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020-1031-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 579014 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Englund, Anthony Hudson, Town of 020-1031-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: b~ Y'a 17.29.19.14362 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. / Septic 6'4 4-6,A Benchmark nn 6'Z5 1d0' .5 Alt. BM `A l'v Si 9'~f , gs e., Wee/ Aeration ' Bldg. Sewer S 4 Ph ~z Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO ~P~lr WELL BLDG. Vent A' Int a ROAD n b J g 9~~ 3 7 ` Septic I Dt Bottom '725 5 16 Header/Man. Ae tion Dist. Pipe / bre 1 • 4~ Holding Bot. System Final Grade 6 PUMP/SIPHON INFORMATION Manufacturer Demand Sto`o r t~ l $ GPM dL . T Model Number e A A a J ` t-. TDH Lift Friction L ss System Head JTFt Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PiT DIMENSIONS No. Of Pits Inside Dia. r uid Depth DIMENSIONS 3 Ql~ Z !~K ~ ~ SETBACK SYSTEM TO Y V P/L BLDG/ WELL LAKE/STREAM LEACHING Manufacturer: ~Z INFORMATION CHAMBER OR Type Q'6 o )tA'-N6 ~ A6 I7 / UNIT L1G~lx1 J p"V.AJ DISTRIBUTION G SYSTEM Model Number: Header/Manifol it Distribution x Hole Size Ix Hole Spacing= Vent to Air take Length Dia Pipe(s) 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 Mul ed Bed/Trench Center 5r. '75 Bed/Trench Edge Topsoil ` Yes [M No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 956 Daily Road H dso WI 54016 (SE 1/4 E 1/4 17 T29N R1 9W) NA Lot 2 Parcel No: 17.29.19.14362 1.) Alt BM Description = 6a ~!i8 'X~- Af VJ , ~u n 2.) Bldg sewer length ,s = ~i I _ ► a~ amount of cover Plan revision Required? w~ Yes XNO Use other side for additional information. / J Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) County r 42 1 S ty a B gs Division S/ : C f / D x P.O. Box 7162 *r~ K ~ Sanitary Permit Number (to be filled in by Co.) F JU ~Madiissoon, W1 53707-7162 c.~ CROIX l ~ s►cara s ST.01Vf)CIEL PMENT "I ! Sanitary Permit Application State Transactio umber In accordance with SPS 38321(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 submitted to Project Address (if different than dress) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes m accordance with the Privacy Law, s. 15.04(1) m , Slats. 46 L Application Information - Please Print All Information ~P ~+N Property Owner's Name i. fo Parcel # Property Owner's Mailing Address Property Location 2 L ~U - 1) ar l Govt Lot ' CJ City, State Zip Code Phone Number _ C Section 17 4 ~S ~rz tti ..Va 4 7/s Irer GS 77 circle one II. Type of Building (check all that apply) T 2 N; R 1~ E or L Subdivision Name 14 1 or 2 Family Dwelling - Number of Be droom r3 a t,Q~ B ° 11 PubliGCommercial - Describe Use ❑ City of ❑ State Owned-Describe Use L CSMN / ❑ Village of t+✓ T g e 6+~ ! ia Town of Gt l ©1 ' III. Type of Permit: (Check my one box on line A. Complete line B if pplicable) G A. ❑ New System Replacement System ❑ TreatmenVHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal- ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner (j 1 y -l ~g~ IV. Type of POWTS System/Component/Device: Check all that apply) J- R Non-Pressurized kSound , 0 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 (explain) V. Dispersal/Treatment Area Information: Desi Flow (gpd) Design Soil Application Rate(gpt Dis Area Required Dispersal Area Proposed System Elevation r OA VL Tank Info Capacity in Total # of Manufacturer Gallons _ Gallons Units A qq 0 New Tanks Existing Tanks ° V Gv° ~ n wt7 w Septic or Hokting Tank 1600 d-Ooo i oo 2 W e x Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print Plumber's Signature MP/MPRS Number Business Phone Number 1- Z313 % Y T/S Z V 7- 3 Zd3 r le'A tic h i~ 10' Plumber's Address (Street, City, State, Zip Code) Z ~2 v SQ m e1%r e-~- cc, 2 5-yeoz S" VIII. oun epartment Use Only Approved prove Permit Fee Date ue Issuing t Si $ 475, t~ 7 Ix 15 6 . er@' n eason for Denial IX Conditill>WIEII[fONWi~teasons for Disapproval j.' Sepfic tank-effluent MW and Xe b✓ t 5 0^"- wt,r8 ,a@~ as f ►~aiAlalAe~t dispersal cell must all as-per management plait 0mvid6d by.O{d 10- Aa~ ~ICA- is 2. 0 $06001K T6'-' 0- mowlmd. tll8 ~ ~•C~ f OfdhMflON~ Attach to complete plans for the system and submit to the County only on paper not less than 8 in z 11 inches in size SBD-6398 (R- 11111) OWNER Page 3 of 3 Lu o ~ Name Brian Parnell CST 231314 Addre s ~F5~, Xt, i ~ccr~c ~-1 S Y ~/6 Date AL Benchmark 1 '7C 14elze ~1 /GO. U A Benchmark 2 ❑ Soil Boring 17- _ 1 Suitable Area 1" = 40' Scale _ I L f r e i , ~ I l i I! i t ' I I~ i l I ~ I I I Etf i ; I I O I I I ' 1 l 0 I, , I I i i i ► O! E l i i l l l l I! i i i ! I 1 ! rt ''~r I ~ I ~'r I I { ~ ~ ~ I ~ ~ ! I C- -71 i ; I ; ; ! I lt1 I ; I { ~ i E ~ i I I I ~ I E 1 I I I , ~ i I ~ ~77 !i1 li ~I E I F ! i ! I ! 09 i i ! I I r I I ( I I I CONVENTIONAL COMPONENT DESIGN Residential Application J INDEX AND TITLE PAGE Project Name: vl f d fit G ce Owner's Name: n f 3 y 5 L cc .2 Owner's Address: SG ce , r yam. f~~ wz Legal Description: Township: h6 Z County: Subdivision Name: Lot Number: 2- Parcel ID Number: o ZO / L ZO Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber: gf; a 1( !'n ell License Number: 2-3 V Date: Phone Number 74 ~ Z 1/7 3z 03 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 OWNER Page 3 of 3 Name h ry Brian Parnell Addre s CST 231314 He,Jso-c cc.S 5-V O16 Date A Benchmark 1 ~D9 L sI-o/ze /"~O` U A Benchmark 2 F-e4 cep°p~'" L Soil Boring Suitable Area F = 40' Scale e ! ! I Ad ! o. i i o I Jr- -2 1 f , r 47 j (Se i it i i 1417 6 A ~y . ,n" 6 y°%'*-i~ 2 b- y~` X ~'~e egg 3oo~~ix~~ vP®~rl mo'c`ks d-fe ~~f r z C, 'o/y1 G-e y ~ Z j263t+-io ~ ° z -Cs p Z 71-11 SOIL ABSORPTION SYSTEM DETAIL 1 GRAVELLESS LEACHING UNIT Page of Project Name: ~/rT n -;1'- y 4-/17f /a,, -,0 . ~j No. of Celts d Per Cell 3 ft Cell Width /b Total No of Z~7Z- 8o ft Celt Length C/00 rq ft EISA Per Cell ft Cell Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating 1nfi trator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer. -n l~r~ ~a r Gravelless Leaching Unit Model: 2 03 N - . Qft Typical Cross Section Finished Grade / Observation Pipe with approved cap or vent a •;:-:;:•:"::;::•::s::•:•:;>::•:;: .