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n Cl) O '' 'o 0 o n N O o (D b o �, f � (D 3 c O L� r I = C N m � CO A Cil CD O 0 N _ O T N < < CD gg O ? 3 N p O O m 3 0 CD 4 3 a ;I I p n c le O W m x N j N CD � I 3 0 n U( — CO fD 7' < T1 < N 0 O (D M ((4 C CL A O CD C C, N 7 7 Cp 0 r W Q (D CD 7 N C,) w N (D N N i N to 0 (n 3 CD m (D (0 (Q CD C OD C> Ln C dU O 0 cc N C ('3 7 7 3 O 7 N C '�.. 3 7 m D oZ LU 0 M (D f Lo v r C D N a d d v CD tlj Z> Z✓ D (D - � N (D "C7 E;:2 CD co Q CD CD '0 r W O 7 ,,-�,� C --{ CA 4D O Z C) CL O CD N N «, C', L A A ...� Ln o L (D (D O c A (D N W � CD 0 n 3 CD O I C T 7 p O * O O 2 � � o y y N f c v v o o 3 CD CD l d a CD o CA c TI ( 3 Oa m„ CD o CV y 0 Z D co Z Q � I C, N C� N at O 9 ' - 0 O 0 O CD y Q) m O O CA (D a) CD c m CD c Q 7 (D (O (n O N I a ' W v a " I ° o ( Z CD I W v T > CL C (0 CD = W o D n r � a < 3 a O O Ci CD(D O CO - I w n c Q (n m n X W N p Q n1 N R, O �� C N CD 0 CL -o m X, m o CD oc�o m CD O Cp N X � O (D' y (0 rn O O O O O (D (D p p 0 0 O C.1 O CL n Cl) O '' 'o 0 o o (D b C (D 3 c O L� r I = C N CO A Cil CD O 0 N _ O T N < < CD gg O ? 3 N p O O 0 CD 4 CL a ;I c le < N j N CD � I Co ° O 0 n r N CO fD cl ',. ° a' M C CL O O O (n P O 0 v m y � 0 cc (D 7 7 m D oZ LU 0 f Lo 0 c a (D CL N O 7 ',i _ --{ CA 4D O Z C) CL (D m 0 3 A A 0 FF (D O A W � CD 3 CD T c 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 [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Lange, Steven I Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: 03 3 1 (3 An TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake ! d00 F i l.,- LJ e e lc-5 f. Z l� 1 Aeration Po 6 - Holding Dist. to Well - 7 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r� Friction Loss System Hea TDH Ft Forcemain - Dosing Dist. to Well - 7 Bldg. Sewer z; Aeration — St/Ht Inlet BLDG WELL LAKE /STREAM LEACHING Holding INFORMATION 7,cn� 97.71 Z 1 i PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GPM Model Nu ber ELEV. TDH Lift Friction Loss System Hea TDH Ft Forcemain Length la. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 515145 0 State Plan ID No: 3 Parcel Tax No: 163.3 Alt. BM LieAr- 020 - 1265 -60 -000 Section/Town /Range /Map No: 75 29.29.19.1296 STATION BS p, HI FS ELEV. Benchmark Z v 3 / Z 163.3 Alt. BM LieAr- �� f 1 G� -7 1 7 - d 75 jb Z 51 Bldg. Sewer SETBACK — St/Ht Inlet BLDG WELL LAKE /STREAM LEACHING St/Ht Outlet INFORMATION 7,cn� 97.71 Z 1 i CHAMBER OR Y. uT T7.3 Dt Bottom Z.O ) Type Of System: 19° 1 f g 7 z$ Header /Man. UNIT 755 s5'.sz Dist. Pipe 7. -7:5 75 . 5 Z- Bot. System p 1� Final Grade St Cov r ieks 2(, EZ Gc 3 Z S ✓� Z _ d7 BED /TRENCH Width / Length No. Of Trenches xx Mulched PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Length Dia �� f 1 G� -7 1 7 - d SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Model Number: �� J Type Of System: ( (, / UNIT DISTRIBUTION SYSTEM 21-,L4. Header /Manifold Distribution ti x Hole Size x Hole Spacing xx Mulched ,, L Pipe(s) \ Topsoil "I-, Yes 0 No Yes Ej No Length Dia Length Dia Spacing SOIL COVER v Pro a..ra Rvctamc (lni. YY Mmind Or At - Grade Svstems Only C_ _0 Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 35 Bed/Trench Edges \ Topsoil "I-, Yes 0 No Yes Ej No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Is Inspection #2: / / Location: 501 Country View Road Hudson, WI 54016 (SW 1/4 NE 1/4 29 T29N R19W) Rossing's Country View 1st Add Parcel No: 29.29.19.1296 1.) Alt BM Description V � to �r Int -� Attach caarplete plans (to the County oaly) for the sysbeas oa paper net bas than SM x 11 tscbes In size 7 a SBD -6398 (R. 01/03) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County C Je (9 1 NV Ions�n Math 53 62� Sanitary Permit Number (to be filled m by Co.) Department of Commerce (n, 60 "� + � 515 �7 Sanitary Permit Application State Plan LD. Nugbc.r A h+ In accord with Comm 83.21, s. Adm. Code, personal information you provide Wi may be used for secondary purposes Privacy Law, al. 