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C a ~ ~ ' ' v_ v ~ ~ ~ 3 v O O O o c c G C C C C G G d' ~~ G N Z N N N ~ ', ~ D v v o - ~ ~ "' ..r N d B A _ '0 N = ~ O c0 v N ~ J W 4 ~ .. ! ' A D ~. o - ~ v ~ I o N I p N ~ ~ ' I, ~ m. a N - o ~ ~ t° Z m ~ _ ~ n ~ ~ a .P .. Z ~ p ~ ao ~ m j N m ~ ~ -+ Z ~ ~ o -• l ~ ~ i ~ ~ o cr N m -' I J ~ ~ ~p A I a W pj ' i n (D T c a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safe~v and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Aitchison, Tom Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: r~ ~ ~ GSA' TANK INFORMATION _~ ELEVATION DATA TYPE ~ MANUFACTURER ~ CAPACITY Septic LJ,' ~~---- . ' S~ ~aod ~i S. ~-c.~.,,. STS / T~ Aeration Holding TANK SETBACK INFORMATION TAN TO a~ P/L ~ WELLS SCo BLDG Vent to Air Intake - ROAD Si~e, .~ 7 ~ ~ /'S~v~ ~Oa ~ ova D a I~b Z / ~5~! / / Aeration Holding PUMP/SIPHON INFORMATION ..c V Manufacturer Z~_~ ~~~ Demand GPM Model Number n , ` ~ ~ / TDH Lift~a -! , Frict~n Lao ~ System H a~ ~ TDy `. ~~t ~7 Forcemain Len~~~ ~ Dia.z ~ Dist. to Weld. 15(o i SOIL ABSORPTION SYSTEM County: St. Ct"oiX Sanitary Permit No: 515075 0 State Plan ID No: Parcel Tax No: 020-1132-30-000 SectionlTown/Range/Map No: 20.29.19.636 STATION BS 3. ~5 HI rtt3 .g FS ELEV. f ~ Benchmark 3. ~' i~ /~ Alt. BM ~ ~, , Z •9a da . 9, SUHt Inlet tier (o, 96 • S5 SUHt Outlet `~ ~` Dt Inlet \_ ` Dt Bottom -- ~~,1 ~ ~Z . ~~ Header/Man. ~+ ~ ~, / p U Dist. Pipe , r• ~~ esq. / Q U Bot. System 3 ~,'~ Final Grade . ~ /~ • /p CC St Cover ~,,~~. c.~~. z ~a ire. ~ ~,< 5.37 y'$. 5 BED/TRENCH Width Length / No. Of Tren s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~~ `~+ ~_ ~_ '- ~_, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:~,_ INFORMATION CHA uNET OR ' Typ f Sy-te~ ~ 3 ~~ ~ ~ Model Number: DISTRIBUTION SYSTEM N°~~ ~'~0f..~5 ~1_ ., _ Header/Manifold Distribution !/ ~ / c Pi e s x Hole Size h ` x Hole Spacing ~/ [ Ve to Air Intak~~ / / i \ j ` ~ 5 S th ` ~' ~~ Di i ` L ~ ~ ~' ~ 7 .~ ` J ~ ~ a Length D eng ng a pac SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bedlfrench Center ~ j..5 Depth Over Bedlfrench Edges ` xx Depth of Topsoil ~ xx Seeded/Sodded ~l~ xx Mulched ~ ~ ~ s ~ No res 0 No ~• i aE COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~F/ ZS / ~~~Jnspection #2: / / Location: 888 Willow Ridge Road Hudson, WI 54016 (NW 1!4 NW/11_4 20 T29N R19W) Willow Rdge d A~ Lod 27 Parcel No: 20.29t.~19.636 1.) Alt BM Description = C.O~lJ~• ~~1 ~OtJ~-- ~ ~ ~-r~ ~e~"`~'~ t" ~~J 2.) Bldg sewer length = ~I t r ~ - ~ "~ IorC., b V (~i ~ 1 ~ ~~GTt, ~ I ~'~i~ ~~ s ~...1 - amount of cover = 1~~ ~'". tom( Plan revision Required? Yes No ~ ~~ ~~ ~ ~ ~~ Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's ignatur Cert. No. ~eolGr~mP,h-f- ' commerce.wi.gov Safety and Buildin lv o 201 W. Washingto e~O~i County St. Croix i sco n s ~ n Madison, V~~~,,,y,,, Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 ~ 0 Sanitar Permit Ap lication antionNumber y p 1670354 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are project Address (if different than rt~ailing ad submitted to the Department of Commerce. Personal information you provide may be used for secondary / /,` /~ 4 r u oses in accordance with the Privac Law, s. 15.04 1 m , Stats. ` L/ I. A lication Informatio Please Print All Information ~~ Property Owner's Name ~ Parcel # 020-1132-30-000 Tom & Sue Aitchison Property Owner's Mailing Address Property Location / 2 888 Willow Ridge Road ~ (Q ~J OIX COUN'T'/ Govt. Lot City, State Zip Code PtANN er NW'/.,NW'/<, Section 20 Hudson, WI 54016 (715) 386-1260 (circle one) T 29 N R 19 W II. Type of Building (check all that apply) Lot # ; sJ~/ILn7 w ®1 or 2 Family Dwelling -Number of Bedroo s 4 ~4 27 Subdivision Name Willow Ridge 2nd Addition ^ Public/Commercial -Describe Use Na City of ^ State Owned -Describe Use ~ / CSM Number ^ Village of /~~ ~. Na ®Town of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~~ New System Replacement Treatment/Holding Tank Replacement Oniy ^ Other Modification to Existing System (explain) System .~----._ B. ^ Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner l Ex iration IV. T e of POWTS S stem/Com onentlDevice: Check all that a 1 ' ^ Non-Pressurized In-Ground ^ Pressurized In-Ground At-Grade ^ Mound > 24 in. of suitable soil ~ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explaln)Hoot H-600 V. Dis ersal/Treatment Area Information: Design Flow ( ) 600 ~ Design Soil Appli ion Rate(gpdsfl 0.60 ~ Dispersal Area Required (sf) 1,0.00 sq.ft. Dispersal Area Proposed (st) 10.00 sq. ft. System Elevation 99.00' @ 6" above / 98.50' contour VI. Tank Info Capacity in Total # of Manufacturer w F a Gallons Gallons Units t' U F / /' ¢ u a ~ New Tanks Existing Tanks / • (~ ~~-~` .. ~ / _ / 1 c~.. ~ ~ F ~ ~ a a f ~ septionrxoldingTank 500 1000. 1500 1 WleserConcrete/Weeks ® ^ ^ Concrete I~- d n°sing chamber 1000 1000 1 Wieser Concrete VII. Responsibility Statement- I, the and rsigued, as me responsibility for ' 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Pium is Sign ~ MP/MPRS Number Business Phone Number James K. Thom son ~ 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020-5413 VII . Coun IDe artment Use Onl Approved _ isappteMe Permit Fee Date ssue Issuing nt Signatu _ Owner Gi ea r~~Denial $ ~ / _ /~ o l~ IX. Condit~1~~/.Reasons for Disapproval / n + ~ t ~'i ~ ~ ~ ~ h ~ 5~"~ a.S ~ ~- C~© 1. Septic tank; effluent faker and dispersal celC must all be services /maintained ~Qt~ ~ as per management plan :provided by plumber. cI' fie" / h ~° , t ~+ GaJ >~ S . 2. AN satback fequit'ements must be maintained ~~ as pef ~ppli~ble ecwdo { oidinaelc~s. Attach to complete glans for the system andd~sbmit tdthe County only on paper not less than S 1/z x 11 i hes in size ' SBD-6398 (R 01107) Valid thru 01109 5~ /va a.C~- t~ s~e~. ~ 1c~c. ;.. ~.ra..t~,a,~, ea,do.M¢u~- ~(o. S~ i P~oposzd,4t-~.-adc Aa,,~rrs a%s~~s4/area. Two (-~ 4yy8'o,-•,~~c4s SPacedat a ~~deciid ~y S 4`b n ~.~~~~~ ~ con ~' 8y ~ ree o o' Co~c,'~tea6 d. E. Co/'~e/' _~ ~ i~ rJ tom- ~4 EXi sf;~9 t~bcot~.+n _-- _~ ~ ~~ ~ ~\ ~ ~ garden y' ~^J ~ U ~ Ind ~ ~scl~. SAO \' ee°cX P.d.C'.~orce..w,~ ~ ~ . So o `~°~ .~ 8/ue v ~. Sprkci 3C ~~ v ~~ ~ W ~ d `~~ ~~ ~l SDI -0~ ~, ~, a d~ . i~ n: ~jri.36"r~ 1, ~a ~eeKs c~c~ 5cp1s'c ~1t~ c)a.4le (a ' \ cc7cod~ Y ~~n 9 ~o-~ d~Jl \~ ~~~~ PrepOSCd +~~ estf Gmtrt~ /'cL sed,2.o` b~, irfo,nu~' car 'U~r...+6Lr'a5 ~c..5snq/Tcc-/r .STG-/GO ~fF/u ~n~ rr'/'~-~'fo be S c.~ a t jJU-M}a G,/iSC./a~. /scan 3~ Scale ~ ~ = 5/D ~e ~ ~ ~s~ • yeX,st/~.~ y~0.~Ce e(e~l ~V I 1 ~mcss E d Su.San ~f! Ai tc,(;son P~ayv (~ ~ B~ c.~9i //orv ,Q,-afyt lQon.d f/k dscm, c~/. ~I cvYyn~y~, 5c~. ~o T . of ~ dsm, ', ,oc/• a°2o-fl32-30'~.62;nq,/.72A. ^ 8'/ uxode~ L~~e c/Q ~ioYl S ~7VSE+'~ S.T.Occ.~/~-E jnVtrr-~~ bra de a~/ore~oosc,cl P. e. /oca~, ~-, P C. in/~~in/trt ~r~caal4ir7i~dorE.a+E PGA..: aotto.n of P. c. e,YCC/a~ior~ *, I 97. ~o' /~. zs-' 5~.9~= 97 ~' y2.2s' ~~ 8 °~ ~ Proposed ,4t-.-ode pOce7TS a%splrs4/area. Two (~J ~' fg "pr.-Fr'~ es Spa ce.d a:E Conc.~tttot ~. E. Corrre/~ \ a~',oo~,a. ~sru,.,colertJ`-/cncp" ~I e.-.._,~_ wcacl ~~-mod D,'s 4 q b con ~~ ~- _ bi '9^~ a ' _` _ .- --... •~-.ro ~ ~ ~~~arden 'JY ~ ~~ ~ tro'twQ Znd 3'Sc.1~.SG0 ~ /lvu 34vr ~ 1 ~A ErO s~cX Pv.e.~orrcmaZt _~ _!, f FXi Sfj'-~q ~bcctr~xr„,, ~ct~ dZrj~ ~y~.tfirV We// ~I o c a ~~ k~ o% i~ ~ ~~ ~, `: d ~~ ~ \~ 4a {~ ``~ __~~ ~\\ ~. a~kc ` ra? rs: 'J4cl~3 Cc~+L~ ~P~'~-~X~ c~a.'EJe /ac 3i ~ , " \ cc7codu~ ~ L4c.7h 9 o •a°~~ ~~ Q JLv R~ Uy~~\ ~ ~ Af6PO5Co~ k.9(QSIr C~ncrr.