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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GEI'!'~RAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Buchholz, Rick & Ma Beth Elliott Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ,, TYPE MANUFACTURER t CAPACITY Septic w Z a n~u~ ~ ~ ~_ F 1~,., /6b0 ~;, ~a to k,. 52S Holding TANK SETBACK INFORMATION TANK TO ~a ~ L WELL (+~LD~G. ~~~ ,[ant t' r, take -~+tiV"+ ROAD Se~~ ~ ` Aeration ---__ Holding PUMP/SIPHON INFORMATION Manufacturer Model Number`"' _'~"°°°"'~•~-~--.__ nd TDH Lift Friction Loss System H ~` TDH Ft Forcemain Length ~ - la. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / ~ DIMENSIONS 3 90 ~1' 2 SETBACK SYSTEM TO (y / /L INFORMATION Type Of System: ~ 8~ Go r..~e •..~ t DISTRIBUTION SYSTEM Of Trenches" 3 i re~c.l~~1 ELEVATION DATA STATION County: St. CroiX Sanitary Permit No: 515083 0 State Plan ID No: Parcel Tax No: 020-1314-40-000 Section/Town/Range/Map No: 28.29.19.1590 HI I FS I ELEV. Benchmark ~' ~/ 1 ~ ,~ ~ /~~ Alt. BM~t 1 _ ~ J~7 Bldg. Sewer I SUHt Inlet ~ SUHt Outlet c~ ~.~ ~- ~ Z;G /a . 9~r• ~ S Header/Man. Dist. Pipe Bot. System Final Grade St Coyer ~.,e ~ ' V eil~ ~~v~ yt,c i0: 3 9G PIT DIMENSIONS No. Of /OL• ,~ ~.~ . , / . ~S 95 . ~ ~~, 45 ys . y ~Z. 9i~. 3iG s. ~~,~5 '7, 3g 9S, `~`7 ID• 910• Z ga 9~,8 \ ~i5, I o~ Liquid Depth ~~- LUIS VV CLL L/1RC/J/RCt1~V1 ~~++v~~~~~v ~a~i..~~. CHAMBER OR ~ a ~,~ ~ /l „ „ j ./ l ~, UNIT Model Number: [lU /V J'~ U~ Header/Manifol~, /~ Distribution Pi x Hole Size x Hole Spacin\ Vent to A~ntatce Len th Dia 9 ~ ~ Length Dia Spacin pe(s) ~ 9 3 fr ~a SOIL COVER v Pressnra Svstams only rY Mound Or At-Grade Systems Only e vs~l. Depth Over Depth Over xx Depth of (~,~~ ' xx Seeded/Sodded xx Mulched B~ rench Center `7~ J~ Bed/Trench Edges ~ Topsoil ~_~~ es [] No es ~ No ~~ COMMENTS: (Incl a co a discre~ei~ies, persons presen-t,'~'fc.) Inspection #1: / / Inspection #2: / / ~L~, Location: 762 Crosby Drive Hudson, WI 54016 (SW 1/4 N~W~,1j/,4~~2~8,(T~29N 19W) St. Croix Estates Lot 4 Parcel No: 28.29'.19F.1590 1.) Alt BM Description =F`~~trs' ~av- (dOc, S "^"""'_'t'~ ~ Ns ~ i~l.~~ ~/~,,,..~~,." a~J W"'~ °-•..~ 2.) Bldg sewer length = ` ~~1,N CJ~ '~ ~ ~ ~ ~ , ~~~~ t~ 3 r a e~ -amount of cover = ~ GL~~O~.., ~ Q q (swl~-~j. Sy15ld'1`,~ . ~/ U tl Plan revision Required Lf Yes No (,, 9 ~ Use other side for additional information. ~`~"_ _ O ` _ _ _ - ~~=---.i.~~~ ( Df- ~`_ _ / ~~te ' Insepc is Sign a Cert. No. SBD-6710 R.3/97 r ~^~+~" `Tws I r 1~~ ,~ ~ ~~t( ~ ~~~t,~, bl~ `~s~- w~U co~v,..G /~~a V1D ~; G ~• l1w+l) c.,1- ~n,tadZs.~., ~+~ cr.4•.r ~ 1n~e. ~S~[. i ~ ~bSD ~~'~' Safety and Buildings Division 201 W W hi O County , ` j ~ C ` ~ ~ ' . as ngton Ave., P. . 7 ~ ~ ~ , /d t x ISCO~~ ,~ Madison, WI 537 7 'tary permit Number (to be filled in by Co.) Department of Commerce (608}266-3 .i!1~ OQ Sanitary Permit Application RECEIVED I d i h S`~" p~~~~-tuber n accor w t Cornet 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) r' Project Address (if different than mailing address) `z (oz c'QosBY j~Q; ~~ I A . pplication Information -Please Print All Info h f~ 1 So ~.~ w t T `f`ol ` Property Owner's Name PLANNING; 3 Z Mid Off zo - r& ~ ~~ ~' ~h ~ ~ ~ ~'l~ ~ d 1'n ~ (;~trcel ~ Block # !3(~F ~ ~"~ Y ` ~ ,o,- , Jt.~c ~o o s ~ an : ar o - 7 o Property Owner's Mailing Address ' Property Location ~ /S9~ ~~ z ceosr3y ~.F ~ ~E S~ ~' rL`" ' ~~' Section Zg City, State Zip Code Phone Numb er - , ~ C~~S~O~I W~ -~~Qsl~p / 7 ~gl "+ ` Z ~ Zed fq(circle e T N R E II. Type of Building (check all that a I PP Y) ; 1 or 2 Family Dwelling -Number of Bedrooms A ~yy` Subdivision Name y. CSM Number / T die ~ X ~ '/ +~ ^ PublidCommercial -Describe ~ d g ,tom ^ State Owned - Describe U e l.) - ~J 1 ~ S 2d lv E/1/ S t'i , g ;/ ^City_^Village Township of N~Sp A, III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem y ~Re lacement S stem p y ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I - l> `sT' C t (+~ o'i" sf~ `!s ZQ ~ s fo" EN s Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil . , ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ~~~~~~' r' a ing Tank ^ Peat Filter ~ AerobiL Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media r Leaching Chamber Dri Line ^ Gr$vel-less Pipe ^ Other (ex lain) V. Dis ersallTrea ant Ar Design Flow (gpd) Design Soil Application Rat gpdsf) - Dispersal Area Require (sf) 6 ~ Dispersal Area Proposed ( ~ System Elevation ~ 0 ~o ~ I z$ ~ zg~ 0 9. 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 / ~ ZSt7 ~ !/~~ s S 4/ {~ /~ ~ ~ c ~ /~ / ~of-~ s'tlt:~ L ,~ ~o ! ~ ~~ S~- S VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWT5 shown on the attached plans. Plumber's Name (Print) Plumber's Signature /~ MP/MPRS Number Business Phone,Number k~ ~^Do ~~ ~ ~~ S z~. So 3 ~ ~ i 2 - 863= 1 ~' Z 7 Plumber's Address (Street, City, State, Zip Code) VIII. Cozen /De artment Use Onl Approved ^ TIIVe Sanitary Permit Fee (includes Groundwater Dat Issued Issuing ant Signet re ^ Owner iven Reason enial Surcharge Fee) ~ ~ ~ / ZZ I~ IX. Conditions of Approval/Reasons fpr Disapproval s~rst~ul owr~f`R: 3~ - ~ }~ ~ ~~ a ~ c4 0 ~ ~ 1. Septic tank;.eftlGlnt filter and ~ dispersal calf must gll be Services! maintained /~ ~ as per manapetner>t plan provided by plumber. !~/ t .~„ rBJG ~ SQ, S~ ~ b ~ ~ ~ ~- 2. ~ ~F muses / ~ ~ ~~~ ~~ . P~~° , 5 Attach complete plans (to the County only) for the system on paper not less than 81/1 x 11 inchu in size SBD-6398 (R. 01/03) R1LlC .~UL~~olz ~ m~~y ~~~~ ~~~~o~ ~ 6 z C C~0 s b~ ~ r ~ u~ ~ Sfi Ct®, x E s-~a.-t L s L.~, ~" ~ ~j` i y 5`f ~. -~v~. ~. l . ~- ~ Lo . t~ b ' S G a. ~ ~ I/~" ~ ~p . ,;. ~ - 3 X 9 ~ ~ Tiec.H tel. g~Glk, k.~• S/~ ~n~.y /`~ `'~ ~lL1~z ~ - 3~X ~o''frcKCi,/zo ~h~~b+-i~/.z~,,~s/Zo 4 C_ ~ ~~ -~~r ' ~ .~,- O }~+~.