5.04(lxm) Project Address (if di then mailing address) / ffenwtt L Applicafim hdormadon — Please Print AD Information Property Owner's Name '� 2 Parcel # Lot Z 1 Blade # SEA u tots bzo-lZlos- 0 -�00 Property Owner's Mailing Address r '+ & k iowod �O / CO N N T►2 V l� 1,tJ � p PUaNN1NG Property Location Z5F, z 9 City, State Zip Code Phone Number pup s(�D� �role ) (aiE Z 9 T N; R pe IL Ty of Building (check all that apply) 1 or 2 Family Dwelling — Number of Bedrooms 3 ❑ Publio/Commemial — Describe Use ❑ State Owned — Desoribe use I : l �✓ 4—A4 Subdivision Name CSM Number ROSSINGi CouAIT f VIEtJ ❑City_❑vm p Wownsbip of Hu gge d IIL Type of Permit: (Check only one box an litre A. Complete line B if applicable) A- ❑ New System Replacement System ❑ Treatmeat/Miling Tank Replaoemcot Only ❑ Other MoMostion to Existing System B. ❑Permit Renewal ❑ Permit Revision 11 Change of ❑Permit Transfer to New Lot Previous Permit Number and Date lasuod Before Expiration Plumber Owns � — IV. Type of POWPS Check all that apply)..'e�. Non — Pressurizod In- Ground ❑ Mound> 24 in of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ PressurizW In -(3round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Reonvulatin Synthetio Media Filter 01,cwhingaisinlicir ❑ I)n Line ❑ Gravel -kss Pipe ❑ Other ( lain) V. DispersalfIrreatment Area Information: Design Flow (gpd) / Design Soil Application Rate( Dispersal Area Raluir Dispersal Ar oa Proposal System Elevstian L1SO I G//3 5 `71 yD VL Tank Info Capacity in Gallons Total Gallons I Number of Unite Manufeoaunr /d �G 6 2 , 5 Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Tanks lixistir>e Tanks Septic or Holding Tank 61 /000 / 2( 9 1 q 11 S 't w geltl i ' x Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement 1, the undersigned, assma a respandmiky for insiallat[on of the POWTS down on the atherbed plain. Plumber's Name (Print) ' JoNN Sc. m lrr = 441 ' ture /aul Z 7 to MPAIPRS Number Z 3 O Business Phone Number 7 / ,S - 5 V9 - 6 H S Plumber's Address (Strut, City, State, Zip ) 616 15 - 0 7 - 1-f It V 6 n?6Az!5E7 Wr SyGbZ S VIII. Use Only ❑ Sanitary Permit Fee (mcludes Groundwater Date Issued I Iss ' t Signedge ) Surolerrge Foe) q 7:5 co Given Reason far L 09 DL Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3 , /ilwrlyt>�ar'nr 5�i I�t�(I 5�1 prl- 1. Septic tank, etflUent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. J 2. AN "tbsck regtal'ements mu>4t.be maintained aspert� /. Attach caarplete plans (to the County oaly) for the sysbeas oa paper net bas than SM x 11 tscbes In size 7 a SBD -6398 (R. 01/03) �V ALT 13M EL ; 1033 2- ' TOP ®'r ,!W5Ad crtoN CA P a .v 5.% ® 13ACKOcE Pi 7 5 (-oOF- - !/ .,5� ✓5 i Fm E L = J L l o O I L , c X /57 4 t 7 A /U Jr, ?"o g,dr LtSeIj 4 L F /(l G W T H Q A)6 w Z (r / 6d¢CC o l✓ 74XJl� tevi tf PecYLv/c' SAS Ic tre Swt c A(4tJ V 4LVe 7 /3E N5r' Ea O Z t e� q 2 3`x (t!` Q u I K u -re-e tv c4 es G 4e ' BBL 1 NouS� o L S.T". r_ "XjSTiAJ(o /000(5 ,4t. rr C •r4 i( - RUM \ V1�LVr N0 JA Z.at Ackes l-��� s a �✓ 1�t1 r �5 SlQ / � �64Wi /V & &V ' la /( /5 ,j e5e r t4, eCAL 0 ' IE 'Al Woks ZZ3 76 0 ,� ate_ ► ,� - - 1�14 0501U WE -I E " ILI I V 5 Z / , 7 "Z I N, �R� �✓ P84WiNG t3 .' �� _ l} 07 - - - ��r1� - O PkS I A (3 m ' k = /co, -roP o i= '7 PVC /,Pe LT tam F L ; 1 03 32- � TOP- of JwsioE c1 Cc4P O/V s. i If ° of 4 f: 6 X /5Tr'IV to - /OQC (a4 -r 101 TD',_ *e -_ >�L0W G w 1 T H Q ' �)6W Z,(c cco.v Ti�wh - _ - W i T H tf PO L 4 C C 1r S --- 5 =_ IC/ c T /I. SqL c Aw Al -- V , 4Lve_ i t3r f NSr�I' - 6 ,aepN, - Cl � ;1 - ®WELL- - 53 AG I - - $u LL IRUM -- i -3 Z 1C(r� - �.