~e. /'4r'~sePds oo by r-+a.n/W[acfwcr. ~'G.., ~ f~ 6e s.~ ..~Scmg..0. Carr, b.Lr'~S R ~° .. 5sw1/Tcch be s~a~/o4mjoa'/3'. /..~ c.) n B~{ 4~~ E"/e da ~o~-~ s J~e ~ ~ ?aS7 ~ So"%eda/ua~ionPi~ ~ fxst/;~ 9r0.~Cc e/eN ~ ~ Lc cad f1r~..5~.~(e i ~vmcaSE d Scc.San ~(! Ai f r,(;so~ Pray4. (~ Q 8~ c~9r//aw Q-d9t loud f+/«dsrm,u~/. ~.o t 2 7/ ,2 ~Oa dd, ~/n•-i fo ~i Arco ,Q, dyQ, /l ccJy.//yl.~7Y~r,Scs-.,2o r.06/~dSan ,St • Croix Go. t,J/ „_. .Inn., ~.~.. z„_ir4^ Lnr.,~ /77 Q. ~~i'sE.'~ 5.~: o~/~~t i~v~ ~ 97.110' Gr-a de af/o,-e/oosc.c~P.G'. /oca~,'on : /d'~. ZS"' P.G'. in/lain/erti: y~,9i ~rCa~l4ihindcrEaf. PGI.: 97Ln/ aot~o•n of P•e. eXecviEion ~ 9'1.25" ~IC~PY P. 8 0~ 9 commerce.wi.gov i ^ ~scons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary June 09, 2009 CUST ID No. 30021 JAMES K THOMPSON A.C.E. SOIL AND SITE EVALUATIONS 340 PAULSON LAKE LN OSCEOLA WI 54020 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/09/2011 SITE: Tom & Sue Aitchison 888 Willow Ridge Rd Town of Hudson St Croix County NW 114, NW 1l4, S20, T29N, R19W Identification Numbers Transaction ID No. 1670354 Sate IB Pdo. 745336 Please refer to both identification numbers, above, in all comes ondence with the a enc . FOR: Description: At grade, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1227749 P ~ w Maintenance required; Replacement system; 600 GPD Flow rate; 38 in Soil minimum depth to limiting factor fr~n,~L$I'd original grade; System(s): At-grade Component Manual, SBD-10570-P (R.6/99), SSWMP Pub. 9.6 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ~D~pp~t~M and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system. is to be A constructed and located in accordance with the enclosed approved plans and with any component manual(s) ~ referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. SEE COIF=' No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system malfunctions so as to create a health hazard, the properly owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the At Grade Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. JAMES K THOMPSON Page 2 6/9/2009 ! • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of COMM 84.. • Insulate building sewer per COMM 82.30(11)(c). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Begimiing October 151, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to file appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Patricia L Shandorf POWTS Plan Review , In grated Services (715) 634-7810, Fax: (7 ) 634-5150 , M-f 7:45 am - 4:30 pm pat.shandorf@wisconsin.gov Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. JAMES K THOMPSON Page 2 6/9/2009 S • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of COMM 84, • Insulate building sewer per COMM 82.30(11)(c). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise snaking them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Beginning October 1S`, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Patricia L Shandorf POWTS Plan Review , In grated Services (715) 634-7810, Fax: (7 5) 634-5150 , M-f 7:45 am - 4:30 pm pat.shandorf@wisconsin.gov Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. RESIDENTIAL AT-GRADE DESIGN Pressurized -Sloping Site INDEX AND TITLE SHEET Project Tom & Sue Aitchison 4-bedroom At-Grade Owner Tom & Sue Aitchison Address 888 Willow Ridge Road Hudson, WI 54016 Site Address: Same Legal Description NW1/4 NW1/4, Sec. 20, T.29N., R.19W. Township Hudson County St. Croix Subdivisioh Name Willow Ridge 2nd addition Lot No Parcel ID Number 020-1132-30-000 Plan Transaction Number 27 ~J BU1 1N~ -Page 1 ~ ~ Page 2 Q1.1D Page 3 Page 4 Page 5 Page 6 ~ ~ Page 7 Page 8 Page 9 Index sheet Calculations At-grade drawings Laterals and dose tank Specifications - Management & contingency plan Pump curve & specifications Site plan Attached Soil Evaluation Report Designe James E .Thom son Signature s---- Date 05/19/09 Designed pursuant to: At-grade Component Manual for POWTS SBD-10570-P (R.6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) License Number 30021 Phone Number (715) 248-7767 Version 4.0 (04/03) Page 1 of 9 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet -Sloping Site Flows and Site Data Entry. (r or c) R~Residential or commercial? 400.0 ~ Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 8.00!. % Site slope 98.50!Contour elev. below lateral (ft) 38.00' Depth to limiting factor (in) 0.60 In-situ soil application rate (gpd/ft^2) Distribution Cell Information __ _. . (1 or 2) 1' Influent wastewater quality 10.00' Linear loading rate gpolft 10.00: Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 100.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) C~~! Center or end lateral connection C_J Number of laterals 0.125.; Orifice diameter (in) e.g. 0.188 "ot a rinai ~ 1.25 Estimated orifice spacing (ft) calculation 2.00' Forcemain diameter (in) 3.37 Forcemain flow velocity (ft/sec) 110.00 Forcemain length (ft) y or n , y ;Does forcemain drain back? 92.75; Pump tank elevation (ft) y or n ,_ _ y ~ Are laterals at highest point? ~~~ ~ NA 3 ~ Z.~ 6.5 System head (ft) x 1.3 17.9 Forcemain drainback (gal) 2 ' / 5.25 Vertical lift (ft) 45.0 5x Lateral void volume (gal) 2.54 Friction loss (ft) inimum dose volume (gal) ~~ 14.29 Total dynamic head{ft) 33.0 Syste demand (gpm) 1 ~~ Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice 'Total Tank Capacity (gal) Designer ~ in ;Total Working Liquid Depth (in) must select 1.25 in x 1 Gal/in (enter result in cell G46) one lateral 1.5 in X X diameter 2 in x Treatment Tank Information s in x i 1,000! Septic tank capacity (gal) __ __ __, Weeks Concrete j Manufacturer Effluent Filter Information Dose Tank Information SiMRech !Filter manufacturer ! 1.0001 Dose tank capacity (gal) _- _: ' STF 100A !Filter model number 19.6! Dose tank volume (gal/in) Wieser Concrete {Manufacturer ._ ..___ ____ _ _ ____.a Project: Tom & Sue Aitchison 4-bedroom At-Grade Transaction Number: Page 2 of 9 AT-GRADE PLAN VIEW T D -t I /-- 1/6 B Observation pipes (2 typical) D 1 ~~ ~C A 10.00 ft B 100.00 ft 1/6 B 16.67 ft C 12.00 ft D 5.00 ft E 2.00 ft L 110.00 ft W A x B 22.00 1000.00 ft ft ~~ ~ ~a~ 1 r ~~ =Total aggregate cell A x B U =Plowed area L x W E~ Cap Typical obs. pipe. Slotted in the lower 6", and anchored securely. 6" AT-GRADE CROSS SECTION Synthetic fabric cover Lateral invert elev. gg.00 ft ' :~::::::::.. .E Surface contour gg,50 ft and system elevation C ® = 12 in. topsoil and subsoil over aggregate and tapered to toes. = 6 in. aggregate below pipe(s), and 2 in. above pipe. Jft Finished grade elevation f-- Observation pipe at aggregate toe 8 % Slope 1~ D Plowed la er Y below L x W Project: Tom & Sue Aitchison 4-bedroom At-Grade Transaction Number: Page 3 of 9 . ' ,. ~ PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram -Center Connection ~ P - ~I IE X--~IExl2 I x231 Laterals & farce main of PVC Sch i0 Last hptP dntled near ro Pnd cap (per COMM Table $4.30.5] Robes died an the bottom of the lateral, egvalf}p spaced • =Turn-up ~m'ball valve or cleanoutplug Lateral Specifications 0.125 Orifice diameter (in) Center X 1.24 Orifice spacing (ft) 2 40 Orifices/lateral P 48.98 16.5 Lat. discharge rate (gpm) 1.50 2.00 33.0 Sys. discharge rate (gpm) 110.00 14.29 TDH (ft) Typical Pump Chamber Lai Final grade "~ Weather-proof junction box Tank component is properly vented Electrical as per NEC 300 and Comm 16.28 WAC disconnect Lateral connection point Number laterals Lateral length (ft) Lateral diameter (in) Forcemain diameter (in) Forcemain Length (ft) rout Approved manhole cover with warning label and locking device 4" Alternate T ~,~ outlet ^location ~ g" min. ] I~ Approved outlet joint Tank full Inches Gallons ~ /~ Provide 1/4" c A 33.8 662.8 Alarm on weep hole or c B 2.0 39.2 B antisiphon ~ C 3.2 62.9 Pump on device. o D 12.0 235.2 93.75 ft C Totals 51.0 1000.1 --• Pump off D ~- 92.75 ft Zoeller Pump manufacturer JH Rhombus Alarm manufacturer BN 151 Pump model number SJE 1011421 Alarm model number Project: Tom & Sue Aitchison 4-bedroom At-Grade Transaction Number: Page 4 of 9 At-grade System Maintenance and Operation Specifications Service Provider's Name James K. Thompson Phone (715) 248-7767 POWTS Regulator's Name St. Croix County Zoning Dept Phone (715) 386-4680 System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect and/or service once eve 3 ears Ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99). Lateral Turn-up Detail Finished ••........