' '~~ ~-^' ZIP ~~~~~ PROPERTY LOCATION: ~ U.1 1/9 ~ ~.`> ~ 1/9, Section _~2, T -~`~~ N, R ~ W Town of ~f'r ~~;=,n_1 ~ , St. Croix County, Subdivision ~~~ k ~/,~~f ~g~.c~QT, Lot No. ~Z Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents 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 Auqust of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. d SIGNED DATE ~~~~~~~ St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address DEPARTIb1ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INflUSTRY•, DIVISION LA80R AND PERCOLATION TESTS (115) MADISON, W 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATI N: S sw ~l '~ TI N: J1 /TZ9 N/R~~ TOWNSHIP/~!!! inGICIPA~ ~T~• .~ OTNO.: BLK.NO.: Sy~BDIVISIO NAME: ~ atc (or udsoHl /Z3 Ask 1~1.~„ t' ~5- COUNTY; C'~O ~ OWNER'S ~! J qvt. {~ 1 lL ~ ~ MAILIN ADDDR,~SS: d~OL3'i" I~KCX~iZ ~'~ / 2 'L ~ iec NO. BEDRMS.: COMM AL D S RIPTION: Residence UN~.. _^, New ^Replace ~~L,S ~ S~ nvv. ~- mae su~woiu ror system V~ 51ta UnSUltabl8 for System ~~ Ivj ~h ~ w vaacnvsl ~ wrvs m~auc P FI I N A I N S TS: Q~ z 1989 c~T 3 ~ q@~ ~ gc1~k.N~a~AY COI~`J ~T^~ . M NS. ^~ IN•GROU~ ^~ " : S ~ _Ia~L H^ ~G~~ . %r b JTSp VTi',M:lopti~a REC ~dNv ~ ~ + .. If Percolation Tests are NOT required DESIGN RATE: I If an C`~ss ~ L y portion of the tested area is in the N~ under s.H63.09{51(bl, indicate: Floodplain, indicate Floodplain elevation: ~~ PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH'ffit ELEVATION PTH T R UN OBSERVED OWATER•INCHES E CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK lF OBSERVED (SEE ABBRV. ON BACK.) B- 1 ~~o q~Sb > 8.so 2~''$t_SC~ ~~~i~e~~1S ~~..$aNS,L s"8~.~~s~FG B- '~- °I .~~ g7.Zz n1o>J ~ > ~ •7S Z3 ~BcstTS fZ ~k$QtiS.L /~ BaNSI L 6Q~~&tiGS~G ~e B- ~ '~ 9Z- ~.bq No•.s~ ~ ,9Z ~9~QCSL-r5 iS~`f3k~~~ ~ 61 ~If ~eti~StC~~. G ~~°' B- '~ ~ 9ti 9~ 9~- N©~,~ > g.9Z "Bcs~7s ~o gRN~ts iv"(3~~5, Be,,C~~~~. B• ~' q•S~ •'~.] UNtr >. _/.Sd ~Q..g~sLT-s z4~~gQ~IMs 24n$6t,~S,C.-TE~^-Gyf ~16'rTl~~ B- sr ~' g.~~, c~s~~r~ \cr• ~-f- PERCOLATION TESTS TEST NUMBER DEPTH , I1dp1 E WATER IN HOLE FT TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES l S A ER SWELLING INTERVAL-MIN. p p I p PER INCH P. 2 4.4 NoN~s 97.zo 3 > Z ~. > ~ < P- 3 N X7.70 '~ ~ Z > i > 2 t P- P- t JSTloty A ~~ 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 9Z ~? 5 ~ _. ~ --._~_ r-_ _ __ ~ ~ i 1 . __ . _ - r _-. f 1 ~ ~ r_._.._ r . ~._... _. _ .. ~ _ i _._ _ .~ . 6' ._ _ _ . _ 8-I~. , , ._ - -~.~ . ~ . 5 ~. _ _ - _ - ~_ __.. _ __ _._ ._ ._ _ V: q ~ ~rti1GHMg4JC-TOP O~ 2~ L _~ _ TN 1 ~ .- .. t_.~ ~ ;.___ _. __ , ~~ ~._-.2' ~.._ _ . ,__ sa ~ ~ti~~ ~ I~~ ~~,~ K ~= M•®-~ ~ ~y ~1:~~ ~s-fi~-~~5 ~ort~ ~z~ sySrtKw, Etv.= 9z.~~- ,~ 8.rn. Te,~ e~ B ~o~k i3o,saw".,~-t- F~V. = /dv_c Sc~l~ b 30.x= (3a~-ic c.oa~ ,L1 }~a /c 3 (7a t"fi ,Qp~o rte C l l~. :. 92.7 5 ) ~~r. Scn ~a M ~ M M v N _.. ___~ /~ h ~'P • -~. d J ~ Y + .°"~ . J ' S Y d . ~ at ~ • , N r : ~ ~ v ~ J: . :~_ M '~L. ~ • - c~.. x A- ' ' M _ ~ :}-- t - ? ' ~~J ~ .. ~~ y • .. ~. ? '. r • .:.t .Y • ~.. .,'~,H ~ • ~ A ~ I~ r ~ • Y~. ( ' , , , ~ _ ~ ~~ = .•' o" ~ ~. P' .~- %6 t d 0 ~ .9 p d ~n V A ' ~ ~ J ~ri H ? i -b t ~ i ~_ J 7 ~ ~ ~ . 1- ~ -- r~ ~.- ; ~' / ...~~u~~,° 11;. 1 ': ~ d 0 s 4~ ~~ s 0 J J ;V . ~ ~J 0~ ~~ v T H ~ j• • I I ~ ;t ~ ~ ~J c~- ' ,_ ~ t~ c~- ~ , ~ d I `~ > ~ o ~ ~ I ~ i i y I J ~ 0 ~ I s ~~ ~ 1 ` i s `N I d ~ ~_ I .its' . '~ ~~. J .~ 0 d c9 J ~J ~. ~? ~ . . .. ~~ s . d ~ .. ;:. o- vl < c N ~ ~, s .. +~ 0 r" ~, ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 21, 1990 RE: Certificate of Compliance FROM: St. Croix County Zoning Lot 122 of Park View Estates SW 1/4, SE 1/4, Sec. 17, T29N-R19W, Town of Hudson St. Croix County, Wisconsin St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on May 21, 1990 and revealed that the system was designed and installed in accordance with all local and state requirements. Should you have any questions, feel free to contact this office. cj ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 21, 1990 RE: Certificate of Compliance FROM: St. Croix County Zoning Lot 122 of Park View Estates SW 1/4, NW 1/4, Sec. 33, T29N-R19W, Town of Hudson St. Croix County, Wisconsin St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on May 21, 1990 and revealed that the system was designed and installed in accordance with all local and state requirements. Should you have any questions, feel free to contact this office. cj C~Oo p~T