~ ~a~ ~~ Shy ~ `~-3 3/orQ- 8~+1 t r'~h y ~~ ~ lt(. ~ Q' 1 .~ S ~+Kft: ~ 's~ ems„ 2 S ~ ;6 ~S~ ~~~ ~ o m S i V~.,~.~c..-. , uo s ~ t~ ©Q t 0 W r~bt•{ lob ~:Ifi~r ~~~ (~~~ rzso ~~- 5T ``~. ©c.~ rA u ~ ~`• ~~ ~ .1U ~ / ! ,~ I ~~ ~~•. ~~.war ~ C~PY W~L.~ ,- ~ 6 z C ~~ s b y~ ~ r ; ~~ ~ Sfi Lr®~ x E s-~a-t ~ s L.~,-}' ~' `f' ~ y s -~-~. ~ ~~, ~. ~ c~. ~a • ~nu~ ~ ~~ ~z a so 3~ 5~~8 ~° q ,;. ~ ~ ~ s-~ 34 s C- ~ o-~ ~~?~- I z ,~.`. s ~„~s l~ ~ ~ - 3 ~X 5' O Tiecti tel. +. s'YGl.~ r+T b ~? fs',~ 3 Z o ~ a ~ _ 3 X go ?.~aNCI-/Z /L ~ ~c~/-TdT°l ~~~c~ `fs br ,i ~x moo' ~~. Sh.~ ~ ~ ~' 3 3/ar!- ~ ~ ~~,~.~ h ~S~ ~,~~ 8~itr~h y ~ ~y' > ~v~l~a. Z~'~'~'Tc.~sY,7o~ Q- j ~ ~ . ~OOa>S4I ~z~ Ko S ca ~4- ~ a o o ~ rn bo~wk ,,~,~ ~ e,,.~ i ok ~: ~,-~ ~ 3 't' ~ ~^'~ P Ooh g~ ~ ~ zSo ~Ac. 'ST ~.p~.D rAUI~ ~~`^• zq' S~ ~ ,~o ~~ D~ •J,~wa Y Wt l-~ .~ ~~, DIVED SOIL EVALUATION REPORT z Division of Sat~y and _____.._ ~~~,3 ---------- ----- -~._.. ~. ~ ~ ~ 11~8rari 81/2 x 111nr~es ~ 5 T GaZo i ~, ~+dude. twt r,~ sr,ated m: ----- peroent ape. SC81e Of dimen8ions, ilOlil'18nolAl, ffiId ~OCBi QOf18Il~i` to °= °-°-°°~ -••• a _ p810B~ ~.~. O ~ O ~ /V /J~ YO ' VV ~~ p~~~tlg~fmaBon. Date t rro~on,rou ; ~, a used ror ssoona.y vwo••~ t~ ~. ~- sa (+) t~N)• G(.Ly~- R' c. /.3ucLi~iolz 3 M~RY,~F>G~ ~'//i~~" ~ ~ 5 ~`~ 'Z~ GovL Let ( ~/4 1/4 S T N R E ( ) W ores ndarese - i.. c,¢os a y ..~~ • roc # y Blom ~ sr surd. Wanre a ts~ Roix Fs~rtirFS vas s . t3o Stye ~ Ptwne t-IvDSD~ ux 5 YT~7 ~ 7 ~ 3~'/• r7a7 ,^ ~ o raT~ ~, ir{~t~s'o~u cRosl~ AQ . ~,.- ~ tse: ~ RBSiderrr~ ~ Nrmber of bedrooms ~ ~ coae a~+~a new ~re - j, ~ o ° cpo a t or oorrenerdei - - Parenc rrr~erla~ /ors eu~?IC' SrIN~? oyf~ X1.51,. ~ooo ter, won ~a ti R -~ '°a'.'~'~ : 1~ ~ Qo~1R Ms 1~-~-/a'~'c~.. RECEIVED a - - ~ ~~~ JUN 0 4 2009 .~ o ph Ground surfaoeelev. - R 0I • tD factor ~l y,[Irs zonilntr3 Rate Horlaon ~eplfi Dorrrirerk Redox Oesaiptlon Tezbure Struchrre Corrsistenoe Botxrdary Roots in. UArr>se~ tlu. Sz Cart. C.alor Gr. Sz Sh 'Cf0l1 'EtF1R2 a 8 /o yR 3 ---_. s L 2M, s6~ s ~w ? nN . ~o .. ~' ~ • 3 7.5 -. S~ ~ a.,,s .- . • Cv O~ _~oy~ 7 1~1 Ci1'f' ~ . . , ~ ~ r?l sa- d / '_' -- ~ , `7 /. ~ Q O eorln~ " h3 ~ * . o ,~ x/12,. ~ ~ 3• ~ pit Ground surtaoe elev. ti , 0 ~ ~ sw ~ Moriso n Depth Dortrbrarrt Redact Desaiption Texgxe Structtee Come Boundary Roots GP OII! in. Munsep Glu. Sz. Coat. (.alor Gr. Sz Sh. `Et~1 •Et512 / o• /OR~3( -- Sc. z~s S c~ Z~ .~ .. Z /0 ._._._ ~ L 5 W --- ~s o, s w - . ~ i ~ _. ,vr„e .~. ~, • tBlluerrt #1 = BOD > 30 _< 220 mall. and Tss >34 _< 150 myl. • Etrn,ent #2 = BOD < 3o TSS _< 30 rrglL . ~~~~•?~t~ ~IGG~T~ ~ i~G '.7S Addie~ Oats EvaN.rr6on Corrduc6ed Telephone t:uri~er Ulbricht & Associates M 2 • ' p '7~,5. ~~~, 34~f Z.. P' ~" 2812 10th Ave. Spring Valley, 1AF+-54767 - ,~tF' ~ so~~ ~~~ ~ y - ~xrsri sysr-~.,. ~s ~ ~ov~. __--- r~~~~- y A ~~ v~ . R • ~~ • ~3~ y. yo 1 3 ~ ,® G~o~d su~ace ele,,. /~ % T ° ~ o~~ . ~,, ~ . //D ~,, Rate Fiorlaort Oeplh OoMneM Redoa Desaiplion Texlue Structure Commence 8oundeuy Roots GP OAE &~. , : MunseN flu..3z. CoM. Colox fax. Sz Sh. '~1 'Efl~2 o•io ~o yc --- G ~ ~Fs6~ s ~ 3-F . ~ Z 0' ~ -- L fS ~ . .S -- SL f sh s - y . 7 ~.s ~2 ¢ g - [,S p cs - .~ - v / G ' ~ ql/ - p.7 /.~ -r ~ ~. f•It wv.ww.aw~awcwv~. .w w•apw. w w.wwy wawwn ww Horizon Deptlr Dom~nt Redooc OesoripBon Texture Sduaue Coroe Boundary Roots f h 11Aurrse4 ~. Sz Copt Colox Cx. Sz Sh. 'E1~F1 '~ .1 - SG -f'Sb f tc~ .: 3 •s S - ~ sc. cs - •~~ ,, s ~ ...._.- o c - ,. •~ o ~ s ~ ^ ~ ° ~ ~ Ground sutfaoe elev. R 10 fackox in. SoA Rake Hodson DapQr Dorrirrar~t Redorr Oesaiptlon. Texture Stnrr~ure Corrsiskerroe BotrrrdaKy Roots GP WIf in. Mrrtser Qu Sz. t;,aR Cobr Cdr. Sz Sh. •E1f#'I 'E.1~12 BgUig # ~~• ~~ Crwmd surtaoe elev. , . '~ ~ ~ePw b factor in. SoA Rake Horimon p~ h, ppr~t Redox pespiption. flu. Sz Cant. Color Texkure SMwirre (Y Sz S'tr. Caariskenoe Borxrdary Roots 'E~i1 . ' . h:~~ ,.,ti R ••,~~c~~d~Z ~ . 13~ y, yo oaJ /~ Property Owner ~ ~ /~~ D Paroei ID #. Page ~ d ~~ # ,® pi `Ground surface elev. ~~ / 7~ Depth to 9rr~tg factor //O , &r Soto Rate Hortaon Depth Dominant t2adooc DesaipUon Texture SUUCiure Consistence Botmdaq- t~ GP OA! &r Munse9 Qu, 3z ,Cont. Color Gr. Sz Sh. •E1f#1 ~f#2 .S -- SL f sh s - • `~ 7 ,t rt ~ .._ , Pit Ground surface elev. R Depth to 6ndting factor in. Soil Rate # ~ ~~ Horizon Depth OonrirraM Redox Oesaipl<on 7exhrr~e Struc~rrre Corss~terrce t3orerd~- Roots GP Dfit~ Ur. Munse9 Cltr. Sz Cont. Color Gr. Sz Sh. - '~1 '~ ~, _, 5L ~•Sb n,K f c,v . ~ , , 3 •S S - SL cs - -7 ~, S ~ _-- p C - ., ~. D 7 S ~~ ~ ^ Pn Ground surface elev. R Dep1t, to thrrll~g rector in. ^# ~ ~ Sag Rate Hodzon Depth Domirumt Redox Description. Texture Struciune Oarmiseerr0e Bourdery Roots GPDAE irr. Munse9 Qu. Sz Cant Color Gr. Sz Sh. 'E!f#1 'E1~2 ---- r--i n . _ . U ~~ ~ u Pit Ground surface elev. n t7epm m rmrorrg raavr "'` 309 Rats Hbrimorf Depth tr. Donrinertt Munse9 Redoor Description. Qu. Sz. Cant Color' Texture Sfrruirrre Gr. Sz Sh. Con~enoe Bormdary Rooms '~ ~ . c , , o ~ , ~ ~ c ~ ~ . , ~' ~ ~ ~ w ~ ~ . y h d~~N ~ ^~ dy~z~~ ~~o`~~~ ~ y b ~ .~ ~ ~ rn h u~~s ~ ~ v T Gi,~~ M~K~v ~ Z s ?~ • \~ \ ~ Q--~~. ~TJ T 'T O \ T~~ ~~_,`` '~1,v1 1 ` ~ -fa- 4 ~\ ~`-~. c~ c ~ ~~ ~ Z ~ -. 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N' Y v 7 ~~t~~ ~~~ :T ~ ~'~ mu I e>71ma ~.m ~11m~~iii"aG~l'~ ~ ~ I Nr0'N9 11'Y 1 :~ ~. ~;-. _ _ ,~ . r .. ~~. _-.. ...._. .. _ ~. .......-.. _.__ _ ._.. _. _. _._..__...,-_.,- r .."~ .a fl ''~"' -~~ 7 <' ~o S .~8 06/22/2009 11:46 7156475181 h3" a X N D rh ~ ~ a C Z ~ C ~ n ~ ~ ~ w ~ ~ ~ O © ~ •-•I -i D z o z~ m ~ cn ~ c ~' o m S, X N `~ m f*1 Q m v ~ a o to z n ~ { ~ ~ v z O O n ~ m m ~ Q r~ m -a r~ Q J WIESER CONCRETE 84" n II -a O v r~ I u 7 r O r 4> .