��� e,eel7) i� NL M N - rI�.G Qui K LI - rte NG14 t` ,� ate_ ► ,� - - 1�14 0501U WE -I E " ILI I V 5 Z / , 7 "Z I N, �R� �✓ P84WiNG t3 .' �� _ l} 07 - - - ��r1� - O PkS A �-- GPD ft. NVIsconsin #Isla IL EVALUATION REPORT Soil Application Rate Department of Commerce accordance wit Comm 85 Wis. Adm. Code Pale 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Roots percent slope, scale or dimensions, north arrow, and location and distance to nearest road. *Eff#1 02 - 12x5 -sa000 Please print all information. Rev' ed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). none 2fsbk Property Owner Property Location cs 2vf Lange, Steven & Pamela Govt. Lot SE1 N 1/4, S29, T29N, R19W 5 -16 Property Owner's Mailing Address S �' 1 ZD�g Lot # Block # Subd. N me or CSM# 2msbk 501 Country View Rd. 29 gw Rossing's Country View 1 St Addition 1.0 City State Zip Cb(fd�Ol4�§itWNqqp�bbeer ZONING OFFICE City ' Village i Town ❑ g Nearest Road 10yr5/6 PLANNING & Hudson i WI 1 54016 1 Hudson i Country View Rd J ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand and Gravel Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7gpd /sqft rate. Possible system elevation for replacement area is 94.40'. 11% Slope. GPD ft. 1 [:1 Boring Boring # ❑ Pit Ground surface elev. 101.60 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. *Eff#1 Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -5 CS 10yr3/4 none sl 2fsbk 10 -30 mvfr cs 2vf .6 1.0 2 5 -16 .6 10yr4 /4 none grsl 2msbk none mfr gw 1vf .6 1.0 3 16-44 4 10yr5/6 none gris lcsbk lcsbk mvfr cs - - - - -- .7 1.6 4 1 44 -87 10yr5 /4 10 yr6/ 4 none grs Osg cs ml cs - - - - -- .7 1.6 5 87 -120 s 10yr6 /4 none s Osg .7 ml - - -- - - - - -- .7 1.6 �t 2 Boring # ❑ Boring ❑] Pit Ground surface elev. 97.40 ft. Depth to limiting factor 121+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -10 10yr3/4 FILL ---- - - - - -- -------- - - - - -- --- - - - - -- CS 2vf - - - -- - - - - - -- 2 10 -30 10yr3/2 none sil 2msbk mfr gw 1vf .6 .8 3 30-49 10yr4 /4 none sl 2msbk mfr gw 2m,1vf .6 1.0 4 49 -58 10yr5/4 none grls lcsbk mfr a - - - - -- .7 1.6 5 58 -75 10yr5 /4 none grcos Osg ml cs - - - - -- .7 1.6 6 75 -121 10yr6/4 none s Osg ml - - -- - - - - -- .7 1.6 CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ���❑ 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/11/2009 715 247 - 2941 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s30 mg /L and TSS < 30 mg /L SBD -8330 (R.07 /00) Property owner Lange, Steven & Pamela Parcel ID # 020 - 1265 -60 -000 Page 2 of 4 F 3 j Boring # ❑ Boring Z Pit Ground surface elev. 98.30 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 *E02 1 0 -14 10yr3/2 none sil 2fsbk mfr cs 2vf .6 .8 2 14 -25 10yr4 /3 none sil 2msbk mfr gw 1m,2f .6 .8 3 25-40 10yr4 /4 none Sil 2msbk mfr gw 2m,lf .6 .8 4 40 -57 10yr4 /4 c2d 7.5yr6/8 7.5yr6/1 sil 2msbk mfr gw - - - - -- .6 .8 5 57 -63 10yr5/4 none grcos Osg ml cs - - - - -- .7 1.6 6 63 -120 10yr6/4 none grs Osg ml - - -- - - - - -- .7 1.6 1 1 1 1 74 :y��_ 1 d I I I I I � 1 6o� * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L /_- I 71 c1 F Z I Boring # El Boring Pit Ground surface elev. 98.30 ft. Depth to limiting factor 120+ in. Soil Application Rate Horizon D Depth D Dominant Color R Redox Description T Texture S Structure C Consistence B Boundary R Roots G GPD/ft *Eff#1 * *Eff#2 1 0 0 -12 1 10yr3/3 n none A A 2 2fsbk m mfr a a 2 2vf . .6 . .8 2 1 12 -24 1 10yr4 /4 n none A A 2 2msbk m mfr g gw i im,2f . .6 . .8 3 2 24 -35 1 10yr5/4 n none s sl 2 2msbk m mfr g gw 2 2m,lf . .6 1 1.0 4 3 35 -50 1 10yr5/6 n none g grs O Osg m ml a a - - - - - -- . .7 1 1.6 5 5 50 -120 7 7.5yr5/4 n none g grs O Osg m ml - - - -- - - - - - -- . .7 1 1.6 59 " -91 "' there are discontinuous 2" bands of gravels black in color. Ryan Yarrington came out for an On -site inspection to verify that the black color was NOT caused by reduction or oxidation. Boring 1 Boring # Z Pit Ground surface elev. ` 1 01.1 ft. Depth to limiting factor 122+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10yr3 /3 none sl 2fsbk mvfr cs 2m,lvf .6 1.0 2 8 -16 10yr4/4 none fsl 2fsbk mfr gw 2m,lvf .4 .8 3 16 -22 10yr5/6 none grs OSg ml cs 1vf .7 1.6 4 22 -35 7.5yr5/4 none vgrcos Osg ml gw - - - - -- .7 1.6 5 35 -58 10yr6 /4 none grcos Osg ml cs - - - - -- .7 1.6 6 58 -122 10yr6/4 none s Osg ml - - -- - - - - -- .7 1.6 � ►1 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Schmitt Soil Testing, Inc. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Steven & Pamela Lange Thomas I Schmitt, CST 227429 Address: 501 Country View Rd. 1595 72nd St. City, State, Zip: Hudson, WI 54016 New Richmond, WI. 54017 Phone: 715- 47 -2941 Subd.Name: Rossing's Country View 1st Add'n Lot No.: 29 Daft ay Legal Description: SE1l4 NE114 S29 T29N R19W ■ Backhoe pit Township, County: Hudson, St. Croix County ♦ Bench Mark El. 100.00' Top of 2" pvc pipe 0 Alternate Bench Mark El. 103.32' Top of inspection pipe cap on existing septic tank Slope= I I% Scale I" = 40' e , !Y, g rH 7 TiAN 13 R y an yam,. ,�e 1{ 1 �,.. ® � 7 eA irr/ID 0 3 38 ►3' ls." C All" 6 y P roP `saj °rr .o PWAM 5')'4 Pr"� Lo Jv ,. _ . a • Mdc7% AM lk K " t i A .., N ;erg x �il c } p i S C i } G 7 O • L O ;erg x �il c } p i SCHMITT & SONS EXCA YA777VG INC 586 VALLEY VIEW TRAIL SOMERSET, WI 54025 IN-GROOD SOIL ABSORBTIONSYSTEN FOR STEVEN & PAMELA LANGE ADDRESS 501 COLMR Y WEW ROAD, HUDSON, WI 54016 LEGAL. SE % NE % S29, T29N, R19W TOWNSHIP.- HUDSON COUNTY ST. CROIX CONTENTS Page 1 Plot Plan Page 2 System Cross,Sedion Page 3 Effluent maker Information Page 4 Bull Run Valve Information Page S &6 Management Plan Attachment I Soil Evaluation Report In- Ground Soil Componentt Manual (Version 2.0) SBD- 10705-P (N. 01 /01) By: MP.RS: 223760 Date: September 21, 2009 INFILTRATOR Quick 40 Standard Chamber Cross Section 4" PVC Inspection + Vent Pipe PL -525 Effluent Filter - Effluent Filters .: Polylok Inc. Page 1 of 2 Made in the U.S.A. Polylok Inc. 3 Fairfield Blvd, Wallingford, CT 06492 Call Tol Free: 888 - 765 -9565 EnWI: polylok ................................................... ............................... n......................................................................... .................................... .... ............................... .................................... ...... . ....................... ....... _............. ................. ........ ... You are Here: Home > Product Details EFFLUENT FILT Raising the bar in filter t Enlarge for details ®NEW PL-525 Effluent Filter PRODUCTS Description Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent Effluent Fit filters. The PL -525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the Extend & L largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off Rise & RI the system so the effluent won't leave the tank. No other filter on the market can make that claim! Distribution Accessorie Ordering Information Request a Quote Related Products Pumps, Be: and Step S; Features I Sews / Gas • Rated for 10,000 GPD (Gallons Per Day) • 525 linear feet of 1/16" filtration • Accepts 4" and 6" SCHD. 40 pipe • Built in Gas Deflector • Automatic shut -off ball when filter is removed • Alarm accessibility • Accepts PVC extension handle The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. Maintenance Instructions: 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL -525 out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace septic tank cover. PL -525 Installation: Ideal for residential and commercial waste flows up to 10,000 Gallons Per Day (GPD). Installation Instructions: 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & LokTM or piece of pipe to center filter 4. Insert the PL -525 filter into its housing. 