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020-1138-50-000 (2)
n N O o N O 3 o °0' v1 g T n T' I v • CD A CD CD Co "S n -i O Z yy Z O p Z O N Z fD w O O c f N c `C • s N 3 O N c A O w �. 5. c �p �p iv p D 0. a w Q1 Co CD d N N v w m co rn ►� CL 0 1 �. C C O O 1 O O OD n C A �p �I = CD C O O CL o '� OD N V n ! 3 N 4 CO, - O .�^.. 7 C G) C G) lr C7 m (n a m (n Z A co a m y w CL cfl D (n a c �p c O_ ID W C 0 0 N O. W C r �'. O 01 `�a� rn O :3 z �j co a°\o p a ( D o c V Q ° p ' CD C L Ooo c oo p Z O n \ p 0 j y C c `j w cn rn 3 rr Q !mil 1 00 00 cn 0 0 A O N C 0 C c 0 c S�D - C0 n v c c N rn c c CO) co 0 m W CD N O' M M O C7 CD r ? C G w j K N ' y y CD M N d 3 m C- N CL . 3 r. c ` I o D D I =� D Q 0 0 7 @ m v CD tv • c m c3 CD I CD c CD c n CD Z m ' �° m -4 Co I I A Z co c U) c n0i a I a j A O 7 0 Z N W to m co a 3 a Z G !: o !` I y m Z CD m IQ a m I C o n a :3 c c o I a o a o z U) cn N y v � t I o I I 'e x CR CD CL o v I I N q I I O O CD CD oro qb �0 o o o o s. a � � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law, s.15.04 (1)(m)I. Permit Holder's Name: City Village X Township Krenik, Paul I Hudson, Town of CST BM Elev: Insp. BM Elev: + B M Description: -- ? G 13 /17- 9s.�5 9s ' r TANK INFORMATION TYPE MANUFACTURER CAPACITY Sept G'_ , , 9 -it- h'(- sa o A a' n " I —1a0 Length 11014i �j0 l 7 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Fric' n V TDH Ft (jyt S� Length in6. �j0 l 7 Bid? Se� - SETBACK SYSTEM TO Aeration BLDG St/Ht Inlet '` LAKE /BYRE LEAC Manufacturer'.�� Holding St/Ht Outlet • 7 �� / p 7 0 r PIiMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Num ELEV. TDH Lift Fric' n System Head TDH Ft Forcemain Length Dia. Dist. to Well ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 499122 0 State Plan ID No o. Of Pits Inside Dia. Liquid Depth Parcel Tax No: A lt. BM 020 - 1138 -50 -000 Section/Town /Range /Map No: 29.29.19.696 STATION BS HI FS ELEV. Benchma DIME NSI o. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3/ A lt. BM J Bid? Se� - SETBACK SYSTEM TO P/L BLDG St/Ht Inlet '` LAKE /BYRE LEAC Manufacturer'.�� 9l St/Ht Outlet • 7 �� / p 7 0 Dt Inlet INFORMATION Ty Of System: / y � Dt B to � ( �Z UNIT UNIT Model Nu�� L I DIST IBUTION SYSTEM Header /Man. � 7. Header! anif Id r Dist. Pipe - 7 O x Hole Size S 7. r _ q Bot. System /� _ 0 q1.0 Final Grade Length_ Dia Length 1- 73 ZZ at Cover B /111 n/1vCO __ ...____..__ !a 6) C Only -- 0.8' 9f 7 0 �! 6n, —r- SOIL ABSORPTION SYSTEM f }- xx Depth of xx Seeded /Sodded BED/TRENCH Width Length No. Of Trenche DIME NSI o. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3/ Yes No J _ SETBACK SYSTEM TO P/L BLDG WELL LAKE /BYRE LEAC Manufacturer'.�� ER OR INFORMATION Ty Of System: / y � f � ( / UNIT UNIT Model Nu�� L I DIST IBUTION SYSTEM — � 3 r � Header! anif Id r Distribution C,/ Pipe(s) /�j Y y {l x Hole Size x Hole Spacing Vent Ib A.. Intake -! 7`� Length_ Dia Length Dia Spacing B /111 n/1vCO __ ...____..__ —_. -.v_ ne,.....A n. Af f'- -A. C Only Depth Over 1 Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7 FBrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / UAf ,, spection #2: / / y Location: 787 Ghert Lane HWdn, WI 54016 NE 1/4 NW 1/4 29 T29N R19W) Gherty's A dition Lot 3Bik3 � Parcel No: 29.29.19.696 1.) Alt BM Description =�� S� c _ c> 2.) Bldg sewer length = G�ju,4 - � & ,/ 4w y 4 a" V q 7 . 2 - g0 • a _�,� - - amount of cover - � y (o , e`7 �9 •q y , � Plan revision Required? /es No � Insepcto (Q S 2 Use other side for additional information. _ L_ _ -. _ __ -- -- gn t re SBD -6710 (R.3/97) Safety and Buildings Division County ar N 2.01 W. Washington Ave., P.O. Box 7162 r►seonsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 2 � l I I Z Z Sanitary Permit Applieatio State Plan I.D. Numb/e�r In accord with Comm 83.21, Wis. Adm. Code, personal information r —�� — may be used for secondary purposes Privacy Law, s15 'Project Add ress (if different than mailing address) I. Application Information - Please Print All Information RECEIVED 3 3 1 >Kly Owner's Name Parcel # 1 # AUG 1 6 2006 oz o- �(38-se, -oa�G,7 b Property Owner's Mailing Addr s Property Location ST. CROIX COUNTY , �' /,, Section Z City, State Zip Code Ph 4 / ctrcie ) T � N; R/ I-I Type Building (check all that apply) of p t or 2 Family Dwelling -Number of Bedrooms_ Subdivision Name CSM Number 11 Public /Commercial - Describe Use G l S ,9 ❑City_ ❑Village Plownship ofA ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System