••.. ............... Grade \ ~1 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution ~ Long Sweep 90 or Two 99.00 ft =~ 45 Degree Bends Same Diameter as Lateral Project: Tom & Sue Aitchison 4-bedroom At-Grade Transaction Number: Page 5 of 9 At-grade System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10570-P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure Distribution Svstem No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan if the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Tom & Sue Aitchison 4-bedroom Transaction Number: Page 6 of 9 ~~ so ,~ ~5 15J 4 12 ~ 35 10 tsz ~'~ £0 9 25 15~ s 8 20 ~~ ~ T 1~,,~ ` to 2 5 c ro cxwr+s PUMP PERFORMANCE CURVE MODEL 15111521153 TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feet Maters Gal. Liters Gal. liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 3.0 45 170 81 231 70 265 15 4.8 38 144 53 201 81 231 20 8.1 29 110 44 1B7 52 197 25 7.8 18 81 34 129 42 159 30 9.1 - 23 87 33 125 35 10.1 - - - 22 85 40 12.2 -- -- 11 42 Shut-ofl Head: 30 fl. (9. im) 38 ft. (11.Bm) 44 11. (13.4m) 01150aB ~~"'~'""~ °"~" Model 151 _ 'a3.0~~.,.-r. hi.~~:man,..S~yeP~r /4.6cr~a/. CONSULT FACTORY FOR Models 152 1153 SPECIAL APPLICATIONS e77ss 7 718 !578 S 27!12 • Tuned dosing panels available. • Electrical alternators, for duplex systems, are available and supplied wiU1 an alarm. ,. J718 • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle contrds. • Sealed Qwik-Box available fa outdoor installations. See FM 1420. • Over 130'F. (54'C.) speaal quotation required. 1511152!153 Series 15111521153 YODELS Contrd Sdecdon Yodel Volts-Ph Yode Am Simplex Duplex N151 115 1 Non 6.0 1 2 a 3 BN151 , 115 1 Auld 8.0 Included 2 a 3 E151 230 1 Non 3.2 1 2 a 3 f3E151 230 1 lwto 3.2 Inducted 2 a 3 N152 115 1 Non 8.5 1 2 a 3 BN152 115 1 Auto 8.5 Inducted 2 a 3 E152 1 230 1 Non 4.3 1 2 a 3 BE152 230 1 Auto 4.3 Included 2 a 3 N153 115 1 Non 10.5 1 2 a 3 BN153 715 1 Auto 10.5 Included 2 a 3 E153 230 1 Non 5.3 1 2 a 3 BE153 , 30 1 Aulo 5.3 Included 2 a 3 O CAUTION ~:~~ ~nstaiianon of controls, protection devices and wiring should oe done by a qualified ~.:censea el ec tncran. All electrical and safety codes shouttl De followed including the most re, er.c Natrona; Eled;nc Code (NEC) and the Occupational Safety and Health Act (OSHA). i I i i ,2 Ire s ire -L sx2oae SELECTION GUIDE 1. Single piggyback variable level float switch a double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Atternata E-Pak. 3. Variable level oontrol switch 10-0225 used as a control activates, specify duplex (3) a (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. YaL ro: Po. eox 1e347 Louisville, 1(Y 40258-0347 L' O ~~ ,UanufacNrars of.. SHIPTO: 3848 Cane Run Road Louisville, 1(Y 40211-1981 Qvw7-rPul+as SNCE /9.99 nr~Jrwww.zoe®11er.ccm PUMP !O. a (502) T78-2731.1 (800) n8-PUAAP FAX (502) 7743824 © Copyright 2004 Zoeller Co. All rights reserved. P5. ~e~'9 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 2157 Page 1 of 3 A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%Z x 11 inches in s¢e. Plan must County Croix St include but not limited to: vertical and h i l t f i BM t di ti d . , or zon a re erence po n ( j, on an rec percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 020-1132-30-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Thomas E. & Susan K. Aithcison Govt. Lot NW 1/4 NW 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 888 Wilow Ridge Road 27 Willow Ridge 2Nd Addition City State Zip Code Phone Number J City ~ Village ~ Town Nearest Road Hudson ~ WI 54016 (715) 386-1260 Hudson Willow Ridge Road J New Construction Use: Jy Residential / Number of bedrooms 4 Code derived design flow rate 1/ Replacement J Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable General comments and recommendations: Site suitable for At-Grade or Mound system with 6" sand lift placed on 98.50' contour. 600 GPD Na Boring # J Boring /J Pit Ground Surface elev. 98.87 ft. Depth to limiting factor 50~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texfure Stn~cture Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-17 10yr3/3 " none sl 2fsbk mvfr cw 3fmc 0.6 1.0 2 17-33 10yr4/4 none Is Osg ml cs 2fmc 0.7 1.6 3 33-50 10yr5/4 none s Osg ml gs 1fm 0.7 1.6 4 50-63 10yr4/4 f2f 7.5yr5/8 fsl 1csbk mfr cfnr 1fm 0.2 0.6 5 63-75 10yr4/6 none s Osg ml ~ gw - 0.7 1.6 6 75-90 10yr4/4 f2d 7.5yr5/8 fsl Om mfr - - 0.2 0.5 a Boring # J Boring ~~ Pit Ground Surface elev. 97.22 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-8 10yr3/3 none sl 2fsbk mvfr as 2fmc 0.6 1.0 2 8-22 10yr4/3 none Is Osg ml cs 2fmc 0.7 1.6 3 22-38 10yr3/6 none gr Is Osg ml aw 2fm,1c 0.7 1.6 4 38-45 10yr4/4 f2d 7.5yr5/8 fsl Om mvfr aw 2f,1m 0.2 0.5 5 45-57 10yr4/4 f2f 7.5yr5/8 Is Osg ml aw 1fm 0.7 1.6 6 57-63 10yr4/4 f2d 7.5yr5/8 fsl Om mfr aw 1fm 0.2 0.5 7 63-98 10yr4/6 one s Osg ml - 0.7 1.6 'Effluent #1 = BOD s> 30 < 220 mg/L an TSS >30 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign re: CST Number James K. Thompson 5~- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/28/2009 715-248-7767 Property Owner Thomas E. & Susan K. Aithcison parcel ID # 020-1132-30-000 Page 2 of 3 a Boring # J Boring ~/ Pit Ground Surface elev. 97.67 ft. Depth to limiting factor 45" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-12 10yr3/3 none sl 2fsbk mvfr as 2fmc 0.6 1.0 2 12-24 10yr4/3 none Is Osg ml cs 2fm,1c 0.7 1.6 3 24-45 10yr3/6 none gr Is Osg ml aw 2fm,1c 0.7 1.6 4 45-60 10yr4/4 f2f 7.5yr5/8 fsl Om mvfr aw 2fm 0.2 0.5 5 60-72 10yr4/4 none s Osg ml aw 1fm 0.7 1.6 6 72-92 10yr4/4 f2d 7.5yr5/8 fsl Om mfr aw 1 fm 0.2 0.5 7 92-114 10yr4/6 none s Osg ml - - 0.7 1.6 Boring # ~ Boring ~J Pit Ground Surface elev. Nd ft. Depth to limiting factor 41" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-12 10yr3/3 none Is 2fsbk mvfr as 2fmc 0.7 1.6 2 12-18 10yr3/2 none sl 2fsbk mvfr cs 2fmc 0.6 1.0 3 18-31 7.5yr4/4 none grsl 2msbk mfr cw 2fm,1c 0.6 1.0 4 31-41 10yr4/4 none s Osg ml aw 1fm 0.7 1.6 5 41-55 10yr5/4 2fd 7.5yr5/8 sil lcsbk mfr aw 1fm 0.4 0.6 6 55-72 10yr4/4 none s Osg ml aw 1fm 0.7 1.6 7 72-90 10yr4/6 f2d 7.5yr4/6 sil 1 csbk mfr - - 0.4 0.6 ^ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and 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. SB0.8330 (R.07/00) A.C.E. Soil & Site Evaluations • ,. , i~¢rxa, rrL~'K~ To o ~ COi1C/t~Q~ d. E. Cor'iaer' P'~----- c~cadu~ /--~.co n ~ by .' ~ ~ '~ ~ ~ • , - - - - - ~ \ ~ \ tc7codec~ .~ ~~ Lk~.•~n .' ~ ~ ~~- ~~ ~ ~' ~ ~ ~~ ~ 97 ~ Canfu.r- ~ia`rden ~ i ~ ~ 96150" EXi sd; ~~~ .PCti dGgGG 2nd 3Mry ~ $1 a«„~ ,~ • ~ o ~. 