5. Replace the septic tank cover. Baffles, Sal Deflectors Rebar Spac Handles an Signs Landscape Fors & Cl Butyl Seala Concrete A Pressure F Filter and C Rebar -Lok Acciessorie Reber Safe Technical Relate Pump, F 24" x 12 Filter Al; SmartFi Prom http://www.polylok.com/products 9/20/2009 American Manufacturing Company -- Bull Run Valve AMERICAN Pagel of 3 ONSITE AMERICAN MANUFACTURING COMPANYV INC. Home About I Site Map Products Drip Sy ste m s Controls Contact Data Ce nter THE BULL RUN TM VALVE The Bull Run Valve TM is designed to split flows to septic fields or systems. In addition to the advantages of longer life and easier installation it is the most public health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak -proof and external operating characteristics. The change over from one drainage field to another can be accomplished in less than a minute by simply turning the valve without digging or contact with wastewater. F C ITEM DESCRIPTION BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER w/ CAST COVER BRVKEY28 BULL RUN VALVE KEY 28" b 2 WS RISER CAP ADAPTER RISER TUBE C OUr PORT r OUT PORT f IN PORT The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated periodically to direct effluent to one or the other of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. BULL RUN VALVE Complete Valve Kit Contains 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter 4. Watertight Access Cap BRVCIRI5ER - 4" � V t NATIRMGHT ACCESS CAP VALVE DIRECTION HANDLE http://www.americanonsite.com/american/catalog/brv.html 9/14/2009 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION Owner . v n & Pamela Lange Permit DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units Wieser C P ■ NA Estimated flow (average) 300 gal/day O N, Design flow (peak), (Estimated x 1.5) 450 gal/da ❑ N, Soil Application Rate 0 . 7 gal/day/ft Standard Influent/Effluent Quality Monthly average* When combined sludge and scum equals one -third (Y,) of tank volume Fats, Oil & Grease (FOG) S30 mg /L At least once every: Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA Total Suspended Solids (TSS) 5150 mg /L ❑ Peat Filter ❑ Wetland ❑ Other: Pretreated Effluent Quality Monthly average ❑ N, ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Biochemical Oxygen Demand (BOD S30 mg /L ❑ N, Total Suspended Solids (TSS) S30 mg /L O NA Fecal Coliform (geom m 510' cfu /100ml ❑ N Maximum Effluent Particle Size Y in dia. ❑ NA Other: ■ N ❑ NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIO Septic Tank Capacity 1000 gal 0 N, Septic Tank Manufacturer Wieser C P ❑ N, Septic Tank Capacity 261 gal O N, Septic Tank Manufacturer Week's C P ❑ N, Effluent Filter Manufacturer Pot l o k ❑ N, Effluent Filter Model When combined sludge and scum equals one -third (Y,) of tank volume O N, Pump Manufacturer At least once every: ■ N, Pump Model ❑ N, ■ N, Pretreatment Unit ❑ Sand /Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: ■ N, Dispersal Cell(s) ■ In- Ground (gravity) O At -Grade ❑ Drip -Line ❑ N, ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ N, Other: Inspect pump, pump controls & alarm ❑ M Other: ❑ year(s) ❑ N MAINTENANCL sGHLUULt Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ■ ear(s) ❑ month(s) (Maximum 3 y ears) ❑ N, Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ N, Inspect dispersal cell(s) At least once every: 3 0 month(s) (Maximum 3 years) Y ❑ N, Clean effluent filter At least once every: lei ❑ month(s) • year(s) ❑ N ❑ month(s) r N Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ■ N Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ N At least once every: ❑ yearts) Other: ❑ N Switch drainfields At least every 3 years MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificatio Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Ti inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or lea measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfa The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pond of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires 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 en contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 1 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatm units, and any servicing at intervals of S12 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. 