Replacement System El Treatment/Holding 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. Type of POWTS System: Check all that app 1 YJ G (A ZNon - 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 Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel - less Pipe ❑ Qther (explain) 1, 11 1 A V. Dispersal/Treatment Area Information: ht,.. • S Design Flow (gpd) 960 Design Soil Application Rate(gpdsf) Dil Area Required (sf) spersa Dispersal Area Pro sf) posed ( a System Elevation u &I).W®g�so VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastl Gallons Gallons of Units Concrete Constructed Glass New E)dsting Tanks Tanks Septic or Holding Tank OCR OI Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility 46 Installation of the POWTS shown on the attached ph um Plumber's N (Print) �j PI s Sig re MP/MPRS Number Business Phone Number it 8e5 r� C= 9,21 7 3 Z. 0WO Plumber's Address (Street, City, State, Zip Code) n D Z7 /V lN� J 01h VIII. CountyADepartmenjUse Onl Approved El Disa ved Sanitary Permit Fee (in des Groundwater Date Issued Is g A t Signatu (N tamps) ❑ O eason o ial Surcharge Fee) ¢ G . 0 IX. Conditions o r /Re 1 I OWNER: 3) ' �� J l `Ca SYSTEM 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. F -e 2. All setback requirements must be maintained as per applicable code /ordinances. Armen compieee pians tto the county only) for the system on paper not less than SIR a I I Inches in size W) 0 89,s SBD -6398 (R. 01/03) /'- /off map A4ine. ?cLLL1 kren� k � Tm LOMtion 787 7 RotktAaes+er V� s ? 1 . �I san G h Trwo , � � Q� s GL Lt -}'D CJ�� S q�-1kg�g 3 0 i Cam 5: I i �a Q� o� 0 3.11 2�,N Vb1v� po 0 , 9I�s� �88rg� Q 9 9 y s 9� s 51 UVo Map A4 Me riom ! u -fie �1ees r '787 Ck [c e Lorca. ion G�Ge o E� �III7 1 . Qn� I 4 GXISfi1nr S s p y � bj) Kl,u VD1VQ o c� _N.Qw � ° A - ►oo Zalo1 F; 1If(, �x i ,ti o W , \,p ISR p IL U J Yv� HOME J 1 z a� �ioN, I►eN �1zs X1100 �88r 9p.Sb 90 , 00 y 895 b C r R �� F �� J raro ON PORT 1 3 Wisconsin Department of Commerce SOJL�EVALZJ� Page of Division of Safety and Buildings in ac or h I.Mn. Cod A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than ches in slz . ust St. Croix include, but not limited to: vertical and horizontal refereno 24909 OUNTY" Parcel I.D. percent slope, scale or dimensions, north arrow, and I ion and to nearest road. 020 - 1138 -50 -000 Please print all information. Revi y pat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 5 Z 3 O Property Owner Property Location Govt. Lot NE 1/4 NW1/4 29 T 29 N R 19 W Paul J. & Jacqueline K. Krenik in. Property Owners Mailing Address Lot # Block # I Subd. Name or CSM# 787 Gherty Lane 3 3 Gherty's Addition City State Zip Code Phone Number City I Village 0 Town Nearest Road Hudson WI 1 54016 1 (715) 386 -7416 Hudson _ Gherty Lane none New Construction Use: Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na -- a - 3 General comments and recommendations: Site suitable for gonventional POWTS @ 0.7 gpd/sq.ft. Install f ive trenches at 48" below grade u sing 55 "Quick 4" chambers. Existing system elev _ . 0.8 Boring # Boring >1 31 " in. Soil - Application Rate Pt Ground Surface elev. 95.55 ft. Depth to limiting factor APP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E�; PD /ft*Eff#2 19 -37 in. Munsell Qu. Sz. Cont. Color 2fsbk Gr. Sz. Sh. cw 1fmc 0.6 0.8 4 1 0-8 10yr3/2 none sil 2fsbk mvfr as 3mc,2f 0.6 0.8 44 -109 1 Oyr4/6 10yr3 /4 none sil 2msbk mvfr cw 2fmc 0.6 0.8 2 8 -24 24 -29 1Oyr4/6 none gr Is Osg ml cw lfmc 0.7 1.6 4 F5 29 -89 10yr4/6 none gr s 0 sg ml gw 1f 0.7 1.6 89 -131 1 Oyr5 /4 none �� ,1 � r s 0 sg ml - - 0.7 1.6 S pit excavated to a depth of 108 ". Remaining depth of H#6 evaluated by use of shovel and hand auger. H#s 4 & 5 contain approx. 40% gravel and cobbles. I I Boring # - Boring factor to I orov Q >109" in. Soil Application Rate n_......a c..r�. a '> 7 ft ne..r►, 1I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 PD/ft'E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -12 1Oyr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 12 -19 1Oyr4 /4 none sil 2msbk mfr gs 2fmc 0.6 0.8 3 19 -37 1Oyr5/4 none sil 2fsbk mfr cw 1fmc 0.6 0.8 4 37-44 10yr4/6 none gr Is 0 sg ml gw 1fm 0.7 1.6 5 44 -109 1 Oyr4/6 none gr s /1 0 sg ml - - 0.7 1.6 Soil evaluation pit excavated to a depth of Rem 'ning depth of H#6 evaluated by use of shovel and hand auger. H#s 4 & 5 contain approx. 