-----Soil Backfill S 5'in - < ; : <; Geotextile Fabric 07 yft Infiltrative Surface 12 in Q I i 13' ft Limiting Factor ~d in 77 Slotted and Anchored Ventl Observation Pipe with Cap ■••■■■■■■■■■■■■■•••aaaa~raatarrrasa■saaasaa■■■srararraaras■aasar a■wrrsra■ Plumber/Designer Signature: License # 2 3 13 Date: INSTALLATION INSTRUCTIONS ~ I bwaswin abW PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS i center ifter Vft ins 9 Fat - Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the fitter housing on the (B) Remove tank cover and pump tank fitter housing on to the outlet pipe. outlet pipe. tf necessary. (B) Make sure that the housing (B) Insert the fitter cartridge in the is positioned so the fitter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service- completely inserted in the housing. MAINTENANCE INSTRUCTIONS i Nil Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back D USE • a if necessary. into the the housing making sure 1 WHEN FILTER IS REM -s ING t (B) Pull the filter out of the housing. the fitter is properly atighed (C) Hose off the fitter over the septic tank and completely inserted. USE RUSBEI Gt:OVES _ Make sure all solids fats back into the (B) Replace septic tank cover 1I+I CEANINGFILTER~ septic tank. POINTS OWNER'S MANUAL & MANAGEMENT PLAN Page . FILE INFORMATION SYSTEM SPECIFICATIONS Owner A', f o s~ ~Cx:1 Septic Tank Capacity lg~)® gal D NA Permit # oo, Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 ( c'1~ D NA Number of Bedrooms 0 NA Effluent Filter Model 13 S2~ NA Number of Public Facility Units 0 -NZ Pump Tank Capacity gal 0 AA Estimated flow (average) 50~ gaUday Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 13 NA Son? Application Rate d~ el/day/ftZ Pump Model D NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit O NA Fats, Oil & Grease {FOG) 530 mg/L 0 Sand/Gravel Filter D Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/l. 0. NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L .0 Disinfection- 0 Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s). .0 NA Biochemical Oxygen Demand (BOD5) - 530 mg/L 0 In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L - 1 NA 0 At-Grade 0 Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 O Drip-Line D Other: Maximum Effluent Particle Size Ys in dia. O 'NA Other D NA Other: 0 NA Other. 0 NA *values typical for domestic wastewater and septic tank effluent. Other .0 NA MAiIN3ENANCE. SCHEDULE Service Evart Service ` Frailuency inspect condition, of tank(s) At least once every: 11 month(s) (Maxanum 3 years) DNA M s) Pump out contents of tank{s} When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 month{s} (Maximum 3 ® year(s) Years) DNA Clean-effluent fitter At (east once every: 0 month(s) D NA ~ r-~-year{s} Inspect pump, pump controls & alarm At least once every: 13 month(s) 0 NA 0 year(s) 'aterals and pressure test At )east once.every. O month(s) 0 NA 0 year(s) At least once every: 0 month(s) 0 NA Other. D year{s} O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal rags shag be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, -Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. . The dispersal keg(s) shag be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.. The.ponding. of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents- of the tank shag be removed by a Septage Servicing Operator -and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of- effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shag be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION Fcr new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting Products or other chemicals . tpt may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents / the tank(s) removed by a septage servicing operator prior to um system start up shall not occur when soil conditions are frozen at.the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the.cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWT S Maintainer to assist in manually operating the pump controls to restore-normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal -cells. Do not drive or park over, or otherwise- disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater strewn may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butte; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; Pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin. Administrative Code- • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated.- • The contents of all tanks and pits shalt be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall. be excavated and'renvr4W or the covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil>absorptlon system. The replacement area should be protected from distuibance and compaction 'an d should not be Infringed upon by required setbacks from .existing .and proposed structure, lot Ines and wells. Falk" to Protect the replacement area will result in the need for a new sort and site evaluation to establish- a sukablereplacement area. Repiace#yent systems must comply with the rules in effect at that time. 13 A suitable replacement area is not available due to setbai k` and/or soft Wm adons. Baring advances in. POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluate to identify a suitable replacerment'area. Upon failure of the POWT'S a soil and site evaluation must be performed to locate-a suitable replacement area. If, no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at-grade soil absorption systems may be reconsmnrated in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must cornply with the notes in effect at that-time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR NC>~lT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CWICUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE. INTERIOR OF A TANK MAY 8E DIFFICULT-OR IMPOSStSLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAWTANNMI Name ,-i r a :g )2!c/-? e! f 11- Name ---d- - - Phone ~~s= Z y?.