~ a ~ ~ ns~ Z ~ ~ orr-~ v ~ S_ 2 u ~' ~ z 4 0o y. r i ~m N of V ~ ~ C NQ m ~ ~ N r ~~ z ~ ~ zz ZI ~ M ~ p m Cm v ~~ Cm Q ~ i ~ r b rn Z r m PAGE 01/01 Z ~ r ~ m m G~+~D ~r~~~~~OQ~vi uDi ~v ~QO~~~zr'~+»~z ~C7 ~O 2~~2~6-• N map -+ ~" =~0~- ~ ~Im ~WApON;~ N W A "p O b p ~ ° ~ r~ r~ O n o~ m ~ --I rn n O~ z m~ ~ ~T1 r 7D N m SAM MILLER HOMES scAL~:i 4" _ ~' ~ Q ~ wLP65d 1000-MR W~E"E~ concR~rE o ~ DRAWN 9Y:SWT p z wJ71~ U$ HW'l10. MAIgE~ ROCK. WI 54750 DATE: 6/7.2/49 \a 800-325-8456 FILE:seetie tanks zc REV N0. Hanes BATE: r a f- "' I O C m COMBINATION SEPTIC(DOSE CHAMBER TANK & PUMP SPECIFICATIONS Access Opening, not top of cover, Access Opening, not top of cover, must erdend to a pelnt no greater must erdend at least tha "Below Finished Grade ___ 4"Above Fin s v1J~ATNlrR PRo~~• ~~ ~; ---- t.-.- '~ _.. _ _ _ . . - _--...__-- ----- -~ -- - i I ~ ' ~, ~ 1u1.1. rl z. 3. y z ,. I,, ~GQ`5~ aP~^~tiy ~,r Ltis~1 ~~i6 'ir`` - ~ -~ 2~r ~~~ ~o2CarMAN Tn~~ ~~'I~ ~~ (~>'~~ GAl ST ~ D 60 5'a l lam- G . ,. + i ~/~,,PVG S~EE~~ ,. '~ywk ON ZO S OL I t) S o r g 3~ G :nN ~Z sra„~ p:p~ - - ~ {~~F .k--J D 'p~~; 3 " .Sa.-~ d o r q r~ ~ 1 ~ h_ q u n ~e (-~ c~ i ~,' C'¢ n,~r olue r ~u h ~~lc~ ~s Two Compar ment Septic%Pump Tank /~ ~ Gl~'2i~~' o n ovfs~'de SGU~c /LS j ,` : ~ l .J SPECIFICATIONS TANK MFR: j ~ ~ ~ S ~ (~ DOSES PER DAY: TANK SIZE: SEPTIC CoS''~? ~ ~• `GAL. '~ DOSE VOLUME: -- ~ ~fl GAL. DOSE r' ~®b GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: Zo ~ ~~ r `- ~ S.'2~ CAPACITIES; A = INCHES = V ~/~GAL. MODEL # S'3 Switch type: B = _2~INCHES = Sz,~O GAL. ~] PUMP MFR: 20 I(e~/ C = ~ INCHES =~`~~• 5~ GAL. MODEL #: SWITCH TYPE: ~(~-~' D =_~INCHES =~03-2 GAL. REQUIRED DISCHARGE RATE ~~GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e). vERTICAL DIFFERENCE BETWEEN PUMP OFF•&~DISTRIBUTION PIPE (LIFT) _ _~ FT. MINIMUM NETWORK SUPPLY'PRESSURE (DISTAL & NETWORK- PRESSURE) _ + ~FT. ~_~FT. OF FORCEMAIN x ~_FT./100 FT. FRICTION FACTOR ....... _ + ~Q ? FT. ,, ~~ TOTAL DYNAMIC HEAD (TDH) _ - FT. INTERNAL TANK DIMENSIONS; LENGTH ;WIDTH ;LIQUID DEPTH T\~ /MPRS IGNATURE:~~~1~ ~ LICENSE NUMBER: ~ Z ~~ PUMP PERFORMANCE CURVE PUMP PERFORMANCE cuRVE 'PUMP PERFORMANCE CURVE SUMP /EFFLUENT MODELS EFFLUENT MODELS 318', 112" 8 314' SOLID PASSING CAPACITY ' 318",112" & 314" SOLIDS PASSING CAPACITY 13 191 MODEL 48 53155 1 57159 72 76 90 1371139 1/014140 151 152 153 0 0 0 16114181 16314163 16514165 1851/185 186/4186 16814188 18914189 191 Gal. Liles Gal. Liters Gel. LAen Gal. LBen Gel. LBen Gal. Lion Gal. Liles Gnl. Dien 100 379 61 231 81 271 58 220 115 519 145 5/B 15 170 '~ 93 351 61 231 81 131 58 110 110 530 140 530 15 170 85 311 60 227 81 131 58 110 131 507 135 511 15 170 79 299 59 Yt3 BD 227 SB 210 128 181 131 198 d5 170 70 265 57 218 58 223 58 220 122 181 125 173 45 170 82 235 55 Z08 58 220 B5 322 SB 220 1111 439 120 151 45 170 IS 170 46 172 55 106 70 285 58 220 104 391 109 113 d5 170 ' 20 76 33 125 50 169 51 193 SB 220 90 711 97 387 45 170 _ - 15 57 39 - 148 32 111 SB 220 71 28B 85 722 /S 170 23 B7 9 34 52 197 51 193 89 261 45 170 _ _ - 10 3B - _ 15 170 16 106 51 19] d5 170 _ _ _ _ _ - _ - 31 117 2 8 3• 129 45 170 - _ - - - 18 BO 17 84 b 151 ' _ _ _ _ _ / 15 _ _ _ _ 70 114 _ _ _ _ _ _ _ _ _ _ _ _ _ 20 76 10 38 56 R. 17, im 86 rt. 20. im 89 A. 28.dm 73 R. 22.3m 111 R. 31.7m 91 R. 27.Im 110 R 33.5m 137 8 n.8m 0099228 A CAUTION Model 185/4185 should not be subjected - to less than 30 feet TDH. • NOTE: For Pump Performance on Model 112, Industrial col- 150 - umn ex losion roof um ,see FM0219. 2' 2 2' FLOW PER MINUTE Opggp2A n U ti Q Z 0 I' 0 ,. 151 ~ SEWAGE AND MODE t 211 264 266 267 268 270/4270 282/4282 284/4284 292/4292 293/4293 294/4w9a 295/4295 ~ _ w r..l en u wl. u1.~ col. 1,m wl. 1.. w1. ul.," w1. u~ wl. w.~ cm. u.,. wl. w.,. cm. 1n... ca. u.n r . .., ca. ,.1«, • 5 L5 81 ]10 AU ]u t1B 185 Il8 181 138 n1 I]2 500 12) .B1 I)9 8)8 110 SJO -' -- 198 A2 P1 810 F ~ D EWATE RI N G 10 J.0 SJ 201 60 22) BB Jl) 89 J]) B9 J}) 101 ]61 96 ]8J 15) 591 IN 189 -- -- IB1 685 99 )SJ 6D IS 1.8 ]3 III 3] B5 b IBB 50 IBB 50 189 ]) 191 61 112 IJ} SOJ 108 bB 118 M) 185 635 1& 698 30 6.1 10 ]B 10 b 10 )e 58 212 N ,2a n6 101 91 ]u 108 q9 1'A 56B 16B 83fi ' I 24 ).6 -- -- -- -- -- -- -- -- -- -- 29 110 8 23 13 2)8 ]5 281 88 383 138 515 131 581 75 ' JO A.1 __ __ __ __ __ __ __ __ __ __ __ __ __ __ 12 159 54 311 82 110 121 15A 110 530 35 10.) __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 3] 115 85 218 1 b9 118 1B] -~ 10 II.3 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ t0 b n IB3 91 J56~ tt5 1 1]5 . ~D __ _ ', rt -~ .~ -. _ 50 60 15.3 IB.3 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Y IJ lNl 19 B9 59 3J) ~1y 1 ~ 65 ~ ul-oi l Nwtl~. 19.5 I1 . S.Bm 18 I1. S.Sm 31.5 11 . 6.em 31.5 I1 . 6.6m II.S 11 . 8.em 39 I1. B.Bm 26 R. ].9m 35 It. 10.)m 11. 1l.Bm 50 11. 15.1m 83 It. 16.9m ]5 !1. _ _.J 11 9my~ , 60 -' 55 i ~ I -1 -_..._ I ~- I i - ~ i 0099040 -i SD _ ~, 45 4D ' 35 - - - _ 1293 ~ I I __ ~* ~ . -+-- ~ ~-- I ~_-_ -~---~ ~-fi--fi - ~ - ~ ~ ~ l ---~ ~ - UMP PERFORMANCE CURVE . 3D I -t -- SEWAGE MODELS 1 25 I I ~ 2" SOLIDS PASSING CAPACITY ~ 20 266, 267 282 270 - 15 10 i 5 I A CAUTION Model 293/4293 should not be i 211 264 292 284 294 295 subjectetl to less than 15 feet TDH. ~~ ~~ .+~ ~~ ~u vu Iv ou yu IvV I IV ILV IJU I4V IJV IOU I/V ItlU I9U CVV LIU LLU LJU ~+~_ Tom"--__-~~T. 0 BC 160 240 32C 400 480 560 640 720 800 Oo99oaABLK FLOW PER MINUTE © Copyright 2003 Zoeller Co. All rights reserved. 6 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer b ~ Z- / ~'c 1~t/~i p~ Mailing Address ~ ~ Z CiC. D Jr ,B ~ j} li y ~ Property Address ~ ~ z- ~ ~ ~ 8 513 ~ ~/ ~ / ~--/ (Verification required from Planning & Zoning Department for new construction.) City/State ~~dsoti wt Parcel Identification Number OZa • ~ ,3 / 7 ''' ` ~ ' ~~ a LEGAL DESCRIP,/TION ,~/ _o Property Location 1 ~ ~ t/a , s ~ t/a , Sec. Z 9 , T Z~ N R~ Town of 1~~ CIS a h Subdivision 57. C-~ o'~ ~ .