6 I cad ~ `~' d( $P!'4 Lt ~ r, _ ~~ a ~, ~~ ~.Y,sfi~ w~a ; o< ~~ o ~' ~I ~~ ~ 1 ~°^~J~ ~~ ~, 6~ \ ~~ ~X,;s~-.~ ~, cvoa~ ~ ecKs cn.+c,,~ie ~~'~~~ owe -~a~ ~a'~ ~JL ~a Py~~~ ~A (A n Scale: / = s~0 • 50.% Ada/ua~ibnfli ~ • ~X~'s~' 9ro~tc e~td.• I I~ I ~,MaSF d SccSon ~ Ai fc.(Fso~ P~ay4• S$q cJl//ow ~Q, cl9t ~Qoaaf !+/k~o'~L u~/. O ,[pt Z7, z=°add'~a~-- ~60 ~i/loco ~2.ody¢, gGVYyq~f'yr~ Sc~.,2a T . oF' h4tidsm, ~. G~OiK (m, ~/ ~u• °°O~-f/3Z-3o-cit? 62:np1.72A• 8~ uxcde~l R~ n ~I it I ~.oF, 2157 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. C A.C.E. Soil & Site Evaluations I~ ounty Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must t'1 St. Croix include, but not limited to: vertical and horizontal reference point (BM), directi d percent slope, scale or dimemsions, north arrow, and location and distance to t road. arcel I.D. 020 1132-30-000 Please print all information. Revi d By Date Personal information you provide may tx=used for s~ri~~l~i~y Law, s. 15.04 (1) (m)). I L Property Owner Property Location ~O Thomas E. & Susan K. Aithcison ~~~ QQQ Govt. Lot NW 1/4 NW 1 S 20 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 888 Wilow Ridge Road ~,, LROIXCOUNTY 27 Willow Ridge 2Nd Addition City State Zip m er J City J Village ~ Town Nearest Road Hudson ~ WI 54016 (715) 386-1260 Hudson Willow Ridge Road New Construction Use: ~/f Residential / Number of bedrooms 4 Code derived design flow rate Replacement J Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable General comments and recommendations: Site suitable for At-Grade or Mound system with 6" sand lift placed on 98.50' contour. .~---~-- 600 GPD Na Boring # ~ Boring //- _f/ Pit Ground Surface elev. 98.87 ft. Depth to limiting factor 50,E In• Soli Application Rate Horizon Depth Dominant Color Redox Descriptron Texture Structure Consistence Boundary Roots GP DIft2 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/3 none sl 2fsbk mvfr cw 3fmc 0.6 1.0 2 17-33 10yr4/4 none Is Osg ml cs 2fmc 0.7 1.6 3 33-50 10yr5/4 none s Osg ml gs 1 fm 0.7 1.6 4 50-63 10yr4/4 f2f 7.5yr5/8 fsl 1 csbk mfr cw 1 fm 0.2 0.6 5 63-75 10yr4/6 none s Osg ml gw - 0.7 1.6 6 75-90 10yr4/4 f2d 7.5yr5/8 fsl Om mfr - - 0.2 0.5 Boring # ~ Boring Pit Ground Surface elev. 97.22 ft. Depth to limiting factor 38~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 0-8 10yr3/3 none sl 2fsbk mvfr as 2fmc 0.6 1.0 2 8-22 10yr4/3 none Is Osg ml cs 2fmc 0.7 1.6 3 22-38 10yr3/6 none gr Is Osg ml aw 2fm,1c 0.7 1.6 4 38-45 10yr4/4 f2d 7.5yr5/8 fsl Om mvfr aw 2f,1 m 0.2 0.5 5 45-57 10yr4/4 f2f 7.5yr5/8 Is Osg ml aw 1fm 0.7 1.6 6 57-63 10yr4/4 f2d 7.5yr5/8 fsl Om mfr aw 1 fm 0.2 0.5 7 63-98 10yr4/6 one s Osg ml - 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L an TSS >30 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson S..- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola. WI 54020 4/28/2009 715-248-7767 Property Owner Thomas E. & Susan K. Aithcison Parcel ID # 020-1132-30-000 Page 2 of 3 Boring # J Boring If Pit Ground Surface elev. 97.67 ft. Depth to limiting factor 45" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none sl 2fsbk mvfr as 2fmc 0.6 1.0 2 12-24 10yr4/3 none Is Osg ml cs 2fm,1 c 0.7 1.6 3 24-45 10yr3/6 none gr Is Osg ml aw 2fm,1c 0.7 1.6 4 45-60 10yr4/4 f2f 7.5yr5/8 fsl Om mvfr aw 2fm 0.2 0.5 5 60-72 10yr4/4 none s Osg ml aw 1fm 0.7 1.6 6 72-92 10yr4/4 f2d 7.5yr5/8 fsl Om mfr aw 1fm 0.2 0.5 7 92-114 10yr4/6 none s Osg ml - - 0.7 1.6 Boring # J Boring / 1~ Pit Ground Surface elev. Na ft. Depth to limiting factor 41" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/3 none Is 2fsbk mvfr as 2fmc 0.7 1.6 2 12-18 10yr3/2 none sl 2fsbk mvfr cs 2fmc 0.6 1.0 3 18-31 7.5yr4l4 none grsl 2msbk mfr cw 2fm,1c 0.6 1.0 4 31-41 10yr4/4 none s Osg ml aw 1 fm 0.7 1.6 5 41-55 10yr5/4 2fd 7.5yr5/8 sil 1csbk mfr aw 1fm 0.4 0.6 6 55-72 10yr4/4 none s Osg ml aw 1fm 0.7 1.6 7 72-90 10yr4/6 f2d 7.5yr4/6 sil 1 csbk mfr - - 0.4 0.6 ^ Boring # J Boring ,~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx:ture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/Land TSS a 30 mg/L The Department of Commerce is an equal opportunity service provider and 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. SBD-8330 (R.07/o0) A.C.E. Soil ~ Sibe EvdluaNons 4 , tS¢e7C.F. ~4~'K~ To o ~ COi1C/1t~CQ~ d. E. Cor~el' af,a°s~,a. /~sja,.,colc/cr/`aiG2cp, 1'~~- tcJcodQ-c~ ~•-~ ~Q.co n ~ by ~ ~ ~~ ~ ~ Lk~.•~n .' _ ~ ~ -~ ~ ~~ ~ ~' ~ ~ ~~ ~ 97.E ~o„fcx..~ / ~~a..~de„ ~ ` ~ 9B.so' i~,d end ~ ,~ esw .~ . ~y O 1~ ~ o EX~b, 6 /ccC ~ v ~. ,Ff:iducc. sprat. ; ~ ,, er,~-~ ulcrr o ~; ~~~ of ~~ ~ ~~~< ~~ ~, L`,~- d~~~ H $~a1e : ~ = f~0 ~ 5o,%eda/ua~ib.-~~Oi~ ~,masE. dS~.cSan ,f! Ai f~iso7 P''w°. BP.~Q cx9: //ow ,2, cl9t ~Qoad f1« aFsan, u9/. O Lot 27, z"°add'bah ~60 ~i//oco,Q dfQ, gcvl%nc~Y~, 5~„~o T , oFh4~dswi, ,acl. ~o~o-f/3.Z-3o~cr~o 6e:~y,/72A• uJ ¢.t1:3 C.w, t 5cPly'c.6~++1t~ ~1e~ ~o' 1 ~L a~` ~~ ati~~ s, ~- ~w ~..~ n 3~y_y~, , 8~ ezode~ ~, 3 o f' 3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owned--__ ~~ct~S ~= ~ 5 u5 ~trt ~ /~ i~~ Chi; S o~-, Mailing Address ~8 ~~ ~~a~ ,~r'cl.4e. ~a Property Address _ ~Z11-s~Q (Verification required from Planning & Zoning Department for new construction.) City/State ~LC.-~Sr/yj,~ (.~I Parcel Identification Number ~~ - /~ 3.2- 30 " d~ SS~a/~ LEGAL DESCRIPTION Property Location ~ t/a , dJL.t~ t/a ,Sec. .2-~ , ~N R~W, Town of T h` Aso.-~ , Subdivision ~~ ~~d rc,~ ~ L/C} e ~ ~`f ~ ~i'~J a ~-s ,Lot # ~. Certified Survey Map # y~,z¢-- ,Volume - ,Page # Warranty Deed # ~~~ 5~0 7 ,Volume ,Page # Spec house no Lot lines identifiable es SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than If3 full of sludge. Uwe, the undersigned Gave read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. tun bedrooms _`~ ,~ ~~ .~ SIGNATURE OF APPLICANT(S) ~~L~r~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. os/as) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the o~~`,Sue :~c.,~;sa-, residence located at: ~_ 1/4, ~~'/4, Section ~, Town~_N, Range~~W, Town of moo,., , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. ~ ©u~ J.r~, ba~1~ ~r~ss. To f,e ~c,~/oc.~ Most recent date of service,~c~.,,e, / 9 Did flow back occur from absorption system? Yes No ~~ (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: refab Concrete _~Steel Other • (if known): ~.J~j ~'o~c~e.~ (if known): ~~ veal's censed Plumber Signature) (Print Name) itle) (License Number)/MPRS ~z ~ ate) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) :ACAD Drafting, Inc, (866)416-6845 To:Ace Soll 8~ Septlc (17152487764) 10:44 06I11109GMT-05 Pg 02-01 n z in 69~„ 9 ~„ D m 56, s D ~ _ C ~ y ~ Z -t, [~ ~ ° ~ c~ m ~ Z ~ ~ ~ 51 ~• e \ i 3,• 61 ~" 5.. 0 I D N ~ ` - /. I. ~ ~~ ~ ~ D N v C _ _ i m D ~ ~ ~ ~T 1 C ~ D ° 54" ~ m ~ ~ m ~ 0 ~ L o ~ ~ z z ~ ~ ~ D G7 ~ oa ~ ~ D ~ ADO ~N C~~~== O Q p III'TTTIII ~ /1 Z ~ _ ?~j ~ A ~ ~ D~ ~ _ ~ F~wO~ ~ \ •• ~~ ~ ~^' L _ O v C' Oo ~O ~ ~ y ~ I f~*1 N , ~ cr ~ Q \ ;~ n ~ O C d A ~ ~ Q e ~~ ;~ ~ ~ s N O O W ~ O ~ O H ~' ~~ ~~ y°o D '°°orn D I z m o ~ o0 70 Z D ~ ~~` 2 Z r Z ~~ -a m0 n ~~ o m m ~ ~ ~ p-~~1 OO ^~~ ~ ~ R1 ~ g v ~_ ~ ~ ~ ~ ~ x r s m o cn = AGE SOIL & SEPTIC DRAWN BY: S. EB=RT SCALE: 1 4'•=1'-0" PRE-POUR: m ~ AITCHISON JOB HUDSON, WI 2 915 RILEY ROAD CD PORTA IICA WI GE ETE 53901 DATE: O6 11 09 REV. BATE . POST-POUR: -~ \ z PH: , ° FAX: 7f 5-248-7764 800- 362- 7220 FILE: ~s e,~ zoos ~rR~a~e soir & s tro- A~r~~a~s~.aW w U C? D 1 ^ 1 v L~ 11 1 ~•'~ F.... 3 ~J ~. L f i• L7 Q ~• ~J t!