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Home My WebLink About020-1187-20-0000 o y O m Z ~ y N O y ~ N a o cn Z D ~p O y ~ W ro ~ fl. _ ~ ~ Z 0 ~ ~ c c 3 ~ ~ m m w' 3 O N .~ C 3 m 7 N ~d o ~ D va ~~ 91 C1 T1 ~ y m d _ d ?' m cow' z y oy ay n. N ~ N 'A'y N S y O y' y f0 O 'O fl. ~ N N N -p 'O • O 'D ~ y 3 Z n. °~ m a obi o. f m ~~ ~ o ~w ~m f n~ ~ ° 0 0 o- <,,> ~ om-°-' a ~• o- 0 m o ~ o ` ~~~ _~~ ~' f' ~ 1 ': ~~ I O -+ ~ N ~ ~ A W ~p 7 a w I ~ ~ ~ - " ~ ~ a a N O 0OO oOO m ~ ~_ ~ fD f0 ~ ~ N ~ ~ N ao ao ~ ~ co 'O 'O ~ = ~ ~ ~ y N N N ~ ~ ~ ~ o 3 °-' ~ ~ eo Z ~ Z D m ~ ~ ~ N ~ y ~ ~ i 'O N (G ~. m ~ I O C a W ~ I a °o r: 3 y Z N c a I I O N y O C ~- N O ~ N N '~ 7 Q y ~ C O a o co (~ VA Iy O. p c o O Z O o ~1 a c rn a 3 ~ Q ~ ~ 0 3 O s (~ N C m 7 N j' d N ~ D y ~ ~. O Q 'O d fl. ~ ~. 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A 2 ~ .. ~ m N ~ z A ~ N ~ m ~ A a' H ~a A S ti 0 b ~. ti b ~ vo H A ~ ~I w a a ~I ti ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMl~TION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bra ,Brenda Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL E Vent to Air Intake I ROAD Dosing Holding PUMP/SIPHON INFORMATI A Manufacturer Dem d P Model Number TDH Lift Friction Loss System Head TD Forcemain Length Dia. Dist. to Well SnIL ~4gSORPTION SYSTEM ELEVATION DATA c°~nty: St. Croix Sanitary Permit No: 488042 0 State Plan ID No: Parcel Tax No: 020-1187-20-000 Section/Town/Range/Map No: 28.29.19.1174 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet t Bo ade a t ipe t. System Final Gr St ver BED/TRENCH Width Length No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Modet Number: DISTRIBUTION SYSTEM HeaderlManifold Distribution x Hole,Size x Hoie Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing C[111 CnVFR ., os~~~~.e c..~re.,,~ n..i., ,.., Mn~inrl nr ef.Rrada Svs}amc ~nlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil i ~ Yes ~ J No ~] Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /~ Location: 591 Lenertz Street Hudson, WI 54016 (NE 1/4 SE 1/4 28 T29N R19W) Lenertz Addition Lot 2 Parcel No: 28.29.19.1174 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = q - -__ -- - - __ Plan revision Re uired~ I ~~ Yes ~ a No ~ ~ ~ Use other side for additional information. I__ ~~ _ i _ ~ ___ _ __._ - ~ ~ Date Insepctor'S Signature Cert. No. SBD-6710 (R.3/97) .~. SYSTE 1 Sei dial ty and Buildings Division County Ol ington Ave., P.O. Box 7162 _ L~ ,~~O~~~n son, 266~gtrEl~~® itary Petmit Number (to be filled in by Co.) O A'~ ~2 De artment of Commerce - Sanitary Permit App a ~ Ste a P-an 1.°. N"n ' `per CC rr Wis. Adm. Code, personal info ion yot~tuttide ~ 2 2005 In accord with Comm 83.21 ~ , # 1220 SO.S ° 5 ~ ~~ , may be used for secondary purposes Privacy Law, sl (1 xm) Pr et Address (if different than mailing addr ) I. Application I r lion -Please Print All Information ~ ro Owner's ~ _ ~ P~ I # Lot # Block # V r _l~ ~ l ~ ~ ,.~ Property OGw~ner's MaiJling Address /~ i~ ~j'1 ~ v" Z M1-~ • Property Loca~t`ion ~Q ~'/.> J ~ '/., Section ~ ~+ City, State Zip Code Phone Number r 1~ ~/ ~ ~ ~'~` ~' '~ circle ) T t~ ` N; R~E o~ t l ) h k ll th a app y ec a I . Type of Building (c Subdivision Name ~ ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ fi lt ~~~ ~ li ! -Public/Commereial-Describe Use , ^ State Owned -Describe Use ^City_^Village ^Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) ~~ - ~ - '`~' ^ New System -Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ge of ^ Chan ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~~ ~ (~ ~_ , 06 Zt?~D IV. T e of PO S S s tem: Check all that a 1 ,~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating and Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ I-I s Pipe Other (explain) ~ t i.`' V. Dis rsaVft'eatment Area Information: t 7 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ (sf) Dispersal Area Proposed (s System Elevation ' J ~ / ~U , ~J . ~ ~.~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ ~ Db ~ . t J ~ ~ x Aerobic Treatment Unit Dosing Chamt~er VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached pleas. PI 's Name (Print) Plum Signature MP/MP rR~S Number Business Phone Number Plumber's Address (Street, Ci Sta Zip Code) ~- p J i VIIII. Coun /De artment Use Onl Sanitary Permit Fe includes Groundwater Date Issued Issuin Agent Signature (N Stamps) Approved ^ Di Surcharge Fee) ~ ^ O en Reason or Denial ~ -' ' Z ~ ~~ IX. Conditions o p o 1 ~ , ~, ~Qd ` ' ~T~~' ~l yI `~~ S l' h , R . X / ! , f r~,~ ~° ~u u~ ~~ ~ ~a~e... ~ .^^~. 9 M OWNER: ~ ~`'S ~S 9 Ili tank, effluent filter and ll must all be serviced /maintained l ce Ie sa _ n.... a, n . r t t...~....., .... '~r aS per management plan {~tuviuGwasg~cwoemmpewpw~oao.~~..~~...,~...,,.,.....~.,..~....,..„_,._..._..-.. 2. All setback requirements must be maintained as per a plicable codelordinances. S~D-6398 (R. 01/03) s"ISe tc~ 1~'rr Z _.....~.~..~ p ~ ° ~ ~ `~ -~ $ ,~ N k ~ n i` ` 1 ~ L VO ~ ~ ~ ~ -1 s >- t -ta e, n` ~ w~, ~` ~ ~ ~ ~ ~ ~ ~ ~ ~ C K ~ ~ ~ ~ M ? h C tt ~ n ~~ i ~ ~ o ^ ` F ~ o ~ s ~ t..1 ~.f ~p '~ t M cv+4 :~: ~~~ ~ y P ;,,' ~ M~ ~~ a s c w e.- r~ srn ~^ P /aL~. cd ~z ~~~ t~.~ d f' fi~~f~ son ~~..~ p - f t ~i-r, "~C ~/ l A r .. a A ~~ i I.~ ~A a 1~ 1 ~ ~ p p ~~~ ~h ~~ 3~Q4. ,) ~.. r .~. 3 i I ~~ ' ~ - ~ TlNee 1 1 f N`~1 I ~ ®- - - t ~ 111 e ~ ~_ ~ '~~ o~ ~ g q9r. o -' ~ 1 .~ ~ F !~ A, f s _b ~ p w Iv~e ~;,,F~ q~~~o ~~°' f ~ .,~s ^ tis ~ A n~ ti~~ .~ ,~.. ~aH Y~' a cox ~~u.r qq o ~ ~ v.~ A ~ 3 2 rj S 1~ ` 1 ~ ~ P~ ~ a~ JT ~ -~ I I f i ~A n !~ i r R ^~ M o ~'t Q ~~ c Je T ~ A /e ~`4t+. s 0 h ~.~uvf. fGpf/C t bk C= ~_.~ ~' ,. • a c~ ~'• C ~, "".}"_~,.2. ~, */ ' commerce.wi.gov isconsin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary December 14, 2005 CUST ID No. 220673 CHARLES L WEBSTER WEBSTER EXCAVATING, INC. N5815 770TH ST ELLSWORTH WI 54011 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/14/2007 Identification Numbers SITE: Transaction ID No. 1220385 Animal Care Center of Hudson Site ID No. 708044 591 Lenertz Rd Please refer to both identification numbers, Town of Hudson, 54016 above, in all corres ondence with the a enc . St Croix County NEl/4, SE1/4, S28, T29N, R19W Lot: 2, Subdivision: Lenertz Addition FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1054306 Maintenance required; Replacement system; 410 GPD Flow rate; System(s): Conventional POWTS Component Manual, SBD-10567-P (R.6/99); Commercial System The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: f,A ~, • No animal waste shall be discharged to the POWTS. All animal waste shall be discharged as solid , waste as described on page 3 of 5 in the plan. ~(3 ` ~^ r~~ ~' A copy of the approved plans, specifications and this letter shall be on-site during construction and open to "t; inspection by authorized representatives of the Department, which may include local inspectors. All permits C ~' t: RT .t' required by the state or the local municipality shall be obtained prior to commencement of DIVts N construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should ~ r F~ G O conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Robert Kanter v POWTS Plan Reviewer ,Integrated Services (608)261-7735 ,Monday-friday 8:OOAM - 4:45PM rkanter@commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 WiSMART' code: `7633 Eee-Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 •h Webster Soit Testing tt Sewer System Design Charlie £t Kris Webster, Owners N5815 7700i Street, Ellsworth, WI 54011 Telephone: (715) 273-3430 Fax: (715) 273-4181 WI Licenses: MP220673, ST220b73, ST 261669, PE18803 POWTS Index Sheet Page 1 of S Conventional System for a Commercial System Property Owner: Animal Care Center of Hudson Hudson Township-St Croix County Contents Pa ae 1 of S Title Paae Pa ge 2 of S Sketch Pa ae 3 of S Cross Section and sizing calculations Pa ae 4 of S Mana ement Plan Pa ge S of 5 Manasement Plan ... ~. . 1. °a• Design in this plan is according to "In Ground Soil Absorption Componenet Manual for POV~S" ~ r x Version 2.0. Revised Jan 30, 2001 ~1 °z`"s ~n~ ,~ r~ ~"~~ ,~ ,f ,i ~ CC.,'.;c:.::,.,F iY AiU uu' '°"S • ~~`~~~,~~9`C Oj,~~~~~• _~/l ~~S s i~ ;;pOwL~c•rJ~~ ~_....q_ /~ , ~.~~ (C-HARLES L. = WEBSTER .~- S ~ E-18803 L[ ~ ~ ' ELLSWORTN 4l ~ ~ ~ WIS. ~ ~ •~•~~~ ~5 t sjs~ ~c~ f'.r rclwe. rysn'~. P/~ ~ar ~~ ___...._ Z ~ ~ ~ ~' 1„i k ~ n Q, w '° o =± ~ 4 a ti 1~ ti `~ a e, VO Y ~ L 1.f 11 ;, e n rA ~ t ~ 3.~ ti ~. Zi ~- c ~ ~ ~ o o ~ ~ F`t +. M ~ ~' ~ n~~ h ~ ~ r ~ ~. `~, u ~ '~ O ~- ~ ~ ~L ~ ~ ~ ~„ ~ ~~ `{ ~ ~ +~~ el ~ c Q e (~ . ~ ~ ~ ; ~ 1?~ Q ny, ~i ~ ~ .e '' '~4. A I ~~' (,! Co~c #asu.1' I.~ I~ A ~xM +~r; ,~ qqo r-'' ~~y S~~ Cw~tPµr ~~r ~~ ..,. : ! - ~- - ~ ~ nn recce 4 N`-'1 I J - - - I ® ~ ~ ~ 4 ~ ~, ~ ~ ~ Q ~ f =~ ~c tc ~ n opt ~ 4 ~ _ " td ~, ~, ~ ~ ~ ~~ ~ ~• O , ~+ ~ vwr ~ ~. c~ M ~~ ~ ~ A ~~~ +4 ~ ~ r ~A ~ ~ ° ~ T h ~!. 4 ~- ~. ~r ~ ~ I~ ~ } R, I s ~ z ,, I ,. " A I I~ D aI A ~ ~ R 7h 'b `i~ p ~~~~ ~ ~$ A A A n~ ti~~ ~ .~.. 7 ~ ~, ~ . q e +~ ~ ~~ ~~ ~F A Q a n *4r~ S 0 ~~ 4 0 ?