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 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 BE DIFFICULT OR IMPOSSIBLE. POWTS INSTALLER Name John Schmitt Phone 715- 549 -6651 m:PTAnF: SERVICING OPERATOR (PUMPER) Name Rons Sewer Service Phone 715- 749 -0153 ,t,. AI AIKMAMICO rV Yr 1 a IQIA114 Name 1 / 11 -. John Schmitt Phone 715- 760 -0486 ..1-102 ATnov A" , runorry LUL,#4L nG%7vw Name 1 W" ■ .+ St. Croix Cty Zonin Phone 715- 386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and /or dose tank presently serving the following residence: (Street address) -5 Cou ry ae y V , t w QQ located at: -5,E 1 /4, J F 1 /4, Section .1, , Town N, Range / q W, Town of /- lyp5a/0 , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 9 —d- f — 0 Did flow back occur from absorption system? Yes X No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: / 00 0 Construction: Prefab Concrete 2C Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) ( W ensed Plumber Signature) (Print Name) ' 94 P e S. (Title) oZ 3 7 & 0 (License Number) MP /MPRS -a / - (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 ST. CROM COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer STC V 6 W, f Inez R L d AJ& E Mailing Address 50 1 Cat 1V r e Y 0 6 GW )Q0 d4 O S o N , WT S 1 Property Address .5,'" I ''C (Verification required from Planning & Zoning Department for new construction) City /State 4 u a s © N VJ Parcel Identification Number 1) a p " 17 to i — 6 4 - 0 00 LEGAL DES, CRIPTION Property Location E 1/ , 1J 1 E 1 /4 , Sec. a2-, T �N R-13-W, Town of u p so N Subdivision {� S S / N b S (D 1 40 7 , e Y V 16W J T .I a p , , Lot # . Certified Survey Map # , / p , Volume , Page # Warranty Deed # _ - y , Volume Z � - ,Page #. Spec house yes a Lot lines identifiable (Fj) 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 plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNAWkE OF APPLICANTS) 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) U 2468P 452 STATE BAR OF WISCONSIN FORM 1 — 1998 WARRANTY DEED Document Number II This Deed, made between Michael J Begley and Anna M Begle husband and wife Grantor, and Steven F. Lange and Pamela M. Lange.husband and wife Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property "): 7 4 8 3 2 0 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12/05/2003 09:30AN WARRANTY DEED EXEMPT ti REC FEE: 11.00 TRANS FEE: 824.70 COPY FEE: CC FEE: PAGES: 1 N Estreen & Ogland 304 Locust Street Hudson, W154016- �''I"`�� 020 1265 60 000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Lot 29, Rossing's Country View First Addition to the Town of Hudson, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. None Grantor warrants that tt{e title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except < - / /h� Dated this day of �� UQ l l L, �W3 (SEAL) Michael J. Begley AUTHENTICATION Signature(s) (SEAL) authenti4E-"1; S W 9kTX I N A NOTARY PUBLIC STATE Or WISCONSIN TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 3 -60337 (Signatures may be authenticated or acknowledged. Both are not necessary.) WARRANTY DEED (SEAL) Anna M. Begley (SEAL) x ACKNOWLEDGMENT State of Wisconsin, ) as. St. Croix County �t" o rsonall� came before m is day of l>pQ,= the above named Michael J. Beolev an Anna M. Begley. husband and wife. to me known to be the person who executed the foregoing and acknowledge A e same. tary Public, Statelfof Wisco My commission is permanent. (If not, state expiration date: STATE BAR OF WISCONSIN FORM No. 1 — 1998 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. 