~ ._ ~~ O 1 . ~J ~~ Q V7 Z Q~ W f~ V t t ^: `~ { ~ i;.e.,, n. T..r Cwr~ Np: A 4. RApvus LrwrAr ENaRO Lchenv C a+o B~]Nr Efvrwu ANacL /I/! 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S /h /..; 1+ p11~~ ``~ r4s' ~ `BI ~ R~ ~ f A~• - 45 o asA.ew« <Arc ^ ~. ~ NBOOV 3 Z /~ 73 ,?< ~ ~'~. 11 `L ~ 43 4/ ~ `L. ~Y~~ $~ 't 1 I L Ii I .I , ; Q . 386. t2~ ~ \"~I ~ p~ ~.,.~ ti 2:~ 8 ~~'~ ~ 1 w l ~~ d ~. O: h .: 8 ~ " ~! ;e ~~' ~:a 1 ~ ~ "~ ~~~ 0~ a pQ,: pQp ,f~ 101 ~ , ,~ // ~ii~4 / ~ / A .` ~~ j ~ `.; 6 W N >>• •4p ts• /r qq / / 1 \ ~~9 ~ ( '' '~c i j ba 5 (.~ N pi h ti~° a~'~, j ~ 1,< 1 ~ ~ / D4 'E ~ ~~., ' .: ' ~ '/ "as ~iivr• ,~ L0. ,~\c ~ I X14/ 7~ ~ ,/ •R Na re: <YD.(>N ANO EAST L/NCS p/ Wccpw S DF A L ~„ ti 69 o `~ p q~ ~ INE OJO/NfNp F~/O(.F A00/TfON ANO W/LL pIV rQ/06L T'rp AOOf T/pN 3NOWN I ~. ~. ~'~ b $< ~}( F (•+,<~ ~ HLRMN AAL COMMON ANO IOfNT1fAt ARe B ~ 1 1 fAA.N03 L /NL! . O/11LRLNfL3 /N ~ E . y ~ @. ~{ RLSf/GT of 43/N( A Ofif<q LNT RE1fALN<L Q '~ /pR BASS D/ ASSUMED .BEAR/N(J I ~>• a _ ~gCGNSi , S ~~~ B-p/J~ /70.p0 7 ~ V , . - 3 HEITN P. S C5 ' .P¢uisps,//.%f 17>q ~y ~APi ~ /97G CASIVELL. Ifl. ° h 9A 055{0. MIMN. .-• - 5161 _ ' -~ ~ ~f~\~ ~ 8(, YEV OR ~' ~ _ ° ~ ~_ J ST. CROIX COUNTY ~tJ4 OF SEC 18, THE SOUTH 1/2 OF TH E SW 1/4 OF SEC 17 NW 1/4 OF SEC. 20 ALL IN T. 29 N., R. 19 W. There ore no objections ro this plat with respect ro Seca. 236.15, ' 236.16, 236.20 and 236.21 (t> arsd (21, Wis. Srots., and H 65 of - the Wis. Admin. Code as Drovidz3 by Sec 236.12 thl, Wiz. Stah. Ce/Qrt~,ifyie4d~this ... ~~. doy of ... /~. ~......... I9.T/P. UNPLATTCO LANDS -^•••••~~-'~•-~~ ................._........................ /C D+rector, Regioael Piann:rrq $ community Assistance Cepannianf o` icxol Afiovs $ Development S BJ J3 00 ` N BG /f pp f 31S 00 H - ... _ f' .1'.0.23 -T is . p -_-.__ . _ _~ _. _ _.. ~---'~' w•ft~/f _' ~~ I L- ~ sae F °°' N y ` .<sf..r.,> °f 5`d 1 5` ~0~ to v A /t' BG •/G DO "f 31/.76 Ov rL. o r -7 F /' l 155 dl~ ~ °` ~~~ 'Sachon /7 -~ N B9'S9'.Sv "!y 4A0"00 `~-v \~ - _ ~ I 'Q--- ~` - - ~ E- zoo.oo zco.ao o '- ~ o i-~)~ ~~ rR sv'vA.rvAfr fASfNf.vr m b ~/ h OD ~RAPN/! SCALE /V FEET "^ 1°°a~ ~ 511!8 Dti 2 ~ .. i p o .rP im za> .iao i iQOO ~ Q ® ~ 3'o SD n, ~v cwcr n h dd ' rv ~ 1 ~ hVh \..-/00.00' f.~ ' q ~ ~ h 46 ~ ~. _ ~` ~` .w/,- l ./f G9^SptP Ia4 10.37 II ,!{~ ~ '. 6' "\ 11 " /x103-. 3a Sf' °"`f" /:z.....w ~ ; /4.73. ~`1z~00 DD S °~~ "~' ~~ \ y y E tF n> , '':Z I ' ~ w ,,-n e9'a9:sP'sv r , ji -~JC2.4~o°~C rar w~ ~g "~``~ 'A P' ~' / O!•Jl;foi/ '' ~ ~' _ ~1~, "' t ` o SZ ~ $ 1n ~ s.~ ":.-\ Ds , .^~_ Nii a;A9H' .t iSLH e`.q c H o ~ \ '`O J $ F ~j~ ~' ~e4 °0 ~ .t A' J'~T9of e~ z \ \~ ~ ~, SY 7 ~OO..E IS/. 90 1 1` ~, 2 ,5 ~ ~ - roe ~ \ ~~ ~ g~ ?3/. /'~ ~ ' n ~sr °° -:w ° G \ ~ 00 ,/' 1 r ' / 1lOy'0- °0' '+~. , ~'.- '4 . 100 1 tASLMtvr • f.p` 5 j 110 'a. \~ -, r~*.,>r'• A, L $ ~ z~ ~sf oA.wACL r+~ s 1 ~ \y iB,YS °a `~ ~7 ,..~~ ` « Z r v39'~~s"°4 AAnvALt fASCNCNT ~ p N 6pC . 0 w e 4. ~ . a. ~ ~$~w.i\ N5100' io a i~f' -~5 lO ` ~ ~ ~37'~j3 `~ .~*j~, ~\ .5°3p~1'b \~ \ hl~~r ~.OON 7B~ E•/~~ ~'l~'a°t ~\,\\\ ~c`~s ~V .d .s = s'sn:3i.0 5~ ~ •G ~ oA0 ~ .E ~ - ra Id 1d~ ~ ^- ` iR R rm l°`b-:~,. bo ~ n 31 `s'ir.. ~ ' ~ ~ , _~- ~ ,~, 9B ... cep - ~ ,e( $ ~ • Fec''•1+- ~p o. i ~ or I •f 16 ,-~-~. ~+~- ' 36Di 1,9.5/ ~1 '• , ~'E q' Jf~tAb ~. s~ - c r rse \ f.r ` de 101,1 ~ ~ { ~ ••\\ ~ ~ `"t ~ >JIJ. ~\ o nwrrf''~"wcN> V u 7 ~ '1 ti v ~ ~ ~ --' 4 '`~ g ~ '~ 6''- _ ~ - ~~ ~`` .°~h 1(sA° N X059 z~ ~ A. -~'~ L E 6 E N O 1,y/1 ...~~- ~f ,~ g N/ G r 1 '~ ,-- lArtnT ~ ~\ 1 ?00,04 y fem. ~\ 3° ~` ~~ ,~ `•p~-' ~'/~GN~ ! o - 1.. 3o~'leoNP~~ {NucNiNC 3.eSLes.~L/NfwL Fovr 9 a:•rt. ~' 7 SUN 43' 43•• iN /4' l~ f' lRPN PPE, dYE GPNN/N`s//3ALes~L NfAL FvoT /~y ~I.~"~~ ALL PLAT BfA.t/N65 AAf RfFfAtNffO TP TNf `YfST `°'h C.o ~ n / ~ Y _,. L/Nf PF SEfT/ON PO WN/fN NAS A.v ASlUMfD BftPI/ry^ .......~,~./`r `A,.v.45 of /V D'03 40"Y'Y T6/s :ns/ruwawf was dro/ted dy ~~ ! ~~ ~'"e~/~ _ S/.'EET .3 Of .3 SHEETS , nnruMENT NO. STATE LAR• OF WISCONSIN FOB,I~ 1 -- 1992 T~'TiS D46d, made between Richard A. Whitcomb and __ Ge c r g i a__ A . _- Wh-i t c omb -l..-h u_si~ and•__and•• wi-f e-a.•-••__-•_-•----_-•_ -----------------------------------_ .....---...._ ._.---.......-----•----• - --...-------•-- ... raptor, --- s„d _ Thomas_ _E._ Aitchison anti j:ssan R. A3.•~c'Yi son, husband and wire as sur~ij%urah=p =arit~al .---Pr•opert-y-'• ----- -•---- •- •- - --•• -----•--------------..-- ----...... _ ._ -- ------- - -•-------------...--•--...- - - .., Grantee, w1~I30SS6t~1, That the said Grantor, for a valuable eonsideration...._. of one dollar and other valLable consideration conveys to Grantee the following described real estate in S t . Croix County, State of Z1Visconsin Lot 27, Willow Ridge Second Addition t:o Town of Hudson, St. Croix County, Wisconsin. riil3'v`'~~w ~~~ THIN 9~ACC Rart3CAV CD POR RFCORDINO DATA REGl~T~R'S ~~Ft~~ sr, eRO~x co., w~ i~e~'d for Record AUG ~ J 139 !tt 10: 4 5 A.~ n - QpgisSOr of RETURN TO Tax Parcel No:.------------°'----~-------------- This .-•---..~:5._.-.•--...---._ harnestead property. (is) (is not) Together with all and singular the hereditamt=nts and appurtenances thereunto belonging; Richard A. & Georgia A. Whitcomb _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrancer except easements, restricCicns and covenHnts of record, it any, and will warrant and defend the ame. .... ...... '.. ~...... ... - ` r ~~~. Dated this .................. .. .- --•-- _........ day of ---•--•--- ' -.......... 1~~... /,~' ._ ...-----'-------------------------•--•---. ...-.. ... --•--..........(SE A I,) t/ - -` ~l :......~ r ...s .. ............ (SEAL) Richard A. Whitcomb ice' ~ ~~-- . ' ~'..-f~.zy=<... r'r.....~=~=~~. ..(SEAL) ' ¢ C;eorf~ia A. Whitcomb AT3TI-IENTICATION ,F~CIiNO W ]~EI1Q•MENT Signature(s) -.__-.. - __- - cm4Tr., C>F WISCONSIN { St C'rojx s. --- ~- --- ------- -------------'--county- ! ~~ authenticateii thin _.......dag o£.___.....- .., 1P._.... I'ersonnoll~• came before me this :cilr!~.day of - c r_'~ . . ----;`~~f=Gnl-f==T---•----------- ..., I94.'-f•. the above named .I;.i.c _axd...A.,.--W~•t~-Qmb---~-na-------- ----•---------- "•------------•------------- -•----......- .-_Geo_x$ia•--A :...Whitcomb T]TLL:: MEbIBEFt STATE, F3:lR ()I~' •GYIt<-O\SiN (Ff. not, _--.. ....---- - -- -- -_..-..._ ................. --S ._.. .. --- . ........... . authorized by ~ 7^F..4C>, ~Tis. Slats.] tr: ;.;r }.;,,.,~.•n to hp the tacrson ...--- -.. «•hn executed the [~~ V i..; I°~~S lTl irr:..C k6 ... 'i - ..... rR::.; S....,.- . .... ..... ... THISIT1 STRli M-c l`1T Vl4S O'; ~~FT>=-'O ~L~y.p ~- /C ~, ,~~ - - - ...- : r . _ , , l~ ~..•.c asZY PUBI.IGrtws ~ .r~4' ~`~-.,~ '" t~.E1.L.Ly.S.--f3<v83iIS ~ °' .~¢;x~~'_ r H u d.S. O.L7, a W i _ J %~ v c v, _ - .S`~t r, Y (' 1 '{ ii", , .ii,!-iTit. is :. .., hn .. .•It ~Iit,.`/Itt'tl ii' .~f ~nn~.~j..i:., 1. , ,.. \r.. 't ~:ni .inn ~. n`'rn:n n•.,.. t' nn'. :I :..., t`S nir-:1i ir~•~ . .v...,..,. .,r ~~anlns: - . ~ .. .. .,. wiaai~..rv-, ,..,._., ~T.t'Pre r: au n •.ti-I~.:rn.,t~. •,a•~ .....~.. ..... Wisconsin Department of Industry, Labor and'Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village Town of: ITCHISON, TOM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Vent to Airlntake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Count ~T. CROIX Sanitay990~~0 State Plan ID No.: Parced~`~o.1132-30-000 ELEVATION DATA A9700372 STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Ht Inlet St J Ht Outlet Dt Inlet Dt Bottom Header J Man. Dist. Pipe Bot. System Final Grade Manufacturer Demand Model Number GPM TDH Lift `riction System I-[ TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Num er: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length 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 Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 20. 