30% gravel and cobbles. r LID ash � Effluent #1 = BOD 5 > 30 < 220 mg/L a TSS >30 < 4 rfl mg/L uent #2 = BOD <30 mg/L ana 15b � su mgrs CST Name (Please Print) Signa e: CST Number James K. Thompson 5--- 3602 Address A.C.E. Soil &Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceol , WI 54020 426/2006 715 - 248 -7767 Property Owner Paul J. & Jacqueline K. Krenik Parcel ID It 020 - 1138 -50 -000 Page 2 of 3 F31 13oring # j Boring 01 Pit Ground Surface elev. 92.71 ft. Depth to limiting factor >110" in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -11 1Oyr3/2 none sil 2fsbk mvfr as 3mc,2f 0.6 0.8 2 11 -30 1Oyr4/4 none sil 2msbk mvfr cw 2fmc 0.6 0.8 3 30 -39 1 Oyr416 none gr Is Osg ml cw 1fmc 0.7 1.6 4 39-48 5yr4/4 none gr Is 0 sg ml cw if 0.7 1.6 5 48 -110 1 Oyr5 /4 none / gr s 0 sg ml - - 0.7 1.6 u 'S H#s 4 & 5 cor tain approx. 40% gravel and cobbles. ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # --I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Rood *Eff#1 GPO *Eff#2 F-1 Boring # --I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Rood *Eff#1 GPO *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. �P 18 d 3 b .ti EXiSt� GJC /l 1 KcsiderlLG d u.,C %► • So,/ ed2/aa,�o� p'� n ♦ C /eda�:on /^ VV! Pa,,l er'6ni e,,aego., 1,6 3, 61X 3 6har6 i 4 a(., -17q Sec. z9 T, o,CAdsa", 5� . Cro; K /aw a �. t t ti w � t t � i r t 63 lex4 Aso 582•o � �,5.��� 61m � t �r /Y be d� �e�.►�;ned.bi- Eo S P5. 3 o{'3 FILE INFORMATION Owner 7Q Permit # I/ d' ZZ. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of SYSTEM SPPr1FIrA'nnluc DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units XNA Estimated flow (average) 0, ❑ NA g al/da y Design flow (peak), (Estimated x 1.5) (� ��� 00 gal /day Soil Applicate �j NA I al /day /ftZ Standard Influent /Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg /L Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solids (TSS) 5150 mg /L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD 530 mg /L Total Suspended Solids (TSS) 530 mg /L ❑ NA Fecal Coliform (geometric mean) 510 cfu /100m1 Maximum Effluent Particle Size Y. in dia. ❑ NA Other: year(s) ❑ Disinfection ❑ NA • alms— tyNlom Tor aomestic wastewater and septic tank effluent. nk Capacity (� al ❑ NA Manufacturer Fnk j �e� k S ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ��� 00 ❑ NA Pump Tank Capacity month(s) ❑ year(s) ❑ month(s) NA ❑ NA Inspect pump, pump controls & alarm al Pump Tank Manufacturer ❑ year(s) ❑ month(s) NA Pump Manufacturer Flush laterals and pressure test NA Pump Model ❑ year(s) C h NA Pretreatment Unit b NA ❑ Sand /Gravel Filter ❑ Peat Filter ❑ NA ❑ Mechanical Aeration ❑ Wetland year(s) ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA DI In- Ground (gravity) ❑ In- Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 4 ❑ month(s) 19 year(s) (Maximum 3 years) When combined sludge and scum equals one -third (Y of tank volume At least once every: �} ❑ month year(s) ls) (Maximum 3 years) 'A ❑ NA ❑ NA ❑ NA Pump out contents of tank(s) Inspect dispersal cells) Clean effluent filter At least once every: At least once every: month(s) ❑ year(s) ❑ month(s) &KC I ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) NA Flush laterals and pressure test Other: ❑ year(s) NA At least once every: ❑ month(s) ❑ ❑ NA Other: year(s) ❑ 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 (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 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 cell(s). If high concentrations are detected have the contents of the tank(s) 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. 7o 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. • +hp QQw #AAfp A# 00, * 01#4*M i,H14 Ni w aaaa Ile Famm and p disposed of bM a 11QI0l610" Giewlel"" 0"OPA040 • 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 utilized 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. ® 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 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 DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS nneOArno MIIIAPPRI Name -- - .- �� u\ Phone Name Phone �a nneOArno MIIIAPPRI Name -- - .- �� u\ Phone `' POWTS MAINTAINER Name Phone ntn_I I A rf%nv AI m unRITV ., Name -- - .- �� u\ Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address ?e t � �,� Property Address S'9_'r7 (Verification required from Planning & Zoning Department for new construction.) 1 City /State � ,D s d N 0( Parcel Identification Number 0,W —// — �CYO [• 9 �/ LEGAL DESCRIPTION Property Location' /4 ,' /, ,Sec. t, TN RW, Town of �/,��SO/lJ Subdivision Lot # 3 . Certified Survey Map # , Volume , Page # Warranty Deed # '/03,4 '10 , Volume ��.� , Page # o 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(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ATURE OF APPLICANTS) trf/ // ©C DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the A/L / rp_h j k residence located at: 1/,, % Sec. ;; .?q , T R /q,_ Town of IV�j �$Q,J , St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good cond'tio and it appears to be functioning properly. Last time serviced (o Did flow back occur from absorption system? Yes No /(if no, skip next line. Approximate volume or len th of time: "� gallons — minutes Capacity: )a5 '0 Construction: Prefab Concrete i/ Steel Other Manufacturer (if known) : W'm -tf- Age of Tank (if known) : � tit (Sign u e) (Name) Please Print �a 910 4/ (Title) 11 (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name �� 14e jej� Signature , MP /MPRS viocumcw NO. STATE BAN OF WISCONSIN FORM 1--19U WAI(PIAM DEED 403240 ' 35 a"! ASTERS OFFICE James M. Ritland and TW e D ad ............................. V _ A ST. Mix Co., WISE av" W s ............................................................. ............ ...................................... Rocl& for Ro<d this 3rd ........................ ...................... ..................................... ....................... ............... Grantor, day of July A 19 K0 %" T_` � _!5 . 1C."K ' _ — and. ......... ......... 1# 00 Pel s m. W16 .......... - ........ ... . 72 �" ............... ...... ......................... ............................... ...... ............. I ...................... ............ ........ . ...... ......................... .. . ............. ................................................................................. . Grantee, ftwar of 0"1011 Witnesseth, That the said Grantor, for a valuable consideration ................. ................................................................ ' .... ........ 1X conveys to Grantee the following described real estate in ttmr..gTq'."'.'1... *gTunk ro County, State of Wisconsin: Lot 3, Block ' Gherty's Addition to the 1-cel Tax P-a Town of Hudson, located in the !; 1/2 of the NW 1/4 of Section 29-R o 19. . • .............................. FE14 This ...... ---- -- --- __ _ . homestead property, (is) (is not) Together with all and singular the hereditament& and appurtenances thereunto belonging; And ....... Jaws-M– -Ritland.and. - Cheryl. - L.. - Ritland bushand and - wife ------- -- e ncumbrances except -get'-foyth warrants that the title is good, indefeasible in foe simple and free anJ clear of e above and will warrant and defend the same. d this ........... C?/ -----_----- ay of .(SEAL) James M. Ritland .......... ........................................... ....................................... .(SEAL) GG ........... ...... . ...... . .... ..... ;�k .... Cheryl Ritland ............ I ....... .. ........ . I � ... .. ... .......... I .... ................ . .- .....(SEAL) --- -- ------------ ........ . ....... ------ ---------- AUTHBNTICATION Signature(s) ............................................................ ................................................................................ authenticated this ........day of ........................... 19...... ....................................................................... ............................................................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .......................................................... authorized by 1 706.06, Wis. State.) THIS INSTRUMENT WAS DRAFTED BY ------------------------ - ---------- -- ---------- - ...................... matures may be authenticated or acknowledeed. Both ACKNOWLBDGMBNT STATE OF VMU% ...............•.... ................. County. `P_ I . / ........ day of a, 7n I came before me thiA� ...... Ily al a ........... the d Jain R11tiand an eryl L a ....... . .................. Si�ban and w . i TI;E I ...................... ... .................... .............................................••............ ............... --------------------- ......•............................. to me known to be the person ._S ........ who executed the foregoing instrument and acknowledp,&ka."e. .......................................... . A .......... Q ..... -- -- ------- .......... Notary i�blic . t;J106FLORI DA M st expifttion ,y _Co"iss* n is gpMa 21 1 45 "58' 49 - 1 300' - v , 22 145-56'49- 1 BL CK 3 ' k, 0 23 160'26'04" i - - 24 160'26'04" wee g 6 0 25 94 "17154" ,j 1.4 100, - c /15 26 195 46' 1 27 206 ° 41' 10" 2: 20641 10' 1 : . .. ............... i�GON 2 158 ° 15'00" LS 30 158. Is Do" AO 500-09 100 -0150-14 101.2' 132.83' 320- 1 0 4 RIVER FALLI, "Ass 6 35' U-) N100 °09'00 "E DhTF:C), I I 97G ;r cr) I �d 35 cli ( cr) is LLJ r. 0 CD There are no objections to this p!ct w it h svSecs. t to Ss, 236. 236 16 7 , 236.20 md �6 21 0 N's Stuls H 65 0 the W, Ad—, Coo a-, 2 t , i� Certified this f , ado of d 1 Di—t-, Re, ' p,,I & A,;,tan [)- . ..... "'It 'If L-11 Aff—, & 720 em 380' 300' 1960. 1 BL CK 3 - - wee g 6 0 ,j 258.15, N 09.03 100, V - N10*01'2011E - - Nj 0 o 0 ,j 1.4 100, - c 4 6 . .. ............... i�GON . 4p LS AO 500-09 30 0 1 0 4 RIVER FALLI, 6 35' U-) N100 °09'00 "E DhTF:C), I I 97G ;r cr) I �d 35 cli ( cr) is LLJ 258.15, 4 O N O Co 00 0 °6,3, d CD �t 4 O � I h o N N i i � I C C 60 O C I I Y C Z 3: I LL C f3 O) 3 � O ° I Q � a I Z y cn Z Z !' O O` a Z o N w a m N F- Z 0 o z a 2 4) z v N ~ 3 c '2 i V N M N c cc N •� N a N N u L O 0 z m z Q z N o - — E R N m - @ N TO CL m 0 °� 0 m m = o p N 3 0 � IL IL IL � I 7 0 N LO c LO rn to J U rn } �) = CO C) � n 0 O E 0 0 J a m N N Q C UJ ) (L L � c6 O O _ O O W C cl c cdi a O o f r\ H N a O M C a� N °—' 0) °o c CO o d w U Z c FBI O N 'p C� +.+ E t • o N O N Z cn I Q I I C el d M a �t a ' a • a m .2 m r `k*i r A E C UCL C Ov)v Parcel #: 020- 1138 -50 -000 05/23/2005 03:49 PM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.696 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner PAUL J & JACQUELINE K KRENIK * KRENIK, PAUL J & JACQUELINE K 787 GHERTY LA Valuations: HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 787 GHERTY LA SC 2611 SCH D OF HUDSON Improve SP 1700 WITC RESIDENTIAL G1 Legal Description: Acres: 2.761 Plat: 1979- GHERTY'S ADD SEC 29 T29N R19W GHERTY'S ADD LOT 3 BLK Block/Condo Bldg: 3 LOT 3 3 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -19W Notes: Parcel History: 33,800 Date Doc # Vol /Page Type 329,200 07/23/1997 715/466 2005 SUMMARY Bill M Fair Market Value: Assessed with: Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.761 33,800 295,400 329,200 NO Totals for 2005: General Property 2.761 33,800 295,400 329,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.761 33,800 295,400 329,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r 1 Al J Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER PA14 €NS at TOWNSHIP ��u nS0 n/ SEC. T ON -RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 8 /1 /DV. O 0 G/+nuro n.FkT TO CY+/aN6E Ih4fwG� O.i'T 6' OLIE/z /00/ To /„ts AIZOPE4J Z. "-' � Rr sID.�.✓cr' / �yl —41A .' Q i i/ 3 I GAS G � i � y �o'TO ,tionTN /'�p�rry L; rve OVE/i JDO' 7 a ,TY LS iv E ;i au7A/ / '5JAy Zz'z INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 1 ti x-, '740 ario.69c Elevation of vertical reference point: Q, 00 Proposed slope at site: y 1 � .k PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Pump Size Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Y .S Trench: Width: X P R Length: Number of Lines: Area Built: �aa Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Pt.� Number of feet from well: j / Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Number of rings used: Elevation of inlet: Capacity: Elevation.of bottom of tank: Number of feet from nearest property line: Number of feet from well: Number of feet from building: Number of feet from nearest road: Front, O Side, O Rear, 0Ft. Alarm Manufacturer: DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING; LABGR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIOP P.O. BOX 7969 BUREAU OF PLUMBIN< MADISON, WI '53707 r CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D. Number 11( a_gned I El Holding Tank El In-Ground Pressure El Mound COVER NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: / 1 SPECTION DATE: LIOUID Paul Krenick c/o Zappa Bros. Exc., Hwy 35, Hudson ��,5 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. ELEV. - . PIT NE NW, Section 29, T29N -R19W, Town of Hudson, Lor #3,B1k #3,Gherty's Ln DEPTH: GRAVEL DEPTH Plumber: MP/MPRSW No. - . Connry: Sanitary Permit Number: NO. ISTR I N,,,,l Anthony Zappa 1614 St. Croix 64936 V NT TO FRES1 SEPTIC TANK /HOLDING TANK: ABOVE GO ELEV. MANUFACTURER: }} .� y V� ( " W LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL P O LOCKING COVER PROVIDE LINE l 3 Q" 01 5 AIR INLET- J DYES ONO ❑YES' 1JJNO BEDDING: VENT DIA.'. VENTMATL: HIGH WATER ALARM NUM ,,ER FEET FROM ROAD: PROPERTY LINE �t� WELL !_f BUILDIINN // TOFF- REE.Sf- IVENT AN�E'7 OYES C l ��. 7 O ❑YES NO NEAREST {. DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYE.-, ❑NO I OYES ONO GALLONS PER CYCLE: P DCONT LS OPERAT (DIFFERENCE BETWEEN PUMP ON AND OFF) r OYES C SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) rf%1M % 1C1UT1nh1A1 CVCTCM- nR OPER LINE G: VENT TO FRESF AIR INLET: IVIUU1vU by 1 tm: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand, TIONS MEASURED. DYES 1:1 NO SOIL COVER I TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ONO DYES 0 N DEPTH OVER TRENCHJBED DE E PTH OVER TRNCH /BED DEPTH OF OP OI 5 DED SEEDED MULCHED. CENTER EDGES: Y E S Q NO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: TR ENCHEY /� �#I1INltNS; f ., MANIFOLD PUMP MANIFO DI TR IPE MAN FOLD MATERIAL: NO- DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.r DI A.. E PIPES CIA.: 11 INANP }t 3i+gi HOLE SIZE HOLE SPACING D CORRECTLY I TCOVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ YES R op WELL: LINE: DYES ONO cetch System on everse Side. I LHR SBD 6710 (R. 01 (82) ❑ YES ❑ NO WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING: COVER INSIUE DIA.. #PITS. LIOUID .e�+ n*�r031 " FILL /�' TRENCHES MpT / C IA L:� PIT DEPTH: GRAVEL DEPTH DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. ISTR NUM BE , OF PROPERTY WELL BUILDING: V NT TO FRES1 BELOW P ABOVE GO ELEV. INLET. ELEV. END - . PIPE FEAT FROM LINE l 3 Q / AIR INLET- J NEARI~S'I' --mar IVIUU1vU by 1 tm: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand, TIONS MEASURED. DYES 1:1 NO SOIL COVER I TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ONO DYES 0 N DEPTH OVER TRENCHJBED DE E PTH OVER TRNCH /BED DEPTH OF OP OI 5 DED SEEDED MULCHED. CENTER EDGES: Y E S Q NO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: TR ENCHEY /� �#I1INltNS; f ., MANIFOLD PUMP MANIFO DI TR IPE MAN FOLD MATERIAL: NO- DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.r DI A.. E PIPES CIA.: 11 INANP }t 3i+gi HOLE SIZE HOLE SPACING D CORRECTLY I TCOVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ YES R op WELL: LINE: DYES ONO cetch System on everse Side. I LHR SBD 6710 (R. 01 (82) ❑ YES ❑ NO � I Wisconsin DILHR It1. V, LRBOP & HUTRn RELRTIOnS APPLICATION FOR SANITARY PERMIT (PLB 67) S4 ( )� COUNTY UNIFORM SANITARY PERMIT # �l y9.?416 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ? t , 1 u L kE' EN i'G K % Z,rPP�f ��POS , �a'U1t,�1i /o �l 7Yc v 3 S PROPERTY LOCATION CITY' f'Iu1�S01� VFtt - t: - t E: A) N A414, S Z f , T i , N, R E (or) TOWN OF: LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME NEAREST ROAD, L K STATE PLAN I.D. NUMBER 3 3 Ghy6_14T s ApAr•. 6: r S I N . N rt- TYPE OF BUILDING OR USE SERVED Oao _ 11 -- d --Odd' L 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System U Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank [� System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued EJ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Septic Tank Capacity Total Gallons # of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic /20 0 077 0 X 4 P rivate El Joint ❑ Public Lift Purnp Tank /Siphon Chamber Holding Tank capacity Manufacturer: W />ES!�! N IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Septic Tank Capacity Total Gallons #of Tanks Prefab. Concrete Site Constructed Steel Fiberglass Plastic Lift Pump /$iphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROP (Square Feet): Alternate course(s) of Action Available: %. 0 077 0 // O -- SE ?ZCA X '77 r > 4 P rivate El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Sign 7 #AP /MPRSW No.: Phone Number: Plumber's Address: `"' J ( J / Name of Designer: f �qp tBR �XC iOA T iOZ , ��y 3 S , l\)n. 0Dkl10 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: 0 (,! 1 <R WSJ Fee: Date: Q p / �/ �0 Approved ❑ Disapproved 0 Owner Given Initial Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property U J ' ' OR ay Location of Property A16 k A100 k. Section a 4 , T a 4 N- R W Township au Ds o k J Mailing Address 1�T 3 aoX �a 9U as a J a2 a c, Subdivision Name Lot Number 3 Previous Owner of Property d A^iES ,ems 6 r.( Total Size of Parcel .2. 