0 CO) 0 C 3 � m 0 m N K • CD EA O O Q L 3 m o � � A C CO N CL N O O j 0 N C O CA O N � 7 CA p 0 °o N o CO) v co N ' 0 N T . N O c CD f o. l A ? � A z 0 Co rl) N coo Z Z M I co c a N a O W o 3 Q O CD _ C W N CD Q C CO) CO) CO) C_ " C) N N O CD D CL 1 = CD 7 v a) 0 C CD 3 d N cc Ln 3 v O N O y N o D a m 0 O Sv cn < D a CD rn XI y CD C N OD w C C O w C1 a '-' CD W � CD CD O iZ3 i j O U) C �1 v � ` N 0 m co co a CO co = 0 m N K • CD EA O O Q L 3 m o � � A C CO N CL N O O j 0 N C O CA O N � 7 CA p 0 °o N o CO) v co N ' 0 N T . N O c CD f o. l A ? � A z 0 Co rl) N coo Z Z M I c a o 0 ' _ -3: CO) CO) CO) O cr CD N v v o CD N 0) T 1 = CD v 3 d cc CL v z N O Z W Z D a m 0 O s CD rn XI y CD C N OD C C O w Cp a n 3 � Z O_ CD U) C �1 v a 0 T Cw D CD a ^' C 3 H Z W D a o' 7 - T SU C z a 0 m N K • CD EA O O Q L 3 m o � � A C CO N CL N O O j 0 N C O CA O N � 7 CA p 0 °o N o CO) v co N ' 0 N T . N O c CD f o. l A ? � A z 0 Co rl) N coo Z Z M I W. Mn_47C= Cn AAA 02/08/2005 04:41 PM PAGE 1 OF 1 Alt. Parcel #: 29.29.19.1296 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 " LANGE, STEVEN F & PAMELA M STEVEN F & PAMELA M LANGE Last Changed: 10/29/2001 501 COUNTRY VIEW RD Acres Land Improve HUDSON WI 54016 Reason RESIDENTIAL G1 2.010 Districts: SC = School SP = Special 170,300 Property Address(es): ' = Primary Type Dist # Description " 501 COUNTRY VIEW RD SC 2611 SCH D OF HUDSON General Property 2.010 SP 1700 WITC 170,300 200,400 Legal Description: Acres: 2.010 Plat: N/A -NOT AVAILABLE SEC 29 T29N R19W 2.01 ACRES PT NW NE, SW Block/Condo Bldg: NE & NW SE LOT 29 ROSSING'S COUNTRY VIEW FIRST ADDITION 2.010 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 170,300 200,400 29- 29N -19W 0.000 Notes: Parcel History: Lottery Credit: Claim Count: 1 Date Doc # Vol /Page Type Batch #: 138 12/05/2003 748320 2468/452 WD 02/15/2002 671273 1837/269 WD User Special Code 07/10/1998 582796 1339/347 WD Amount 07/23/1997 866/562 SPECIAL ASSESSMENT 27.00 more gnnA SUMMARY Bill #: Fair Market Value: Assessed with: 49337 259,000 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 30,100 170,300 200,400 NO Totals for 2004: General Property 2.010 30,100 170,300 200,400 Woodland 0.000 0 0 Totals for 2003: General Property 2.010 30,100 170,300 200,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 138 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Cn m m b >v CIQ fD w (D a ro 9 rt Z O W Ln N N I—� N 1 F" N 1 Cb d O Oq 1-+ w rt O �r m m 0 x� n f:'� O N. 9b a� 1—' P rt N• N 00 N O i ., N ! O a Fh C/) t n a N• ('t O H cD rn C/3 Cn O C7 ll rt O .A rl F-h C/) f �•O � H 1 O 1 , N "p 1)� I I I I I Cl) � z v, Z I 0 d o, o v, o W Q . L CD y N N C A 4 CO CD N N N CL O ?� I 000 � Ch m n 3 a o I O N N I � O CD (O to c a W I O 3 O o CT � I N I _ i y o C o I o v :r 3 m= I � v C c I a � Z cn I I o � I I C I w m a 3 Z CD CD I � � 0 w I o I I I I I I m 0 D i3 a C 0 .' I N O 0. N — CD z 0 I cn I a I co 0 I Q I CD cn I (O I I co 00 co I I o 7 I CD I 69 0 o 0 10 _ 0 N � 01 O_ H N 0 CL O N CD W N � � � � O c 0 a o m � o. rn 000- rr •vvv_ o �o Z W Z D n C co H 'O C C :3 N (DD d cc n A 0 CL 3 ° o 3 H Z Q W G C 7 a 3 T o � a c � N D. IV Q O O m O y O CO) cr 3 .. m " M co y Ul g a a A n A Z O G) Cl) to o Z z M A r°. A) O O O 0 M a a fi A '7 O a N O O V A ti N 40 a � N ti W a '.. 9 I _ Ir _ AS BUILT SANITARY SYSTEM REPORT Form - ST C- 104 OWNER ✓ TOWNSHIP ,Soy , SEC. T Z'7 N -R 1EC ADDRESS &K'fzg7— ST. CROIX COUNTY, WISCONSIN SUBDIVISION n 7 V� i- I!OT 9 LOT SIZE 2 '. 3 7 PLAN VIEW 5 Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM cG.a 24xz4' wm--1 l (�y 1 � Noks� ' Z8�x5o i a F S ' L C R t t 3 1 6 ITi _VA sto °-t- �k� -r, WC-) S yLta ,,., El. D I3, k S. W, CO✓ µa.,r U / � Vv" aJ\-/ 'Tlc". N INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used e.5, t,�,lo�'[e� rua✓ Elevation of vertical reference point: 100.0 Proposed slope at site: -5 o we Sfi Y PUMP CHAMBER Manufacturer: 141A Liquid Capacity: Pump Model: Elevation of inlet: Pump /Siphon Manufacturer: Pump off switch elevation: Gallons per cycle: Alarm.Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: / g� Lenth: Number of Lines: 3 Area Built: 6 Fill depth to top of pipe: q a Number of feet from nearest property line: Front, O Side, O Rear,O Pt Number of feet from well: Number of feet from building: y� (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Area Built: Bottom of seepage pit elevation: Has either a drop box O or distribution box O been.iy. ^cd on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capac;`v: Number of rings used: Elevation of i twat of tank: Elevation of inlet: Number of feet from nearest property line: Number of feet from well: Number of feet from building: Number of feet from nearest road: Pump Size Bottom of tank elevation: Front, O Side, O Rear, 0Ft. Alarm Manufacturer: DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY &BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON WI 53707 State Plan I.D. Number: Sid 4 i N u , Sec . 