29.19.636,NW,NW 888 WILLOW RIDGE ROAD LOT 27 Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ^^~ . ^^ Safety and Buildings Division ~~^^~r^r. SANITARY PERMIT APPLICATION Bureau of Building Water System 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county than 8 1/2 x.11 inches in size. ~~ ~ j • See reverse side for instructions for completing this application state sanitary Permit Number v~j ~ The information you provide may be used by other government agency programs ~ v"ious~cation ^ Check it revisiD (Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name -~ ~ Property LocaUOn R jy E (or~ S Zo T Zpj N / v4 N~/4 '~ ~ C , , „ , Property Owner's M ili Address Lot Number Block Number City S ate Zip C"q ~ Phone Number Subdivision N e or CSM Numbe ~ ~ r bIG- .S / d I OW ~ II. TYPE F BUILDING: (check one) ^ State Owned 3 ^ ity ^ Vd age Nearest Road ~ ^ Public 1 or 2 Famil Dwellin - No. of bedrooms Town of H r~( i ~DsJ ~ -G III. BUILDING USE: (If building type is public, check all thatapply) Parcel Tax Number(s) ~ ~ ~ ~~ / ~P ~Z + I ~3 Z _ 3 b -v 1 ^ Apartment /Condo 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 box on line A. Check box on line B, if applicable) A) 1. ^ New 2. ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of 5. `~ Repair of an ______System ________System ____________TankOnly______________ Existing System _________ExlstingSystem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other ~ 11 eepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Req~~~sq. ft.) Pro hs (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation o ~' " ~ ~~ mo t , ,~ le?• eet / ~~ Feet VII. TANK INFORMATION Ca acit in altos g Total ll # of k Manufacturer's Name Prefab. Site Con- Steel .Fiber- Plastic Ex er. P i ons Ga Tan s concrete glass A p New n Exist strutted Tanks Tanks p Ic Tan or Holding Tank /C+01~ /(~ ^ ^ ^ ^ ^ Lift Pump Tank /Siphon 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) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~l~ 3~ 2/3b ~ ~ P umber's Ad~re/ss (Stre t, Cyty, State, Zip Co ) 1©Z ! ~~ ~f ti~15o•~J GJ~ . C~ ~.~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps) ~A rOVed pp ^ Owner Given Initial i Surcharge Fee) ~ _ ~ s on Adverse Determinat X. CONDITIONS OF APPROVAL /REASON FOR DISAPPROVAL: SBD-639B (R. OS/94) DISTRIBUTION: Original m County, One copy To: Serety & Buildings Divrion, Owner, Plumtar INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 and 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. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 1/2 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 1 15 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 contamination investigations and establishment of standards. ER - i ~ 1~l t 1? ~J[' •:% ~ i ~ ~, c'~~/ , TOWNSfIIP ~,f ! SEC. T N, R W . ADDRESS ST. CROIX COUNTY, WISCONSIK. ' ,~t [/f_~Slty 11 i _. DIVZSIOy t r '; L t ~ i[ ' it 1 /7l' ~" ~, LOT ~ ~ LOT SIZE PLAN VIEW Distances S dimensions to meet requirements of 862.20 . S HOW E4'ERY NG WI' THIN I 00 I'EE T O F SYSTEM +~ { iti' _ - -2 ~ i - ~ ~ - t 7 ., ~ + / ~ ~ 1 ~ 7 ~.. ~, ' C ~' r " ~ ~~ - _ - ~" ~ t. 1" ~ _ ~ ~ I S di~ L~ c~a-t} : ~-e I oa th ~ Ar ~ o ~T j ~ ~ i 'TIC TAIr'K(S)~ MFGR.~~ COlICRETE~_ STEEL • N0. of rings on co~er~~ Depth Cs DRY :`GHES N0. of v~dth length .area no. of lines ~ width_~ length ~ f' -area ... ~ ~ .. depth to top of pipe ~~," ~Y. RATE AREA REQUIRED AREA AS BUILT_,_ f- ~ ~ ' stiaimer: The inspection of this system by St. Croix County does not imply complete ;~liance with State Adadnistrative Codes. There are otter areas that it is not possible i.n~pect at this point of construction. 5t. Croix County assumes no liability for Stem opezation. However, if faily~e is noted the County will make every effort to ;orctiine cause of failure. EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THI5 SYSTEM. ~ - . ,. `INSPECTOR ~ ' DATED ~- ' /~ ~ ".~~ _ PLU.IBER ON JOB G~,~- ~.~.~ ~ ~ -~•~'~/ -. 1l~ LICENSE NtRiBER ,~ ~ •~ - So/'~. ~J~it'/' f--/ C.4-7-i ©,r.~ ~4rC~ T~"iPiP r1F - G/FT' ~~p GK'S s y Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Page ~ of Z' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County p ~ include, but not limited to: vertical and horizontal reference point (BM), direction and .J T C/f, ~~ x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # !, 02~-~~~3z-~~ APPLICANT INFORMATION -Please print all information. Reviewed by Date Personal intonnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ~QM ~% TGLi %SON Govt. Lot NW 1/4 N(,J 1/4,S 2C~ TZy ,N,R ~~ E (or W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 8 8 g ~/Y~o~v ,~'rDG-~ ~'9 ~ 27 ~v//low /~~~~-~- City State Zip Code Phone Numbyyeryy nn ^,/ Nearest Road 7~ U~.SO~J I /(•~~. I.540!(p I ~ Z L 5 ) ,3dr~ • l L~oD ~ City`.l ~ ,' i~[ nag i LJ Town I ~/~%4~ /Q/'17~' l~l~ • ^ New Construction Use: 'Ll' Residential / Number of bedrooms '3 Addition to existing building ^ Replacement ~- ~'DD~1`y f CODS "~ y~O rovhY'S ~oD~- 5~- ~O Code derived daily flow 7 gpd s/ ~ Recommended design loading rate bed, gpd/ftz ~ trench, gpd/fi2 Ab~s~ lS~n'~ a~required _ ~0 ~ bed, ft2 7~O trench, ft2 Maximum desi ~ loadin rate ~ bed, d/ft2 )? g g ~ ~ gp trench, gpd/ft2 'nfiltration surface elevation(s) ~ V~ p/ ~ Q [ • z~ ft (as referred to site plan benchmark) Additional designlsite considerations - /^ ..1~,' Parent material ~o~M S~Olk~,vT~ Oy~° ~f~v~P .S~9~tspy ~vl~ lood plain elevation, if applicable ~~~ ft S = Suitable for system Conv ntional Mound In-G~r~ou/nd Pressure AT-Grade Syste/m in Fill Holding Tank U = Unsuitable for system ~ ^ U Lfd'S ^ U L'7 S ^ U ~ ^ U []'S ^ U ^ S SOIL DESCRIPTION REPORT Boring # Ground elev. i ~ 2 , ~ft. Depth to limiting factor .7 i!.-!~ in. Boring # ~v l Ground elev. ft. Horizon Depth Dominant Color Mottles t T Structure C i t B d R ot GPD/ft2 in. Munsell Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. ons ence s oun ary o s Bed ,Trench t o-i ~nYR 3l3 sl~. t-F R s c f t~ ~y ~. S Depth to limiting factor ;n. Remarks: CST Name (Please Print) Signature Tele hone No. R©Q ~ ~ ~ (`c Gt'i'' Its • 3 ~~ ' ~ S Address CI~S.S ©'/t1~/`L Date CST Number ~'~ • ~ v1~Sa.1J (,cat . S4o~~ ~ ~ 7- ~~- csr~, .~. y~Z. t~DOtA.,~t ~(~ a~ S VST Remarks: ~X/STlN (r- Syfl~'~l ff "1~/d~~GPS 7~ ~ ~•c~ ~T>F 4~~YY0/iiit..~% .sDi~S . PROPERTY OWNER PARCEL I.D.# Boring # Ground elev. h. Depth to Limiting factor in. SOIL DESCRIPTION REPORT Page of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: Boring # Ground elev. ft. Depth to limiting factor in. ,, -- Remarks: Boring # Ground elev. n Depth to limiting Horizon Depth Dominant Color Mottles Texture Structure Consiste ce Bounda Roots GPD/fl2 in. Munsell Qu. Sz. Conc. Golor Gr. Sz. Sh: p ry Bed , Trenchi , , , factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor , 'n' Remarks: SBDW-8330 (R. 08/95) f .. S C L L. o / ,~ "7 4 / ~P%~~ ~ i ti O (~Z C~~H,~~ y I nE~K [ O /Z y / ~ I _-_~ y-~ c s d:~ f , sys r ~9- z~ /3til"~o~o~~~~~~ 0 ~E~L 1/ :~ '`~~~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, Wt 54016-7710 (715) 386-4680 AFFIDAVIT OF SYSTEM REJUVENATION Property owner: _ -T~,,,, /~ ; ~ c h S an/ Address: ¢3 f3~, 4~'~ low ~`, ~ ~. Q Day time phone : (~~ ~ ~, (,, - J Z ~ p Parcel I.D. # U`ZL~- l / 3 Z.