~ o ~I ~ S ~ A- ~'~ ~ ° T' _ , _~ I i i r n I~ I~ o ~'t ~t.2vca~..i /- YGp 9~1C r~A/f A r ~A IM i4 ,, ' C~..fs,((- Sew t,'c~. ~~' 12is~-h,6~,,t,o~- Ceps y~o r " ~ 0 ~~ ~~~ ~~ . ~ ~ ~_-® ,,, ~_~ } t ® ® .r =86~ ~ '~ih• sc~.cd~ O ~v c ~3 a7,~ T sb~. S~GP 9'IC f~ ~~ ~CefN4GC'~/dh f0 e.'f~c. rn tifi~'i mvf Y,.d/,1~, o ~ q~Illt! 6k.fim~i 6r2C- S'ee, f ft/'e/i ~7 S'l~ef'c~ Kr1`eS`~irPf.-~ " mu'aX 'f' in f f/ frd•fOY~ ,T' s'7tC/~' ~ld~ Pl1.. ~ ~ Y sys~.~ ass 3 t`~ ~~,~ ~~ w,t~ _ ~,~ga,cK 4 liz. ~s ~ r b~rsc)yyE t/a~ ,p/f~enS' . /n~ t ' ~ p~+pk+~¢! !MJ-s~i•vs.~ 4 /' ~ 1`~ Seep JYI f s''WZ ~ 7~Gwle t'Y~C~.Ch•t~' ..~,.-_ l1/m ~ to stay. : ~a le S EcT ! o n/ ~ - ~ ,~ ~1V. T s. ~ , X~., o~ x~ !eV e•l ,~,: ~~/-.GJ ~'O, l~ g i rl~mp-e.d tawiaY .E'l '~' `~~ oZ'~ ...3_g~'*o4_ 4S' F-~, i' ~}~ in/'Y~tvJ T ors 4:x s~bl4o ~oyG r/~( o c c cL PA IV ~ f~ T~i.`r sfil'fcw.~ JCI^VCr d ~e7`eh:h~~ e~i4."e c~j't~ S 7~c~,/~ t.MSC ~~PJ1-'~ t°iire rs~r~o%yecs ~liese ar-c ~ T ~oot~ rydr~.ss,~' iI7 '~~o ~4.rh1eC ~"ao,-st°~ ~ ~d~4io+oMr1.. rLie °krn~r. GSTi!",J'fPS C~. ~' a~.ki` r+, td,w" e l' ~ O r..ct' to.-~ eks pea ~d~'- /i~rs,"~., S~w~sf~ is'. /rt rp f sC/o,~s.~~"~ 1~/^ oM 7`~i G jr~ln~ic sys~~ ~~x.'o% ayiN.~/ w•-x1~- is co/lce~e,olc,,,i-t'~: t1 ~ /~~~c%~`Iy /i1~~G~ ~tJ,i~'~ r4~sf~ric~...s Y /~/ /s1~ec-<:h d 0~4.»r~ S~C'i. t2,,16%•c~%t l..ic, /enOf da.~ ~. d /,Icease. C Lv.?s7`~~,iG~vl~. /7 ~+."'~. ~.~i' °t ~ G a2 f~oc~ta/ rm `~e~terc~'se ~~ why-,' a ~4t 7` pti~e.e/ i!~ dV~•1 .s'~oa..s,r °dc 7t~c .1'~`G/C~. S~~INr A -•c 1 'Q`~ d. !/ e..',,/}'ti`s ¢` /3F.pd ed. = /4 3~Pd zC~ ~u.st•~c-r e /.s~d ed- - 3~~.Jd ~ 'w,Da. ~/. ~ti~dssCecoHC'r f'loa. .~ 17~~,~p o[ A yU YK~ d; ¢ia a ~ _ <3'8~' cgL..~u-L.4T/oNS ~./'oYi`dt~ ~ sew' b i~' e,, ol~d/~ - l Z_ `f ~ ~ ~ sz7`. Ott /a6 c~ j/iaY/ ~ ` ~~~ ,9 ~d p~,,,,, ~~ dr eX s f~%~- s/VS-te ~~ Systc,,~ ~/s ~~ H~~ rd~dc, ~ ~ ~c. c~..~ dcr !h .~~trd~~- G~.azr~`s- e ~ G~ 4,4, ~ ~p brik~ ~eC' 3l0 ~~u,:vd~~a~ aFel •. Fll_E INFORMATION POWTS OWNER'S MANUAL 8c MANAGEMENT PLAN Page~,of ~% Owner ~ ~.'~~ ~ C~~e.. Ce.. fP,.. a ~ /`~4.~sa,, -~l~ C- Permit # DESIGN- PARAMETERS Number of Bedrooms ~ ~NA Number of Commercial Units , t'ma•,s~.eyc '~ %er,` It O NA Estimated flow (average) 2 ~ ,~ al/da Design flow (peak), (Estimated x 1.5) ~ !(,~ aUda Soil Application Rate ~- aUda /ffz Influent/Effluent Quality Monthly average' Fats, Oil 8~ Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ^ NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size ye inch diameter SYSTEM SPECtrtcA t t~rvs Septic Tank Capacity --~- ~~~ ~ Auo al ^ NA Septic Tank Manufacturer Gt~Ec1~ c~~c}cf'c ^ NA Effluent Filter Manufacturer ~ a 6e./ ^ NA Effluent Filter Model ~ - /o v ^ NA Pump Tank Capacity al ~ NA Pump Tank Manufacturer '~[ NA .Pump Manufacturer ,» NA Pump Model ,~ NA Pretreatment Unit O Sand/G,ravel Filter ^ Mechanical Aeration ^ Disinfection Manufacturer ~ ^ Peat Filter ^ Wetland ^ Other. ]ANA Dispersal Cell(s) ~l In-ground (gravity) ^ At-grade ^ Dri -line ^ In~round (pressurized) ^ Mound ^ Other: • Values typical for domestic (non-commerda~ wastewater and septic tank effluent ' a . ~ Values typical br pretreated wastewater. MAINTENANCE SCHEDULE -T- / dh !~r /--,, ifie.- d Y L '4"'V, j T / ^ Service Event Service Frequency Inspect condition of tank(s) ~ At least once every a ~ ^ months ~4year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-thins (Y,) of tank volume Inspect dispersal cell(s) At least once every „S ^ months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ~"' months . ^ year(s) Inspect pump, pump controls & alarm At least once every ^ months ^ year(s) NA Flush laterals and pressure test At least once every ^ months ^ year(s) ~ NA other. At least once every ^ months ^ year(s) ~ NA other. At least once every ^~ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of ithe following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicng 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 tie 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreat+pment components; and any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ~ !`Th.~s+, J / t"IIL~ Can fC~ o T ~~LC~Ic I? Page ~ of `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 POWTS 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 aver, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction orelimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; 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. ABANDONI~rI ~' Jam' When the POWTS faits and/or is permanently taken out of service the following steps shall be taken to insure that the Wisconsin`Administrative Code: system is properly and safety abandoned in compliance with ch. Comm 83:33, • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their 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: ^ A suitable replacement area has been evaluated and may be util'~zed for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction aitd should not .sue ~ be infringed upon by required setbacks from existing arld proposed structure, lot lines and wells. Failure to p>E~o4c.~ protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS 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. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT O)CYGE DO NOT ENTER A SEPTIC, PUMP OR OTHEE E ; RETEE-RjOR OF A TANFC MAY EB D FIF CUIL7 OR IMPOSS BLE. MAY ESULT. RESCUE OF A PERSON FROM T ADDITIONAL COMMENTS ~~ ~ en f s S 7`cy-i T~t;S i-s c2 NC' l~ POVYTS INSTALLER Name Tv~w. ~ dk ~ kc ~ It d '~:~ Phone 7't ,S'- `!~.2.~` 9 7~ POWTS MAINTAINER Name Dam!/s Sc t.T. S c~vi~ c- ~Phone T ~S - `~ ~~ - / ~ ~ -s EPTAGE SERVICING OPERATOR PUMPER LOCAL. REGULATORY AUTHORITY S Name j~ ~ a.-c !lr` s e rrc s'e~ ~rf~e. Phone 7~S - 42s'- /b ~~ Agency Ft .Cro,k ~' ~Qk ~~ Phone Tt.S'" -386 ~ 6 ~ Q S station agenaes. This document meets This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and an the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(7). (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2J~1) C ' +1' . Wisconsin Department of Commerce SOIL EV, ' "Division of Safety and Buildings in accordance with Co TION REPORT Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 ' siz Pla~iust ~ ~' • inGude, but not limited to::vlwrtiraf and horizontal referenc.~s BM), d' arcel L0. percent scope, scale or dimensions mirth aROw; and loco d distance road. ~. Q20 •. j%p~~-20 - G+~D Please print all informat A~f~ ~ ~ vI~ ed by Date Personal irtfotrrtatiort <you provide maybe used for secondary p Privacy L~ ~"~'Qi~r~~t~1. dM1,Q mow. .~ I I ~"O~O "' €' ~" ,~ Govt: fof 1/4~€ 1/4 S TZ N R- E (or~p?J 1,:. Property;Ownefs Mailing Addre ~ >': ~ # Subd. Name or'@9AAtk `. ~,. .:, City State Zip Code- Phone Number (]City ~ Village Town: Nearest Road New Construction Use: ^ Residential / Number of bedrooms Code derived design flow rate GPD Replacement ,,1 j~ Public or commercial - Describe: ~1Nr~,~tL C/4i~' C~'~yT~fL Parent material ,1J~f- ~~/~' ~/j~/~ Flood Plain elevation if applipble ft. General comments ; and recommendations: 1~ /L (~~ ~ ~vA-L Se <<-- l -mss ( I ^ z~ ~`l~- ~ ~~f4 „ . ~.~- a Boring # ^ ~Bori _,\ w V ~/ Pit Ground surface elev. ft. Depth to Limiting factor ~ „3 in. ~ Soil Applipdon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z / sL ./ F . '...'--- ~. Zc S • S' • ~ a Boring # ^ Boring pit Ground surface elev. ~T 3 tt Depth to limiting factor ~ in. t gwN ,,, soil Applicatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/it= in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 --- ~ . ~ Z ~ s- 3 .r-- L c s - . 8 J Jrr ~ ~L ~~ ~.~ • • Effluen t #1 = BOD_ > 30 < 220 ma/t and TSS >30 < 1 50 mall ' Effluent #2 = BODE <'30 mg/t and TSS < 30 mg/L • - CST Name (Please Print) Si najtua-~ CST Number 2~ //~d Address Fogerty Plumbing & Perk Testing ate Evaluation Conducted Telephone Number 28288 McKenzie ~ ? ` ~~ ^-- JIJWIICr~ rr1 ~oVil ,.-- _~ - ~,~ . ,,= . :' Property Owner. r ar'~~r~~~?i,frPiir~~ ~~?/Y~'' ~~~7"~ 21 ^C~Id `~ ~ ~, ~: 7 3 Boring # ^ B ring ~ ,. ~ ~ s, .....,~ . . ` Pit '. ground surfai;el:ele~. ~ i{ Depja, tp limiting factor ~ in. ,,` ; 3 ., v , ; ~~_ ~w r / ~ Soil Applicaton Rate Horizon 'Depth Dominant Color Redox t)bSCription w•x„= ;~:.1?exture • .,Structure Consistence Boundary Roots GPO/fh In. Munsell Qu. S~: Go . C (~~a~s ?~~~*~' R "~ C;r. Sz. Sh. •~H#1 •Eff #2 p Z '~~ ~ • _^ ~ .. iii 2 ( ~ ~` '~ ~_ 2 `~ Boring # ^ Boring ^ Pit Ground surface elev. tt. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots aon rappncauon Kai6 GPD/ft' in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ~ •Eff#2 ;; Boring # ^ Boring n c,r Ground surface elev. ft. Death to Iimltina factor t~ Horizon Depth Do_ minant Color Redox Description Texture Structure Consistenoe Boundary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -'Eff#2 5 ~ .. - ., • Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent tlf2 = BODe < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provides and employer. If you need assistance to access services or need material in an alternate format, please,contact,the department at G08-26G-3151 or TTY GO8-264-8777. sso-a3ao tx•~I ~~ .