~ S~~.t-E"Q. 5 ,Lot # Certified Survey Map # Volume ~ ,Page # Warranty Deed # ~~ ~- ~ ~ 3 3 ,,Volume ~~ ,Page # ~ L Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumbetr, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the. Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. S~GIVATURE O ` PPLICANT(S) DATE i *** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION OwnerR.ctiard ~. $~tih.lz /~~ $~ F~(~~-F- Permit # DESIGN PARAMETERS Number of Bedrooms (p ^ NA Number of Public Facility Units ^ NA, Estimated flow (average) ~~ al/da Design flow (peak), (Estimated x 1.5) 90D gal/day Soil Application Rate ~ gal/day/ftZ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA * Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity (~' ~S"p al ^ NA Septic Tank Manufacturer ~.iSd~ ^ NA ,Effluent Filter Manufacturer ~oI Io S-Z~ ^ NA Effluent Filter Model ~Z.'s ^ NA Pump Tank Capacity ~d p al ^ NA Pump Tank Manufacturer ttJ ; ~ s ~,i ^ NA Pump.ManufacturerzQ,m,((Qf ^ NA Pump Model '~ AJ ~ 3 ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ,3 ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurize d) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event - Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 ears) ear(s) y ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once ever y' ^ monthlsl -3 ^ yearls) (Maximum 3 years) ^ NA Clean effluent filter ~ At lest once every: ~., 2, ^ month(s1 Sa year(s- p NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^yearls) ^ NA other: At least once every: ^ monthlsl ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. ' 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 cellls) in one large dose, overloading the cellls) 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 over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater 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. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33; Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings 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 o- 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 utilised for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to 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. 1^ TL.. . L.. . L~~...e . N a :; ^ 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 OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ ,r ~ pKd, ` Phone ~,~ Z- g~5= ~ 9Z '~ SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name 5T L lC~~ v,,~ i't ~ mot. Phone 7~s- 3~p ~~ This document was drafted in compliance yvith chapter Comm 83.221211b)11-1d)&If- and 83.54111, 12- & 131, Wisconsin Administrative Code. START UP AND OPERATION Page _ of For new construction, prior to use of the POWTS check treatment tankls) 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 tankls) removed by a Septage servicing operator prior to use. ' 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 over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater 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. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33; Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings 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 utilised for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to 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 andlor soil (imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~1 ~ The - '--- -- '--erg-evel~eted-->:e--ide ^ 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 OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ e, l Ovla~ Phone ~,~ Z-S~S= ~~L SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name 5T ~' ,` r1~ n : ~1. Phone 7~~" ~ ' -~p This document was drafted in compliance with chapter Comm 83.22(2i(b)(1)(d)&(f) and 83.54(1), (2) & (31, Wisconsin Administrative Code. Polylok PL-525 Support Stand Should you feel it necessary to add addi~onal support to the PL-525 filter, use asix-inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The exte~ion pipe needs to be anchored to the filter housing with one or two #10.X 112" SS screws. Anchor 1-2 Stainless steel screws through housing and into pipe. Use #10 X112"` -- 6"Schedule 40 Pipe Pipe rests on bottom of tank 06/22/2009 10:42 7156475181 WIESER CONCRETE aw-099 oootdua~~ 958-5Z~-008 it ~rori ~oµ^''" sn •~ a sooz xaNnNVr :ova o9tti~ w~ nn nn n iMS.~.a NMVaa ~13~YYDY ~ ~ ~~~~ ~31d0 'ON ~3t~ •~ _ .i 1~3N05 W J Z ~ W ~ ~j N ~ d O J w~w 7 z ?O a as O W ~ V Q W !- ~j W~ ~ C5 X V ~ F N ui m p~Q O , ~o~ n Q ~. ~ 7 W ~ 7 4 m O p t Z T ' Zx ~C F- Q W ~ 7 ~ .C~ ~ a0 o ~ O < C 4W m~ a - U ~w ~WW .a c~a~ ~ z ~ z o W O U ~ O Q _ ~MJ J~ W ~OV7 m NO O o 7 ~ ND Q r N Ww N ~ N^ ~ Z 1 V W _ N'-l h p ~~ ~H~yJ1~ O] ¢ J~ O W,4 ~~ W Q Z~ ~~ ~_ Z W= 7 J ~ M ~ ~Z J ~Vl~'• U N S 3 2 0~ =47 p~k~'zc~z ~~G?~ p ~ „ oU~ ¢` ~ ^~~ ¢ ° d U O z InJA s '`tz ~ v ~ Q H :~ w ~ ~ J Z Q ~ Z ~ Z J J W D_ O --cr c~ ~~ u „48 ~\\ C~ ` , v PAGE 02/02 BQOZ 'N`df '/~~~1 0\ p ~ l'df1NdYV ~11d3S ~ o y O \ 2!W-OS9 0006d1M Z d 0. N 0 a O a z a w _ ~ ~ ~ ~ m F N a V N O X 2 4 H r w O 't I iti I H Z W W W ~ ~ U O O U ~ N_ I F U U r N 2 Q O U ~ O (''~ W W N V 5 W N O U W Nm ~ ~~ O la- U O ~ Y N z OF U 4 ~ ~ N ~ ~ ~ V C 4 N `1 x H W W O J z `r „£4 ,~~5 yi.i ~J~JPAGF ~~~ . ' ( i J STATE BAR OF WISCONSIN FORM 2 - 1999 I Document Number I WARRANTY DEED This Deed, made between Lynn S. Stillwep and Deborah L. Stillwell, divorced and tanrelr~arr Grantor, and Richard J. Buchholz and MaryBeth A. Elliott, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): /~ ,~ 6249~~ KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECIMtD 06-16-2000 9:30 Ali MARRANTY DEED EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: 1020.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area Lot 4, St. Croix Estates in the Town of Hudson, St. Croix County, rvame ana xenon AaQress Wisconsin. /~/i 020-1314-40 Parcel Identification Number (PIN) This is homestead property (is) i~Iao Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ `T ~^ day of June 2000 . AUTHENTICATION Signature(s) Lyon S. Stillwell and Deborah L. Stillwell, husband and wife / ~,~ authent"catyd i ~'i Y` clay of June , 2000 . Kristine Oelan TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § '706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI Oi6 (Signatures may be authenticated or acknowledged. Both are not necessary.) ~ L n . Stillwe « Deborah L, Stillwell ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. s Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: -) ofpersons signing in any capacity must be typed or printed below their signature. h,rormwion Woreasionab company, Fonda„ eac, WI STATE $AR OF WISCONSIN aoosss-2o2t WARRANTY DEED FORM No.2- 1999 ~, .. Q o ,y ~ v o a a 0 0 N h O r '~ tr Zt •~ O N • N O O ~ tx, C~ ~I 1 ~ ~ ~i O e~ r`~i +~-, r A O Z Z ~ rn N F- (n O Z ~ .J ~ ~ m Z ~ ~ f"` ~ w M W x 'o U c~ v w m a ~ J U O p O ~ O ~ ~ H c 0 O' N -O 7 O N = °r' at a a m ;~ L ciao ~ 3 o O ~ ~ O I I I N N ~ I c ~ I N O Z ~ O v I 'a Z ~ C N lL c l0 O O) Q ~ ~ ~ Z y I ' ~ ~ a m ~ ~ c T ` 'V W C O (O N C ~ U ~ N m O ~~ = y I N ~ ~ C O O O ~ O d f L 'r'+ O R t6 N ~ O _N I Z S Z O Z ~ Z I ~ ~ I .. d1 C. '~ ; (6 U ~ ~ `~ ~ ooa ~ ~ ~ ~ a a I - O O O ~ a a a ~ ~ ~ a I ~ ~ ~ 2 ~ rn rn -O j O N `~ R 0 0 0 O O ~ N N N Q O - -p N p f~ ~ O ~ m O ~ ~ ~ 'a ~ .~ O 'O ~ Q ~ (n f6 U ~ `,g ~ I W O O O) ~ N O N N ~ ~ c I U d ° J a~ o 0 0 o ~ 'O N N N N y C C O) ~ ~ ~ ~ - \ C O C ~ y 7 N N N l 3~ y j ~ c ~ L ao v v v N !n M O O V1 Z N O ~' p -~ t0 V ~d' (n a+ •~ y a L` I c :; 3 ~ O ( U r l- ~ . ST. CROIX COUNTY ZONING DEPARTM t AS BUILT SANTrARY REPORT /~ Owner ~` ~1 WQ~I ~(Jj Property Ad ss 3 9 ~ 9~ ``_ Ci /State 5 ©~ `"' ty ~_. S' ~~ 111 R~c~iVEO A<~ E ~ _ ~ ~9~9 ~~ x .~. ~~ ~' ~, ZnNiNGQ~¢If.E, ~ i Legal Description: i „~ Grog -f ~.TTr~.:._._ ~~ Lot ,~ Block _ Subdivision/CSM # .5~ t/a ,q~'/a, Sec. ~ T~N-R~W, Town of .~[ „ nc ,, PIN # - SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: _s,v_ Tank manufacturer ~-/ tn~_ Size ST/PC ~ ~d~~ Setback from: House a3 d Well ~ P/L ~'~' ~ Pump manufacturer -~-' Model - Alarm location `-~ (HOLDING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location Vent to fresh air intake Water Line SOIL ABSORPTION SYSTEM: Type of system: ,~ ~ ~rr~, Width ~ ~ Length ~-5 Number of Trenches o2 Setback-from: House ~. Well N ~ P/I, as Vent to fresh air intake ~~ ELEVATIONS: Description of benchma Description of alternate Elevation ~~ Elevation Building Sewer ST/HT Inlet 9 7 33 ST Outlet 9jo'~ y PC Inlet -~ ,-.~ PC Bottom ' Header/Manifold ----mop of ST/PC Manhole Cover ~~ ~ ~ s Distribution Lines () `~' lv. ~.3 () C! 6 ~ ~~ ( ) Bottom of System (j) ~-S~ ~ (~ `~5 , Final Grade (n 99~ ~ (~ 99, ( ) Date of installation ~ ~~ Per nu ber ~a ~ State plan number Plumber's signature License number ~~J~'.j~ Date k~'6l Ins ector~ ~,n...". Complete plot plan ~ •kl~ ~ ~~~ ~.~ ~ ~ ~ ' ~ si ddb . ~ ,+ ,~ r NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 1, 1y ~ i b~` b INDICATE NORTH ARROW .' V TANK INFORMATION X7.1_- ~ TYPE MANUFACTURER CAPACITY Septic ~ ~~. ~ Sf~ Do ' Aeration Holding '~ ~~' TANK SETBACK INFORMATION ;,~~,~,~~,~ TANK TO P/ L WELL BLDG. vent to Ai f~IrrESR'e ROAD Septic ~ ~~ ~ tL ~'~ 3 ~ NA D A Aerati NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model N PM T Lift Lr SYStem TDH Ft Forcemain Length Dia. Fi ELEVATION DATA untyST . CROIX nitar~P~~ttPjl~: ate Plan ID No.: rce110>~r1314-40- A9900044 STATION BS HI FS ELEV. Benchmark • Q - ~O~ Bldg. Sewer ~'~ ~~' ~' ~/ Ht Inlet (~, 2 ~- S ~ Ht Outlet ~ 2.. ~ ~' D Header /Man. Dist. Pipe Z ~, Bot. System ~ ~ ~ ' ~ Final Grade ~bd ~ d y~~~ SOIL ~~PTION SYSTEM / ~ ~,(~ ~,L1 ,, ~ BED TREN WidLfL / s Len th ~ No. QLTrenches ~ ~ PIT No. Of Pits Inside Dia. Liquid Depth DIM N DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Man fa !u. SETBACK INFORMATION Type O R B Mo el Nu er: System: V 7 Z 5 ~ i ~ ' T OR UN ~ ~ 6/ DISTRIBUTION SYSTEM ' ~ Header /Manifold ,~ th 6r Di L n ~ Distribution Pipe(s) L n th~~~ Di ~'~" S in ~ x Hole Size x Hole Spacing ~/~ Vent To Air Intake ~ ~ g e a- g e a. pac g / O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 28.29.19,SW,NW 762 CROSBY DR - S`PY,. CROIX EST. LOT 4 i ~ 33~ o~ b~~ 5cr,~~r l~J ~ Sys a~ca ~S way du~ ik ~~ 4/r3~f I~ to; ~~b l~,r `/2`"e~rr~wl,~--~, ~atw;l/ ~ y ~1~,~d t~<~ ~ra( s'~µ' .~...~t~ ~Sf C~,xr 5~.c,.~ c e r >~ Ue~f' ~ ~ Plan revision required? ^ Yes ^ No ~ Z J Use other side for additional information. (' SBD-6710 (R.3/97) Date ector's Signat re Cert. No I WISCGnSIn 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 L~Qv, s.15.04 (1)(m)]. Safety and Buildings Division i `~ CO - SANITARY PERMIT APPLICATION PoBow302ngtonAvenue s ns~n In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the sys ss County S ~ than 8 tie x t 1 inches in size. / ~ ~ ,v • See reverse side for instructions for completing this ap Ion ~FC `~, ~~' F r State Sanitary Permit Number 3 a ~g~ /yf- Personal information you provide may be used for secondary urpose ,,,~ °~(!r~ O ~P ~~.. Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). ~/„ 1 G'/`Cl_ ~• ! {,p,,~ ~ ; ate Plan LD. Number I. APPLI ATI N INFORMATION -PLEASE PRIN 1 Property caner Name ~ ~ S, Lv ,iZ. pe Loc I , t is N y14 T aq' , N, R 19 E (or Property O er's Mailing Address.t ~ ~ 3 Lot Nu 2 Block Number, , pity, St to ~ ~ Zi Co e ~ Phone Number Name or CS Number ~ ( > ~ S ar. II. F B ILDIN (check one) ^ State Owned It Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ vowan OF ~~ III. BUILDING 5E: (If building type is public, check all that apply) Parcel Tax Number(s) Z~- Z-(. /(,~. /~.f+ 1 ^ Apartment /Condo ~ ~ ~ ~ '` O 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) ,q) 1. New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an -__System ________ System _____________ Tank Onl~r_____-________ Existing System ________ Existin~System - B) A Sanitary Permit was previously issued. Permit Number 3Z~ Date Issued Z, - V. TY OF 5YSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other ~~~~ 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 11 ^ Seepage Bed // //-r ~ 12 Seepage Trent ~ ~ 22 ^ In-Ground Pressure 42 ^ Pit Privy (7;k~ SJ ~ G~ iJ~ Gt r 43 ^ Vault Privy ~ 13 Seepage Pit ~ 14 ^ System-In-Fill 3 X = 2~ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade ~~ Req ' ed (sq. ft.) Proposed (sq. ft (Gals/day/sq. ft.) (Min./inch) Elevation ~ Feet , Feet VII. TANK INFORMATION Ca aclt jn allOns Total # of r Manufacturer s Name Prefab. Site l S Fiber- Plastic Exper. N i E i Gallons Tanks Concrete tee glass App ew x st n strutted Tanks T nks eptic Ta or Nele}nx~Rcr , tQ~ ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI b is Sig atu : (No tamps) MP/MPRSW No.: Business Phone Number: t S } r- ~~ / ~.+ C ~~ - ~~J~~J Plumber's Address (Street, City, tate, ~ Code): T ~ ~ C1 1 .1- $t.J IX. OUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit F e (Includes Groundwater at ssue Issuin ent n ture (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) SO ~ ~ ~~, ~~ ` Adverse Determination / X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS r .. , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration.date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399). to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must~be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal-description and parcel tax number(s) of where the system into be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VIJ. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and. holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix,(e:g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only.. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submiti?e~fto~the county. The plans must include the following: A) plot plan, drawn to scale or with complete`dimensions, Iocatid'ti of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump orsiphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump:manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~~~~ ~ w~ n~c7 -! 3i ~- ~~ --o°o S ems.. i r ` ,~ Coo ~ ..~ ~ m Top rrr Fow~d~c~"~~ vnn Er ~ Oo ° a ~o~ ; ry ~" ~o-S3.7 NQ~ £~' I d D ~ t`~~ ~t ~ 0 90 ~ 6ur S'~ ~ ~ ~ ~rr~- 44e~ .. Wisconsin. Department of Commerce SOIL AND SITE EVALUATION g ~ nDivisiori of Safety and buildings Pa a of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County T include, but not limited to: vertical and horizontal reference point (BM), direction and S 1 ~ r~~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # O ~- I31 - ~ -cx~~ APPLICANT INFORMATION -Please print all information. Rev' ed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ /2. -/ • Property Owner Property Location S Govt. Lot S~ 1/4 N W 1/4,S g Ta ~,N,R ~ 1 E (o~W Property wner's Mailing Address Lot # Block# Subd. Name or CSM# 9.3o Q ,~ ~~ IU ~ a+1 ~~ Cc~o ~ s ~. ~s City State Zip Code Phone Number ~ Nearest Road City ^ Villa e Town ~i1`C - N N S50 ~ ~ _ ~4~So~ ~ ~ rc~Sb,~ Dr, New Construction Use: Residential /Number of bedrooms ~_ Addition to existing building Replacement Public or commercial -Describe: Code derived daily flow ~„/ gpd Recommended design loading rate i ~ bed, gpd/fit ~ B trench, gpd/ft2 Absorption area required R5 3 bed, ft2_ r Otrench, ft 2 g g _~Zbed, gpd/ft2 z ~ trench, gpd/ft2 C~ Maximum desi n loadin rate Recommended infiltration surtace elevationc(s) / 5 • '' (as referred to site plan benchmark) Additional design/site considerations ? 1 h tcy~ 4 rc~e ~}abc G',f.~c~3Y~ Parent material ~~~~ l~ ~ ~ ~ Flood plain elevation, if applicable ~~~-ft S = Suitable for system Conventional Mound In-Ground Pressure rade System in Fill Holding Tank U = Unsuitable for system ~ S ^ U ®S ^ U ~ S ^ U `~ ~ ~ U ^ S ~U ^ S ~J U SOIL DESCRIPTION REPORT Boring # i/ Ground elev. ~~Lft. Depth to limiting factor ~in. Boring # a Ground elev. . ~ft. Depth to limiting ~/f~ :., Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ 7-d~ o - s ~m s bk Pt1 f r ~ a,~.~.. ~ S ~ .6 3 sa /o r - ~ 0 ~ - ,~, r8 --s3 ~s ~ ~ 6 ~ f s f* ,3 ~,~ S 3 /M /o r d `-~ s p ~~ -- . r 8 Z ,0 ; Remarks: ~1 r ~r ' Q., .L.. . v u ~. r rcn rai rya. CST Name (Please rint) Signature Telephone No. a ` ~ ~r~s S /.3S Address ,~~ Date CST Number ~ ~ v -~- N~e~~ ~ on~ ~-i s d~ 7 S3 PROPERTY OWNER ~~n -~ ~~' ~~`1,.~~11 SOIL DESCRIPTION REPORT PARCEL I.D.# (~ p~ D ° ~ ~ 1 y - ~~ "~t~'-' Boring # Ground elev. ~D/. 3 ff. Depth to limiting factor ~_in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~~~ Remarks: Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: Remarks: SBD-8330 (R. 07/96) L ~r ~`i~~n,.3 ~.~~ _ S w~/y 1~1w ~~ S ~~ T~ -14 u~ ~°. ~ r-C.0.. ~ ~, J j'V~ V~ 5 So t ~ ~-cec4 so •~- C~ao-L31~~o_00~ sc~.~. I'~-= (moo ~ , ~~ , _ - a ~: ~ m iop 3-~a~-- ~~ a a ~( c h~+m~~s- Q~~ Bm ~l l~a'P~c ~'/ /o/ ~ as o s~~ ; ~©~F ,, ~~g~ a~ ,~ aZ ~ ~ ~ c~ ~ o _- ~a ~ fl~ '~P ~~~9~ ~ __~_ _ ~i~' N , a a ~ $ ~ ,~ yy~~ N Y`°-~ Qo ~ Q ~~ 7 m pmt N f ~~ y {G ~j N m ~ n 4 g ~ ~. .9 u n YY S N ~ ~ N ~ ~e O 4 X i 9' a W , V ~~ 3 UJ ~ ~ ~ ~' ~ n w obi ~ ~ g v s ~ ~ am ~ g ~C mn 3 Q O R Q ~ m e N N m N ~ ~nn m N y y$$ G~ ~5. a ~~ §N q K C / VJ g V C ~1 C D O • N m . ~ ~ ~ ~ x ~ r x _ ~ e s~ s Q • • • • "~ -~ ? O r- r a- 0 _ ~~~<~ ca Q ~ ~ ~~~acQ' w C~ ~ 3 ~ ~ c ~ Q~Tm~~ m v 1 ~_~ ~ ~ ~ r-' ~ N Q n~ ~.C ~ n ~ ~~3 3m w,~ -° w~ w 0 w o u~ ~ N° ~~°-~ ~ ~a~m a~ X4°'3 m ~'• ~_ m o~o~ 1 ~ ~ ~. C .