- 3 0 Legal Description of property: ~l W !Y W ;, Sec. "Z-o , T. Zq N. , R . LAW . , Tn . of ~K-L so.{ , St. Croix County, WI As owner of the above described property, I acknowledge that the septic system serving this residence (is/ -not undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Signature: Date : ~ /~ 1~9~ 5/97 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~on~ '~ ~~~°~S~,a residence located at : }~~1/, ~_1/, Sec . 2ca T~_N, R ~~ W, Town of ~u sea St . Croix County, Wisconsin. 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 ~ ~ l q'-~ Did flow back occur from absorption system? Yes No~ (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: 1 oop Construction: Prefab Concrete ~.~ Steel Manufacturer {if known): Age o f Tank ( i f known) : ~ -t „ < (Signature) (Name} Please Pr' t (Title (License Number) ~1 tsi~, (Date) Form to be completed by licensed plumber {s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Other Name Signature MP/MPRS sfx~c-i~o 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 ro ert '~ P P Y-1vc,~ ~i-~c..l^~ i S~~I Location of property ~1 t,! 1/4_~~~ 1/4 , Section ~_, TAN-RAW Township ,,~ sd..t Mailing address ~ g g ~'~ \\o~ ~,~ ~ ~~ Address of site `-~aVy~,~ Subdivision name ~',11„~_, Z~~ r. o~ \( Lot no. ~_ Other homes on property? Yes~_No Previous owner of property _ ~ ~ c.~w~., ~,J ~;t cow. ~ Total size of property Total size of parcel - Date parcel was created Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house)? Yes _~_No Volume ~~4G and Page Number ~p~' as recorded with the Register of Deeds. A WARRANTY NUMBER AN certified delays of references shall also INCLIIDE WITH THIS APPLICATION THE FOLLOWING: DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE D THE SEAL OF THE REGISTER OF DEEDS. In addition, a survey, if available, would be helpful so as to avoid the reviewing process. If the deed description to a Certified Survey Map, the Certified Survey Map 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 . 4 S ~ c-~~ -~ and that I (we ) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. ~} ~5 ~ c~o''- Signature of Applicant Date of Sig ature Co-Applicant Date of Signature STC-I05 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERiBUYER yr,'l l~- i tG ~'1'- ~ a ~l MAILING ADDRESS `c3 `~ ~ ~ ~ 110 w ~~~ d~-~¢_. Z~. ` l~ 4- ~ S `'~^' PROPERTY ADDRESS S a, wt. C-. i1 (location of s'ept`ic system) Please obtain from the Planning Dept. CITY/STATE t 4 ~a.SC„s f V~t~i ' PROPERTY LOCATION ~~ 1l4, N W 1/4, Section ? y , T~_N-R 1 ~( W TOWN OF ~ ~~, ~5 d -,t ST. CROIX COUNTY, WI SUBDIVISION ~.~,..)', `~~~~- ZL ~ LOT NUMBER ~_ CERTIFIED SURVEY MAP ,VOLUME ,PAGE ,LOT NUMBER 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 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 60% of the cost of replacement of a failing system, which was in~aperation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year e/ 'ration date SIGNED: < ~,~ DATE: ~ / ~ ! l~' S' 7 St. Croix County Zoning Office Government Center 1 !O1 Carmichael Road Hudson, WI 54016 11/93 '• `DOCUMENT NO. STATE PAR OF WISCONSIN FORM 1--14s! WAAMNTY DEED 451Q0'7 ~vcC r~ct ~ This Deed, cnade between Richard A. Whitcomb -and - ------------------------------ - --- .Geo_rgi,a--A.--Wh,itc-omb-t--.husband and wifet_ -- _ _ - ------- --------- -•-- .........---- -••--•------- ._.-- -...-----•-•-- - -.-......- ranter. and..--Thomas. E. Aitchison and Susan K. A3tc~1 son, -husband and wife as survivorship marital ..--- - _..prope.rt.y.:.---.. .. -- --....-•----•-- -- -•-- - --- -------- -- --------- ---- -- ---- ------- ...---- .....-.-..~ Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... of one dollar and other valuable consideration conveys to Grantee the fol{owing described real estate in -S t . C r O i X Gounty, Stste of Wisconsin: 7W ~[ RiitR4[O IOR R[CORCIIN OArA REGISTER'S OFFICE sr, cRO~x co., an Reed for Record auc 2 ~ ~ss9 d 10:45 A• Iyi . ~~ flspi~NrolOwd~ .en+.. *o ?u Pared No: -.._•---• .........................• Lot 27, Willow Ridge Second Addition to Town of Hudson, St. Croix County, Wisconsin. .-~-~=~~ This _._-__is._...._-_.._... homestead property. (is) (ia not) Together with all and singular the hereditamenta and appurtenances thereunto belonging; Richard A. & Georgia A. Whitcomb And -- --- - - ---------- --- - ---- -- - ---- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restzictions and covenants of record, if any, and will warrant and defend the~ame. Dated this -----------...~1~~ -t-.--.--- s AUTHENTICATION day of - - - _ ~s_Jc~ ` _ '_ _ _ , ---.....- + 1~.4 .. (SEAL) _ ~i%~ ...-- /.- - - :.-.-.. ~:,.-_-~~ - - (SEAL) Richard A. thitcomb ` -. -/ - - - ..(SEAL) lt`z~=~- ~/OE._~L~?GG'-.._(SEAW Georgia A. whitcomb Signature(s) ------------ ----------- ----•------•-- -- ----- - -------- authenticated this .-_..._-day of_ ......................_, 19__.- -- - -_.. TIT'..E: MEMBER STATE BAR OF WIBCOXSIV ([f not, .- --- - - - ---- - - - - suthoriaed by § 706.06, Wis. StatsJ fl, B~~fR ACEBIOWLEDf3MENT ST ATE OF ~*~CO~EIPi St. Croix ~ as. --- ---------- --- ---- -------._-.County. ~ ~p~ i //~~ Person~r ~e before me this -.._r.'~?l_!L.day of ....LLI_ --- -------------_-+ 19~t~~- the above named Ri.c~r_az.d__a,__k~i_t-comb..-and-- --. Georgia_ A,__a'hitcomb __ .. _---5..---_. -..-. -. __ to me kno:cn '.a ~e -,+- ceron -.. -. _.. n•ho executed the ,fcre:~r~s± ina`~~ri=-c ar,3 acknowledl;e the =ame. COMMERCIAL TESTING LABORATORY, 1NC. 5a4'Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 8378 (WI) 800 962 5227 ST. CROIX ZQNING ST. CROIX COUN1`Y COURTHOUSE HUDSON, WI 54016 ATTN: THOi'~S C. NELSON REPORT NO.: 32122!01 REPORT DATE: 8/03/89 DATE fiECEIVEDi 8/01/89 ~2~--.. l~ 3 21~-~--~t' OWNER2 Richard it Georgia Whitcomb LOCATI~l2 ~6 Willow Ridge Rd., Husdon, WI COLLECTORI Mary Jenkins - St. Croix County Courthouse SOURCE OF SAMFLEi Outside Faucet COLIFORMS 0 /100 ml INTERPRETATIQN2 Bacteriologically SAFE NITRATE-NS 3 PPm Under 10 ppm is safe for human consumption. Ct%.IFORM + NITRATE LAB TECHNICIANS Fam Gane WI Approved Lab No. 19 PAGE 1 7- L ~' REc~i~~~ °` ~ AUG 7 ;989 =~, ..--- ST CFiah - r'. COi1N1Y ZONfN(30Ff~ ~, `. J. ,r .w , ,:. ., f ~r { Means "LESS THAN" Detectable Level Approved byS PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 (715) 386-4680 Richard and Georgia Whitcomb 888 Willow Ridge Road Hudson, WI 54016 Dear Mr. and Mrs. Whitcomb: An inspection of the septic system on the Richard and Georgia property located in the Town of Hudson was conducted. At the time of the inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the passibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:sa August 1, 1989 7`26/89 J%' %' ~~'r%'~ PLEASE NOTE: BY THE LEGAL CONTRACT, WE NEED TO -HAVE Tii~ REPORTS F ` ` ~! BEFORE AUGUST 4th. -' ' ST. CROIX COUNTY ZONING OFFICE / g l ~ , ~, Y ~ St . Croix County Courthouse I~~v "' 911 4th Street n ~ ~ Hudson, WI 54016 't ~ Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can__be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Richard & Georgia Whitcomb Property owner's address 888 Willow Ridge Rd - Hudson Legal Description 1/4 of the 1/4 of Section , T N-R Town of Hudson Lot Number r~_Subdivision Name Willow Ridge II FIRE NUMBER 888 LOCK BOX NUMBER Color of house Cedar Realty sign by house?