76 A C - Date Parcel was Created 14/7/7 C (/a Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes __.Z No Volume 916 and Page Number ,y 6 ( as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING X1. Warranty Deed 2. Land Contract r . 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ee4ti.6y that a t atatemenU on th.ia 6onm ane true to the beat o6 my (ou-0 knowee.dge; that 1 (we) am (a►ce) the owneA (A) o6 the pno pent y des eh i,bed to thie in6onmati.on 6onn, by vchtue o6 : deed neeokded in the 066.ice o6 the County Regi4ten o 6 Deeds ab Document No . y a � 0 ; and that I ( we) pneeentty own the pn.opoaed .6 to bon the sewage dk4po.6at ayatem (on I (we) have obtained an easement, to nun with the above de.6cAibed pnopenty, bon the conatnucti.on o6 said Ayatem, and the same has been duty tecoAded in the 066.iee o6 the County Reg .ten o6 Deeds, as Document No. ). / A i 9 L T4� n V "ef, .1 � REGISTERS OFFICE L d X r-'O., WIS. ryl itlanly TIC a d e ST. CROI f Pt-c'& fcr t& 3rd G� ►"Ithr, d6Y0(--2u'-Y. A.D. 19 11 35 I V (i J �ic - I�A , � ' l K wife f I -Do p Grantee *;liter of 1>66de Wj4 k,: a oc. i� h, hat f- r to (:rant e d d Croix RE7URN TO -ep. stbtt in -- ---------------- R] - "3"' ( t ,." S *� I i t - j - ' to the Tax Parcel No: ----------------------- -- .. ..... IcYK.rj I cated in the F 1, ' 2 of tlle 114 of Section 29-29-19. A r V T D fis} r ',,'t) T : I j s� ric a 1 r t'lie ,erediflairielts a-, ai ',k - a t—es f And aiad- - Clieryl L.. - T - 1 t 1, aTld wife Aa"Tcint's tl.at the t fle is good, in fee simple and f7i 3and clear of as set QOV0 an�e� rx-ept T) meted t}Js M ,nt and dcrtrid the ay o! tSE kL) 7 L LT Cheryl, Pi t 1 aii d S FA L Al 7 1 H E -K I I C A T 10 N - - - -- - - of. - --- 19 - -- ACKNOWLEDGMENT STATE OF - ally r ur ----------------- Av. came hefcre me t )i day of pp 01 1- . the abc-ve ��afnEpd li- I A L'- -, a a Chery J T � �h i t , an Jrl eryl L. Ritl6wnd, ------ -------- I ... --- ---------- - --- -------- ------- ---- ------ ------- -- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER QqO 4 J A /t rL,t t e ROUTE /BOX NUMBER N"sT 3, $G X 6 8 Fire Number CITY /STATE gyozo�V GlJ /Sc , ZIP PROPERTY LOCATION:N _ ,Vt t ) !%, Section a9 , T Z? N, R /9 W, Town of f- luDSOA/ , St. Croix County, Subdivision �HC/2T`� Lot numbe Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ?1 DATE IZ31t -N St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 H z W H 9 r r 9 H H 0 z d 9 H [TJ H 0 E z x H b Sign, date and return to above address. v_ y s x a m m c N r i c m �� a m s �q r,L O C N Z a v Z a M c m n � S m r C) g 0 3 w ` 0 O `< U) Al N ° 7 m o X o o o 3 �0 � % a � c coco 0 CD 0 0 C ° a00 o- N C j a ) C) M 0 _ 0 >r a w A CD Cn CD SD 0 cG "' N 1 0 o M N OD C) 3 a o .»� (a cc w com0, > > = < 3 'Z? c� Q� f SD 0 cn- 3 O W M —CD a co C -% co 'a N CD CA o Dc m o o f a. w 0 y O .. Q o w 0 � � o CD N o CD cn aM o C fD = * -% 0 —C o0 p N , — n 0 w wN�aco� a b oo v,Nww -� CD cp a v°, aw �0 .«a o w rn Qw =cam . _„a cn 0 c o .: C =1 (n �► 13a cD -+ 0 ca *= CL lb 0 -► CL o 0. Qm w -.. •<c� .. ?m 3 M OM 7 CD 0 m o `< to 7 % cow m a C a =*n s c w 0 00 0 a o <� cw~pa5 1 0 r,L O C N Z a v Z a M c m n � S m r C) g 0 3 w ` 0 I�:�I�tL �a�E' �X�TH� i��J ^�IfENT �o OKiG -iNyF� TEST Il°>E' of <o �2-�I DE RTME OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS IND STRY, LABOR AND PERCOLATION TESTS (115 DIVISION -HUMAN RELATIONS (H63.090) & Chapter 145.045) MADISON WI 53707 LOCA6 I '/ SECTION: 10/ N/R 6 E (or TO WNS Y LO; NO.: BLK SUBD ��ONSAME� CO UNTY: V ,A4i X OWNER'S /*"IeEFi:S NAME: ?i4 L �� R t AJ I'C MAILING ADDRESS: 2i1 's f/� 3S N . �V DSo 4� i S . S a Co 7 •0 100-S9 0 . I Mr. RATIBIr.- R= Oita — itahla fnr cvctam 11= Cite -- itahin fnr cvctam DATES OBSERVATIUNS MAM PROFILE DESCRIPTIONS: PERCOLATION TESTS: CONVENTIONAL: NO. BEDRMS.: DESCRIPTION: PvNew ❑Replace Residence y ICOMMERCIAL )f.+ EST. HIGHEST RATIBIr.- R= Oita — itahla fnr cvctam 11= Cite -- itahin fnr cvctam DATES OBSERVATIUNS MAM PROFILE DESCRIPTIONS: PERCOLATION TESTS: CONVENTIONAL: QS DU MOUND: R]S DU IN- GROUND - PRESSURE: DS DU I S-ILLOLDIN YSTEMIN- FHG DS �U TANK: DS 7U RECOMMENDED SYSTEM:(optional) c soAA&i • AAA : is? 'yy7 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: CG/fSS �_ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 9CS (vlo i°'11d7' BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) OBSERVED EST. HIGHEST B- (� 7 •0 100-S9 -v-- > 7d Xk 43Aj . S,` /,s qP��a. S�' . oAP . iv. . S o .�5,� -vD �' Goe B- P- C. S . B- P _ B- fee- O,i!' NFL ZE%r ea,07 7 0 This B r a conventional sqpti B- PERCOLATION TESTS --) tn br - <> TEST NUMBER DEPTH INCHES WATER IN HOLE AFTERSWELLING TESTTIME INTERVAL -MIN. DROP IN WATE EVEL- INCHES RATE MINUTES PER INCH PE RIOD t PE OD2 PERIOD 3 P- P- P _ fee- O,i!' NFL ZE%r ea,07 7 0 _ 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. p%4_ � f SYSTEM ELEVATION ( I p -4 E • f I s 0 �E tN / I y " I �� l r .�V x r Q �Ri I I of e�/pY'1 .�Jjc>i .�.a I • S E � a L lily k INSTRUCTIONS FOR COMPLETING FORM 115 - SB - 6395 To be a complete and accurate soil test, yOur re;aort must include: 1. Complete legal description; 2. Ttfe use'section rnustclearly indicate whetherlhis is i; residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a nevv or replacement system; a, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON FOIL CONDITIONS; 6. PLEASE use the abbreviations shown hem for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used it desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; . Complete all appropriates boxers as to dates, nannes, a €ldresses, floors plain data, percolation test exemp- tion, if appropriate, 10. If ;tae ;nformation (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sirs The fOt rn araci I:alace yrrur current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL. AUTHORITY WITHIN 30 DAYS OF COMP €_ETION. ABBREVIATION FOR CER SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bndrock cola . • Cobl:ale (3- 10") SS Sandstone g" — Gravel (under 3 ") LS - Lirnestone s — Sand iGW — High Giomidovater c; Coarse Sand Pf rc P: tcolatif7n Rate MlKi s - Iles €um Sara(I W __ �vV,>l` I> - Fine Sand E31dq .- . Building L«miny Sand > GYealoY Than sl — Sandy Loam < - Less Than I — Loam Bn ... B ;'ovtra sil -_ Silty Loam BI ...... Black ..__ Ssl ?: day 'Yc! -..... Clay Loam y ...... Yelic- -, -V scl Sandy Clay Luair, R Red sicl — Silty Clay Loam mot Mottles sc Sandy Clay wr -- with sic - Silty Clay fff _ few, fine, Faint ' ._- Clay cc ._ corrmon,coarse sit Prat mm Many, rnediurn m --- d uck d — distinct • • prominent IIWL - Hugh water level, Six general soil textures surface water for liquid �ttvaste disposal BM - Bench Mark 'VRP - Vertical Reference. Pint a n EN'1�6 Rev. 008 f • + • 'REPORT ON SOIL BORINGS AND PERCOLATION TESTS ` WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION;�;4,��k, Section �� ,TLN,RLE (or),W,fTownship or Municipality Lot No. Block. No. r"Y > ./ y r ' .10, ; , County ' - Ivlslon Name Owner's /buyers Name; T% �'� �: •� >��' A • . � Mailing. Address: - h •� rr, -`/ C �. Cf• i / + . +.r, t` /�� TYPE OF OCCUPANCY: Residence X No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER 1, ;DATES OBSERVATIONS MADE: SOIL BORINGS l ' �// PERCOLATION TESTS E� "2 SOIL MAP.$HEFT f [ 7 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL NUM- INCHES THICKNESS IN INCHES BER HOURS SINCE HOLE 1ST WETTED WATER IN HOLE AFTEF SWELLING TEST TIME INTERVAL IN MINUTES DROP IN WATER LEVEL, INCHES RATE MIN /IN PERIOD 1 PERIOD 2 PERIOD 3 P — ! !! ,!.J i Po �. Z- J1. %) }� (•/ (..r B— t a i, /�t�i, rC- y r.+i, ' ".? i, i3 " d�•'i _S r, t , e P— PLAN VIEW Locate rcol i n e P— P- • 1e ( ( pe at o t sts, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable arei Jndicate nurnber,of square feet of absorption area needed for building type and occupancy �' ` ' -� % " Indicate scale or distant Give horizontal �nd•Ysrt'cal reference pointsP dic to slope: r0! .LI fit le y I +t _._ _ -'.__ ...�. _.. _..., .._ »..» ._... »_ '_.._.. .__._. . -_ -. ..__...T.. .._ .... I.� v+ +w.we+r+..e.•.I+��e -_- Pe C I 3 , SOIL RORINr; TESTS TEST NUMBER - .TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK IF OBSERVED IN INCHES OBSERVED ESTIMATED HIGHEST �+y t7 �ii B— r /�t�i, rC- y r.+i, ' ".? i, i3 " d�•'i _S r, t , e PLAN VIEW Locate rcol i n e • 14:01 ilk - — Jew - SOIL RORINr; TESTS TEST NUMBER - .TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK IF OBSERVED IN INCHES OBSERVED ESTIMATED HIGHEST �+y t7 �ii B— r /�t�i, rC- y r.+i, ' ".? i, i3 " d�•'i _S r, t , e PLAN VIEW Locate rcol i n e 1 Q 'r1 M /• j 3 f' c'r1I °�- " L' __.40 . /)t 9 l o p � 5T O o� 3o p b" o �E e SCE /E: 30 pR °� o AQ /f'Xy7' Ti�F�rT�re�T pt'fiiv F %�� a It PA) AT s. W 40r co,e VjA- V a h .� O I I • I I I � I � I � I I . So , toT \ I 940 A) , � NEXT T o o,P� �� s� f POST. Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade �y Above Pipe io Final Grade 4" Cast Iron Vent Pipe