~-~- ,o ' ~, ~ ~ I -~ ~ ~ N N { ' xl ~ i I v li ,fitt I ' ml ----1 r-----I- w~ I ~ ~ 7 ~ ~ ~ r ~ -o ~, '" T i e i M ~ ~ ~ 0 n ~ -1 ~~ ~___ _ _ _ ____ __ _~l ~W ~~ v oc 4 ~` b~ ~, ~ ~ ~ 4, ~ ~ I ~ ~ ~ ~ ~ ~ ~ W ~ G I 2 ~ C ~ ~ ~ o. z,.. Q ~ ~ ~ ~ ,. ~ ~ v a 3 ~' k H h ~~ ~~_~ ~Y3M ~~ ~ ~j~~ ~~ ~ ~ O N O 1~ Y. 00 N N ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK septic tank presently serving the '~ residence located at: ~Range~W, Town 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 a ~ Did flow back occur from absorption system? Yes X No (if no, skip next line.) Approximate volume or length of time Capacity: o~G ~ ~ ~G 7~5' gallons minutes Construction: Prefab Concrete Steel Other Manufacturer (if known): ~~ S Age of Tank (if known): _~', a r' S (Licensed Plumber Signa~ure) ~~~~5 (Title) d /~` `t (Print Name) ~~~f~d ~ (License Number) MP/MPRS l~ ~~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) 'eoaK 811 rA~t 3s ooCUMeNT two. STATE BAR OF WISCONSIN FORM 3-sines , 43'780 S ~ oun cuiM area ...................Pamela J. Bray..Iaetta...._...............-.................--........-... w;isa~~>~. ~0-..1liaasla..,~x..8xax ........ ................................................... TNI• lfAC[ R[[[RV[D fOR RtGORO1N0 DATA REGISTER'S OFFICE sT. cROix co., wi R~c'd for Record MAY 171988 01 3:00 P. M a ~NNr o/~ tM fallowing described real estate ia ...............~~.C.r..Cl<.Qix............-.. County, State VNiseonsia: Rs.uRN .. Lot 2 the Leaerts Addition to the Town of Hudson. Begging' at the Northwest corner of Lot 2, thence North 89. 37' 46" Bast 66.00 feet along the South line Ta: Parcel No :...................... ........ of Lenerts Street; thence South 00' 22' 14" West 250.52 feet *long the West line of Lot 1; thence South 89° 37' 46" Weat 66.00 feet; thence 00° 22' 14" Weat 252.52 feet along the East line of Lot 3 to the point of beginning. $~a ~~~ Thu ..:~~ . r!~t -.... homestead property. (is) (ie n~ort~)- Dated this .............~`:~..-.--..-....-..-..._.-- day of ..-..--....... .. .. -.-...-.....-..--.-........-.-.........--, 10-. __ Pamela--J. Bra- Isett .....................................................................(SEAL) ----.........---.....-.............-•---...-....-.............-.-...(SEAL) s AIITHSNiTICA?IOW antheaticated this _._.....day of ........................... 11f..---- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ----------------- ----- ------•--- •-••-----.-..--.--_.- anthorized by ; 706.06. Wis. State.) THIS INSTRUMENT WAS DRATTED BY ...Pamela...I---BraF..Ise tt s--• ......................... ..... .. 634 4th Street, N.E. .. -. ACSNOWLSDOIi[16N? STATE OF WISCONSIN as. SL: Croix Coaaty. Perwaall came before me thin ._ 17th ~y of Y ........... ......... ~"~Y ............................ 19.88 the aboet named .-.-...-. Pamela J. moray...IsetLs ............................ ......... .. .. .................. ..s-::::.::.~::..-• ---......-... -.....-....... to me known to be 16~ Derso~ ... ~--..--. who ezecnted the for Q inatrnme,~'t'atd ack owled~e the e. O •~ ~ M 4r- t f9 G~.1 ~ awes ~ y ...-~ .................. Notary Public -.--..'..~~.4:-Q..-.~t. CrOtX--County, Wis. ,. ~ / O • ' N 00° 22' 4" W 541.17' ~ ~ 258.47' 282.70' `~\ '~ ~ `~~ i ~~ r N ' ~ eo oo• m A A uu ' 50 ~ ~ m ~ N ~ V O QI v ~ ~„ d • ~ ~ G y ~ 0I N ~ H I (p " r. rn z Zvi o, ~'' i,1 ' ~ I ~ r ~i ~ o ii I rn ~ A ~: ... -~ . ' o m ~: 00°OS' 12" N 00°22' 14" W 480.96' I ~ ~ ~ ii 1 .0 ~ ~ n o N ~~ o ~; N 00° 22' 14 " W 250.52' i > i; i I i ao 'j ~~ I m z i Z -- rn N , ~ caNi -ml ~ ° O ~ I 1 ' I A Ito ~, ~~ ~: --~ (7 r z ' ~ H D ~~ i m o a~ rn i O !~!, r N r N f I N rn Z t7a~ O N m ~! ~ 1 N r ~ (O Z ~- ~ N ~ r a~: , ~ a I v ~ Z rn 'n N ^~ ~ ~ umi m 80 00' • V Cfl ~ , ~ V - ~ LNII ~ ~ ~ ~D O ' ~ ~ H I I I rn m I ~ ~ rn m ~ ~i ~ 50'~ o ~ ~ BUILDING SE ACK LINE ~ I ~., . --- --- --- --- --- -~ .a' z ~ z ,.'~, ~ N O r .' ~,L~y cZ rn 0 4 0.55' o ^,`~ aOS' I c o WESTERLY RIGHT-0 -WAY LINE o'~^~~dS~y ~ O .• - ----- -230.00---------- ------------250.55'''---------- 80.01' _~. _.~ 30 38 E 60.56' -~~S E tO1n c°n x---23 - - - - ' ~- _ - 300 - - - - - U. S. H. 12 UNPLATTED LANDS ~ ~~r,~ -----I--,- I c e, a ~y r+ o e i ~ • ~ O ~ l~ ~ ~ m «« p a r,?, cn - ; ,rT 9' o r~ -~ -~ a -~ a io -'~~ °mrmr I F o p ~ ~. C O O N s p r Fr-l N :~ ©~ mmzm~ O w C -IO1Z ' ~c~'~i a47aZ -IX r Z ~-+ I-+ mmX _ <~c~m o s -~ n a c»a ^0 ~~ c:. M, arnrma (AN H H ~ 0 0 o~r~ _,F rcnsv~r mA z o z z ~~To r m /*. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 {1){m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Bray, Brenda Hudson Township CST BMElev.:- ~ insp. BM Elev.: ' BM Description: ~ (~ . a uo . ~ ,yam 5 CSTgvv~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~: ses~g Z ~,.~ ~o~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic'~2- 32 r ) ~r ~j t NA Dosing ~ °'x` NA Aeration Holdi PUMP /SIPHON INFORMATION Manufacturer Model Number TDH Lift L Force Length Did. I Dist. To Well GPM Ft ELEVATION DATA County: 5t. Croix Sanitary Permit No.: 370318 State Plan ID No.: TR.~s ~~ : 3io~ 6 Parcel Tax No.: 020-1187-20-000 STATION BS HI FS ELEV. Benchmark ?j•~j0 fb3 ~ (c,'fl .~ Alt. BM ~, Bldg. Sewer '°'~'t St Inlet ~ ~.~ c)~.5-.fir I+1: Outle ~ b • `f ~ R~ - 3l Dt Inlet Dt Bottom -^ Header /Man. g• f'~ ~ qs, ~5"' Dist. Pipe .2z 9S•S`C Bot. System 4', ~{~- ~c~• 3 3' Final Grade vu St cover Z 2 . ~ ~ w . g t..(~- ~„.Q Sc~l <~ S . Sid ~~-.qZ' SOILA~RPTION SYSTEM(I Z1 r~fia,H..,-~e~S ~,Q~ ~, B~$ RENCH Width r Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manu acturer: ~ ~~ ^ ~~~ SETBACK CHAMBER M N INFORMATION Type O ~ ~ I ~ ° , ~~ OR UNIT um er: o a , System: ( (o ~}~ DISTRIBUTION SYSTEM Header / ani old U ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent 7o Air Intake ~ Length QJ~ Dia. L Dia. acing 7 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 ^ Yez ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: I o /`3 t / ~ Inspection #2: -T f" Location: 591 Lenertz Street, Hudson, WI 54016 (NE 1/4 SE 1/4 28 29N R19W) - 2829191174 Lenertz ditio~} Lot 1.) Alt BM Description = N~I¢ L~ p~s~-es ~Se~~x.c-~S ~~•+~~ ~~';^- °~"o' ~_ 2.) Bldg sewer length = ~c:s . ~~~ ~ ~~ I ~ ~ ~~~''~~~ ' S`~O~ w ~(~ b~ /-amount of cover =~ ~ ~Qwr'~"(~°'a~` '~, _~n ~ Q ~ ~Q ~ Ae ~ n 3) ovJ~ ~- P l l~ ~.,,. C9.an~, Z "~ C,R..mw~-I Q.~.~ t K i'c•~ -~ ^ ~'~` U ~" `. ~L~ - Plan revision required?s~~ No se th~eiy s~~e fo1r' dditional information. 12' Zq ~ Z (~B~~1~(R.3/9~~~ ~f ~ Date n I e r' Sygna`t}u~re ,, ~ Cert. No. ) v~^+,~-S~' ~ ~ kswl oo ~+a.. c.er~- -~ e~t~ ~.~~ a~aa~~~oux~e~ll 1~d7+-~ve.. a'~e~ Sanitary Permit Application Safety & Buildings Divisior ,In accord tiith Comm 83.21. Wis. Adm. Code 201 W. Washington Ave See reverse side for instructions for completing this application PO Box 730: `~seonsin Personal information you provide may be used for secondan~ purposes Madison, WI 53707-730: Department of Commerce (Privacy Law. s. 'Yl ) (Submit completed form to county if na state owned Attach com lete tans (to the county co v onl vstem, on r less than 8-I/2 x I I inches in size. County it ary Pir~n Number O State San eck if vis o prey ~ Ccation State Plan 1. D. Number / !'I¢N~~ D O } I. A lication Information -Please Print all Informati Location: Property Owner Name ~ ~ ~ [OQ~ W Property Location ST C /4sE I /4, ,N, rty Owner's Mailing dress Prope ~ ZON Lot Number Block Number ~ p ~ II~~t: City, State ~ Zip Code ~° Subdivision Name or CSM Number ~~ia Snr/ , .,~ S' (Y~l/~ 9 X78 G ~.U~.tT'L /lfl~TZbtJ II Type of Building: (check one) ^ City O 1 or 2 Family Dwelling - No. of Bedrooms: ^ Village Town of Public/Commercial (describe use): ~}~" flif/~~,n ~ - '/ State-owned ~ ~^' III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road Z p) 1. ^ New System 2. ~ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax u her(s) S stem Tank Onl Existin S stem ~- ~'7 -- B) Permit Number ~~~ ° ^ A Sanita Permit was reviousi ~ issued °t• I ~~ IV. Type of POWT System: (Check all that apply) `lam . ~ 2 -'"0''`~ Non-pressurized ln-ground ^ Mound and Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade , ~ Aerobic Treatment Uni ^ Recir ulating ^ Other: a 3 ><~ 12 Z~( V Dis ersallTreatment Area Information: " ' 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. PercolatCon'Rate• 6. System Elevation 7. Fina! Grade Required ~ Proposed ay/sq Rate (Gals./d . ft.) (Min./inc h ) Elevation /~ ~ j VI Tank Information Capacity in Gallons Total Gallons # of Tanks Manufacturer Prefab Con- Site Con- Steel Fiber- glass Plastic New Existing Crete structed Tanks Tanks ^ ^ ^ ^ S,~' ~ ~ ~ Z ~i~' w ,1sd It g~tJ t'vv ~` ^ ^ ^ ^ ^ Vll Responsibility Statement I, the~unders(i~ned, assume res onsibility for installation of the POWT own on the attached tans. PgB~tr P'fU~rle'1Di~~ & Perk Te8 ingmber's Si nature (nos ): #P/IotPRS No. Business Phone Number ~~~il'D G ~'- Plumbe s ress tree[, tty, fate, Zip Code) Spooner, WI 54801 VIII CountylDepartment Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) l~Approved ^ Owner Given Initial Adverse Surcaarge Fee) ~ Determination ,~ oZc2 , ~ 0 ^ 06 - IX. Conditions of Approval /Reasons for Disa proval: ~-- t , E P~i.w~..wu s~ ~^+r-Rs. os p~.. L `h I.