~_If so, list firm: DIRECTIONS: CO RD A EAST TO WILLOW RIDGE ROAD TO FIRE #888. PLEASE INCLUDE, IF RT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged py running the water for several hours before the test can be conducted. ~~ '~ REPORT TO BE SENT TO : Jenny Olson - Century 21 Bertel sPn-C:ndd ~Cw` ~.h 706 19th Street S - Hudson, WI 54016 ~ ~;, Closing date ~ NOTE ABOVE -`~ ~, '`~ WINTER TESTING: Many times water lines are turned off, or silf cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with ,this office to ensure time when entry may be gained. ~.~,'' Firm or individual requesting services : nny Olson ~~~ Telephone Number 386-8207 ' "~, 1' ~ A N O I I c S+' ~ ~ ~ ~ I ~ ~ I I ~ ~ I ~ " I I cn3 zzv, z I oro~ =x~ z ~' I es co o? I m v ~ o o o o m I~ a~ n a m ~~~ H w ui I ~ a n ~+ ~p ~ ~ N fD N ~~ I a ° • ~ N d N I o ~~ ~ ~ n o I m m ~ ° 3 a a o ~ o 7 U! 00 ~' I S, °° I v I ~ to z y c~ 4 ~ I ~ ~ D m ~a' D a u , c7 ~, ~ ~ W c W N c 3 ~ mm °' I a O I ~- ~ m ~ ~ I o I ~ ~ ~ I ~ I I = I ~' I O z 000 ~' I A O ~ -~ ~ 7 Cn "0 O~ I ~I3 i ~N~ 3 ~ I °° o' ~ m ~ ;o ~ I ~ m °> > °' •° I v ~ • c o ° I v 7 ~ ~ I d ~ • • d I ~ a I ~• ~~ I a I o I =~ I D ~ ~ ~ I ~ ~ I ~ ~ I ~ ~ y I ~ A ~ O 7. n I w ~ I c a ~ m ~ I 3 z ~ ~ ~ ~ I r = n 1 I ~ n I ~ I W ~ I a I I ° o I I y ~ I ~• I w I ~ I I ~ a v I A d a a ~ ~ m a ~ ~ I ~ ~ _ I ~ ~ I m ~ I c ~ v I .o ~ o a I m o I C N I ~ y I I I I I f~D I I I I .-r I I I I I O I I I I I o I I I ~ ~ p ~ p O ~ O ~- c ~ ~ ~ ~ ~ !I. ~ ~ ;•~ A ~ i r: m', rn o ~ m N fD 7 0 7 VI p, d C ~ -a°D a ~ ~ o TT ~ J N o w a ° co co ~ o m o a ~ ~ ~ c a ~ v v ~ ~ ~ ego M ~ ° ~ °-' rn 7 D cWU o a ~ c~ y ~ N ~ C O 7. fD ~ a 5 O C 7 a A A a 0 o :. 3 M Z w c a 3 m c n e~o_ '30 d_ ~ o = N O a N Q o CO ~ ~ W O ~ N w ° o o go N ° c 3 K f Q ro N a a a ~, Z_ eyD J ~ K ~ ~ ~ ~ o ~ ~ A v ~ !~ C ~ ~ \ 1 m Q p ~• ~'! ~ e~ C ~• t.~ ~• O ~~ y ... ti ti 0 0 a A w ;n dQ ,owe ~ O ti N ti • AS BUILT SANITARY SYSTEM REPORT R-~ =~~~jT/uL~1/_7 ~~Z'~ ; ('!~/ , TOWNSHIP UC / SEC. T N, R W O; /~1UUtCESS , ST. CROIX COUNTY, WISCONSIN. _ l _ ~."3DIVISION :~~t~L~,' ~~ /fJL`[ LOT.;~~ LOT SIZE - PLAN VIEW Distances ~ dimensions to meet requirements of H62.20 - ~ni~w r.VC,KTTti1iV(i w1 THiN l UU FEET OF SYSTEM J` 1 - ~ ~~ ~- i ~ 7 '-L 7 t ~ 7~ - ___._ ....~ _.,._.1 _ I a ~ ,~ ~ ~' ~ N -~ t i I SC di ALE va : ~ e , oa ~ - th '` A~ ~ ~ rol _ i -{ a __. - ~~~TIC TANK(S) G , ;~ MFGR. ~1~-=~_~` COPiCRETE~_ STEEL . N0. of rings on cover Depth C3 DRY WELL it~NCHES NO. of width length .area no. of lines ~ width I~ length ~'~, area ..1 Y~ ~ _ depth to top of pipe _~~, " ~ . (~G?'cEGATE / % %~'rt t~~v /7 . FtRY. RATE AREA REQUIRED AREA AS BUILT ~ ~/~}' ~tistiaimer: The inspection of this system by St. Croix County does not imply complete :o:-pliance with State Administrative Codes. There are other areas that it is not possible 1Q inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County will make every effort to tttermine cause of failure. i~EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~ - ~'INSPECTOR DATED (_ ~ .. ~~% . _ .~~ PLUMBER ON 30B / 'Y -~ _~ ~.~-,~..~ ~ ~4~ ~...~ LICENSE NUr'IBER •?,~~, , ~ ` . . l - -- . .. - , ,. _.. _ ~.. r --- , REPORT OF INSPECTION INDIVIDUAL SE(UAGE SYSTEM San~.~:any Pe.nm~.~ .~~~~ S,~a~e S P p.t~.c <'~ C `~ ~2~1~L~~~C~ ~~t~~~~Fown.ah~.p -:~~~lL~_~~~ = ~ S~. Cna~.x Caun~y NAME SEPTIC TANK ~ - - ,/-~(~~ ~ 7 ~,(~~ ~`~ S~.ze~d~_ga.~.~on~. Numb en ab Compan~mert~~sy~ ` D.t,a~anee Fnam: GJe.~.~ ~ (~.~ ~~. 12 o an gnea~en a.~ape -~ ~Z . $u~..e.d,ing ~j-~~. Gle~.~and,3 'f~ ~~. DISPOSAL SYSTEb{ D.ie~ance Fnam: H~,ghwa~en_ _--~~. GteQ.~ ~~Z. B u~..~ dti n g.__.~=d ~ . ti,i,ghwa~en. S~. FIELD DI~'NENSIONS: Ul~,d~h a~ ~nench _-~0 _~ti. Length o ~ each .~~.ne__. 3 '~ ~~. Numb en a ~ .2~.nea_ ~o~a.Q .2eng.Lh a ~ d D.i.~s~zr.ee be~e~veen To.~a.~ a6t, anb~~.an .. ~- 3 f/ Requ.ir~ed area r ~~T DIMENSIONS: ?,ine~s ~ ~ g~. .2.ine~s~ ~~. ar~ea~Q ~ti2 lQ ! ~ ~~2 12; on gnea~e.n a.~ope --~ ~z. Gle.t~.and3 ~ Fx. Depth a~ naer~ be.2aw x~,.2e~~.in. Depth a~ naefz aver ~.i.2e /Z- ~.n. D ep~h a b ~~..2e b e.~aw gnade~-i.n . S.e.a pe a 5 .tneneh ~^ ~.n pen l 00 ~~. Depth ~a 6 edtca cfz S~. Depth ~o g,toundwa~en --- ~~. Type a~ Coven: Pa en an S~naw ' Numb en ob }~~..t~s Gnave~ ancund p~.~~ yep na Uu~d.i.de d~.ame~en ~~. Dep~6~ be2aw ~.n.2e.t 5~. 2 To~a.Q ab~sanb~.ian anea ~.~ ~ Ahea nequ.ined ~~2 "~ INSPECTED 3Y ITLE ~-C~ APPRt)VED ,DATE _ D 19~i'f/ . REJECTED ,DATE 14~! ~~ - !\ ~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES o ~ DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH M P.O. BOX 309 MADISON, WISCONSIN 53701 ~ `r , /,-, REPORT ON SOIL BORINGS AND PERCOLATION TEAS/TS LOCATION: /~l~'/a,N~'/a, Sectiono?~ , T~N, R,~j 81(or)(~Tow hipJojr (Municipality !`/'~/~4M Lot No. ~ ~ ~~ a ~- ~ d-a~/~~it~ County ~~`' .~ ~, Block No. ~ ~~ r ~/'oi diva on Name Owner's Name: 1""~4 ~F- 2 e.N Mailing Address: -St TYPE OF OCCUPANCY: Residence ~- No. of Bedrooms 3 ~,<< Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS ~ ~9` ~~ PERCOLATION TESTS S' ~9` SOIL MAP SHEET ~~ SOIL TYPE -S~ ~ ~- S'4~~e- ~O~M PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS H E WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- INCFIES THICKNESS IN INCHES OL SINCE 1ST WETTED SWELLING IN MINUTES PERI D 1 PERIOD 2 PERIOD 3 MIN/IN BER P l ~©; ~Q ~ ~^re ~i4~~i9 / L /'mod ~ O (rs (v P ~ (~" _~e~ ore ~fI'~iS7 /Z ~" G' `~ J~/ 3 -3 P =~ ~(~ " ~.e C? Ore l~q~!" /?i /f ~a S~ J~ ~ ~/Z ~ /L SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ 3 ~6" a,~c c > p6., 8~=7s ~" s~ ~ G I ~ ~ o ~~ s S9N s~ B_ .S- j~ii" ,~~~ ~ j`'6`' 7,. -F S, '~" S~ ~fi(r--, ,2 (o" s S~" s,G PLAN VIEW (Locate percolationtestssoil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate n m ~r of square feet of absorption area needed for building type and occupancy. ~'~ ~ OOO°i -~ I dicate sca}e or distances. Give horizontal and vertical reference points. Indicate slope ~ ,S~s -E- ~Of~~.--..~..-¢ p ~C ,~s ~~ f GC ~ ~ i `~ v Sv r • ~ ~ ¢ ~' 1 ~ ~ °~ kC 2- c p ~ g \ G ~ ~ .~ r - _ - f,, n,. ,.,.. c ., -~ - • ~ ~~~0 ~~.~ ~ ~ State and County State Permit Permit Application County Perm' /~~ for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL .REQUIRED Date... Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: / , ~c/ ~J B. LOCATION: '/~_'/a, Section ~, T~ N, R E (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~/.'//~sdol/' ~a:L~,~ , C. TY E~ OF OCC PANCY: *Commercial *Industrial *Other (specify) Variance Single family ~_ Duplex No. of Bedrooms ~ No. of Persons D• SEPTIC TANK CAPACITY QfJ~ Total gallons No. of tanks ___t__ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete ~_ Poured-in-Place Steel Fiberglass Other (specify) New Installation ~ Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate • - - Total Absorb Area sq. ft. New~Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top), No. of Trenches Seepage Bed:~_Length- ~~~Width~_Depth~a~.-Tile depth (top-..~.~~._No. of Lines.._~ Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land ~g'6 Distance from critical slope WATER SUPPLY: Private L~' Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that l Have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME ~~~lN/~/~ /ST/~ ~F~~~ C.S.T. # and .other information obtained from Q caner bull _ 1 Plumber's Signature MP/MPRSW# .~2~.~ Phone #,~y -~ fq ~~y/ Plumber's Address PLAN VIEW: Provide sketch below of s stem (include direction of slo a and all distances in accord with H62 20 Well loca- ~~ Y p tion shall be included on the sketch, Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate.