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020-1288-20-000
n ti O C .d+ 7 ~ N 1 (p 3 J I 3 I ~ ~ ~ ~ o o I c ~~ v~ w Z I a~ 7 ~ ~ ~ N ~ ~ c A I d S ~ ~ 7 c i ~ ~ C D 7 ~ d ~ S 4 "~. ~ Sri N (D f D ~ O ~ to ~ { ~ ~ '~ ita \ ~ ~ W N C ~' N <p S7U O ~ O ~ ~ ~ ~ °° W Q 'aa C 3 ~ t7n O O O CO -0 p '~ 'N fD C D I ~ ~ f7 7 ~p (D ~ ~ ~ ~ ~ > > A ~ 3 ~ cn I O 3 ~ o N N O N ~ ~ ~ O ~ W r cc ~ ~ ~ w 3 '~- .~. o o O v ~ ~ ~ °o - N N ~ s p ~ S N A N 2 i CJ ~ '~ I O N CD ' O I ~ y ~ o ~ 0 d o I ~ m o w w ~ c o ~ I I c '9 ~ '9 ~ a O O O cn ~ p ~ l/1 N VJ rn ' O ~ (p CD ~ ID N y (~ ~ I ? ~ A Dt N I L ~ O 3 °i 3 { ~ ~ ~ I ~ A p ~ N Z W Z I o 0 0 =' = p D ~ a O 7 I p ~ N O N O N N A7 O ^" ^^ 3 ~ ~ ~ ~ 3 N OO] ~ ~ p ~ ~ ~ w ~ ro v I m c m ~ c m n ~ 7 7 7 ~ ~ i I ~ C I {]. I W .o a G ~ I ° I o ~ N Z ~ ~ W I s y I m -g. ~ n ~' Q _a "" ~ ~ ~mc 7 N a r. I N ~ ? T N O a p~ ~ a ~ C ~ a j X ~ ~ Z C. ~ ~ ' '~ . O O ~ O ~ S N O O ~ N ~ N N ~ ~ ~ ~ d ~ ~ _. O ~ (7 N n ~ ~ ~ N ~ 3 g m ~ ,~ o - ~~ ~ ~ ~ ~ I ~ ~ _ I °_ 7 _ 7 ~' ~ N I ~ (n ~ 0 2 A O O 0 O N O O O O ~ O L ~ O ~- c cn p i g ~ n 7 I m o ~ ~ 7 ~ 7 'I p CI ~ 'B 1 3 I ~ 1 3 i , o cn T. l _ m co a ^~ ° N ~p O N , ~ ~ ~ ~ ~{ o0 N ~ O O v, '' 7 00 0 N N C ~ N a a cu w o ~ ~ W O = N N d o°o a ~ ~' N 3 O c .. a ~ .. ~ _ w cn N lA fn °~ I N m v vv i ~ O , d '6 N N d N O 3 ~_ li ~ m ~ ' ' I d -- .. l o i 7 D ~ j m ~ O ~p p C A ~ ~ m a N O 7 J ~ ~ ~ Z n C ~ ~ K 0_ I WW Z 7 ~ ~ a o r. o •~ M ~ CD A pj N m ~_ T C 7 a YI .. j ~ --1 N m ~ , f ? .ZJ ~ ~ ~I II A d I. VJ ~, ~s `< `~ O 0 t '.~ O n o a z 0 I O A A 0'Q N ~ O ~I r W O yy ~ y Richmond Robert Juetten: Fence within setback. 12/18 sent letter to remove. 01/04 owner called and said will work on over weekend. 1/8 owner removed every other board. 1 / 15 staff waiting to hear comments from Hwy Dept. 1 / 16 Highway Department (Jeff Durkee) emailed a response he has no vision problems with fence. Another meeting to be scheduled with Highway Department. Sienna Corp: Erosion/conservation easement issues. 12/28 sent letter. 1/9 reed a response from Jon Sonnetag. Sent letter 6/9. Jon called on 6/11 to schedule meeting. Kevin called and spoke with John. John to get back to us. Met with Jon, Larry, Tammy, and others on 8/14 onsite. Working with Tammy. Rush River * send this to Don Schumacher 2012 18~' Ave Baldwin, WI 54402 David Kaufmann: POWTS/Junk. New owners (Ronald Heebink). Will keep File open and will send letter every 6 months. Somerset Neil Cosgrove: Nonconforming structure expansion/floodplain. Kevin (ZA) working with DNR to correct. Terence Steinlicht: Junk yard. Owner called on 3/1/08 stating he was working out of town until next week and cars would be removed at that time. Owner called 3/18/08 no cars moved yet waiting for Somerset Auto to come. Owner to contact me when vehicles removed are removed deadline of May 1St agreed on for onsite. Drove by site on 4/14 and observed progress. Most of junk is cleaned up. Sent letter. Onsite scheduled for 05/07. Met onsite to observe progress on 5/07. Check back in one month. Met onsite with Terry 7/21. Abated. Robert Francis: Junk/animal units. 11/20 sent letter. 11/30 sent another letter. 12/14 sent cert letter due to lack of response. Onsite Jan 2"d if no response. Carrie did onsite 1/3, took pictures of junk. 1/15 sent cert letter with affidavit of mailing. Certified Letter returned undeliverable. RJY took letter and delivered to son of owner w/business card. Requested owner contact Carrie. Took pictures but no change in status of junk. Certified letter returned by mail unopened. Kent Kramer: Sent letter 3/11/08 informing owner of un-permitted ATV repair business. A Special Exception permit is required in the Commercial district. Drove by site on 04/14, ATV business still there. Spoke with Kent 05/8 to tell him that no SE permit application was received. Spoke with business owner, Adam (5/21). He agreed to remove business from ,WisconsinSDepartment of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Krier, James Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: /ov~ o ~oe~ o ~ ~? "ANK INFORMATION ELEV TION DATA TYPE MANUFACTURER CAPACITY Septic )Sn `~ _ ~~ ` ' D,1 Do ' ~ -~/~t~ t9 ~ T~P r 1 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~- C1g t Aeration Holding PUMP/SIPHON INFORMATION l~l J~-A"~/l'-"~/ Manufacturer Demand GPM Model Number TDH Lift lon Loss stem Head TDH Ft Forcem Length Dia. Dist. to We SOIL ABSORPTION SYSTEM G ~/ ('~ j/ ~/ -, '~ ~j County: St. CirOIX Sanitary Permit No: 514999 0 State Plan ID No: Parcel Tax No: 020-1288-20-000 Section/Town/Range/Map No: 21.29.19.1408 STATION BS HI FS ELEV. Benchmark ~~ 3r 23 '~2 -!- ~ oU Alt. BM Bldg. Sewer SUHt Inlet St/Ht Outlet ~ ZZ 9~- O ~ / IetrJ~~ti~7r^'r"-`• ice. 3 I . / ~ ottom ~.1 _y 1.x,1 ~, 37 ~` ~~ Header/Man. t~ ~o. ~- b, Dist. Pi e ~D I ~; Zz Bot. System ~~ M%~' -~T.~~ Q c~ 1 ` /~ ~-'"' -/ ~.2~ Final S~ ~ ~ I Q ~ • 0 St Cover ~ ~ ~ /~ _ (N r Y BED/TRENCH Width / Length / No. Of Trenches / PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ Q C/' (~ 0 SETBACK SYSTEM TO P/L LDG WEL LAKE/STREAM LEACHING Manuf ture~ INFORMATION CHAMBER O / / ~t Ty Of System: r~ ~ .t-~i ~~'r~ \ ~~ / ~ UNIT Model Numbe D IBUTION SYSTEM Heade anifol,~~~ , II J Distribution , ~ Pipe(s x Holee Siz~ x Hole Spacing ~ II CC th Dia L ~ ) th Di L n S i eng e g pac ng a SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over / 1 ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center , 1 h Bed/Trench Edges Topsoil Yes ~ No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ dd ~ Inspection #2: / / Location: 507 Prairie Lane Hudson, WI 54016 (SE 1/4 NW 1/4 21 T29N R19W) Wells Fargo Station Lot 12 Parcel No: 21.29.19.1408 1.) Alt BM Description = 2.) Bldg sewer length =.~~~/~ ~~Q/~ - amount of cover = Plan revision Required? ^ Yes No ,Q ~ ~ /~ ~i Use other side for additional information. ~ ~ QU ~ _ ~~~- I C(' ~u J SBD-6710 (R.3/97) Date Insepctor's Signa re Cert. No. L~ i ~~~A Vent to Air Intake ~ ~ va • io -- L~ commerce.wi.goV Safety and Buildings Division County 201 W. Washington Ave. P.O. Box 7162 St CrO1X ~ , . i s c o n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce Soli / / Sanitary Permit Applica • State Transaction Number ~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of thi to the app nunental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application form fate-owne OWTS aze submitted to the Department of Commerce. Personal information you provide may for secondary ~ ~ C6t llr• ~ , S u oses in accordance with the Privac Law, s. 15.04 1 m , Stats. ~ ~ , . ame a I. A lication Information -Please int All Information ~^^°'~- Property Owner's Name ' p ~ r+. ~ (~ IC' D R e.r G Pazcel # James P. & Marcia A. Krier 020-1288-20-000 Property Owner's Mailing Address r J C P ~ L ~ Q Property Location Q , 507 Prairie Lane TY Govt. Lot City, State Zip Code CE SE '/., NW '/., Section 21 (circle one) Hudson, WI 54016 (715) 386-8479 T 29 N; R 19 w II. Type of Building (check all that apply) 4 ^ 1 or 2 Family Dwelling -Number of B rooms 12 Subdivision Name ^ ~.w~e # Wells Far o Station PubliC/Commercial -Describe Use Na ^ city of ^ State Owned -Describe Use CSM Number ^~ ~Village of ' H d IJ Town of u son Na III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' ^ New System Replacement System ^ Treatment/Holding Tank Replacement On-y ^ Other Modification to Existing System (explain) ' PolyLok PL-525 effluent filter to be installed B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~Gf ~~~ to cf ~g~'/'3 IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 on-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 ^ Pretreatment Device (explain) V. Dis ersal/T'reatment Area Informatio 44 Infiltrator " 'chambers 20.0 sq.ft EISA /chamber + 2 air end caps 5.8 EISA = 891.60 s . ft. Design Flow (gp Design Soil Application R gpdsf) Dispersal Area Required (s Dispersal Area Proposed f) System Elevation ~ 600 gpd 0.7 in-situ soil 857.15 sq. ft. 891.60 sq. ~ ft. 94.25' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units B ~ ~ New Tanks Existing Tanks L I/ P I w ~ w v v ~ ^y ~ w a D ~irC .. rl ~ ~ r C7 Septic or Holding Tank 1,000 1,000 1 Wieser Co Crete X 261 261 1 Weeks'Concrete X Dosing Chamber VII. Responsibility Statement- I, the and signed, ass a responsibility for i lation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Signatur MP/MPRS Number Business Phone Number James K. Thom son ~ 30021 (715 248-7767 Plumber's Address (Street, City, State, Zip Co 340 Paulson Lake Lane, Osceola, WI 54020-5413 VIII. Coun /De artment Use Onl .~ Approved isappro Permit Fee Date I ued Issuing t Signatur $ ~15a ~ 9 3a ~$ ven Reason nial • IX. Conditg>Itg3r{f~p~y~jReasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be servk:es /maintained as per management plan provided by plumber. 2. All setback rt?et~uirernents must be lr~inttiined ~ plat ippliC~ble t;0ek / OfdIr1~ICC. Attach to complete plans for the system and submit to the County only on paper not less than 8 rn s 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 • \ \\ I~r4; ~t c. ~~ L.a..~ c /~ ~e.2~. ~v\ ~~~ yY d ~f v~ ~6 ~ ~ ~ '~ ~ ~ ~~ ~, • ` ~ ~0~ ~ se,~e/a iuQ~~o-~,~, 5 tale: ~ = s/o' Ti~~/Ka,ruc ~n'¢r~ora ~oCiZ cc)e!/s ~o S~ 5c~1~y'nwyy,.sec..z./, r,-z9~ St. ~ro~~C Co ~ ~.J,c ~Oa-J. ~ ozo ~ze8-zd - ~ S,~tc. ~tcs ~a b< /af6 und,3E~arbcc! '~ i / d'YP~sR/ Ct1/ Ys6e~ ~.coecGaEod .u; t-~ ~ i ~ f d.~v~.~~ /o./ve. ~/ r /' ~~ / • ~~ ~ ~` py6c~ ~ C~~L 7 1'S ~ .,~/Proposed ~ ~Q~ ~~~ (d v aIP `~ Cr „ ~ 00 / r Q CC P ~1.~ n ~,~~ ~6L 6..+4 ~"d iT rI !t~ . 8. .: %o o f' 6/ouC ~ ~ ~ ~ ~-epoaed a jaunt 8. To~.~7.r~. E!¢~!' : /02. bG. !S ^ , / !)C ~ 24~ccKs Core. ! ne \ ia~~,,y~ 4 aP. S.>: ~/ ~ Lts~/ucnt ~/Ec~ `~ u ~ou.t/a~. ~ ~ \ ~ \ \ ~~ \\ t~ \\ ~ , ~ ~ \ ~ \ ~~ \ \ ~ \ ~ ~ \ ~ ~ ~ \\ 4,, ~ ~ ~U( ~a~-,(~= Teo dF/ot` s ~ = Gov. co ' `~ S~ \ \ ~4 /p~ ;/ o ri ~ ~ J oo ~ ~ J E s h M ~ d d b ~ iE l~ S/ePC ~~+y CeII, Tca~ E~'c.~elys 4t 3'x 9o'tiy .i Cis--~bus Fw' ~a ~ ~~5~~~ /~I.PQ~ ~3coa/ COPY ~~ P+^ai !'i L \ t.a..- C ~v~ Z/~~' ~,~ ~w~~~ ~ v( c ~~( b ~ Se:/eYa /ua~'o~~o. • /ocrtfcd /oi 3r~wf~c Stale: / = s/o' Lot/Z kJfiU3 ~o .s~~ bEY~rawf't; .Scc. z~ r. z9~r; k. /9cJ; T.of'f~~dsoh, ~. Cr'or)c Coy cJ[ ~Oc./. if 0.2.0 /Z88-~.D-dC S~ontcc6ntss ~ ~ `~6~ ~ to bt lcf6 ~ ~ ~-. ~ wd.3E~u'i s, ~ ~~ w ' ~ \P 1 -v` ~~~` ( E.fld~r7~yy /6x0' ~~; ;~ I ky~a~Y/.z../y{s.~cd i' ~ cL~~ovss/ ce,N t5e6e c9' - ;~/ • ~~ ' ~~ ~ ~ y ~'S~'+ `,~/Proposed d ~ ~? 8' ~ ~<< ~ ~ 3 3 J ~ ~ sr / ~- b..k. " tT. ~ oJt lE . 8. .: To o f' 6/ouC ! ~ ~ a'epoaed tQ. \ ,vcaKs Canc. %ne \ ~'owr~r.~'on. Flay- . io.z.l.G. Lsi ,~,ry ~ \4 yy.P. S.f. ~/ ~d~iC LeI(OL-S~r ~ CC ~O µ,ff ~.~ . ~ ~ \ ~ ~ ~ 82 \\ \ ~~ \ \ i` \ ~ ~ \ ~/e!/Q.~o~ s ' ~ 4, \\ L~.d. c ~/ ~ E,r.'s~ ~ S.T. Out/~.t -- 9T. 0 7 ~ ~~ 8'`1 ~ \ 1 t EX~'S~i~g Gli~a~'s~'' ~2/C~l' = 95,~S' ~ ~/ as ^ 8' W !i ~° 0~ Q ~tl d b ~ ~E ~a S/e~+e Z`~xrj~ Sy,s-Ecn-7 e~'cq -"f04pp ~G~ diSP~_/~e~-~~"" Cam!!, TKO E/'41 c~.l.~ at 3'x 9a'~+3' Z Aj 2'~~hS'n-&~i.~.54~{i ce ~~ ~s---- ~Q~ # 3~~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~~ accrudance with Comm 85. Wis. Adm. Code 2150 Page 1 of 3 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper n less than 11 ' in size. Plan must St. Croix include, but not limited to: vertical and ntal refs int direction and percent slope, scale or dimemsions, north a d loca lance to nearest road. Parcel I. 020-1 88-2 -000 Please print all inform Revie d By Date Personal information you provide may be used for s Priv lam, s. 15.04 (1) (m)). 9 .?j~ V~ Property Owner Property Location James P. & Marcia A. Krier Govt. Lot SE 1 NW 1/4 S 21 T 29 N R 19 W Property Owner's Mailing Address p `~ 5~ Lot # Block # Subd. Name or CSM# 507 Prairie Lane 12 Wells Fargo Station City St to Zi~Cfo~8h~6 er ~ City J Village ~ Town Nearest Road i Hudson ~ 54 IN F - 479 Hudson Prairie Lane New Construction Use: y_J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ~/ Replacement J Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS using 0.7 gpd/sq.ft. soil application rate. Invert of S.T. outlet = 96.69'. Recommended system infiltrative surF`Za `~"~v. =94.25'. --~ Boring # ~ Boring Pit Ground Surface elev. 100.42 fl. ~~ Depth to limiting factor ~ in~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-60 multi-colored none fixed fill na mfi aw 2fm1c 0.0 0.0 2 60-73 10yr5/6 none s Osg dl cs - 0.7 1.6 3 73-128 10yr5/4 none s Osg dl - - 0.7 1.6 112" - 128" observed by use of hand auger. Boring # J Boring i/ Pit Ground Surface elev. 99.94 ft. Depth to limiting factor '125" 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 0-46 multi-colored none fixed fill na mfi aw 2fm1c 0.0 0.0 2 46-58 10yr4/6 none Is Osg dl cs - 0.7 1.6 3 58-78 10yr4/6 none s Osg dl gs - 0.7 1.6 4 78-125 10yr5/6 none s Osg dl - - 0.7 1.6 10 ' - 1 5" observed by use of hand auger. * Effluent #1 = BODS> 30 <_ 220 mg/ and TSS > 0 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ature: CST Number James K. Thompson .Z- 3602 Address A.C.E. Soil & Site Evaluati Date Evaluation Conducted Telephone Number 340 Paulson lake Lane, Osceola, WI 54020 9/22/2008 715-248-7767 Property Owner James P. & Marcia A. Krier Parcel ID # 020-1288-20-000 Page 2 of 3 Boring # J Boring _ Pit Ground Surface elev. 99.97 ft. Depth to limiting factor > 122" 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 0-13 multicolored none mixed fill na dsh cw 2f na na 2 13-21 10yr3/2 none sil 1 csbk dh cs - 0.4 0.6 3 21-45 10yr5/4 none sicl 1csbk dh gs - 0.2 0.3 4 43-50 7.5yr4/6 none Is Osg dl cw - 0.7 1.6 5 50-76 10yr416 none s Osg dl gw - 0.7 1.ti 6 7&122 10yr5/ti none s Osg dl - - 0.7 1.6 Horizons #1 - 3 dis I rom site alteration t. #6 - 107" - 122" observed by use of hand auger. Boring # J Boring ~! /~ Pit Ground Surface elev. 98.36 ft. ~ D pt to limiting factor Na in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-73 multi-colored none mixed fill na mfi - 2fm1c 0.0 0.0 Site unsuitable for POWTS. ^ Boring # J Boring _ J Pit Ground Surface elev. ft. Depth to limiting factor 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 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and 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. SBD-8330 (R 07/00) A.C.E. Soi18~ Site Evaluations h ~~ /"r'ai r-i L \ La.- c 3~~ a~~ y~ .J; EX~ sf%~ (~+c ~ca~cl/ i ~ C •; ~ ~ . ~ ~~. t • ~ 1P O, A Sege/a ~u~-E~o~~,-~ •E~•'sE~~y elc~at'or, . /oca~ed /off ~t.-at'r 5 ca/e: ~ = 5/C' ~~''~zis ~ c~~ ~~s ~` sue. SEf~nwys; sec. ~ r. z9~r; ~. Gro~)c Ce., c.J~ ,Oc.J. ti ozr~ -/zed- zo - ca bo be lef6 and;~fwbtc~ .p `~ ~~. ~,rlr$1'S~ /8X 510 ~ ~`~ ~~ l kydraKtl.'ca,Ij.{%!cd ~ 63 iF ~ c4~~Otr.Sw/ ct.(/ Ynbe (~. /i'CeoecG~cd .•~• tl ~ ~ j ~ ~ daUtrf.`an Jwlc/E. - - ,~~ • ~` Ys~~ ~ L ~ ~ / ~ Cd ~ ~ `~ i i ~ ; 0 / Sd 0 ~ 47'cC ~ ~ _ i e ~ 3 N h ~ ~.-+' i. K. oJt i'n o f' 6/ouC' ! ~ ~ ~~. <~a i ~ ~~ \ ~ ~ l ~ ~ ~ \ ~ ` ~ ~ \ ~ ~ ~ tt ~ * 82 ~ ~ \ ~ \ 1 \\ 4 ~ ~ \ }P s \ r \ ~ ~ 1 ~~ ~ ~ 1 1 ~ 8 `V ! 7 \° k~ ~~I E s y a d ~~~ iE 11a S/orzC ~.Lz~.y: Sys-EQM e~'c~ ~9 P~. 3 ~~.~ ~~ F~ ~h >_,. ~~~ J~,> _~ 0 ~`^ J I i= ^r z ~n N `~ ~ `~' CD > -, -, ~ m J C I /; m i r a/~S °U ~ s~ o~ <~ c tl ~ ` 1. .~ n d 3 w w Q Q Z W ~- J 3 W Z 0 ~- U w N r ~ ~~ _ ~~ ~ ~ N ,~ ;' ~ 3 ~~ ~ a v a 3N ~f-" ~~ o ~ c ~ 8 ~ ~~ L h V li ~ ~ ~ f f ~ _ c ~ o ~ ~0~ V ~, ~ ~ o ~ <j i ~ ~'. M ~ -4 . N ~ ~ ~ ' -v o ~ ~ ~i ~ Q a E~ M . _ \~I ~~ V ~. ~~..--~~ T1 ~~~ ..~-~ i ~ .~ a _ ~ ' ~ , / ~. ~ ~% / - ~ii I j ~ ~ / ~ ~ f~ /j ~ i / ~3 _ - © / , (~1 ~,_J2~21 ~A..W 539,29 ' 1 l~~ r~N 88, 039 Squares Feet Nlv ~~o ~.a~ A~:r~~5 'J .~ ~ ;~ i , --- ~ ~k % i N 06 11'02"W 426 11'02"E ~ " , 58• j _ 30 .00~ I i a 3. Acres ° ~/ / % I ~ N ' ! ; nd Draina e ~ , /' `~U~ m ; I. g ~ ~ 1 e nt j % Q/ ~ N l 1 w ' ~ / ro 102 , 232 Square Feet m • 0 _ ~ 2.35 Acres `~° __ ;;- _. ~ , N',Q p /% rD ~.i ~'~ / ~ ~' ~ ~ ~~~ S ~' 1 1 O g~ 4 _ ~- _. 3 " W ~. :rte F~~~et i~ ~I /a - -_...?18_ b3 , _ - i ..~_. ~ '~ w' i ~N i ~ 12 1 '~ , 10 - ~ ~ ~; - 119,bb2 Square Feet ;• ~ 3~--. Z . 75 Acres U1~ i..u, 1 10, 2E . ~g . _.., _ / 7; ~ . f ~ u'u; ' ` cu ~ ~ '~ ' ~/ / ~., ~ ,n r _ - __. -- _- S ~~ 1 .3..W ~ ~ 6'S - ----- ~~ ~ ~ - ~ ' - _ ._.__ 10.90' - - . _ - ' ~; ~ ~~ _ _ _.- - _.._ _. ~ u~ v .J?• • ~ ~~, h .t 'lp ~ ~I ; / ~~,, ~ ;~/1 ;' 128, 2 19 Square r eet ;;I _ ~~ ~~lJ 2. 94 Acres ~~~ j`~ ~ ~ d ~' dln~ a e tY' ~ _ __ Y of ~ag e '~ ~~ t~6.~00' J _ _ _ Drainage easement 583.10' •, __ ~_- ' 162 _00' -L ~ N 00'49'04"W 1471.10 '-~! ~ ~ /~ i I'~ Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.O1/O1). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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 offthe filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of a diversion valve. Valve to be switched diverting effluent from dispersal cell currently in use to resting cell on a two-year cycle coinciding with septic tank inspection and maintenance. 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. 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 ~"''~ P~ /~~'~%a ,4 ~~ e,~ residence located at: 5~' ''/4, i?~J'/4, Section ~_, Town__~N, Range /p W, Towr °t san , 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 service _ ~~. /~~~o~ Did flow back occur from absorption system? Yes ~ No (~f no, skip next line.) Approximate volume or length of til~~e: - gallons ~ l8o minutes Capacity: /~~ Construction: Prefab Concrete Steel Other Manufacturer (if known): (,c~;CSe.~ C.~~r~,s .age a (if known)~T~5-~~,Q~ ~/~~p3 ensed Plumber Signature) /~~'~'~. (Title) S~ 23 ~~ (Date) (Print Name) (License Number) MP/MPRS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 1 13 Wisconsin Administrative Code) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerf~ef~ --J(<~S /- ~ ice. ~ 7`./'i~" Mailing Address SD 7 ~/'~iri e_ ~~„~ Property Address 5~'-~l~ (Verification required from Planning & Zoning Department for new construction.) City/State ~~s~M, ~~• Parcel Identification Number D2O - /•2.88-.~ - G~ LEGAL DESCRIPTION Property Location S E' 1/a , ~~'/a , Sec...2-/ , T _.~N R~_Vi~, Town of ~~o~ Subdivision ~e~~s ~a.~go 5~--~c~ ,Lot # IZ Certified Survey Map # ~..4- ,Volume - ,Page # -' Warranty Deed # ,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 scptic 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 I/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 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 am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~_ SIGNATURE OF APPLICANT(S) 9 /~j ~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zotung Department. *** Include wish this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) DOCUMENT NO. STATE 13AR OF WISCONSIN FOROd 1--1983 ~' rNle srwee weaewveo row weeowolNO owrw WARRANTY D@EL' yvurerVQ III?l 11~~~lsae;r .~f ^. ,-~-__:- -_-a This Dead, nladc: Letlveen .. Sam E. 2~[iller, a_singl-e. man`•~ ST ~C<~{X CO_, W1 ' •----•--• • t! i:e~•e+ tar Reico~ AUG 2 1993 ! - ----- ------ ••-----•----.._... ....._..._ .... .... ..., Granter, ~ 1 D:30 Fi. 1 and. -.~.~mg~ -P,._Krier,__$nd_-Marcia_ A,__-Kr iex_,__husbard.-and••hife- ~~ 1 ~t {Vj SS..S!1SY).Yt}x&)iJ.R T^-~l~?•t<~ .RFQF rty . .. .... ........ ....... . •------••-- •• ~i ~~ ~~~ f ....... ~71tI1@SS@tl'1, That the said tirantar, for a valuable eonsfderstion..._.. ~, 1,__...~~,-~_--_-_ _- -- --_-..._ - - --- -, cunceys to Grantee the followingdeecribed roetl carats in $~_.._GFoix________________ `f weruwN To HeyWOgd 6 (i8r1, S,C, !, County, State of o4 iseonain : 1f P . a , Box 224 •L.~T.__-_ _ Huaso-~_wz_ __-54016 Loi: 12, Wel.l~ Fargo Station in the Town o£ 1•ludson. Tax Parce! t~fo:._-••°----------•--°--•-------•-- ... v `~ ~?~1-~~---"' ~~~ This ...._..is.._not....-...., homestead Froperty. ;41q (ia not) Tahethor with all and singalar the hereditaments r:nd appurtenances tt.9raunto bclon~ing; Afld...........S.aIR.F.....Ma.1.~ex ................................................................................ .................................... warrants that the title is good, indofeaslble in Pee simple and t"roe and clear of oncumbrnnces except nud will warrnnt and dofend the samo. -t l_ Dnted this ..............~-.•..~_........_..---.._..._...... day of _...._.......July..._.._....._..... ........, 10.93.... ...........................................(SEAL) ~~..~~"J.~'.:~~-..~.~~~......__............(SF.AL) ~~ ---•(SF.AL) --------- --.-._ .(SEAL) ~i II AUT~ENTECA'lYON ACgNOWT.EI)QMEINT u ~I Signature(s) _.--_----- ............. ...•_-------_.-_---__--__-_----_--- STATE OF WISCOhTSIN i l ~ sa. ~i --°---------•---•--------------------y ---------------•---------•------------•- ST. CROIii County. I~ authenticated this ________da of___________________.___.__, 19..____ Personally came before me this _.__~°___._..day of 1, ------------------JuiY----------------~ 1Q---93_ the above named ---- ~+ --..~~__~ ._L~~~ler,-- ~- sing. e_ man•-•---•-•----•---•---- ei t ~~ TITLE: MEDdBER ~.""ATE BAR OF 'GVISCONSIN • ' ~! (If not. ______.. - anthorized bg ~ ?Otl.OG, Wis. StatsJ ...-- ----- -----•--------•---,•---•---:---..---•---• to me knoacn to be tho:,p¢r$on _:..:_-.._._ who executed the foregoing 'nsteµr+fen`f a_nd'aC~2rWr?ledge the same. ~- TNIS INSTRUMENT WAS ORA FrcD BV N~ ' .. ....... .. .... _ ...i _._ .. ~.1_ .: .:. ...>... .. .... .. Heywood-_~--Cari_L--S ;C.., hy_ Samuel R. Cari - („Y. ~ ~ ' -'~-~- -- -- a .- k_. G.,_Bnx-_229.,..Hudson, WL 54016 ---------•----- :voi..-.-y_Fuo;ic ~''.~ o _;, ~~';;~_~;~ :........... .._Conntg, ~i~. t._..~_.. r "~-- (Signatures may be authenticated or acknowledge3. Roth DTI- Commission is pe;tR~gent. (if not, state cepi~ra~~tion are not ne<•euga rF•) ~~' ~ ~ date: _.. .......~_......a--./ ... .. ....................., i:r_....-.-1 •I'isrtlec n[ Terra.. ~s e:aninrc In any ea {•,nei[T G~.~IdA oe U~pa: or nrintrai brlor eh~ir sianaa,re WARRANTY .7ERD BTATF. RJR OF WISC~IN9IN 0.'i=oan•in Lc: al nlnoR C.~. In FOR.1i h'o. I - 14111 ~lil.e,.nkxc, wia. STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAM M 1 ~ L ~ ~ ADDRESS (;OX ~ I S 2 Sa ~ n/Z~(/I~t~ I/1"^ Nudsar` w~. syo/ c ~~n SUBDIVISION / CSM# YVELL S ~ARGD ST~q 7/ON LOT # /Z SECTION 2/ T Z 9 N-R / 9 Town of E{~ r/sah ~ og ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM F 37' is t i ',.e .M. T•c o~ ~~, ~•~• Pl,fs. C.r.~e~ iS" : Nofm S (epm Ar iisS ENli ra ' ~ Ac~a ~3 1%~ E~•" IOa"oo So A1rs~ N~7E ~. ,PEA ~` 2- I $ i8X+'o "6fO -- _ _ \~ ~ 40 -=i ( 1 s~ ----_ _.. ~ ~ e ~\^~ ^ 9f Q ~ ! ~t :~ v ~8 w J ~` ~ _ e~ ~ ~ I~puSE~ ~ ~ SS z8 X So WE I I _ _ 61~~ ACES lrxrv pRr yE W~`Y -_ -- ----. - ._ Fz-c INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ., _ BENCHMARK • Tom o~ I ~~; °-l ~ E Ie1' Coi Na-r' E ~- _ ~CJ~ ~~ = S • ~~ ALTERNATE BM: %o~ o ~ ~leck ~.acad~a~ %o .~ ~`~.= SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: GyE;s~r Liquid Capacity: /OoOq~ Setback from: Well SS ~ House i ~~ Other ~14 ~ N/. C,~nar ~/e~ s~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: I S ~ Length yo~ Number of trenches ~ f~E~ Distance & Direction to nearest prop. line: Sow EAST Setback from: well : Gg~ House yS ~ Other s6 ~ 1. Mer~'~ ref /%~,._ Building Sewer ELEVATIONS ST Inlet 7. ~~ ST outlet Y, /o PC inlet ^- PC bottom - Pump Off - Header/Manifo1d8.7sfe sps Bottom of system 95'O Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ~~~~h~~,-. LICENSE NUMBER: /~~~'~~ INSPECTOR: .!1'AN. = y~y 3/93:jt IvQs~+r~'ray-trr~~Qf~~str~1.29.19,5~IVA'fE SEWA~i~ ~~Y~~E LANE •' Lab" and Human Relations INSPECTION REPORT ~SafEand Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^xTown of: BM E ev.: ~~ • ~ Insp. BM Elev.: l ~v- ~ ~ BM Description: c-rn ~ ~ I~~~-- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~eSer ~ ~~ Dosi n Aeration Holding TANK SETBACK INFORMATION v TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic 7~~~ ~ ~~ ~ n~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufactur Demand Model Number GPM TDH Lift Lriction Syste TDH Ft Forcemain Length Dia. H Dist. To we SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitary Permit No.: State Plan ID No.: Parcel Tax No.: A9300091 7~5-~~3 STATION BS HI FS ELEV. Benchmark $, OS ~.~ d~~-B ~•3g' a~.G~~ Bldg. Sewer St/I-Inlet St/~ Outlet ,~t'_sf~ 7 S Dt Inlet g.0/~ ~7pf/~ Dt Bottom HeaderJ~ ~ ~ 9~, ?j8 Dist. Pipe _ ~~ ~, ~ ~ Bot. System ~~ ~ , ~.$ ~ Final Grade ~~ SG7rw 7G ' ~~ ~ ~ ~ BED /TRENCH Width / ~~ Length / No. Ofyrenches P1T f Pits Inside Dia. Liquid Depth DIMEN I N / DI N I N - SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHIN Manufacturer: SETBACK CHAMBER M INFORMATION TypeO µ. B d ~ 'L ?S ~ jLS ~ y(~ OR UNIT o System: , e , DISTRIBUTION SYSTEM Header / ~~ ~ ~ ~ Distribution Pipe(s) ~ ,, x Hole Size x Hole Spacing Vent To Air Intake Length /e 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 : HU~S0~~9Gi%~',0~~~~ PRAIRI~ ~~ C~G~`°~ ~ ~• ~. ~r~! ~~ ~0 ~°~ ~.~~~~.~.~ ~-,~...., c~ f~ ewe" Plan revision re uired? ^ Yes Q Use other side for additional information. 7 ~ ~ ~. ~ ~ g SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .~ -= SONITORY PERMIT OPPI ICOTIAN ---- In accord with ILHR 83.05, Wis. Adm. Code ~v ~'~~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PERMIT # ~Q31 ,G ~'~ 8'/z x 11 inches in size. / , ^ Check ifYevision to previous application wee reVerS@ Slde for InStrUCtIOnS for COmpleting thlS appllCatlOn. STATE PLAN LD. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY /OWNE ~i', L G u 1 ~~~ SI¢~ ~/`~l w PROPERTY LOCATION '/a /~IItJ '/a, S 2'~ T L`J , N, R E (ol~.~ PRfO~PERTY OWNER'S MAI ING ADDRESS LOT # BLOCK # CITY, ST E 21P CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~ s o ~ w~ .S~ O / 3g Z ,fJ~/lS ~~ o S'''1`4a' % ~° rr 11. TYPE OF BUILDING: (Check one) ^ State Owned ^ VILL4GE ~ NDEAREST ROAD ~< ,QNQ/ SON T/ q - < ^ Public 1 Or 2 Fam. Dwelling-¢~ Of bedrooms. PA EL TAX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) O Z ~ _ ~ L g ~ - ~ Z 1 ^ Apt/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 in line A. Check line B if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ®Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^Seepage Pit Pressure 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. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~ 1 SAO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION " ~ 'l Zt~ ~ Z O ~ ~ 9-~. Feet g ~ , Z Feet VII. TANK CAPACITY in allons Total # of ' N M f Prefab. Site C l St Fiber- Pl ti Ex er. p INFORMATION New istin Gallons Tanks acturer s ame anu oncret on- ee glass as c App. Tanks Tanks strutted Se tic Tank or Holdin Tank O~ / GC/~.r 5 @/ Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signat re: (No Stamps) MP/MPRSW No.: Business Phone Number: o~ Stoma Lac ~ 7~ ~- z~l7 3z 3 P umber's AddresssStreet, City, State, Zip Co ): ~ ~ I`1.~i.1~ ~ a.~ t!NO rl. ~ ~ .~`7~~ IX. C LINTY/DEPARTMENT USE ONLY ^ Disapproved S tary Permit Fee (Includes Groundwater a e ssu uing ent Sig No surcharge Fee) /- ~ ~ ~ Approved ^ Owner Given Initial j~~ - ~ Averse Determination V X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning-your onsite~sewage system, contact your local code administrator or the State of Wisconsin, Safety 8~ 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 numbet(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VI1. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/ septic, pump/siphon and holding tanks for this system. dheck 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'fi x 11 inches must be submitted to the county. The. plans must include the following: A) plot plan, drawn to scale oc with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing. information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring grogndwater, ground- water contamination investigations arid establishment of standards. ~' _.~ ,. _~; ~ . -.. t '~. , ~ - SBD-6398 (R.11/88) STC-100 This application form is to be completed in full and signed by the owner(s) of the property being. developed. Any inadequacies will only result ~.n delays of the permit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), then~a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ----------------------------------------------------------- owner of property _.Ei.<< ~u ~ ~m-~~~5'~~ ~7, /~~'r Location of property S~ 1/4 .,~lV_l/4, Section ~, T~N-R~~~W Township ~~~5 0~ Mailing address ~~ ~ ~--t~' 2 Address of site ~~a:~ rte,..-- far h~ ~s~ Subdivision name ~~/~S ~Qr~a 5~.~,'~h Lot no._ ~ /a other homes on property? yes J'~ _No Previous owner of property _~f+i'~-d. WfD-1I S Total size of parcel Z-~S ~, bate parcel •was created _,l Z ~ 3 ~ ~ q~. 'Are all corers and lot lines identifiable? ,~_yes No i Is this property being developed for (spec house)?Yes No Volume9 Z9'and.Page Number as recorded with the Register of Deeds. INCLUDE WIT1i THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMF3ER & THE SEAL OF THE REGISTER OF DEEDS. :In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify .that all statements on this form are true to the ~~ best of my ( our ) knowledge that I ( we ) am ( are ) the owner (s ) of ~ the property described iri this information form, by virtue of a ~~ warranty deed recorded in the office of the County Register"of Deeds as Document No. `~77 2 9 / , 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 rec d in the o~gfice of County Register oP deeds as Document ~~ ~ ~9/_ DOCUMENT NO. II WARRANTY DEAD Ii STATE BAR OF WISCONSIN FORM( 2-1982 i4 4~~s~. ~o~ 9~8.~:.319 ___ - -- _..--... Anita•.G. Wells • a .single woman conveys and warrants to ...JOhn.A•...Elbert-.and..Eric..J.--Lundell,~•-. ..as...Tenants..in .Cammon...an..undivided..one-half..intexes.t....... .e.ach....-• ....................................................---- .....-............................... the following described real estate in .....SC.--Croix •-.-,-.County, State of Wisconsin: All that part of the Northeast Quarter of the Northwest Quarter (NE}NW}) lying Southerly (Sly) of the Railroad Right-of-way; The Southeast Quarter of the Northwest Quarter (.°E}NW}); The East Half of the Southwest Quarter (E}SW}), EXCEPT part to Alfred L. Ekblad in Volume 498, page 484; part to Leslie L. Swenson in Volume 498, page 504; part to Donald F. Johnsin, in Volume 500, page 525; and part to Donald L. Jordan, in Volume 580, page 354, all in Section Twenty-One (21), Township Twenty-Nine (29) North, Range Nineteen (19) West. .I TN18 8-AC[ R[SERV[O -OR R[COROWG OATh REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record Dr:C 3 01991 °t , 2:40 P; /yMA Repbfer of OMds RETU R,I TO Taz Parcel No :..................... ~~~ This Warranty Deed is given in full and final satisfaction of that original Land Contract between the parties, dated December 4, 1989, recorded December 13, 1989, at 11:30 A.M., in Vol. 858 of Records, on page 633-634 as Document No. 454203, Office of Register of Deeds for St. Croix Co., WI. This is not _ homestead pre; erty. - (~s) ~ (is not) Exception to warranties: Easements, restrictions and rights-of-way of record. Dated this .. 27.t.h.- -....._ day of ...- December 19..91 .. ... _ . _ .~..........~.y.~.+... __ _,,.. J , .-• ......................(SEAL) ~ ~sL.~/C~t~C~-/................(SEAL) ......................... • ..Anita. G....Wells............ ...... ...................(SEAL) ... ........ ... _.....(SEAL) AIITHENTICATION 5igna (8) OF Anita G. Wells, a si 81 woman apt d t ' .27t)~ December 1 a ol---• .... ................. 199...-- ...... .. .. .. ..~-~•-----•---.... .........-----••---•-•-•--•------ Leo A. Beskar TITLE: 9fEMBER STATE BAR OF WISCONSIN (If not..-----...--•---...--------•• ........................ •- --- authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DR 4FTED BY Leo A. Beskar, Attorney •itod7'i; Beskar..6..Bo7.e.s~...S:-C :..................... •-- .2~1j9~--NorFth1.Ma3aTT.S. .nn ...... ........................ ...... (azgn~atrur8safn~~fie al~i~e~'t~~ted or acknowled;;ed. Both are not necessary.) ACBNOWLELOMENT STATE OF WISCONSIN ss. ...............County. Personally came before me this ................day of -------- ------••---..........-•----......, 19........ the above named to ma known to be the person ....-......- who executed the forel;oin~,~ instrument and acknowledge the same. Notary Public ... ...._.... ._ _.._.County, ~Vis. ~I}• Commission is permanent. (If not, state expiration date: _ _ ....._.........__.......-...._ ..............., 19........) S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT ~St. Croix County OWNER/BUYER_~~.c. Lc,,,K ~ ~„~ ~ -S~ ~ /''~• `/~' ~~ ADDRESS_ ~c~c '~ z ~ z ~ FIRE NUMBER SD7 CITY/STATE ~k. ~ ~t~ r-1 ~-- ZIP_ ~S'lG~ /~i PROPERTY L~~~~OCATION :,~~,1/4 ,~l/4 , SECTION- Z ~ , T ~9 N-R~,~ TOWN of 1TGc ~so ~I , St. Croix County, SUBDIVISION_ ~~~ ~ccO7o 5~~,~'o ~ ~ 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 a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 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 system properly maintained. The property owner agrees to submit tv 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. Cro Co Zoning Officer within 30 days of the three year expiratio date. SIGNED• DATE• ~ 3 St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 ' Wisso *sin Department of Industry, ' Laborand Human Relations . Division of Safety 8 Buildings SOIL AND SITE EVALUATION REPORT ~„Q. Page ~ of ~ ... uvvv•v ..~u~ ~~.• •• . vv.vv, •..v. ..v. vvvv COUNTY /' ~~ Ix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but ~--• . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north avow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: -'~d ~N( M/«F-re PROPERTY LOCATION aa GOVT. LOT-SE 1/4 N1,~ 1/4,S2 f T 29 ,N,R ~ 7 E (a) W PROPERTY OWNE ''S MAILING AD ESS LOT # BLOCK # SUBD. NAME OR CSM # `T ate 12 - W ccs~QGo CITY, STATE ZIP CODE PHONE NUMBER ^CITY VILLAGE OWN N~t EST ROAD ~ ' v~~ 5~01~ ( ) U~ >~iditl~~l~ t [~ New Construction Use [,~ Residential / Number of bedrooms 3 ( ]Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 4S~ gpd Recommended design loading rate d.7 bed, gpd/ft20•FS trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O.7 bed, gpd/ft2 0.$ trench, gpd/ft2 Recommended infiltration surface elevations l - S •00 ft (as referred to site plan benchmark) Additional design /site considerations AQ~'A 2- 9 .S6 Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL )$ S^ U MgqUND $1 S^ U I GROUNO PRESSURE ~ S ^ U AT-GRADE ~S ^ U SYSTEM IN FILL S^ U HOLDING T K ^ S U U=Unsuitable fors stem , , SOIL DESCRIPTION REPORT Boring # {nyh:{it•.~:9.~ L::::, ~`~ I y: i~:~t ;~ ;w'::~ti:aff.:'::r Ground elev. /pb.6sft. Depth to limiting factor >~_ Boring # t::~ ~ 1 ~; ~~ <} <:.> ~~a',•~atto:: Ground elev. /Ll~3S ft. Depth to limiting factor > <D ~ D~ Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft Horizon in. Munsell Qu: Sz. Cont. Color Gr. Sz. Sh. y Bed Trench ~'' /o - [, 1 ; n , Z .So . G }'n~ ~/ r± V - ~'' ~Y~~ ~ < J~ / ~~ • il' ~ d ~'~ t/~~ z~ ~ ~q o 34 S r-,l ~ 07 oTs Remarks: 4 3 - SC / rh ~~. ~ 0.4 o.~ Remarks: Name: Please Print Phone: C~sd n! Signature: ~/~ 7~1 Date: 5/~Q/O~ CST Number: I PROPERTYOwNER ~AS /`~I,(.~.~ SOIL DESCRIPTION REPORT PARCEL I.D.# L /Z' WF'~S~~2Go Boring # x: ,: ~ ~~ ` `.sitif.`..$ 4 r) ~: 5 X'~. ~~~ Ground elev. /dO.S~ft. Depth to limiting factor > / Boring # •{ z A ::,, n:.; ~: }': {•~S~::vJiti\i~ Ground elev. /~3Zft. Depth to limiting factor y ~~ Boring # JAV:J'•tif 4v4 \>X ~:"i ~ L:2 ~~~ ~:i2i+~Li t•u::'r:? Ground elev. /Or7_~ ft. Depth to limning fa for > 9.~Z Boring # F. :~~;.: • ::..;~ %R \:i ~L~t i}:'viSiti~v}.vF Ground elev. ft. Depth to IimiUng factor Page ? of ~ Hori n Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft zo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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