~- auks ~eh~ E Ott o~ sy~• ,M..~- w~a~t~iM ~- - . ~~ ~~ 6 31 S'• y3 E 7 /~l ~ ~o~ 3 >~/ f~~ ccs , SBD-6398 (R. 07/00) isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 19, 2000 CUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 ATTN.• POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD .~ HUDSON WI 54016 . r• RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/19/2002 ;. - ~ ~,;,' ~, , SITE: ~,. r.Oi;N~' Site ID: 199220, BRENDA BRATS ,.' : zara~r,c~oFF~cs- ~ %' ST CROIX County, Town of HUDS~Ql~~`~'Z92 E HWY 12, `~ ~ HUDSON 54016 ~.,~ ~ , ,~' NE1/4, SE1/4, S28, T29N, R19W ------ FOR: Object Type: POWT System Regulated Object ID No.: 762844 ....Identification Numbers.. Transaction ID No. 436706 Site ID No. 199220 Please refer to both identification numbers, above, in all corres ondence with theta enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Conventional Soil Absorption Component Manual for Private Onsite Wastewater Systems" SBD-10567-P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the conventional component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Aseptic tank filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The well must be a m~n~rr+um of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. CSI ~p~ OPPAF /DN,,IS-ON J tX/ r~~ ' gEE • The existing POWTS must be properly abandoned. ART);IUR L WEGERER Page 2 9/19/00 • ~ The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm Code. If it does not conform a state approved tank must be installed. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm Code, to determine if plan submittal and approval is required. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, HERMAN J DELFOSSE ,PLUMBING PLAN REVIEWER Integrated Services (608)789-5535 , MON - FRI, 7:45 AM - 4:30 PM HDELFOSSE@COMMERCE. STATE. WI.US DATE RECEIVED 09/13/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 ~ ~ • i~cons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD l.A CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.oommerce.state.wi.us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 19, 2000 OUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 ATTN.• POWTS INSPECTOR ZONING OFFICE ST CRODC COUNTY SPIA 11Dd-~.1CILivHCHAEL RD WI RE: CONDITIONAL APPROVAL ~ ~~ ~ PLAN APPROVAL EXPIRES: 09/19/2002 ~ t\ .~ i Idea atie ers =~ Transaction ID 43670 SITE: ---` r, ~~ ~ ~itlr .1992 Site ID: 199220, BRENDA BRAY ~;, ; g ,fie refer tio.~ .identification numbers, ST CROIX County, Town of HUDSON; 792 E HWY ~; ,~ ~~ in all ~' ndence with the a enc~ HUDSON 54016 `~ ?~~ zar, ~,~ NE1/4, SE1/4, S28, T29N, R19W ~~ ~~~~'-- ~ ~ ~. -,-r ~ FOR: ~ ~ '~ Object Type: POWT System Regulated Object ID No.: 762844 The submittal described above has been reviewed for conformance with applicable Wisconsin Adaunistrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Conventional Soil Absorption Component Manual for Private Onsite Wastewater Systems" SBD-10567-P (8.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the conventional component manual aze complied with. A copy of this information must be given to the owner upon completion of the project. • Aseptic tank filter is required. Maintenance infom~ation must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats: • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption azea. • The existing POWTS must be properly abandoned. ARTHUR L WEGERER Page 2 9/19/00 • ' The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm Code. If it does not conform a state approved tank must be installed. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that maybe required for this project. See section Comm 82.20, Wis. Adm Code, to determine if plan submittal and approval is required. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, HERMAN J DELFOSSE ,PLUMBING PLAN REVIEWER Integrated Services (608)789-5535 , MON - FRI, 7:45 AM - 4:30 PM HDELFOSSE@COMMERCE.STATE.WI.US DATE RECEIVED 09/13/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 TITLE SHc~ET Conventional Soil Absorption System for 'C-} U CTL~Z t~ P~'~..:.~ C U ~~1 C ~ fi7`11-'1 ~- Cfl~R.E ~-~~vT~`1Z Page 1 of S This plan has been prepared in accordance with the Conventional Soil Absorption Component Manual SBD-10567-P (R.6/99) Located in the ti E 1/4 of the s L 1/4 of Section Zb', T~`1N, R 19' W, Town of ~,ti~,,, sp~j , 31--_ ~.~tX County, •[disconsin. . _ LOT Z O F LE1J~1'~tT Z - ~D-T'Rti YV ~ ' INDEX ~,,9~ Ip ~;~ ~'o Page 1 of.5 TITLE SHEET ~ ~~ Page 2 of 5 SYSTEI~ rIANAGEi~1ENT PLAN ~~ !j~ Page 3 of 5 PROJECT DATA Page 4 of 5 PLOT PLAN ~ O Page 5 of 5 LEACH CHArIBEP. DETAIL ~~OA ~O V~ Oro PREPARED FOR QCZ.~.J U P~ $~ Y _._ -- -- ::zaz E: t+wY tz - __ _ ~~o~a~~y T OF COb7MERCE .FETY ~~iq g~~~DINGS PREPARED BY TryiC ;RES NDENCE • - ~._ ~/3~ 706 , N~ . ~~ WEGEF~ER SO 2 L . TEST S NG - !~'~ ' ~ aHS aHn . - DES I G~V S~RV S CE ~~ ~ iy r '~ ~ j ARTyIJP L P.O. Box 74 421 N.tlain St. WEGENEM ~ o,~s. River Falls, [dI 54022 E"'"'Op'"' ~. Phone 715-425-0165 Fax 715-425-6864. ~,~ ~j~s j:G~'~ _ q -~' -00 Joh No . Op -Z S ~ ' Conventional Soil Absorption System tlanagement Plan Pursuant to Comm 83.54, l1is.Adm. Code Page Z of 5 Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the Ume of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Dispersal cells No trees .or shrubs should be planted or allowed to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched~as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L HODS, 150 mg/L TSS and 30 mg/L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. - --- ___ =--- --- - --- nervation pipes within the dispersal cell shall be'checked for effluent ponding. Ponding levels should be reported to the owner and anp levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring .in accordance with Comm 83.52 (2). General This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code and shall be maintained in accordance with it's component manual SBD-10567-P(R.6/99)~ and local and state rules pertaining to system maintenance and maintenance reporting., No one should ever enter a septic or pump tank since dangerous gases maybe present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Gode when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service.'Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent, accidental pr unauthorized entry into a tank or component. Contlnaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. ------_ If the dispersal cells fail to accept wastewater or begin to discharge wastewater to the ground surface; additional leach chambers should be added to each cell to increase. the absorption area. ~ Additional plans may need to be prepared and approved by the Department of Commerce, Safety and Buildings Division. . Questions on .the operation or maintenance of~this system should be directed to .the County Zoning office at -~~ S_38b_S(6$~or to the system installer. PROJECT DATA Page 3 of S This system will serve a veterinary clinic/animal care center with 5 full time employees, 5 part time employees and 4 floor drains. A maximum of 10 customers per day are in the clinic with their pets. As per the owner, they very rarely use the bathroom facitities. An exercise room is included in the building with a maximum of 7 people per day useing the facility. There is 1 personal trainer and is considered an employee for design purposes.• ANTICIPATED WASTE[JATER 11 employees at 13 gpd = 143 gpd X 1.5 = --------------- 214.5 gpd 4 floor drains at 25 gpd = 100 gpd.X 1.5 = ------------- 150.0 gpd,, 17 customers (10+7) at 1.5 gpd = 3E-kF--------------- ~r.3-gpd, Total = -- ~~ gpd u02.'~.~ LEACH C:-iAA1BERS The soil application rate is 0.7 gpd/sq.ft. The sizing credit application rate for High Capacity Sidewinder Leach Chambers is 1.2 gpd as per Product Approval info. The chamber bottom is 17.14 sq ft. X 1.2 = 20..57 gpd/unit. 390 gpd - 20.57 = mfr units minimum required. uo~.~s 1~1 ~ S"7 24 units will be installed providing absorption area for up to 493.7 gpd which allows for an additional X93--7~gpd of effluent. qr. i SEPTIC TAiJK 493.7 + (11.61 X 6.58) + (46.77 X 6.58) = 1030.63 gal minimum capacity required. The existing 1200 gal Weeks Concrete septic tank will remain in place. A 750 gal Wieser Concrete tank with a Zabel effluent filter will be installed in series to provide 1950 gal capacity. PLOT PLAN Scale 1 "_ ~'p ' ?~ d ~.~cE- _~ I l ~+^1 b~2 ~~SCIrJ 6 "C\Z~-J@..~- ~ P20P o SEA 1'tO ~111U 1~J -t,~ Page ~ of S _ _ ~. L.E4J FIZZ- Z tZ.y'~ - _'~ r~ v; , ~ ~o ~F +~~~u~~ ~~ C 1J ~4t1Z~T a'r_ L~Nt or Z~(Z RCS LpT> ~ G 1 °% -is' a i tsa'# uk S.~^~X\ST1N6 12v0 6f~rc.. ,, S s ~; o sue. ti ~ ~ ~ ~~, J~ y U I~ ~ I t v~ o~c °~ ~a ~ ~ s .19 ~ ~. S'r1~n~.t't-°l q 5 _ N~ : ~ ~3`()n.I G h1 L .C_ l S 7 S o '. ~1~-t~ ~'1 ~~~~t- c ~ a~~s __w > zs ' ~~-~ r~~ _ _ __ ~`ms13 ~~S t~1 tv~ gr-1 ~ ~z.l v ~Z `re c~D ~~o u e.c~ s`n~ ~n u ~ , _____. NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted.. 2. Install 4" observation pipes with approved caps. (~_ required). 