- 3z0 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Nam cG rte v Phone Phone -216 - 1~~ - This document was drafce~_ cv-.rflance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.84(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN pew of ME INFORMATION SYSTEM' CAMONS Owner - n f 04 Septic Tank Capacity eD O al p NA Permit Septic Tank Manufacturer p NA DESIGN, f►ARAMEiERS Efi kmn Fitter Manufacturer O / DIG : O NA Number of Bedrooms 3 p NA Effluent Filter Model SZ~ C3 NA Number of Public Facility Units p _NA Pump Tank Capacity al 17 NA Estimated flow (averages 300 ~/d Pump Tank Manufacturer ❑ NA FOesign w (peak), (Estimated x 1.5) Pump Manufacturer ❑ NA ation Rate Pu mp Model p NA nfluent/Effiuent Quality Monthly average Pretreatment Unit D NA Fats, Oil & Grease (FOG) 530 mg/L • p Sand/Gravel Filter p Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/L p. NA p Mechanical Aeration p Wedand Total Suspended Solids (TSS) 5150 mg/L. 3 Disinfection- O Other Pretreated Effluent Quality Monthly average Dispersal Cell(s). .0 NA tiochemical Oxygen Demand (SODs1. 530 rrg/L ❑ in-Ground (gravity) p in-Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L 1 NA p At-Grade p Mound Fecal Conform (geometric mean) 5104 cfu/100mr p Drip-Line p Other: Maximum Effluent Particle Size Y. in dia. O NA Other. p NA Other: © NA Other 13 NA *VaNes typical for domestic wastewater and septic tank effhaert. Other: © NA MAlNT1 NANCE 4gc*uq tll.E Service Evert Swvice Fnagtrency inspect condition. of tank(s) At feast once every: month($) (Mania tun 3 years) D NA 10 year(s) Pump out contents of tank(s) When combined sludge~and scum equals one-third (Y) of tank volume p NA Inspect dispersal cell(s) At least once every: 13 mono ~(s) (Ma slunk 3 yam) 0 NA Clean-effluent filter At least once every: 3 p month(s) p NA t~year(s) Inspect pump. pump controls & alarm At least once every: p month(s) DNA p ear(s) 'aterars and pressure test At (east once ..every. O'r°ms (s) p NA 0 month(s) At least once every: DNA yearts) Other: . 0 NA MAUUMANCE INSTRUCTIONS inspections of tanks and dispersal cogs shall be made by an individual carrying one of the following Ocensec or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS tnspecWr, POWTS Maintainer; Septa" Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. - The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the chore , contents of the tack shall be removed by a Septage Servicing Operator 'and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of. effluent fitters, mechanical or wed components, pretreatment units, and any wiping at intervals of 512 months, shall be performed by a certified POWTS Maintainer: A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer b A e n L G~ Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) w City/State Parcel Identification Number 0 2 0 lD 3/ 2©~ 00 4) )-r6-,j l LEGAL DESCRIPTION / u 1-( 6 `1 Property Location S i/o , lV '/4 , Sec. 7 , T2-7 N RZLW, Town of IU Z Subdivision - , Lot # Certified Survey Map # , Volume ©y , Page # 16 01d Warranty Deed # , Volume , Page # Spec house yes (gn Lot Imes identifiable @ no SYSTEM MAIN'T'ENANCE 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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin- Certification stating that your septic system has been maintained must be completes and returned to the St. Croix County Planning & Zoning Department wiftn 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. I/we amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. N, niber of bedrooms SI TURE O APPLI ANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Z^.-lude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -eerence is made in the warranty deed. RED". 08'0-9 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) n '7-A 4 located at: 1/a, IUiC '/4,S ction 17 , Town Z q N, Range / W, Town of N4. So n , 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. Most recent date of inspection or service 20 /S Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /b 6 6_1 e / d- eO4f & Construction: Prefab Concrete Steel Other I Manufacturer (if known): ct' e .e /C Age of Tank (if known)- Permit number (if known) (12~' 1 4 i1 Qf~l P B~ r (Licensed Plumber Signature) (Print Name) -X, s /rte X313 / y (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 JUN 1 1 201b T. CR COUNTY SOIL ~ON REPORT Page ~ of 3 Wis. Dept. of Safety Division of saki arrd in accordance with SPS M. Vft Adm. Code county x Attach complete site plan on paper not less than 8112 x 11 Inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel i.D. o c~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road 2 O Please print all information. R r by Date Pen, information you provide may be used for secmdary purposes (Privacy Law, s. 15.04 (1) im)~ 7 • Property Owner n Property Location c7 Govt. Lot SE 114 ic V4 7 T 2, / N R E (or)(0 Property O jrrer's ~c rrss Lot# slock# Sufxi Narce csl / State Z~ Code Phone Number ❑ city VAve OTC Nearest Road 6~ ~~016 t 7/5~ t 7SI' 6S17 H ki J16 ❑ New Construction use: ED Residential / Number of bedrooms Code derived design itow rate 77 GPD IB Replacement ❑ Public or commercial - Desalbe: Parent material C ? li-'aJ Flood Plain elevation ifappfrcable it. Generalcomnwrds ys fC,., ~G. S74' and recommendations: S ❑ Boring SIIg n c/ ® Pit Ground surface elev.. 7 7 's- tL Depth to limiting iactor> /?J^ in, fSol rRg e Horizon Depth Dominant Color Redox Description Texture Structure ;onsistence Boundary Roots GPIn. Mun sed Qu. Sz. Cont. Color Gr. Sz. Sh. llnjI lc C t~ m EI-7 /vSG. IMS / < 0c 6, 7 ~ /D k-14- IVA- 2C t, c/ 7,Sr/1 IVA rnJ 059 M Cw - o,7 7Y45y' /~i~ ryas OS hZ - 01 7 116 it F 21 Boring # ❑ Boring ® pit Ground surface elev. / ft. Depth to igniting factor ~ ~ 2 S im sod Rate Horizon Depth Dominant Color Redox Damon Texture Shudurg ~A~e Boundary Roots GPD'lt 2 in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. 