-- ~ ~. o~'3a~ ~m`~•~' ~~~ w m N GJ N 'P ~ x _ ~ j rn x GJ ~ ~- ~ -~ CJ~ /~ l J ^~^` Y+~ C7 Q ~~ ^~ _T D O m ,~~~~w r ~ S~~ h r/ ° o, ~ V4 m~ ~ ~ ~ fn ~ ~ .. ~~ t~ 4 ~~~ 4 ~`~~ ~~ ~z I ~-- Invert 11"---~ Safety and Buidirgs Division SANITARY PERMIT APPLICATION tot E.washingtonAve. ~vis~onsin to ac r wi h ILHR . Wis. Adm. Code P.O. Box 7969 ~Dep9Ftment of Commerce cod t 83 05, ~~ison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less count than 8 trz x 11 inches in size. y ~ • See reverse side for instructions for completing this application State Sanitza/ry Pe~rmit8Nu ber The information you provide maybe used by other government agency programs ^ Check if rer,~sion to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLI ATI N INFORMATI N -PLEA E PRINT ALL INF RMATI N 'e`' Prop rty Owner Nam ~t ~~ ~ ~ )~ Propert~ ocation ^ ~ N R E (or va ova S T ~ 1 cl. 1 Propert Owner's Mai /~dre s Lot Number Number BIo ~ ~ ity, State Zip Code Phone Number Subdivision Name or CSM Numb r ` Q~ m N sot ( > S~ C ~ Lc II. TYPE ILDING: (check one) ^ State Owned ~ !t Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms p Village Town OF III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) ~'!~ . ( t ~ ij~j~~ 1 ^ Apartment /Condo d o~O `~ 31 ~ O - © ~ 2 ^ Assembly Hall 6 ^ Medical Facility /Nursing Home ~ 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1, New 2. ^ Replacement 3_ ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an ,______System ________S~stem _____________ TankOnly_-____________ Existing System ___-_____Existin~System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground Pressure / ~ !l / 42 ^ Pit Privy 13 ^ Seepage Pit !~ ~ ~ T 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) c~ Elevation d O 3 ( S ' [~ /,~ / ~ ~--' / Q - ~.L Feet Feet 98 VII. TANK INFORMATION Capaat in allo s g Total # of Manufacturer s Name Prefab. Site con- st l .Fiber- Plastic Exper. N E i i Gallons Tanks concrete ee glaze App ew x n st strutted Tanks Tanks Septic Tank or Holding. Tank ~ ~ 5~ ~ VL9 i ~P ~ fS ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i atlation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pr n Plumber's Si nat re: (No tamps) MPlMPRSW No.: Business Phone Number: ~d~ ~ o `z ~s mz ~ sl Plumber's Address (Street, Cit ,State, Zip Code): - S !fit t`` ~ 1 ~w ~ r~o 5 IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee lindudes Groundwater Surcharge Fee) ate ssue Issuing nt Si nature (NO Stamps) Approved ^ Owner Given Initial ~~-~-Ozs ~ .~ Adverse Determination ~~ X. CONDITIONS OFAPPROVAL /REASONS FOR DISAPPROVAL: u SBl}83>)8 (R.11/98) l>15TRIBUT1pN: Original to County, One copy To: Safety i Buildings Division, Owrrer, flwnber INSTRUCTIONS } w t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD-6399) to be submitted to the .county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(sl must be pumped by a licensed pumper whenever necessary, usual ly every 2 to 3 years. 6. )f you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: !. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line [i if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for al! septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number: PlGmbersm~ast sign application form. IX. County/ Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, locatior o~f holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainslwater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUfdDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~/ 4 .. ~~.~ ~y n,"n S'~ ~/ ~' G'. ~ r~l~, P, ~~'l yn N S-S'~~ ~~sz~ s I ~, `~~c75,3 ~8- ,~ ~~ `'~ ~ ` ~ +~` ry ~~ _ ~~ ~~ ~ y~ ~ - ~7 ~y ~~ ~: ~9l0 s ~, -- ~c~ 5 ~8 T-~9 -~ q w N u~so ~`f GNU rr ~~~4~s ~y duo - /3 /~ - ~a _- oo~ 7 to a. L~ o ~~ IJ ~; ~-~. New ~~ ~~ d, _ ~5~ ~' ~"" Crv S S S `c tor, ,~~~ r <.~mN sso~y o ~ ~ t 17 S. s ~e~-~ " .- • Sc~ `/y u w % S ag7~ N ~~ cJ ~~~5~„ -- - ~. ~~ ~ ~~- z ~ ~o~ y S~ ~r^C~~IX ~S ~i ``~~,, ~ ff~1A Alr inirl- And OD~urallon Pipo ' ~la ~'~~s. ~ : ~-Approrle Vont CoP t', ~ 111nrmvwr 12' ADOr1 float Crad~ ~~ , t0• ~2' Aporo Plpf _ ~~ Carl Iron To final Oroeo , Vonl Plpo WrrA Ilor Or $1nIM11C Cororlny ~'^ ~~ AOOrrpolr O.u Plp~ •. OUINpvtlon ~ , Plpo ~' 0 0 0 -Too >. B• AOOroOolo o O.nulA Plpr j Porlororoe plpo trHor r o ~""Ca.gtln0 Trrmtnollnp AI Oollom Of Sjolom L~cJ•.~ Ivry J SOIL FILL DISTKIBU7101,1 PIPE • ~~' APPROVED ,~y~J~t{C71C COV 2"o>~1~GGR~G111E _/ .. ~ ~-11AT~R11~1- OR 9" OF S?RA' ^1 ::-' OR ~~ARSM HAy r• EV, O ~ ;%Y~t. I:rOF:z-2r/2 AGGRCGATC ~P~v~ % ~., DISi-RIgU71UU PIFE TU. BE A7 LCA57 _ a~ 1FJCHCS BCLOW ORlG11JAL GRADE AUU A7 LEASTtO IIJCHCL t1UT 1.10 MORC THAI.t `12 INCHES BELOW FINAL GRAOC 1'Wctt~tuM ~~P•rN OF ~XoAVATIm~ FKo~i oitlGt+Jq>. 6~t1~~~ WILL BE ~ . IucHEs ?'UhlIMUh1 p~Prll of ~XCAv~TImN ~~011 e~l(,I}!q~ C~R~D~. WILL 6C ~~ INCHCS r StGtJCO: I LIGC-JSC 1.1UMBE12: --L~~`~,Z_ DATE : _~ I ~ -~ / ~~ . -•--- -•'-•--•• Rio ... _ .. :` Y~sc:,risin Department of Industry, Labor and Human Relations nivisinn of Safety & 8uildiros SOIL AND SITE EVALUATION REPORT /~~J~ ~ ~ ,, ~•1 _~~ ~g~g~,,~~ of 3 . - 111 QVfrVIU 11111111 ILI II l VJ.VV• ..1J. I"~U11,. vvaav 1, CO : y ~ ~'.'m...,~ ~.., f I ~ `~~ '~ ~~ St but Plan must include lete site lan on Attach com a er not less than 8 1/2 x 11 inches in size . . , p p p p . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or LLD ~, ; . ~r O~ie {d~n~~~i dimensioned, north arrow, and location and distance to nearest road. z APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ED BY ~; C,r DAT c~,~-ry PROPERTY OWNER: PROPERTY LOCATION / ti John Rauchnot GOVT. LOT SW t/a ~ t/a,S g ) W PROPERTY OWNER':S MA!I.ING ADDRESS LOT # BLOCK # SUED. NAME OR CS 527 Co. Rd. #W 4 na St. Croix Estates 54016ZIP CODE PHONE NUMBER ~sTon WI I ^CITY []VILLAGE MOWN NEAREST ROAD . uc (719 386-3052 Hudson Crosb Dr. ~ New Construction Use (x] Residential / Number of bedrooms 3 [ ]Addition to existing building j ]Replacement ( ] Public or wmmerdal desaibe Code derived daily flow 450 9Pd Recommended design loading rate ~4 bed, gpd/ft2 .~5 trench, gpolft2 Absorption area required 1 ~'~ bed, ft2 9110) trench, ft2 Maximum design loading rate .4 bed, gpd/ft2.5 trench, gpolft2 Recommended infiltration surface elevation(s) 95.30 ft (as referred to site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ~~ S ^ U f MOUND ~ S ^ U IN•GROUND PRESSURE ~S O U AT-GRADE SYSTEM IN FILL ®S ^ U O S ®U HOLDING TANK ^ S [~U or svstem U=Unsuitable SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 99.25 ft. Depth ro limiting factor +84" Boring # :... ::.., v::.:.,,,;: +....,.2: ,.,. :<:, :} y~Mw..N~}};ti :yin w~'~'~+'n~: \i itv Ground elev. 98.3 ft, Depth ro limiting factor +8011 Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cunt Color Texture Structure Gr. Sz. Sh. Consistencel Bourdary Roots GPD/ft Bed ITrendl 1 -10 10yr2/2 none 1 2msbk mfr gw 2m .5 .6 2 10-16 10yr4/4 none sicl 2msbk mfr gw lm .4 .5 3 16-44 7.5yr4/6 none is Osg mvfr gw if .7 .8 4 4-48 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 5 8-84 7.5ry4/6 none S Osg mvfr na na .7 .8 Remarks: 1 -10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 10-21 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 1-80 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 Remarks: PROPERTY OWNER Johri Rauchnot PARCEL I.D. ~ pending Boring # \~4 iiiiii: ii4 :: 3 :. G~~~nd .. elev. 99.55ft. Depth ~~ limiting factor +84" Boring # ~::: . ~~'b Ground elev. 99.2 it. ~ Depth~o limiting factor +84" Boring # ;:h:<:;i ~., y Ground elev. 98.8 ft. -ra Depth to limiting factor +88" Boring # n,:~:...;~.;;: Ground elev. ft. Depth to limiting tacror SOIL DESCRIPTION REPORT Page ? ,_ of 3 E, y Depth Dominant Color Mottles Texture I Structure Consistence ~ Botntary I Roots GPD/ft Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed iTrerxh 1 0-8 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 8-15 10yr4/4 none sil 2msbk mfr gw if .5 ~.6 3 15-56 7.5ry4/6 none Co S Osg ml gw na .7 '.8 4 6-84 7.5ry4/4 none sl mgr mvfr na na .~ !.5 Remarks: 1 0-7 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 7-13 10yr4/4 none sic 2msbk mfr gw if .4 ?.5 3 13-5 7.5yr4/4 none sl lmsbk mfr gw na .4 `.5 4 52-8 7.5ry4/6 none S Osg mvfr na na .7 .8 Remarks: 1 0-12 10yr2/2 none 1 2msbk mfr gw 2m .5 .6 2 12-2 10yr4/4 none sic 2msbk mfr gw lm .4 .5 3 24-64 7.5yr4/6 none S Osg ml gw na .7 .8 4 64-68 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 5 68-88 7.5ry5/4 none f s Osg mvfr na na .5 .6 Remarks: Remarks: ..a " STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot CSTM2298 SW4NW4 S28-T29N-R19W MPRSW 3254 town of Hudson lot #4-St. Croix Estates N 1"=40' BNI.= top of 1" steel pipe C el. 100' Alt. BM.= top of steel fence post C e1.103.42' /~ ~ 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 \~ ~.~ ~~' Z;Z' ~ r eta- - ~~ ~ ~~ ~~' $'~ ~ - ,~,~ c ~~ ,~~'L \ i ~ ~0 h ~' ~~ ~~~ / Gary L. Steel 1-3-95 ~~ QQ~ ~/ ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ ~--~ ti- IN1 5 , ~ 't t_~ ~[vE ~-t_ Mailing Address - ~g`3a ~~- ~ ~a~~ ~ G~n~~ ~~~-~ ~, ~ _ ~ _ _- Property Address - T ~~ ~~-~ ~ ~~ (Verification required from Planning Department for new construction) ~1C~ Sa l~ City/State 4~'o s ° ~'' ~ ~M~ ~ Parcel Identification Number ~ '~-~ - ~ 314 ~ '`~ d ~ ~ ~ t LEGAL DESCRIPTION Property Location ~`^~ %a, N W '/., Sec. 2~, T ~ N-R ~~ Town of ~+A dS a eiI Subdivision ~ ~ -~ ~~-~~'S Lot # ~. Certified Survey Map # _ ,Volume ,Page # Warranty Deed # ~ ~ 4' 44'~ Volume ~ 3 ~ 9 .Page # ~ ~ ~' Spec house ~ yes~~no Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the' septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanpl~unber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposalsystern is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of the three year e. r~-~,--~ 2 ~ Ie , 9 w SI ATURE OF APPL CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the operty described abov y irtu a warranty deed recorded in Register of Deeds Office. r A OF APPI;IC DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' ~ P,I~iER VALLEY ABSTRACT ~ ax :715-356-7554 =b lr '': _ _ _ _ : r. OC ,~ . ,~ ... . fcrti~ ~ •. i ~~'1,• ~Q STATF pAR OF WIytONi1N irORMnn1 ~ tVY2 uucuMetvr r',o. YGl 1~ r Pa E ~ '' WA ~~D~R~IJ~ .. .. ~ ~~+~i~TE'R~3'~~I~E ..=MII llt1V..liiver ,Julnt.:Jl:utuz S7- ~Q~IX^C~~ W) aYWveyi 9Bt1 Wirtalni 10 ~~'. ~ ~ 100 A M Stillye bon ~ ~ -P>i~L1i.~Y~~ a i, ~~ ,.~.. M .•; ,.K. • s•, 1 NMi ~ MTlatw soeirr d{e (al4wnng drKrllu•d nyl ewnc In St. C_roife , ~w ~2t r ~ y.- . Sale of 5-'isrt~~n: ~ ,~ ) r . elrhl9lii~ 'F'~v ,;~ ~,,,..~~ 1111. ~~ •' _ • k ~-i'- . T l.ot Four (4) of St. Ceoix beataa in epa 'lamahip o! Hudsoa, 6t. Caoix .. County, Nlsconrin, ~~ i+ ;,~ i .: r +T~ ~1~Y.. .'~:I . •'!JM A „1~ j .. ~. Y . V: ~ 'Y 11111- it nnc ' (Y) (M null ~~ ~~ ~. ~, ~. LrttilMbn to wsmlrin~ , ~.,y;,~Lr•,i.;. d ~r ~ ~; Daard lhk - 2Bch ~~ ri ~ ".. . H.,.. i~ ~,' ;fib ~` ~; --- (SEALS AUTHENTiCAT20N SI~•tf~luR'ti1 ;ii ~i tultxnlKStrd this dsyu{ ~„_„ 14_ 'I i. '-------_ L TI'iLL•: MEAIBBR S1ATL- BAR Of• WISCONSIN f r Tt • Nicha~l u., i t AC tE ~'; • State of Wifeoaole, :. ~, ~', ~,1, tt d;. Pcnotully agile before ue dlis c~ ~ ~toaa. aM.• .. .rtn.r.:.i .~ .,` :~` , +~T ...; aN 7 .K::, Y ~-.~:~ .` ~+ '~ ~, 1 tte~! the o6aYr ttre M' j• aualwlrl:ed by li:On.p6, Wn. Suu•) iu mt kwwl m !w t!y FeTlota x '' rho t>marsd the (olyapR . ' IlWtlt t K dY MAU•v'. ::N~L~~~~~ TMI$ ~N6TfIVMCNT WAS ORARTQD gV '~„'..,,^ W112t>vr Rlwr Joinc denture -,, ~~, ' P.O. Box A ' Se. Crnia ""'~ ---Nsr-iticin~Bnd NI: 566 k ~ N°ary ~k. 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