3. Septic tank to be 1°t5O gallon capacity manu ~tured by ~tc0 GM- _wegYzS Cu-., c~z~ C~~uG~ -~ r.» "1 Sp 6ttt, ~W~~~ '~.k w/~z~YS~c. '~~~tz, 4 . $ e n c h mark ~w1 #-(- ~L_ 1.U0 -o o~ c~1--t~.rf' Sum , ~-1tF2: - ~_ 44.6 0+.~ C~~rr. S ~ . 5. Divert surface-water around system to prevent ponding at the uphill side. C~ R6C .:~ F~ "s t~~ 4~ ~: eR 'Y sa :~ Y ~s s= P 3N fO r r~ ~~ ~a ~~ c ~n e~ ~~ AZ Y_," ~fL cr~ f ;~ fV ki aW y~ ~~ an ~` c '~ b 5 a E i A r ~ c 7 !S~ • m b q j !n ~ m ~ m x „~ u~ ~ o ~ • a m. rn m -o ~Q .• -~ ~a ~ m ~ ~ O ~ ~a ~; d © z .~ m 6 (D A ~ >v T m n ~ m ~ O C d~ ~ N N a m 3 N 1 ~_ ~ (D O IV ~~ A? ~ _ ~' ^ ~ ~ co X ~ r ~ x ~ S ~ ,p CQ `~ n fA a ~~ ..; ~. ~a ro j ~ w N X N W C" '1 • Ui X ~p W ~ ~ a; ~_ 3' • • • ~ -G ~ S ~ T. I_ ~ ~ (Q 'a C fa C ~ ~' CJ `G ~ n ~ Q J _ J ~ ~ ~ ~~ ~ cn ~~ ,3 n ~ c G c . ~ ~~ O ~~„ ~ N• W Q'= ~ ~ O O ~ m ~3~ o°~~ ~ v i .moo ~ < 3~ ~~ ~Q~N ~Q3~ ~ ~ (7 ~ • ` ~ N ~ ~ ~ a ' c ._: ~- •A-•. ~ = N ~ < ~' Q7 w ; ~~ ~ 0 ~ ~ ... m c~ N a 4 OF S cp ~ ~ V,l~ ~ .,,~ X17(1 b ~ n ~ ~~I ~" ~~I , ~ ~ ~pfl ~ p ~~~ a m ~; ~ ~~ ~~ ~I~ ~~ ~iB G!~ '~ Q. I tt<< ~ „ ~ i~GSCOnsin Department of Commerce SOIL EVAL TION REPORT Page ~ of Division of Safety and Buildings ~ in accordance with Co ~ ~ ~ County ~, ' ~ Attach complete site plan on paper not less than 8 1/2 x 11 ' n siz Plar~iust r'r' ` inGude, but not limited to:.Yertical and horizontal reference r w e o s ' BM), d~" _ arcel LD. d Z .~~ ~~-1D •- ~~ n , north ar ; and loca percent slope, scale or dim nsi o d distance roa . D. Q ~- Please print all informat Q(f~ v' ed by ~ ~ ~ Date ~. Peraonal intormatiorr you Provide may tie used for secondary Du Privacy Lg~ ~ ?• ~`~ O -0(0 - Property Owner ZONt Loca ' ~ ~-' G~ Lo~ 1 /4~~C 1 /4 S T Z N R- E (o Property Owner's Mail(ng Addra ~~ # Subd. Name or~f39kA1R City State Zip Code .Phone Number ^ City ^ Village Town Nearest Road ..: 54~/G i38~ ~' r y .. Z ^ New Construction Use: ^ Residential /Number of bedrooms Code derived design flow rate GPD cor commercial -Describe: ~NZ=~fi,L G4~ C~'~VT~7L Publi Replacement ,,.1.1 s Parent material 1J/~~~ /~- ya'{~/J~ Flood Plain elevatlon if applicable ft. General comments and recommendations: Bonn # ^ Boring r 9 pit Ground surface elev. . S n. Depth to limiting factor ? 93 in. ~~ Soil Appligdon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t / SL /F --~- L c S . S" • P _ ., - s- ----- nt l~iL ..-- ~- • 7 ..Z Boring # ^ Bonng Pit Ground surface elev. Ili it Depth to limiting factor ~ in. ~~./ Soii Appflcatiorr Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Ro/o/''ts GPD/it~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r„ r- L c s --- . 8 .- 3 --- S Z • Effluen t #1 =GODS > 30 < 220 mglL and TSS >30 _< 150 mgll ' Effluent #2 = BODS.<'30 mgll, and TSS < 30 mgll. • - t:ST Name (Please Prinq Si najNw~~ CST Number Zi//~a ~~ Fogerty Plumbing & Perk Testlrtg 7R7f2SL MrKnn~in D.~ ate E/valuation Conducted ~T.elephone Number ~/~L~/d '~/~~' Spooner, WI 54801 ` .. Y ~ . ~` Property Owner `' Paicel 10 # ~~p'" " ~ ((j 7 "' 2 ~ "C~ ^ B ring a Boring # i d ~ ,. 1~ ~ '' ~t Page ~_ of 3 p,( ~roun su acaelev.-~ ff: DePltt 40 limiting factor? 7/ in. /.~,._.. . Horizon 'Depth I Dominant Color ~' Redrax Description , -,~ Texture ' ,Structure Consistence Boundary ~ %~ Roots Soil Ap IIcaUOn Rate GPD/fl' n. Munsell du. Si. CoN. C tor' ~' '~ ~ C;r. Sz. Sh. '~ff#1 •Eff#2 ;,, I I Boring # ^ Boring L__-_j ^ Pit Ground surtace elev. ft. Depth to limiting factor in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots son Appucaaon Rate GPO/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. fL Depth to Iimitlng factor in. Horizon Depth Dominant Color Redox Descriptbn Texture Structure Consistence Boundary Roots .~OII AppI1CaIN)rt Kate GPD/ff= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -'Efff/2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent ft2 = BOD` < 30 mg/L and TSS < 30 myL The Department of Commerce is an equal opportunity service provided and employer. If you need assistance to access services or needmaterial in an alternate format, please contact the department at G08-266-3151 or TTY G08-264-8777. SBD-1330 (R.6/00) t 5 { ~w ~~ -----~- - -- - - --1- i ~ O ~ I ~ ---`-' i~ '# ~ ~) v N ~ N I "I ~ , Q t 1_ ~ff f ml x ------l- - - --- - 1 `~ I y , 1 ~ ~ . o ~~a ~ ~. .....~ ,.--1~1 'o ° r,t i ~ x u- '~ ~ 1 Q I N'1 rv 0 ~ ~ tl ,a v 4 ~ ~~ w v W o h ~ 4 ~ ~ 2 q4 ii ~ p 0 ~ U '42 H V . ~ O x ~ Q ~ ~~. ~.~_~ ~, v M ~Y~~ ~~ ~~ ~ ~o~ Y. oNO to `^' N ~ ~ W L v t~ ~ ~ ~ A ~' 11 i~ a~~ ~ ,. ti 0 3 o H h ~~ y~ ST. CROIX COUNTY ZONING OFFICE ~.~° This is to certify that I have inspected the septic tank presently serving the residence located at : %, 1/, Sec. , T N, R W, Town of St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel _ Manufacturer (if known) Age o f Tank ( i f known) (Signature) (Title) (Date) Name) Please Print License Number Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK Signature MP/MPRS ~~ ~ ~ '~ ~~~s ~ f~s~~ ~, , ~,~ ~ r~~ ~ a' 4~ Y / ~i~~ Other "~/ ~~ ~ ~ n J!h"s.Br ~~'~ ,~ , , ).. ~.s APPLICATION•FOR SANITARY PERMIT 3TC-100 full and signed by the owner(s) of This application form is to be completed in result in delays of the property being developed. Any inadequacies will °ntended for resale by the permit issuance. Should-this development be owner/contractor,(spec house),.. second form should be retained and -.then a this office with the completed when the property is sold and submitted to ----------- appropriate deed-=ecording------------------------------------------ ro ert ~ '~V Owner of P P Y 2 ~, T ~, ~ N_R.~W ro ert ~ 1/9 S ~ 1/9, Section ______---~ --~- Location of p P Y ~-- Township '~'~~`S ~ Mailing address S ~- l~. a~ ,r,,, c,JT s~o l Address of site ' Subdivision name Lot number _ ~ previous owner of property ~.~~ w' ``~`" Total size of parcel ~•~" Date parcel was created ~ Yes No Are all corners and lot lines identifiable? Yes ~_No Is this property being developed2for resale (spec house)? ~_and Page Number /~ as recorded with the Register of Deeds. Volume INCLUDE WITH THIS APPLICATION THEVOLUMEWAND•PAGS NUIiBER, and sure , A WARRANTY DEED which includes a DOCUMENT NUMBER, Y if rocess. If the SEAL OF THE REe1Sfu1 so asEto~avoid delaysoof the reviewing tified Survey available, would be h p the Ce the deed description references to a Certified Survey Map, Map shall also be required. ------ ------------------- PROPERTY OWNER CERTIFICATIO our) I(We) certify that all statements on this form are tru~heo roeebtytdescribed in knowledge; that I (we) am (are) the owner(s) of P P b virtue of a warranty deed recorded ~nandethat1le(We) this information form, Y ~~ ~~~r the County Register of Deeds as Document No. .~ ~L..~ resently own the proposed site for the sewage disposal systemo(erty,(wfor hthe P to run with the above described p P obtained an easement, and the same has been duly recorded in the Office construction of said system, as Document No. )' of the County Register of Deeds, 3TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~ ~ l~ ROUTE/BOX NUMBE/R/ / ~ FIRE N0. ~' / CITY/STATE ~f~Cd~ Dye ~ Vy.L ZIp S~Q~(o PROPERTY LOCATION: N ~ 1/9 S x_1/4, Section 2 8 , T 2~,N, R ~W, Town of ~~Sdvi S7~/laiX , St. Croix County, Subdivision ~~i 7~j p7'~ , Lot No. 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 53000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ~i DATE U St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address of the County Register of Deeds, as Document No. J. ~ ~ . /'~i//?/1 ' DEP JT OF INDIA TRY,' LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (ILHR 83.09(1) & Chanter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: N~ y s~ ~/ SECTION: TOWNSHIP z 8 /TZ R 19E UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: (or - ~v~Sorv Z - 1.,E1.lQ2TZ ADDLT-[oN COUNTY: OWNER'S AME: MAILIN ADDRESS: ~ -( 7i ~ • LLGwy 1 Z 1 ~ l ST. C2L~l~C $~1~.1 D A BR-A`( (~ - g~7 8 1-~-v psOrv w I S~! 0 ! 6 I ~, ^Residence SV.1~. IVEC~1-J;•'t12.~j CC.l~1tCI C~New ^Replace ura i tS uts~tnvA 1 I[]NS MADE (PROFILE RIPTIONS: ATIONTESTS: Il Z.- 1-8~ tv.A, RATING: S= Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GR~~OtUND-PRESSURE: SYSTEM-IN-FILL HOLDING T~~AttNK: RECOMMENDED SYSTEM:Ioptional) ®$ ^~ ~$ ^~ I~1$ ^~ ®$ ^~ ^S_.~J~ Z~~ct~S-~Rc1•I Skluu~Lu~+6 If Percolation Tests are NOT required DESIGN RATE: I If an L y portion of the tested area is in the N • ~ , ender s. ILHR 83.09(5)(b), indicate: Gl..,ft S S Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 30RING 'NUMBER TOTAL DEPTH kCS ELEVATION DEPTH TO GROUN OBSERVED DWATER-Ifs EST. IGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 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Describe what are the hori- ntal 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 land slope. SO~I`Z'OWJ Ot=`1-1ZEhlC.EfE-S ~tcGE 66 ~D~P.`c~ATA I-OA-~1 SYSTEM ELEVATION c. ~. ~ Z~ .~ ' r - - - - 23•~fl_ - -~ LC-J i 4 I i 1 ,-, .-. ~--t~ ~- --1 _Tz ST . i } ~° ~ ~ 9` I o _. ~ ~ ~ ~\ . M , O ~ , c ~ °, ado `"'' _. ~ ~,~~d ~. _ t, oT U N ~ _ i-112.