1.02 ()YA %Z SL rns6k fn v4, C W 0, Y 0-7 6 X6 m s o. 7 1, 96-125 l6 4 16 /VA m s oss - • r t L * Eflluent #1= SOD > 30 E 2M nv& and TSS >30 a 150 mg& * Eflluent#2 = SOD , 5 30 mo1L and TSS < 30 r:xa1L t ST Narr (P ace rs 1 Ssgr-t~ aj Csr t+iur1 Address Date Evatuolion Conducted Telephone Number Y7- 97- 0 3 2. PtoperiyOwner 144 t4O'12 S L Parma fat 4520-1031- 2 0 - G°O 2- 90 -Of 3 13O*V# n Baft ® Pit CMnd surface elev tt Depth to Ong factor 7 /_7 0 3 m. Soil Application Rate Horton, Depth Domes Color Redw Description Texture Mu* we istence Boundwy Roots GPt3IR 2 in. Munself Qu. Cord. Color Gr. Sz. Sh. lvY~ z 0.7 Z l9 9 l~ sib' S,/,Z -zAjkV- CIE 7Y-/33 IOM ~/6 N4- M S' pS rL o.-7 I t 1 s $7- F-1 Boring Lt~~ ir:ng 1 Pit Ground surface elev. ft [Depth to limiting factor in Sod .~catatrt°,ate I Mtzon I Depth is"~Fns'3ir Fti ssi-33 3~SEt3e'3n i c$iy'i ;3a's ic~i'szlc s v ix#F's£n nE .sue, iSs5T2rice a- ~srts f y~vr~ s c.x r.7,~ A r Boring i pit Ground surface elev. I ft. kruti.g factor it:= Sod ~txnt~ . Rate ! i-3R 1 e?z . r---,&, 3 ~ m:€:3tur~ R?dox DesmintiDn ~ i sxiure ~ structure risssienee ~wx~ndacv ~ Rcsc'!s 3 GPDa'€t L°t i',5 3 . i Y y ~ _ * Effluent *1= BOD ; > 30 ~ 220 fngl! and TSS >3{' < 150 try/!.. •"EfFI<,aet=t #2 = BOO 30 mtA and TSS { 30 !rtglt. The Dept. of Safety and Professional Serf=ices is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 609-266-3151 or TTY through Relay. S81"330 (R11x11) -Goo Page Of Property owner ('r O2 ' j L " Parcel tD (520-103- - 20 pit Ground surface elev. it. Depth to bribing factor 7. 3S in. Soft Appgcftn Rate Hor"¢on, Depth Dominant Color Redox Description 'texture Structure smlence undwy Roots GPDIft 2 in. Munsell Qa. Sz. Cont Color Gr. Sz Sh. l -r9..tv;~'~Z Alx YY7~r C-5 1r~ l~,Y 1.x.7 IVA- 0, q9-7q : 41 S- C?•S - t~-a c - G, 7 l 6 try-13~, (o t i i 1 ! t t i 1 # t i i t 1 t 1 l t ~ ~ ~ K i i 3 { i I ~ r 1 Boring = #_r „ a _1 L1 Pit Ground surface elev. £t. Depth to limiting factor in. Sc.,r Rate --q A4-~tiwrt Rate , r. 6. _ F'rusc i ,'.r~'.F:rsavi~ ar5a:.sriTc -F3e3'iraasj ==Cnn r v "nrF 3 .~'+w4 ~?:r~: =°t-tsi:'•. t ~c:,r•~ii Cara:-DesiuT~Jon, Fj T F i. F i t F £ ? F 2 t s i r # F r t r f i 3 ~ E i # It ~ s ; f i i z 5 ° F t F { ; F i F F t i S } ; } f F f f F t # # # i t s a i i i i t r s T F t ~ 1 i ~ ;s t € i i i Boring ~ - i✓ft i3r-`v'.`t surface "c.:r~vr Vii... -visr v mrsii lac tor Ui,iir3'Gilllri Rat--- » - ~i}E 1, ,F-l-._•n err: j; ? e d27 L "SriS3£R•5T I RF xJ?'F; i - £Et"v .i _a-~ £ Roca=- R - - 3 } F F z s i 1 € i { - ~ ~ i r s ' f l ¢ 's t ~ t I i F l~ t t s Effluent 4-m - .BCD , > 30 _ 220T W-1 a-i A'S'S yw = 11:5500 rT#g?l ` Elff1z r° 4 = BO S 30 : tgL a„"•__ -S 3 m~ to Dept. of Safety and Professional Sere ices is an egrtal oppiortunit- service provider and employer. If you acced assistance to 71 access services or need material in an alternate format- contact the depm-trnent at 608-266-3151 or TTY through Relay. SBD 4330(PIVIF) OWNER Page 3 of 3 Name 4,9 fi-A o a y Brian Parnell Addre?s 9S 6 ape,` CST 231314 /lCe 6 SC--q Syy~6 Date A Benchmark 1 7-Of G0 tIke A Benchmark2 ~b9 f~~ce~~ff AIeT?oLo~sfta~t ~L, /63. Soil Boring _ i Suitable Area 1" = 40' Scale _ m a G n u ~ s L 6 i t~ I , t 6 s~ I S e I, ~ g i I ~ I I i ; a I Set:T k ~ _ LIN 6 r r~ L 75 C ,go,zaa D 3g -lb1'8 ~ ~bls. SD 657 ~ p ~ a°i o I avi o I 3 O O vy ) O > 61) p 4 c c i L ts 00 o rn c w m Q m N E c ~ a° c co co N m E m 5 a o o a ~ c I v c y° ~ I m I o 0 v ~ Z t~ I c z c 'v LL c U. 0 Y 0 'O aO 3 lEi Lcu5 3 E Q uE2 Q Q. Cl) M Z f/! Z cy) Z O ~N am am c C7 I I o z v 3 .y m z v rn ac o T N hhw~ f0 d 2 O a 2 m O N O) rRJ ° N ~ LO :3 cu 0) y N CL LO y Q •N~ a In = y a t ~1 o O c p O o z co z y° a Z N 3z m _ _ E o d R cu o L R L > o T - ' - O M Q 0 d " t0 Q w N N N T a Lo h~ ° co co a E Oo E to IL Z N> - P F- OP O rn F F-2 F- _ O m 3 3 3 0_ LL 3 3 3 0 LL ' o m a a a o a as a a m to U) o U) ~n a1JU ornrn z° co oz° l U ~ C. N _O - N 0 y 0 O O O O O O N N N :d O O N :O O 'O ~ C_ N O O co N Q (.n O 'p N QI Z fn i0 y U) 0 C O to to 16 y 1^~i O 2 y c O O m c O O 06 E V o a) 0) cli -It (D v a 00 ° ° 0 0 0 1 Q N H lL y V O j m y € r a N N N N N N 'p O N d N Z ' Of 0) y N v N -O st CO (O O 1 c m IT rn 0 E c co 2= c a t ' O O S J Cp O z y F- Z J (p O z y Z Z r1.' fq L ~ L ik Q m a a ~ Q d Z L: a. rr~~1 E c C w 7 C ay+ C ~1 A ciao 0U)U l0 uU) Form- S T C 1 AS BUILT SANITARY SYSTEM REPORT r OWNER TOWNSHIP 144-" SEC. /Z T _fN-R2 9 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT Z LOT SIZE r"' 3 Q PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM sw~.ti~ sfi~xc 9s. y v se s~r,~r ~ L 5 g ~ go 7l' Wrv INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used S Se - c~~ .:Elevation of vertical reference point: 10a Proposed slope at site: /y el. SEPTIC TANK: Manufacturer: Liquid Capacity: /moo Number of rings used: Tank manhole cover elevation: l~ p ' Tank Inlet Elevation: Z Tank Outlet Elevation: ,&,,111e1 974 Number of feet from nearest Road: Front 10 Side 0 Rear, O /SO feet -From nearest property line Front 10Side ,0Rear, O ~ s-&> feet Number of feet from: well > SD building: S (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: C~ & Liquid Capacity: ~D d Pump Model:Zcl(er 4`J Pump/Siphon Manufacturer: Pump Size 6r3 Elevation of inlet: 2 Bottom of tank elevation: y1~ Pump off switch elevation: Gallons per cycle: ,?moo Alarm Manufacturer: ZAlarm Switch Type: Number of feet from nearest property line: Front, &Side, O Rear, Q Ft.> "p ' Number of feet from well: > l.so Number of feet from building: > l m q ' (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: 1pZ . Number of Lines: 2 Area Built: _~'yo Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, (D Ft. Number of feet from well: >'/j-0 Number of feet from building: LS'o (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, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: llaef Dated: 7 s Plumber on job: License Number : i 3/84:mj _)EPART:MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 79e9 ` . V BUREAU OF PLUMBING MADISON, WI 53707° l J,ONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number ❑ Holding Tank El In-Ground Pressure O Mound (If assigned) A NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER* INSPECTION DATE. Greg Langer 606 - 4th St. N., Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SE NE, Section 17, T29N-R19W, Town of Hudson, Lot #2 Name of Plumber MP/MPRSW No. Counry Sanitary Permit Number: David Fogerty 3289 St. Croix 64927 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED. DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE AIR INLET: OYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BLIQUID CAPACITY JPUMPMODELPUMP/SIPHON MANUFACTURERWARNING LAZY LOCKING COVER PROVIDEDPROVIDED: ONO DYES DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL. ILDING. I(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLE'jl, I H DIAMETER JMATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LE^NG NO.OF DISTR. PIPE SP CING: COV INSIUE DIA.-. #PITS. JLIQUID DIMENSIONS h TRENey ES MA Li: PIT DEPTH DMENSIONS r L GRAVEL DEPTH FILL DEPTH 14S TR PI F DISTR PIPDISTR. PIPE MATERIAL. OR. NUMBER OF WELLBUILDINVENT TO FRESH BELOW PIPESABOV VERE` T. EL, UC G~ PIPES. FEET FROM LINE: AIR INLET: (f ~ , NEAREST--► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES NO meets the criteria for medium sand. TIONS MEASURED. O SOIL COVER TEXTURE JPERMANENT MARKERS: JOBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH/BED 777T~7 EPTH OF TOPSOILSODDEDSEED EMULCHEDCENTER DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.. DIA_ ELEV.. PIPES. DI A.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: C ❑ YES 1:1 NO ❑ YES 1:1 NO NEARESTOM LINE: ( Sketch System on in in county file for audit. Reverse Side. tJ ' SIGNA _ / TITLE: DILHR SBD 6710 (R. 01/82) i wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY AUNTY O~GRQTTEnT OF (PLB 67) UNIFORM SANITARY PERMIT # In4U5TRV, LABOR 6 MUTRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPE TY OWNER MAILING ADDRESS X S/ C IX Gs~ PROPER Y LOCATI N G-TY: V11 6A / C. 5 1/4 y, 1/4, S 17 , Thy, N, R/ E (or) rowlvol=: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD,-L-IRKE OR InA*& -RK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED d . ld3l-- 1 or 2 Family Number of Bedrooms: Public (Specify): 01V-000 THIS PERMIT IS FOR A: li Neal System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 401242 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): R'Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): nature: MP/MPRSW No.: Phone Number: ( 7y9 -3 65-4 Plumber's Address: Name of Designer: w a~ COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: wn Date: ❑ Disapproved A El Owner Given Initial sssO V pproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: D I LH R -SB D-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 r To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i 21 + I i I ~ ;f 1p, ~ rx, f i i =Ll 4f L -7 Fri -1 --7 i 1 t ~ t 1 t ~ 1 , I r V ~ i + 1 ~ ~ I0 I i i r f ~ i e e ti g i lk~ 1 p n l a ;R s /I X V ! `1 I "till i I ' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7 LABOR AND PERCOLATION TESTS (115) MADISO N WI 5370 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP OT NO.:BLK. NO.: SUBDIVISION NAME: s 114 '/7 /T,) N/R E co al Z - COUNTY: OW ER'S E: MAILING ADDRESS: ' hod - ~ f '~J o USE ATES OBSERVATIONS MADE ~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: r-~ PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: PResidence IRNew ❑Replace G / > r J s RATING: S= Site suitable for system U= Site unsuitable for system CONVEIVTIO❑NAL: MOUND: IN-GR IND-PRESSURE: SYSTEM-IN❑FILLHO_LDING T ANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /1/ A N Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH HICK S, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 97.ly `1 -L' '13- r Z4 B- z loo -r r -a. 6 A+B s . B- X08 > /O8 t L ~/I c s ~9r B- 8 ` ',O~ S1 ' S ' e c 2' B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH 3 P- 2 D 41,2fe /lop g' P- P- P-_ P- 6 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 RIO E E a i ~ # t 3 3 E , ITN E 2_C._l..jIJ(/~ j//jam ....SIrF.~.....Y` 3 v40tA P h~ G i - Fa , E I p E E , - - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ' NA rind: TESTS WERE COMPLETED ON: ADDRESS: CERTIFICAT O UMBER: PHONE NUMBER (optional) 7 .3 SIGN ~rfpPi.'~a w l ©~-3 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - IL"TRUCTIONS FOR COMPLETING ,."I 115 - SBD - 5395 T To be c I accurate soil test, your report MU 1. Co i ~n; 2. TI irly indicate wheth( lis is a rf i ~r r 4 Is A- ~ 3IT)CSR A _DING TANK ONLY I ALL C BAS SCE S P[ ns and completing the 7, vi 3 to scale is preferr . A id are permanent; J c n test exernp- 10 } i th( k>)x; 11, _ 12 T BEI BTd T3 U L = T ABBREVI TIO- ' ~m ~'E T(E1 ~1 TARS Ju res 3") n s i ~ - Y R mn r, r HV F T" TI : : for - r j I ! I I e 6,4 s qz~ 0 l I I I I ~r n rl I ~ s s I ~ I i r\ INN i 'k, V r 1i a E ; - s I j I I i j s I I I ~ I ' ' I i i r s i -FT s j s ~ ~ s ~ ~ I r I ~ I t I { S I I s ~ I € ~ ; ~ ~ 1_ i I I N I ; I I ' I I ; I i ► ~ I I~ ~ I I ~ o i ! } I j ~ I i ( I i I i i >:z>ss~:`3fa. Est,.` Z i O 'E aD .0 ` ° c o %rl `Y„r< 0 L: Nil 0. 0 (D 0 V 4 O O V i y o p C W N C- C 0-0 E C&- ' w V - Zo L- c y -0 m 0-2 X3.0 W O co -O C v3 o'a 3oa CO V E C _ Coy C Cf O N j` J = d.O.= N O•~ 2 R -o O W M -CRf C0 C. a 3 voi3 ° Ov ° m= -0 co *0 CO W or o c•-w~a c C-) L 3: V) Co 0 4) m 0) 01 Z Q c~ Fr- ~ N y 0. 0 o 0 0 co ? y ~ 4i cu c0 ~ y co- co am 3 0.0(D.0 ~•0 c 4) 2)0 ~ 3 cc v a? o w eo ` eo 0 O V V M- CL r O Q C a (D00 ~ ~ c' cC Q? C O O N co C 3 cu m`r= ~ ww ° ' O~ ca c co cu N 0 ~ ? E ~o:...ccc 00cu o cu Ci~a °m cc (D 0 co o ~ J E0 _ C _N 4) M F co cu c0 O Y D O C. cc U Q) C C v- O O N 3 G 3 v, o 1 m c0 Y 0 E 0- SOi = cc r~ C! cu cu a M== O a a i I Z C O N h.. V CO E Y •C ° co O v C L- O C N N N (n C- R! t L- N o N C co Q W ~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) Wmwrw" 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 2, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn: Permit X664889 in the name of Greg Langer is being rescinded, and permit X664927 reissued as the system had to be moved. The original permit (6664889) was destroyed and the plumber is unable to return it. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, 1~kaA-~ Mary J. Jenkins, Secretary St. Croix County Zoning Office DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.6. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, 5 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE E!77~ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ~AD SSOF PERMIT HOLDERGreg Langer 6 4th St. , N. Hudson, WI 54016 INSPECTION GATE: BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E V.: SE NE, Section 17, T29N-R19W, Town of Hudson , Lot#2 Name of Plumber: MP/MPRSW No., County Sanitary Per, Numbe David B. Fogerty 3289 St. Croix 9 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: W FINING LABEL LOCKING COVER PROVIDED: PROVIDED: BEDDING: VENTDIA.: VENT MATL. HIGH WATER OYES ONO DYES ONO ALARM. NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH FEET FROM LINE: LAIR INLET OYES ONO OYES LINO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER OYES ONO PROVIDED: PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL OYES ONO OYES ONO NUMBER OF PROPERTY WELL BUILDING I VENT FRESH - TO (DIFFERENCE BETWEEN FEET FROM LINE' AIR INLET. PUMP ON AND OFF) OYES ONO NEAREST-> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until L FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO.OF DISTR PIPE SPACING: COVER TRENCHES: INSIDE DIA.. #PITS. LIQUID DIMENSIONS MATERIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF TO I BELOW PIPES. ABOVECOVER: ELEV. INLET. ELEV. END: PROPERTY WELL BUILDING: VENT LE FRESH PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OEWELLS. tEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED OYES ONO ONO CENTER. DEPTH OF TOPSOIL SODDED. SEEDED: MULCHED: EDGES: I OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING_ ELEV.. ELEV.. DIA.: ELEV.: PIPES: CIA.: ELEVATION AND DISTRIBUTION( INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. COMMENTS: PERMANENT MARKERS~YES ONO DYES ONO SERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING: FEET FROM LINE: OYES ONO r DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) uiisconsin APPLICATION FOR SANITARY PERMIT COUNTY DILHR - OEPRRTrrlEnTOF (PLB 67) inoUSTRV,LR9oR6.HUmRnRELRTions UNIFORM SANITARY PERMIT # l qy?g -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPE TY OWN MAILING ADDRESS ~L PROPERT LOCATION/ GlT-N: 114.,V5114, S , T,~ N, R E (or IVV TOWN LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEA T R AD,I::AE OR EA*9+*ARiC STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: T,NeW System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification ' IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ~Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 1/ Lift Pump Tank/Siphon Chamber ©v L", Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 6 [F Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. e of Plumber (Print): j natur MP/MPRSW No.: Phone Number: w _ Plumber's Address: (~y - 3d S(o ame es. ner: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: n~ ❑ Disapproved -~S ❑ Owner Given Initial it Approved Reason for Disapproval: Adverse Determination Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber l INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; e 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. t APPLICATION FOR SANITARY PERMIT ST C- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractpr,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property j~E'_14 f _34. Section. T N - R W Township --Z-Za - -)t Mailing Address Al L/ ZIL .2.V Subdivision Name Lot Number 2 , Previous Owner of Property CS Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) cati.6y that a t dtatementa on thi4 6onm ane true to the beat o6 my (ouK) knowledge; that 1 (we) am (ane) the ownen.(4) o6 the pnopenty deachi,bed in thiA .in6o4mati,on 6oAm, by vi tue o6 a wavanty deed neeonded in the 066.ice o6 the County Regi4ten o6 Deeda a.a Document Nom .z2 3 ; and that I (we) p4e6entty own the pnopoeed Aite bon .the dewage poa ayatem (on 1 (we) have obtained an ea.6 ement, to nun with the above dea c4 i.bed pnopenty, bon the comtnucti.on o6 said 6yatem, and the dame ha6 been duty %ecoAded in the 066.ice o6 the County Reg.caten o6 Deeda, ab Document No.* S, Ql xx 3 ) . Z 4W ~c SI~GNJ " O R SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ' l r - F Wisconsin Department of Revenue WISCONSIN REAL ESTATE TRANSFER RETURN Langer GRANTOR: Daniel T+r O'Keefe GRANTEE: Gregory 4,, Name Name Social Security Number Social, Securit umber Full Addre59 Full Address 606 Fourth Street - w .address if property transferred was residence Sort r Apt. 413 ThouPScln Drive,, Apt. #8 Hudson. i s 54016; Is grantor relat to "ran e? e a ions 11111 me u es, El Yes" ❑ No Name and addresswhich tax bills sho d be sen if of the same as above J 4K marriage, blood relative, partner, lessee lessor, co-owner, parent corporation or joint owner. / *If yes, explain how related Grantor is Individual ❑Partnershi ❑Cor oration El Other Grantee is Individual ❑ Partnershi ❑Cor oration ❑ Other Telephone: Grantor ( ) Telephone: Grantee ( ) - PART 1- PROPERTY TRANSFERRED ' Check proper box and enter name of municipality and county Street address of property transferred include road a ie and /or fire number. ❑ Ci ❑ Village ® Town es Route .ti ty St frg; X S014 wi scflll~si n 54016 county Legal, Description (Fill in complete legal description in space below or if metes and bounds description attach 3 copies of it 8 shown on the instrument of conveyance. If certified survey map number is used in descriptio0ist town; range, section and acres.) Lot No. Blk No: Section Town Range Plat Name Property Parcel. Number Part of SEI of NEI of Section 17, Twn bip 29, Range 19 described as f6lIms. Lot 2 of Certified SUMP Map filed May 20 j,1951 0 I Volume "4" , page 1 ~0 '-J as Dowmapt Number 3709W. PART 11- PHYSICAL DESCRIPTION AND INTENDED USE 3. + Land Area and Type Estimated 1Kind of Property b. Residential Units, if any 2. Principal Intended Use - ❑ a. L! Land Only El One Family a. 2i Residential -7~ 1. El Agricultural a. Lot size x Tl Acres ❑ ❑ New Construction ❑ 2 and 3 units b. El Commercial ❑ Recreational b• ota Tillable Gres ❑ ❑ Building Previously Used El 4 or more units c. ❑ Industrial El Oth~ (ExplaiiaY 1 4 W.T.L. Acres ❑ El Solar Design c. El Rental ' .r F.C. Ater El . ❑ Earth Sheltered Home 3 I C. Ft. of Water Frontage El Condominium PART III - TRANSFER (Answer as many as apply) 1. It Sale 2. ❑ Gift 3. ❑ Exchange 4. ❑ Other transfer (Explain) 5. Ownership interest transferred It Full Other (Explain) 6. ❑ Deed in satisfaction of land contract - What was the date of the original land contract? ❑ Life estate El Easement 7. Amount of mortgage assumed b grantee? $ 8. Does the grantor retain an. or the followin rights: PART IV - COMPUTATION OF FEE OR STATEMENT OF EXEMPTION ...0{3 1. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even hundred. Do not include'personal property) $ $ `2. Value of personal property transferred but excluded from line 1 3. Value of tax exempt property (solar, wind, waste treatment, mfg. M&E, other) included (Mine 1 $ ) .4. TRANSFER EXEMPTION NUMBER of exempt for Reason51-13 (see instruction) Sec. 77:25. $ •70 b_tD Register of Deeds 5. Fee - thincents per one hundred dollars of value (line 1 times.003) Make check a a --PART V - CERTIFICATION The transfer must be reported regardless of the Grantor's state of residence. Information this return will be used to administer Wisconsin Income and Fran- chise Tax Laws and the Wisconsin Real Estate Transfer Law. f We declare under penalty of law, that this return (Including any accompanying scheldGl~ has been examined by us and to the best of our knowledge and belief it is true correct and complete. Date Print of Type Agent's Name Signature of Gr:n tor or. Agent 3/ y SIGN t` ' not of Type Agent's Name HERE Signatur Grtee or Agent, Date P' 3/ 5 •r~, Phone If Signed By Agent Agent ( ) - ¢ Document No. Vol. (Reel) Page (Image) Date Recorded Date and Kind of Conveyance Mitts 7i9 titi #!~5l85 3/28/85 V LEAVE 19 Code: County Tax District Assm't Dist THIS Parcel Number 19 AREA L 1 1 Office 2 Field 3 Use 4 Reject BLANK D E F I Ratio Consideration 7 PE-500 (R. 5-84) School District No. PROPERTY OWNERS, COPY H z . H a ST C- 105 r" r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d a OWNER/BUYER s tl.~p _ ROUTE/BOX NUMBER j~Fire Number CITY/ S T A T W ~~t rye , ~ ~ ~!S- L0 1,y Z I P „7`5/0 1 3 PROPERTY LOCATION:S_,Ek, Section-17 TRI N, R 19 W, Town ofA406117 , St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment 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. E"~' -DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. c N x n m m ~ ~ (D ~ w = C C N CD CD 0 0 O N o ~ c: Cc: ~ c O C co p O Z p (D (D O ' a C= COD (D a _ u°,° m o n w 0 o -0 ° co - co $ (D :E cD 0 >r '(DD a w ~C D~.>>cc ^ co (D 0 O (D (D OD 0 3 a O ' (p (p W m :3 3: 3°C oc-3oCL C = Z co C: cr OS w (D, =ocDO~v v Nu ~ (D c D, c N Dc~ gm < C Cc -.4 =iTo acD w 0 =r C wow o. atD~I 0 o Q C 06 o N CD ' c=D ' w vi Z N m N (D :E CA D W m Z • (A (D (D M (D = a o aw0 3-.NCD~,_. .D♦ n CDe o=o r m ~p a ,•w~~C w o war' ~-•0 > > w cr CD ac0* c t° D ~ C V CD CA ID - M =r N= o a (D N N n CD (A O N~ a __~t0 a 0 0 w N 0 C + C cp O N N m N c o A w~► CL o f N C c a w O m w (D - (D N ao m aaf a?v~ Q 7 crA 0 L)(o7 ov,'~0oo ~a c a 0 o co a C o C (D S 0 CL =r w 2. 0 3 rF aw a0 ° 0 3 Nom{ y;? raz>>: <sq:? (D (D Z 3e: • 775- Rev 4M ~3' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVI S -i.1 P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:; Section ,T7, N,RZ1E-, .W, Township Lot Block No. I; 7 F t X17 t= r i~ 1. ( ►rty C 2r3 ~C u avtsron ante. 4" Name: -VA TT! No. of Bedro , Residence Efr NT L SYSTEM: NEW REPLACEMENTS...: ALTERMATE SYSTEM DATES OBE -AT OMS MADE: SOIL BORINGS PERCOLXr10N TESTS SOIL MAP NAME OF SOIL.MAP UNIT PERt~~AT#4N:T TS :fttTWE z CHARACTER OF SOIL HOl1ii5 ~ DROP IM WATER LEVEL. l Nq_ SINCE HOLE HOLE AFTE :INTERVAL ~AiNJllrt ` BER THICKNESS IN INCHES 1ST WETTED SWELLING Jill MINUTE$ IOD 1 PERIOD PERIOD 3 5 Pte. 1 f p? 16 W p- / "z- 6t P- SOIL BORING TESTS 4 : " r CHA OF SOIL WITH THICKNESS, COLOR. "'esT varAt 0a"M DEPTH TO GROUNDWAT'Esfi, INCHES TE °J>+ TLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF O IN INC$*$ - B!-- I Z-!) n; E 7 j Z Mfr L 1's o• 1. e A,1 a: A 4-Z6 PLAID` . (Loeate lion tfsts, soil bore h6les sAd suitable soi} ,1 dicat on the plan di;i location and sWare feet 40s%I#a#aEs Indicate number of square feet of absorption area needed for bufidi and.ocq{upalncy 1lttlic $Cali: 11`+dis"111114lis. Give h zontal and- referen nts, )nicae slope. n..G~ rF)L-IC ` L. f . tip, 13 t% mC`< A L , c a fir: . ••~r -',Y .y 3,61 _ f I •t "y,py, Y,x ' ^'y+' i~- ~ .,fit wY F urWersigend, hereby certify that the soil-tests report rne " accord with specif Wit the Wisccansin Administrative Code, and-that thB tton oftw'holw are caret t.Rthe kno and belief. , c #Awn ar a . CST Sigrratt,;., s WjW 7117 FF,-l .91 F - 4 ib !I ~ t 17 " y 44, e` t ~ X-j f - ~ ~ My ..s . v ~~Y~-PY~~^ !,4 ~ st' .F, 'fyF ~ wry p~uw ~ ve~.'.' G Y Y' a a lax RLRORT t# SOIL TI WISCOtOIN DMA.lR'it'M1=NN'1 t3 # AIiiIY # , : fiiCES P.O~ Box 3ft MADISON, WIC diO 63M IN LO(ATiON: 'e, /SA S4, Section 17 ,T ,R 9E (e"00, Township or V f Lot No., Block No. Ccltir#y i~' r.ma ff tiubdivision Name Mailt~tig "Rid~ No. of Bedrooms ~,COMMERCJAL EFFLUENTS AL SYSTEM:. NEW kEPLACEMENT., ALT T SYSTEM ' ?4 DATES OB 7fONS MADE: SOIL BORINGS PERCOL 'VON TESTS SL1IL4WAP SHEET ~r rt, NAME OF SOIL. MAP UNiT : i .1i PE - T t R1' A~'* h r t+Afi ER OF S tL R(P iid'WATE N.UM- THICKNESS IN INCHES SINCE HOLE HOLE AFTE i INTERVAL 7t BER' - 1ST WETTED SWELLING iN MINLfTES MRIOD'T PERJO 'PERIOD 3 P-~ P-, ~ s x !L BORING TESTS TEST DEPTH TO GROUNDWATM:~ INCHES CHAR SO WiTN7N1C94NESS, COLOR. r,.. TEX ti+t£~4Mt#, . PWT10 SEDROCK WUMBER OBSERVED ESTIMATED HIGHEST IF O . ' r l- F , L j~ ;4 'C ,at i~ B_ a - - j J t.4 - R- A4- j lil " soli5cie f► a sails'.} " or# til~nrte ion atcl - - Indicate number of s Feet df'absorption area needed for builds t n9 tyl*" and cY .lndicatt sr tar distar,cees. Give horizontal andx reference points. Indicate slope. t t~, - t? s s . r TFfe~1 ~4dj Z4 ~ L '1" a :1_~-"~'~-~ 4sS t.! Aw.~. . „~;fr~.aC~ , f.•3 ~T_~ s T/ r x a , n_. s , 1, the unden4end, hereby c*rtify that the•soii tests reported an tfiis form were made by me in accord wi ptor reri ethods specified in the Wisconsin Admin!strative Cao and-that the dots nApkied, and location of test holes areCorySa10'ttte best of my ~ knowledge and belief. Na print) Cerdfrcation Na. j Add Name of installer if known . CST Signature F"Pa4y Owner A L fir.t' ltz, u ' ~ • _ ..pats F.. ,..va F. ry 7-4 f Y ~ ~ r ~ ~ r ~ a r4 re n ~aCf ' ~,t~ j f ,,....ee y ~ i..