-, y ~ _ ;_ _~~~SP_ - ~_ ` = ~--- 1 • C ~~ x Q - - _. ~- ~ 3 Eck ~' zZR.®'•-ah~S`a goo' PROPOSED - _ ~ ~ _ _.: _~ ~ ~__:4~~ :.- /~N >`Rc,N_S'x~00'-~ ._ r---- _ $O. _ l3LD~a-- ---'-1-5 L-OCAT4 ETG.N p~~ p ----+~-- - ~~ r"1 a-~~~ ~ ~ G ~P~~~,~~' ~-'Z. i f~-...___- C.T. ~, y~./V ~f -+~~.- ' i ~~ cEn r'-v r ~' ~, -•- - - 8. 1 .. _ ... , .. _... ter~ee„~. __.__Vi B ` ` I .,.,__.. ~.. ~ - ~ o. Qy` ~k..Qn L TS ; ~.Z' l~1 L ~ ~•3 ' $n ~S ; 1.~ - l 93 1,0 ~ 1J~)~, ]. ~' 7 hn Q, g • O.S~L3 5 SU6HtL`1 ~ 'Z.Z'LT $n hl2r~ S r ~ / o•a` ok.8~~~ ;o.q'a~,L;~.3'anlsw/G~;2~if'aftni s- B- Z ~ •~ C[Z..q•~' 1~~~~. 7 ~' ~ b.CJ~811 5 SuG!•I'1'~~t D6vS~~ 1. 5 ~ 1..~' ~k S ' O-~' Dk6h L TS ; a•S' 8~ L ; O.6 '!3n 1Sw/Gr' ; 3.4'6n 'FS ; ~B- 3 ~•$~' aZaJ:7' tJOfvE. > 7. $' o.Z.'8n'{S SIIGfITI-`J D2~st` ; Z-O~ ~3,, s ~ I ' r o. $' ~Ir~f3n 1..~: o.8'Sn L ; -.S'l3n IS w/6r; 3.7'8n ~S; ' B- ~• b q3 )•4 ~)>t.1~ 7 ~• ~ O.3'~h S SLt6tlTL`/ DevS~~ o. S bn '~S IB- S B•~I Ol~l~•9 ~ _ ~~~. 7 g•~~ 0.7' Olz~n LTS i o•~~ ~n t- i O•~/~ Qn /S +~/S~/6F17 6r; .7' S 'Q•S~'$h`~S SUGry1Lyl~t'_h1SH 'Z.J~Bh ~S ' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERI D 1 PERIOD P R PER INCH P- P- P- P P- P- 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a/t all borings and the direction and percent ,f land slope. $o1`Tpi~j Ot=y-t~ c.~, ,~'fE-S ~ ~/C{E (7 t7 ~~tr~TA Lo1~w1 ~ SYSTEM ELEVATION ~ ~ • ~ Z~ ,~ _. _ . _ _. - - -- -- -- 2 •~ _ ~. --- - - 7 ~ 3, bb` 'iv i ~ J o a3o M ~~~ a `..._ _ _ _ I_ i ~O.___ - - _ t ~(~ p,CtX !~ _ ~ ,. __ ~___ _ . _- - _ . _ __ ~ G q24 - ~o ° q3 ~ ~ 'r] ~'~G~1GE a.4 o _ 1-J~nh~ $~ 9~ a ~tt~c.MJS x~ 00~ --w T---~`~- ~..._ _ ....._131..06.-- ~ t _ 11 S____:. _ L.OCa~1Ti; ETC.N -- ----- ~i 7 Z+ -------~ - - --- -- ta.~V L-h cEn L~ r ~' i rQ.~P, __ - _ __ - _ -- _ _ --- - -- - -rn ! -•&-.~ttT L ' J a.l H ~ 2 i.._._ _. ' ~ sT• o --q31 ' __ + __ 1 >r-oT L! w ~ _ ` yr= - -- .... ~~ i~ _-53S.~p' . - --._ggr~_t~l -EL- _933. ~:o~-SP~hcL-a.8"t --- --~- ~aou~!Gttuw..a ~ , I '_ _ 3"~~?- ~'1,, 9 ~2.~~ o~V. SPtke ~$"* -Rd~1ut_ 6R.uv~4 __ i _ _ ~Z-9 SGAI.E 1u=full' tw ~" 1-It~i., ~ S EG Z$ 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. i~Hmt lprmU: TESTS WERE COMPLETED ON: ~~T"Mv~. r`, w~G~~~ z-~-sS ADDRESS: `~QU~-E ~ ~Ox ZZ~ (CERTIFICATION NUMBER: PHONE NUMBER(optionall: C-~--~SwofZT}I t wl SYull 5~6 '7/S-yLS-o/by DISTRIBUTION: Original and one copy co Local Authority, Property Owner and Soil Tester. DILHRSBD$395 (R. 10/83) -OVER - DOCUMENT NO- 4374.0 'eoo~ 8~1 rASt 3~ i STATE BAR OF WISCONSIN FORM 3-19p , rn~s s•ACS Rassvso row RscoRaRO s~+~ oun cuuM oEec ---_•.-Pamela 3. Brag Iaetta gsit~el:ima to ..~gltllS~A...I,~..BxAJt--•-•---•-•---------•---•------------------------------------- the following described neat estab in ..............$C.:-_C~4i?4.._..........._ County, State o! Wiscotuia: Lot 2 of the Lanerts Addition to the Town of ~ludson. 3egi~ncting' at the Northwest corner of Lot 2, thence North 89° 37' 46" East 66.00 feet along the South line of Lenerta Street; thence South 00° 22' 14" West 250.52 feet along the West line of Lot 1; thence South 89° 37' 46" West 66.00 feet; thence 00° 22' 14" West 252.52 feet along the Bast line of Lot 3 to the point of beginning. !'RANSf REGISTER'S OFFICE sT. cROix co., wt R~c'd for Reco-d MAY 1719 at 3:00 P. M a ~„~ ~~ RsruRM » Taa Paroel No : .............................. ~~~~ This ..~~._ n0'Z` -..-. homestead property. (ia) (is ~n7oyt~)- Dated this .............ll:-:-.-..-.....-... ----.--.. day of ------ •--••-•----•--------------------------------------------------------(SEAL) --• .........................•---_.-.•.---•--..._..--••-•-----...-... (SEAL) AQZHEN?ICATIOlf authenticated this ........dsy of ........................... 19-_--_- ° TITLE: MEMBER STATE BAR OF WISCONSIN (If not. ---•-•--••-•-•--•----------------- •-------••--•--... authorized by ~ 7Qt;.06, Win. State.) THIS INSTRUMENT WAS DRAFTED BY ..-Pamela-.1__.Bra}._Iaetta_._-••--------------------------- -- b34 4th Street, N.E. ii>~e~oli~Z~---' - - gna u may su .entua or acknowledged. th -Pamela -J. t3ra• Isett ....... ............................................................(SEAL) ACENOW LSDO11[SNT STATE OF WISCONSIN ••-St.- Croix---•_-•••-•-••--Coaaty. ....... Pereoaalt caave before tae this .17th-••__day ad ._._._._. t"~Y---------------•-----..._.., 19.88--- the above names ._._._.__ Pamela • J...Br~}r...Iaetta.---_-----•---------------•- to me known to be Ib~ peeso~'_.. ~_._.-.. who e:eented the fo g instrnm~Yt-std ack wledge the e. ~~ --------- - ~ ~ .w - - ~ --- ---------------- :... . ~„ ~ •..-.-.. awes --_0!, y ....~ ................................... Notary Pubtie .----.'..~ ~,~.-~.--.~t. _ Croix County, Wis. My Commission is pe~ftanent.llf not, state a=pintion • i- _ ~ N 00° 22' 14 " W 541.17' 258.47' 282.70' N A m v O .00° OS' 12'. lUV. VU' ;` • ~~ ~~ ~ \~ 1~ , 1 r N ' 1 BO 00' m 1 I o 50~ ~N m V ~ j V :.. OI G v !n ~ H 1 (p ~ . m ~~ r ~ ~, ~ rn ~ Z 1 G7 1 z ~ 1 Arn O ~ " ' A o I m '14" W 480.96' °" N N D '~ II I _ rn m 1 Uf 1 m to -1 J" co 0 ~ I .. ~ I I - :~~~ a 1 1 ~ ~ ~ ~ :,, ~ I ~ Ic ?'°^ ~ 1 ~ I ~ z ; i c: ~ n a 1 -~ III Irn ~+ 41 -+ ,y i v rn Z ~ J N ' , 10 AO N m V 1 1 N ~"~''~ ,r., Ir r s Ins I I I'1 z ~'' ' .. Izc ~~~; ~~ ~ ~ ~ ~ ; _ ~ m I--I ' m y m ,: ~ N m ~ ~~ v Z + ~ m .fi u ?I N°~ BO 00' ~ , V .- 1 jD ~' r 1 ~ 1 ~• ^ N ' I ~ trl m i N m ' °; m `~ -a ~: ~ 50'1 ~ m ~ 1 _ --- BUILDINGS ACK LINE --- - J ~. ~•• N Z -~ z -a ~ z ~:: .•~•• 1 H O • 1., z 'n 0 4 0.55 ' o •' OZS~ ; ro m o ~ o -:'~,y ~ 1 00 WESTERLY RIGHT-' -WAY LINE ~d1a ~ ----- - 4 t- --s-~~,.~..~.. ----------250.5~-~--------- 1 80.01' ~, ,,. 30 38 E 6 6: ~~S 8 - - - - - - •'tr- _ - 300 - - - - U. S. H. 12 - --- - - - ~"""""'_" UNPLATTED LANDS n N _.4 -{ 1 ~ f) y~~ m 1 i ~T W JV i io -'tea omrr-m~ ~• C'y& SZD Zr O" C O O a s p. 1-t a ~ rnmzrnl-• 0 1•+ - c -Irnz „r smaz -Ix r z ~ 1-1 mmx '~ :''t~,`.~: ar~nrc-rna u~n~ ° H ~ 0 0 o~rD'w ~: ~ rcnaNr mA z o z z ~ o r to ;~ Wisconsin Department of Commerce SOIL EV Division of Safety and Buildings in accordance with Co TION REPORT Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 ' siz Pla~ust ra' ~ inGude, but not limited to:.vlerticaf end horizontal referenc,~a BM), d arcel LD. percent slope, scale or dimensions, north arrow; and Iota d distance road. ~ a2Q •- .j~ ~ f -2d -- Q'~O Please print all Informat /.j~l~ 2 ~ 9 v' ed by Date ~; Personal infomiatiort you provide maybe used for secondary pu Privacy L~ ~ l~l. ~ O-Ola -~ Property Owner ZO(~ Q t~Loca ' ~' ~'' ~~ Go~ Loi" ~ 1/4~~,,C 1/4 S 7 z N R- E (or~ Property:Owners Mailing Addres ~- # Subd. Name or~?9~ht# City State Zip Code Phone Number ~ City Q Village Town:, Nearest.Road , :' ; _. ~,- New Construction Use: ^ Residential / Number of bedrooms Code derived design flow rate GPO Replacement Public or commercial -Describe: f~JVLar>aA,L CI'3i~ ~~uT~jz. Parent material ~~l~i /~- ~/~/17 Flood Plain elevation if applicable fL General comments and recommendations: Boring # ^ Boring pit Ground surface elev. . S ft. Depth to limiting factor ~ 93 in. ~~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture SUucture Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ ~. / SL ~ F '_"'__ L. 1 c SQ . ~ '- s -- yt ~tiL - ._ 7 L . Boring # ^ Boring Pit Ground surface elev. ~s„~_ ft Depth to limiting factor ~ in. ~i l1//v Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fR in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 -- L • ~ Z _ s- 3 ._-- c s - . 8 3 P --- S --~ 2. • Effluen t #1 = BODs > 30 < 220 mg/L and TSS >30 _< 1 50 mg/L • Effluent #2 = BODs.<'30 mglL and TSS < 30 mglL - CST Name (Please Print) Si ajuoo~' CST Number 2~ //~d Address Fogerty Plumbing & Perk Testing ate Evaluation Conducted Telephone Number 28288 McKenzie Rrt ~/?d~d _ ` ~~ -9 _/ Spooner, WI 54801 , •„ ~ Y~ ,`i 1 \ y "ti: "~ ~ i ~ //~~s,~ ~/ , ~ ~M~f 1 Property Owr-.er _ 1.~~` y f 4i,~'~~~cel ID # A2J~ ^'' II ~7 '~ 2/ ^C~~ d ~ .,--- " '~ ^ Bring r. Boring # } 3 ~ ~~ ~' t .. ..,,,. .,~ ..~ .... a . ,Pit , : Ground surfat:e(.elev. 3 ~, f1 Depjt). fo limiting factor -~_ in. ~~~ '' v ~ Horizon ' Oepth +~ / Dominant Color ~ Redox t)~scripUon ., ~<~~ ~'.12exlure ~ ~ ..Structure Consistence Boundary Roots SolfApplicaUon Rate GPD/ft2 In. Munsell Qu. S~ Gout. C ~~>3?~"~`~~'~'' •` _ _ - ` r. Sz. Sh. 'EN#1 •Eff#2 ' ~ , , , . y ~ ~~ r~~t ti_, 1 1 .. s ~~ ..~ b ~i/lt ~ ~' ..e ~ ..~- L..~J _ ~. I~ _ . _ .r` -_ ~_ 2 a. Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to IlmiUng factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soif Application Rate GPD/ft= in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 . s ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to Nmiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 .; • Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODe < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provided and employer. If you need assistance to access services or need material in an alternate format, please.contact.the department at G08-26G-3151 or TTY G08-264-8777. SANITARY PERMIT APPLICATION couNTY - ~ r71LHR Adm Code Wis 05 ith ILHR 83 I d . . , . n accor w ..n,,~";"'~,.~„~,~,.....,,~,,,e,. STATES NITARY PERMIT # ~ y -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'/~ x 11 inches in size. !/ -See reverse side for instructions for completing this application. PETITION ~ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. No FOR VARIANCE ^ YES PROPERTY OWNER PROPERTY LOCATION R E (o N S T vG '/a S'~'/a s, , , , . A ILIN DRESS ROPERTY OWNER'S M LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ~ j 7 0~ ("f, , ~rJf 6.. O ~ ~ ~ ~ CITY, STATE ZI CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ~ VILLAGE ~ ~ ~ II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR t~LPublic (Specify): ~ ,',V"c ¢ OF APPLICATION: (Check only one in #t. Check # 2, 3 or 4, if applicable) III. PURP O SE I ~ ~'' 1. a. l~lvew b. ^ Replacement c. ^ Replacement of d. ^ Reconnection of e. ^ Repair of an System System Septic Tank Only an Existing System Existing System 2. ^ A Sanitary Permit was previously issued. Permit # Date Issued 3. ^ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ^ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ~-Conventional b. ^ Alternative c. ^ Experimental 2. a. ^ System- b. ^ Holding c. ^ Pit Privy d. ^ Vault Privy e. ^ Mound f. ^ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a ee a e Bed b. ~ See a e Trench c. ^ See a e Pit 2. PE COLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~ ' Q ~~,~ ~ Q~ ~ ,p~ _ blic int ^ P ^J i ' ;3 ~~~ 2-$XIOd Q -$ /a d Feet `' r u o r vate t~F VI. TANK CAPACITY in allons Total # of me ' N f t M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks urer s a ac anu oncret glass App Tanks Tanks structed Se tic Tank or Holdin Tank ~ ^ ^ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: ~ ~-C ~ . .t ,~ o' Ca VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's A DRESS (Str et, City, State, Zip Code) Phone Number: ,r ~/ '-i~ !v G.J L ~~ IX. COON /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee Groundwater Su charge Fee ate Iss g Agent Signature (No Stamps) ~ Approved ^ Owner Given Initial ~ ~ ~ A,t ~,L` ~^ //~~~ n /~ I ( Adverse Determination ` lJ c_.CJ O ~ ` V c.-~n„l~ ~/ l X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a S8Ttltary Permit Transfer/Renewal Form (SBD-6399) to be submitted to the county prior to installation; 5. Private sewage systems mustt7e-properly maintairr€d. The septic tank(s) should'be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a!/ septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number vi h appropriate prefix (e.g.__ MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; ~ - - X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wel'Is; water mains/water service; streams and lakes; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 19$4, 1983, Wisconsin Act 410 was signed into law. This legislation is more = commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate.'The groundwater bill Gfound ester included the creation of surcharges (fees) for a number of regulated practices which Wisco [ms's can effect groundwater. The surcharge took effect on July 1, 1984. Alt of the water that buried rea5~re is used in your building is returned to the groundwater through your soil absorption o system or the dispdsal site used by your' holding tank pumper: The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) .. State' of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION PRIVATE S ~PROVAL .- , •~ ;y Office of Division Codes and Application c. t W h' t A ~~c ~r ~ ~ ~.~, •,~ WEGERER, WL-"BER AND ASSO(:~fll"ES P.O. BOX 74 RIVC=R FAI:I_S, WI 54022 __v___~_~,.,.'' 201 Eas as Ong on venue P.O. Box 7969 Madison, Wisconsin 53707 Owner: RE: Plan Nwnber: S88-03172 Gallons Per Day: 240 Project Name: BRAY, BRENDA - VETERINARY rl_NC Town of HUDSON Fees Received (Priority Review): 100.00 BRENDA BRAY 792 EAST HIGHWAY 12 HUDSON, WI 54016 Date Approved: August 5, 1988 Date Received: August 5, 1988 I._ocation: NE,SE,28,29,19W County: ST CROIX The plumbing plans and specifications for this project have been reviewed far compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. ~1"his approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible far this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for-the code requirements set forth i:n Section IL_HR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW CONVENTIONAL Inquiries concerning this approval may be made by calling (608) 266-2889. ~, Sinc Section of PrKvate Sewage Division of Safety and Bui:ldirigs PPP013/0009n/16 cc: BRENDA BRAY ~__Private Dewage Consultant SBD-6423 IR.10/87) ___ County ~ UW-SSWMP Plumbing Consultant Owner Plumber Environmental Healtl ~. _ ~~~~ ~ o~ y ` ..,~ _ - ~-.- NC~~y~.~ ^~~, SC.~iyG~ S~C''IC',- Z-g m z.9 j,. - ~q „• mrT.n- v ttvUJ~ S1~~R.OIXCvtI'~"~Y 1,-TSn~T"°~I:. • ~ ~ l: 1'~t'. -~_~_ - _ - 1 . ~ iii 1 'J ~. PAGE 1 OF' 4 TTT~ S~~*~ FA GF; 2 C?' 4 PROJECT DATA PA GJ 3 CF 4 PLGT PI,AI~ FAGS ~_ ;. T ~, .,T-, ~~ , c e^„mT~r• - F=.EFA ~,r r ~ r q Z _ _ ~_> ~ 1_G HIN~3-_lZ_ 1~v~S01v, Wl 54~Q1b_ __-: I ` '.I. - - BCC i~: 42 ~ ~. !•i.- ~; __:~'~. RIV~.. FALLS, t~IS~vI ~~ 1~G022 RECEIVED AUG 51988 OFFICE OF dtYfS10N CQI*~S ~~t~ Fc~^t tf'htlt~l~ 588-03172 ~~S~p~so~~s ••••. ~: '~ ': ~ ARTHUR L _ wEuERER axis? E,~t.SwpRTH, ~ ` wrs t '~t ~~S I .G•13 ~4 ~ - ~'L~'N2=''- ~ ~Z-~~ 5 `329 I I t i i 9~9 ~z cy3 9~ g.3 s. `~ _ _ ~~`~~ ~-- - - r-- _-_ _-_ - - `~ Vt3aT B•~-- goo' 5 -~ --- - y' ~ $utLD11JG 5 ET81't chc. L~til~ 1 tO~CfGy'~T I !~~ S~ ------- ~lo'oF 4"pvC v~`~ 8i t'L:i; r L Scale 1"=60' 4''hG _ 3 0= ~,_ ~S~c~"(~~1..~tJERTZ 3T"- C~ S~p,G ~S H GS 0 8~ gU\ v~ S~~ . ,~ ~ E~Z ~ 1N DE 1~~~P . 1 B ~ ~ `~3/ I 3p \ 93) f RECEIVED ~ 8 g ' 0 31'7 2 ~. AUG 5 1988 - OFFICE OF DIVISION - COt~FS Alin ncai iCnTtAN - 0 N ~N J NOTES ' 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install cast iron pipe 3' onto undisturbed soil both -sides of a~~ tank v e: t,. Install 4" pipe with approved cap. ( Z. required) ~. Septic tank to be ~ZSo gallon capacity as manufactured by .-. , :~ ~ r r .... 4 a ~ s - ----- Yr-- _. __. . ~ t:- t l~va ~i on '~n~*t- ~2. ,33.1 ~, sPI-cE ~B t~ou~ C~.0~__ ~~ b 7'R.~e 7l~ S ~ C.T- ~ AcTA _?RGE Z of A C~>U V ~v ~ p 1..~ A L `Ti2. E'>~- CH s `~ S ~T~"~ w ~ 1, L i3 ~ ) /~l S T-/t L l.. ~ Fa R -R~ l S 1~CZ-p r~o S t~ V LT ~~ 1 rf r~-R 4' c u N t c , ~t ~ S~ 1 ~- 5 ~~ ~,vt S S Z - U P~~ o Tt~ ~u -'~ -'~ - ~l-}~LE W1 LL ~~` ? ~ F~:~U7~`5~ 3 ~WUR 'Jf~tt!,uS , ADD S ~T? C TA /J l~c ~-~~LO~-lam ~S - 3 >C ZO C~PD = 6~ _ GPl~ t=-~.up~, ~RAIJJS - 3 x So ~~ = ISO Gt''U e,v S1~ ~ ~S C Z-~ ~ L s T-~~~- Zo x l • S ~ ~ = 3 O G PD ,~ S't~ M R`TE D V o ~- ur-7 ~, = Z ~/ O G A Q -~ S O _._ ~ -.~ . C-'cP ~ c I y-y CSC? ~ D = g 9 0 _ c~rr~.__ • Z- S O _ GR C. - S_C~`P 77 C '~ A--1-~, 1•V l L L ~ E;,---~~ S~-C-~ ~ D S~ 1 L ~R$S ORI~•T7 C~jJ ~Q ~ _ - -- - ~WO~. b12.A11J S- 3 5C ~ ~C 1 6S = X95 °~ Z ~rcz,~ v c ~t~ s~ c N S' w 1 D~ x 10 ~' l..ow 6 ~v ~ ~~ ~~ 1I~1~TALL~> >t~vi pI1VG IDOQ a ~OF ~J3SOSZ,A770xJ ~1k~4 S 88--031 72 ONStTE SEWAGE SYSTEM ~ .. ~~ ~~ OEPARIA4ENT D TRY, BOR UM D OF S ILD S ~. SEE CORRE NDENC:F ores RECEIVED AUG 51988 OFFICE OF DWISION COn~s atfn n~^i t~nrloN 4 I _ -- r ,~" 6 • ~~ ~; i f'ct?P2uv~ Gh~' _}_--- - ~ S , 2~ `._ ~ ~ ~~~ 100 ~ tr a . ~ . REt-~ji~~1S R J~~ P 9~R D A Y~ S pEPI-RSMEµ~OfS ~ Of S ILD Gi~,l~ S S S c~ C~ ~ -~ L-X- ~~~.,v~,~-ply;. CF'TR~r.~C1-i RECEIVED AUG S t~~s OFFICE DF Diil19R~~ Cm~'ce A-iR ~!"'~ rF~frfiq '~ ~' PVC P CR ~i,R t,T°A Pl ~ ~ \ ` S ~? CU~.1=t~'TE D~S'T~L`;~o~ Sox _'~ )~ _ U 1 w•J .!~ ~ /Jh L ~}~ soil ~" n-~~ t'1Lt 1 ~Y 'c-- ~ n a o ~L_ c1 Z7.7 ~ ° ° ~ ~ ~~.! y~`~vc Sou flwR-4. P ~ ?~~ ~ YL~ Apps ~Fu..t l S7{•~ GR~1 DE ~. c ~,.4 viJ~D)-~1 F~ =T~~J '517=4i, i ~~~0~ ~~Zy .v Z~~2` A G6RE 6/j'~ ~,~.~vJ 1~l ST~1 t3v~oja A) PG _ 1i,~~ Z" O~ /~c~GRt 6R?E PT~OU~ P 1 P'E. 888- 031'72 DELPAR7D;IIENT OF INDl3STRY,' L,~BOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (ILHR 83.09(1) & Chapter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, Wi 53707 LOCATION: N'E ~/ S~ ~/ SECTION: TOWNSHIP z$ /TZ R 19E for UNICIPALITY: 1--1v~sorv LOT NO.: Z BLK. NO.: - SUBDIVISION NAME: L.E1JC~.TZ A~DlT~o1V COUNTY: OWNER'S AME: MAILINGADDRESS: ~]G7'Z ~~ ~lGw~ t'Z 3 ~ . CZ2AlK ~3F~,f..~ p A BRA`S' " - ~~"7 $ 1-~-~~.s~yv W I S~! 0 ! 6 I ISF NO.BEDRMS.: COMMERCIAL DESCRIPTION: ^Residence ~~ ~_ V~~~N~y CL1NtC New ^Replace RATING: S= Site suitable for system U= Site unsuitable for system DATES OBSERVATIONS MADE (PROFILE DES RIPT ONS: ER OLATION TESTS: Z.-`-8~ N'~~ ONVENTIONAL: ®S ^U MOUND: ~JS ^U IN-GROUND-PRESSURE: ~JS ^U SYSTEM-IN-FILL ®S ^U HOLDING TANK: ^S ,~U RECOMMENDED SYSTEM:loptional) Z-r1Z:~.,cl~S- ~rtcN Skte~u ~Lw~G If Percolation Tests are NOT re wired DESIGN RATE: q If any portion of the tested area is in the * `• ~ , unders. ILHR 83.0915)lb), indicate: GLf'c S S Z Floodplain, indicate Ftoodplain elevation: Iv PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUN DWATER-I1C~!*LQ3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH kbF, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~ ~ "').•1 I 93 1.0 -.lC~~, ~ ~' ~.~ o• 4~' o~Q•~ L Ys ; t.2,' ~ L ~ ~,3' $n ~S ; 1.7' Q r'A2~ S - o.S`I3 S SLI6HTL`1 t~ 'Z.Z'LT 8n Ybedt S g- Z 1 ~ • 1 1 ~t Z.9 • ~ f~1v1VE. , 7 ~ - t 0~8` O~c.~hL1Z ;o.g'13hL; l.3'Bn1Sw/G~; ~!J'Bhai S; 6.5"fin 5 C SuGNTI_~ DguS~~ 1. S' LT ~Bk S B- 3 ~.g' qZ.q.~' tJO)vE. ~ ~. $' o-`a' O tz61n L Ts ; v • 8' S3 n L ; o. (, 'tan is w/rGr, ; 3 . y' 6» 'FS ; o.z'Br~fs s~l~n c-y D~,s~ ; Z-o' i3h s B- '? • b ~ °t 31 • U ~ NC~i~)F. 7 ~ • ~ ~ o. $' Olr~T3n ~. Ts ; o•B~Bn L ;),$'13n k w/6-'; 3.7' 8n ~'s; 0.3'l~-, S SLt 6tIT Ly Dew s~~ o. S' bn `F B- S ~ $•~ ~ X130.9 ~~~~ ~ ~ S•~ 0.7' Dk-$n L TS ; 0.7' ~n L 1 0, U` $-- 1S w/sc/6N7 6r; .'7' 'O.S/'8r<`fS s~IGrytLY1~6~S '2.J`8n `I~s 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIO 2 P R PER INCH P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. $0~1•-tDM'1 0~4y~ ~ ,~~ ~/~E 6~ Z7~t'tDTA (-~Aw1 SYSTEM ELEVATION ~~• gz~.~-~'~~ ~a _ _ - _ _ _ _ z ~ 'J a LE TZ._sT• ,~ 9 . _ , _ _ ._ bbl ~~ _ o ~ ~, - _. _ _ e._. M ~_ ~ ~,_ . a 'o ~° ~ M ~~~ .r ~ :._ _ ~ a - ~ ~ ~ ~. ~- ~~ - ~t1 ~,__. _ _ . s,'~ . ~~`~.~ _._ - ', "tea Q~ ~ ~ A `~ ~ ~ ~ L_ a >° 7 i ass a.y \ . ~~~~-~ t~5 ~ro 6-' TZI~ u~- 5.6tuvw~p.__ tvf 3 " T2~]. v ;0~~ ~ ;. ,.... J r w : _ ~~=.t~ ~ - .~ !-(yFF~ ~.~ . ~_ . .. y s~ - ~ ~'T N 7 t ~ ____'LOClA ETCN'° r ~- , . a- __,-~-, _ .... -T ~ ~ __~. s7~• ' -~ X' - ~._ _ _ _~ r z_ ..,.. ~. _. _ ~ Q '. v , t'~... ~~;aC`~6~(S ~~ ~C~MPt~~~TIN(; =C~tM 115 - C ~ X395 ~f) ~.7C' "cl E.3iYl}".3{~'~:E' i1(7Ck ui;C;Liiii~d SCT(i'Cf;~$, ~~~t( t'E`.~iOCL i"~ ;. ,. ~. ~.. '~?~.ff)n S'E1:.t51~. "-`1K:ar~' t.` "~"EtS ;S 8 i'f?Sfi,N~tC ~ JC tJC)ttlill~t'f:,~ll ,3P"t))~C?, e,. ~ c SY~a Tt; €. ,, ~ ' . ~ a. C~, ~, bf~xfa, ~ ~ SUI~T"il>~~ { t~ HCJ' '. ONLY lF ALL C~~t~E~ SYST~ .,: !(~~D C° _ .~ :>~ C~ ~.7N SO1' )''T~I~JN;' €i. L" ~,~sE L.t;,,. tl~ ~, ~,n f~f~ t,uris ir~g ~,,. trEU~sr~ blot { left, 7. ~,A~; A L~~1J31 ~ ( ~tin:~ your t~ ~..; ,r,~. C3•.. fir) sole, is ~>refr•;r~er~. A 1SJ~cf~ = Slf1E' yc~u:° 1)ef~cPTr~~.a€~k and ::~.~~tiori refQrefTf-c= rfi_ <.~~ e[f~arlti~ SiTC~~~:~n, and Mfr! E)Ftr~s~~n~~=,nt, ~. L,(7f1 r~[e*:~ al! a~pf~r)~>rrUt:e (se)xes a ~ za, n~.r~frs, acif~r , "ti ~tfafr~ cia~ta, ~~rcola±<€~r~ tes~ €~~xerra~~- €~. if ~i1C i!"t~~ClY7TT3:'OiT (~.lf;'t7 %3~ J~ ~ ...:;uit36t1;: €{Of !"; 3 ~-. ~ !tt €. 2 i3(7~:}t'C?~?C3Ei~@? ~:)CS%; ~G~. ~r1a l<e PE3t~; E3i G' it)[-)i. ~ ~ C ... .S fE?i 4ltl k~E?C~. ~.~~_ ;_ ~..%`.~5~~ # `.rS~ l~~ ~'~~..~~ ~:~({-{ ~°t{~ LOCAL ~~11 t'~CIRITY 4~'vITHI ;", YS ~F ~~.~li~Pl_ET(C.` . HE3 L3 i~3 [:. V SA k I4..7i4R ~Cl i.mi~'t it~~ ~71.,~~~ 7 4 Il a7 'r. ~Jt)Ilv~j.~8~"84£3S and ~P.Xtllk'~'S {~~~§~Y ~'~Cn~3p~4 SC - ~~~C,Y~E' (C)V8;' .l~„i ~R -- _. LzeE;Clf"t1CK ~OE7 .._ ~,L3C)~)iE 1.s- ~~"~ `5~.i .. ... jilfilt~S€~i1f'. ffr -- rav£si {i_fr~uier 3"j Li ~ _ LirtT.^,s?<_~r:e "s _ S<;r?~i i-I~,~"J - Miyt~ Gr~:f)ru~tivzfte!. ~G __. C~c1213 Sc' J~<`1 Tf C{ ~'`~f~C . _ ~'~. ~ ;'~~€i:E? "Y18fi 5 .'_ f~(~(t.ifTt ~8i1(~ r,r - - ., _ ' ' L .,'1 -~ ~.. L~?` . "f ~~°l __ C ' ~rrt E3' 5i .~... ~,y i:_. , ..., t, _" .,. ~.. .. v ,~ .... lL1u..i< c3 1-~1ff,L .. l =~J~,1, ~J~?; ij['IT ~ <€i SC)!S aX4.u!eS vl.f,'-i ~t1f~ li`.~i23ff L'+?:9ST~e €~t:i K>L)Siif Y~i ~~ I L.l I IlG Sl UH141d'Ye 3TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~ ~ l~ ROUTE/BOX NUMBER ~ FIRE N0. _- CITY/STATE d~ ~ yy~ ZIP .S-3~~I~ PROPERTY LOCATION: N~ 1/4 _S X1/4, Section 2 g , T~N, R ~~W, Town of ~~s ~M / ST Gloi/,X , St. Croix County, Subdivision ~P„~Z H'/~Ui ~ b~., Lot No. ~- Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ~/ ~ DATE U St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Nudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address ~ ~ This application form is to be the property being developed. the permit issuance. Should owner/contractor,(spec house), completed when the property appropriate deed recording. ------------------------------- APPLICATION FOR SANITARY PERMIT S T C - 100 completed in full and signed by the owner(s) of Any inadequacies will only result in delays of this development be intended for resale by then a second form should be retained and is sold and submitted to this office with the ------------------------------------------------ Owner of property ,~~' ~.~ ~-, ~///~ Location of property__//~1/4 S F 1/4, Section ~ ~ , T~N-R_/ 9 W Township ~~l~S ~/}-~ Mailing address SG// ~~i~-~.v~-~2-- ~J m-L,r w T ~U ~ ~i, Address o f s i to , ~Gi/ L-~in.~/L--/"Z Subdivision name 2-~h.~r ~Z- Gf ~a~< ~ m-~ T Lot number o2 Previous owner of property ~~~ G-Pin-P~_ 7"~ 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 THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ~.~ 7~{GS• ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). Signature of 0 ner Signature of Co-Owner (If Applicable) ~r~ DOCUMENT NO. 43429'7 WARRANTY DEED STATE BAR OF WISCONSIN FORM 2 -1982 .. -__-_Len Company,_Inc., a Wisconsin Corporation, conveys and warrants to _. Brenda_ J,__ Bray_ and_ Pamela J. BraX ___ Isetts,__ as _ tenants in_ common! __ _ the following described real estate in St. Croix _County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record Feb. 8, 1988 at 8:30 AM . ~egistar of~Deods ~ ` ~~.~ R~~~rl ~~ib r..~.~ L RIYer ~alls, ~~,l+rClriiad ~~ ~ ~'8-l0 Taz Parcel No: Lot 2 of the Lenertz. Addition to the Town of Hudson. (Grantor hereby reserves an ingress and egress easement, for the benefit of Lots 1 and 3 of Lenertz Addition, over ~ ~ ~ the following described property: ~~~' Beginning at the Northwest corner of Lot 2, thence North 89° 37' 46" East 66.00 feet along the South line of Lenertz Street; thence South 00° 22' 14" West 250.52 feet along the West line of Lot 1; thence South 89° 37' 46" West 66.00 feet; thence 00° 22' 14" West 252.52 feet along the~East line of Lot 3 to the point of Beginning.) This ---•-is__not-------._.. (is) (is not) Exception to warranties homestead property. Dated this .........--••--•---•-•-•-•~•--~-... day of .---•- ------• ................................•-----------...---------•-- (SEAL) * ----•---•------------------•-•----------------•----------------- (SEAL) AUTHENTICATION Signature(s) --------------------------------------------------•- authenticated this ___..___day of_________ ________ __ 1 ~~//'''' ~J_ A A --- - --- --------- --------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------------------------ authorized by § ?06.06, Wis. Stats.) ....., 19,~G?. - .~'•-.'-_`-'-`•i'•-y~~----~„-'`•~'"''.`'~-1~ ................ (SEAL) * _By_:____Robert__J-.__Lenert_z_,_-President * _$y-:...-E-~1.~-~n_E=--Lenertz,- ~.-----•--. (SEAL) cretary ACHNOWLED(3111iENT STATE OF WISCONSIN t sa. --------------------- Y --------------County. Personall came before me this ................day of --------------------------------------•---, 19-------- the above named Fn Mn Irnn.n.. F.. 1... 41... ...._.. _.- . l' BOOK ~~..~f','~uE cS~.1 ~ DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -1982 ''! rNls SPACE RESERVED FOR RECORDING DATA - ~~~t ~~J I QUIT CLAIM DEED - REGISTER'S OFFICE - - Pamela J. Bray Isetts ii R@C'd for Record ----------------------------------------------------------------------------------------------------------------- MAY 171988 quit-claims to __~>~~B~~--~'---~xay----•---•-•----------------•--•---------------------------.... at 3:00 P . M •---------------------------------------------------------------------------------------------------------------- !9 Ci~Q •-------------------------------------------------------------------------------------------------------•-------- ReRiner of Deadt the following described real estate in ..............St-.--Croix-__-__---_-_-_- County, II State of Wisconsin: ii RETURN To Lot 2 of the Lenertz Addition to the Town of Hudson. Beg3lnning:.at the Northwest corner of Lot 2, thence North 89° 37' 46" East 66.00 feet along the South line Tax Parcel No :.............................. of Lenertz Street; thence South 00° 22' 14" West 250.52 feet along the West line of Lot 1; thence South 89° 37' 46" West 66.00 feet; thence 00° 22' 14" West 252.52 feet along the East line of Lot 3 to the point of beginning. .~RANSF a This ..~~-. ~~~ _.__. homestead property. (is) (is not) Dated this -------------1 ~------------------•---•-- day of -•------------ --- ... -- ----••----.........-----------••---......, 19. -------------------•--•------------•----(SEAL) --- ..---. ......---- ) ------•-•--~----•-`--•-----•- Pamela J. Bra- Isett -------•---•--......--•--•--------•-----------•----------•-•-•--•-•-- (SEAL) AUTHENTICATION Signature (s) authenticated this ________day of___________________________ 19_.__.. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ---------•---------------------------------------•---------- ....Fh....:..,..7 L... A nnc nc T77:.. ca..~_ ~ ------•--••-----•-•---••--•-••----••---•--•---------•--------------- (SEAL) s ACHNOWLED(}MENT STATE OF WISCONSIN ss. ___St~__Croix_ ___ __ __ --_County. Personally came before rae this __ 17th_ __day of --------- May--------------------------- 19.88 _. the above named ---------Pamela _ J._.Hray_--Isetts---------------------------- .,