~ •41¢d+: ~ '°d ',u cr`y' ; ~'l y tt~ ~,l 'tFv r .k S } L , x,. r k -dams IWWIC! -10 4~ - a 77 R PAGE OF PU=2- CHA/h\BER CROSS SFCTIOIJ A►JD SPECIFICATIONS ,t r Vf NT CAr ~'C.I. VEK1T PIPC WrATHEK PROOF APPROVED LOCKING Z 3' FRCM DOOR JUMCTION BOX -~MAIJHOLE COVER , wil.IGOW OR FRESH l2NMIL1. AIR IfjTAKE i GRADE I 'i"MIN, ~ Id Mlw+. coljDU1T IO"/MIN. - - - - - - - \ lAli-.L l' PROVIDE AIRTIGHT SEAL I I I I APFROVEC JOINT A. I III APPROVED .r 4,1TS W/C.T.. PIPE. r I III '+J/C.I. PIPE EXTENDIAIG 3' I II EXTEMDIA;G 3' ALARM OIRITO S01•ID SC.;. B I I ONTO SOLID SOIL I i oil c i I PUMP- , OFF I ~ 0 COAICRETE BLOCK RISER EXIT PERMITtEL OIJLy IF TANK MAMUFACTURER HAS SUCH APPROVAL 5PEC.IFICAT10US SEPTIC AND 5Cx TAIJKS MAMUFACTURER: NUMBER OF DOSES:___ PER DA`i TANK SiZE : _ ZVJ4 A GALLONS DOSE VOLUME ALARM MANUFACTURER: _ ~rfc/ ~r s i, + 8AC FLOW. - ~ 9 GALI.ONS MODEL IJUMBER: /')L 9 l/.luA CAPACITIES: _ ~__I~►CHES OR -T Z 2 GALLONS SWITCH TYPE' &ddcdd B = ~ ^ INCHES OR ?S- GALLOUS PUMP MANUFACTURER' Cz IWr-kE5 OR GALLONS MODEL NUMBER: ztl S3 on F& INGii~S 0 ~ GALL0Mur SWITCH 7yPE: MOTE PQIJMP AND ALAR71'NTO 7 BIty PUMP OiSCHARC.E KATE - 3 GPM IWSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFEKEWCE 6i~ywECW PUMP OFF AND DISTRIBUTIOAI PIPE.. --o-P FEET f MIMIMUiA NETWORK 5UPPLU PRES5URE . , , -2.5 T~ FEET -1- FEET OF FORCE MAiN X _l F/opfT•FF.tCTIOU FACY0R.. ©zs-- FEET TOTAL 05lJIAMIC HEAD - ..v_ FEET WTERMAL DIME.I'JSiOMi OF TA JK: LF-KlGTH y~ . ,'WI-BT-H ~._._.r ,LIQUID DEPTH LICENSE )DUMBER: DATE: HEAD CAPACITY CURVE cn TDH ' W W TOTAL DYNAMIC.HEAD/CAPACITY PER MINUTE. 30 EFFLUENT AND DEWATERING ERIES 53-55-57-59 7 137-139 163 165 -S r95 CT M G" . LTRS Gtil. LTRS ':L LTRS L;'L LTRS 7 LTRS 28 1 52 ;3` 163 248 :4 394 81 231 231 EFFLUENT AND DEWATERING 305 129 7 216 300 1 231 231 5 4.57 - 72 43 163 t'.4 242 t',D 227 227 26 \ SEWAGE AND DEWATERING s 10 27' 104 136 4 223 227 \ 7.62 8 30 C7' 216 223 00 9.14 55 206 B 220 46 172 206 24---- 1'J vv:0 12.19 \ 40 15.24 33. 125 191 75 - \ 18.29 1& . 57 ~ 3 161 22 70 21.34 - - - 90 114 \ 80 24.38 14 53 70. MODEL MODEL Lock valve: 19' 11 z4.5' 26' 66 87 20 65 . 163 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ SEWAGE AND DEWATERING r \ SERIES 267 268 282 284 293 18 fT* M (.AL LTRS GAL. LTRS G4L LTRS CAL ` LTRS LTRS S 1 .52 U3 408 J2 386 tt. 492 13 681 5,5 ` :0 305 227 2 273 ?S 360 ~.5 598 \ t -1 { 16- \ i 4.57 "j 76 43 163 6 238 511 50 ' \ ^0_ 6.10 8 30 125 0 401 \ 25. 7.62 7 288 \ 30. 9.14 - --4 163 :'7 292 1 4 f 45 \ 4 10.67 - 60 227 4012.19 - - - 46 174 12 40 \ 45 1372 - 28 106 ffJ - - - - { 5Q- 1524 t- 45 { MOD EL Lock Valve: 18' 21' 26' 35' 53' 35 293 10 i 30 MODELS 8 25 137 139 C-4 I 6 20 MODEL 284 4 15 MODEL MODEL 10; 268 282 2 MODELS 55 53, 55, MODEL MODEL 57,59 97 267 U.S. GALS. 10 20 30 '405 60' 70 80 &0 i00 110 120 30 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 PLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . oui f7~/ / CQ O. Box 16347 r/ (502)778-2 Kentucky 40216 AQUA[/TY PUMPS ,SiNCF /939 8 r i i i E LL , i r i{{ t-4- A I i I 4, 4- ; , t S ~ i ~ t C { I - - . _ _ . _ . _ ' , . 1. ~ ..L - EE , n 3 c F - I 0 , , } I-T S 1 ~ , n~ - - _ . LF- nm0 3d c d `n 0 Oc I 3 a w cD > rD n; O 'D 71 T 71 • O CD ? I Q o r l o• Z z r Z 7 Z w I N w o m o OD ~ o N ro cc co K) 0-4 co CL =r m 3 CD CD O O O ) 0 (a 1 N I C N -I (1, I O O M CD O- N O = CD - C, O O CD O O COD c COD cn 7 N O C-0 4 C) n y H o c 0 d w Cn z N a R. N Dn a CD cn s I O o CD ? w c (D W On o°~ ° c ° a N N 0 Q O O N 2 l\C O O CD A C N OD D. CD CD A C. Z O co O 10 00 O 10p O A O C O OD 7 Ln Cr 3 K Q Cn • 0cS 0 000 000 00 0 I A 5 T i i 1 0, O i -i ca O O N D c°o N N N a 3 N N N . NO I~ 4 C !~D O I A Q-A O O1 CD I.. I a ~ I N I ° N o Zco z I zooz O y n 0 D a (n m "m• 3 C D 0 CD O COD y CD N M CD 7 O O N C CD CND CD CD CL n CD II 3 O i a O Cp CD Cp Z CD A n cn x o, t-4 o a N = I Z 0 ~ ~ v a a 3 ~Z c (D d 0 3 M K) W I (D M N -4 Z rr 'a W O CD ~o N CD w G~' a~ ° 3 ~;o n ra 0 3 o z y 3 M 3 m !n z R CD ro IV W CA) Q 3m a it U n C H J~` O O A (3, R Z Q I < a C O O CD N N N N CD CL O N i d ~ ~ j I n I w n N A V Ui ~ _ y a ro H H ~ f c O CT1 7 a can z Ch I O fJ co 0 A Ih r' CD t x :F_' ro U Qr- n , rt c y N cn N. F~ O O N CA O co N w (D CA ~ rt CD CD A J N 0 O O 'S7 CD C-L 0 d r_ C) M O 3 0 d 0 CD ~j CD 'p A~ • 0) (D O z 0 co 7 C V N O• _ =r 61 O w CO CO a N O IC I CD Cl m to O 0- CD CD N CO E O co m o o co O 1 0000 0 > ? ° wo O CD =r V w c m " aw o I,. O D. 7 N j N O C c to cn z D a o cu CQ D N 0 CD W v CD c - Cn a = O J `C ? O O O A A 60'1 Z O rn rn c ch 0 CO) Q z O O O• A cS CS O O y y 0 N Z N C _ rcS N D 0O _c O O -u A CD 61 'O CD N CD 61 N M 61 N N ~ l~V` CL O I Z o O D D D N O 0 3 "me CD c of mI a 3 CD O A Z CD ~it A Z 0, m m co CD CD z c X 0 z 0 m ~ w y Z \C CD A ~J O F 6Ti a v CD AD C N C z C a 0 CD c I CD ~ II y fi 1 A O I ~ fp ti Clo N ' O O Oo CD ° A CD ts+ O p O y O CD a, Al O ti Parcel 020-1031-20-000 10/18/2005 08:39 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.14362 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN L Current Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ENGLUND, ANTHONY J JR & CAROLE J ANTHONY J JR & CAROLE J ENGLUND 956 DAILY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 956 DAILY RD SC 2611 SCH D OF HUDSON SP 1700 WITC j Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE SEC 17 T29N R19W SE NE LOT 2 C.S.M. V Block/Condo Bldg: 4/1060 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W i Notes: Parcel History: Date Doc # Vol/Page (a~~ Type 07/23/1997 1033/12 WD 07/23/1997 710 126 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 38,700 193,100 231,800 NO Totals for 2005: General Property 2.500 38,700 193,100 231,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.500 38,700 193,100 231,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 106 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00