29 , T29 -R19 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson Lo 9 T,, ___ n -1 Holdina Tank ❑ In- Ground Pressure ❑ Mound NAME OF P RMIT HOLDER: Sam T ADDRESS OF PERMIT HOLDER: INSPECTION DATE: / BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK /HOLDING TANK: WIDTH: LENGTH: NO. OF MANUFACTURER: ' o DISTR. PIPE SPACING: LIQUID CAPACITY TANK INLET ELEV.: `/ TANK OUTLET ELEV.: : p+ n I_ WARNING LABEL PROVI LOCKING COV PROVIDED: L° LIQUID BED /TRENCH DIMENSIONS 61 S • 4 D s N t� YES ❑ NO El ,/ YES e NO BEDDING: VENT D A. VENT'M HIGH WATER ALARM: NUMBER OF FEET FROM ROAD: GRAVEL DEPTH PROPERTY L WELL BUILDING: VENT TO FRESH AIR INLET: NO. ISTR. I' v ❑ YE NO NEAREST --► VENT TO FRESH IR INL T: BELOW PIPES: S E V. NIL E E �� �- F-1 YES LINE: r 5 5 I 0 1 ! o �^ II NEAREST �I DOSINGFCHA MBER: f� DISTRIBUTION HOLE SIZE: ❑ YES ❑ NO GALLONS PER CYCLE: (DIFFERENCE BETWEEN PUMP ON AND OFF SOIL ABSORPTION SYSTEM. Check the soil or excavation. (If soil can be rolled into a wit he soil is dry enough to continue.) ONVENTIONAL SYSTEM: MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ED YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: DEPTHS ❑ YES ❑ NO E:1 YES ❑ NO ❑ YES ❑ NO ❑ E. ❑ Nb at the deptl . plowing FORCE Iction shall cease until MAIN PROVIDED: PROVIDtU: ❑ YES ❑ NO ❑ YES ❑ NO NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM LINE: AIR INLET: PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: DISTR. PIPE SPACING: COVER BED /TRENCH INSIDE DIA.: # PITS: TRENCHES: LIQUID BED /TRENCH DIMENSIONS DIMENSIONS / � I Y f J 1 TRENCI�6: �' / MA ERIAL: PIT /� MANIFOLD / MANIFOLD DEPT GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH IR INL T: BELOW PIPES: ABOVE COVER: r 1 E V. NIL E E PI� FEET FROM LINE: r 5 5 I 0 1 ! o �^ II NEAREST �I f� DISTRIBUTION HOLE SIZE: PRESSURIZED DISTRIBUTION SYSTEM: Sketch System on Reverse Side. SBD -6710 (R. 06/88) Retain in county file for audit. WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ♦ Sketch System on Reverse Side. SBD -6710 (R. 06/88) Retain in county file for audit. C ' EZZ DILHR SANITARY PERMIT APPLICATION � _ In accord with ILHR 83.05, Wis. Adm. Code !V . STATE SANITARY PERMIT # - Attach complete plans (to the county copy only) for the system, on paper not less than ❑ S 4/�� 8% x 11 inches in size. c eck revlsion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Al ; / $ GfJ' /a ei /a, S TZ , N, R E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # # Z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER . , n �--- If- .. . % _ r.. - R .0_4 _ 4 �e elp-_ i J. _ / II. TYPE OF BUILDING: (Check one) U State Owned ❑ Public [0 1 or 2 Fam. Dwelling-# of bedroc III. BUILDING USE: (If building type is public, check all that apply) Z q/ 1 ❑ ApVCondo / f � 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 4 ❑ Church /School 8 ❑ Mobile Home Park 5 ❑ Hotel /Motel 9 ❑ Office /Factory NEAREST ROAD 10 ❑ Outdoor Recreational Facility 11 ❑ Restaurant/Bar /Dining 12 ❑ Service Station /Car Wash 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution 11 Seepage Bed 12 Seepage Trench 13 ❑ Seepage Pit 14 ❑ System -In -Fill Pressurized Distribution 21 ❑ Mound 22 ❑ In- Ground Pressure Experimental 30 ❑ Specify Type - Other 41 ❑ Holdingl Tank 42 ❑ Pit Privy` 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: v 1 ALLONS PER DAY 2. ABSORP. AREA 3. ABSORPeAREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION �0 '.. ( S $ 0. � 3 7r Feet 100. SO Feet VII. TANK CAPACITY in allons Total # of Manufacturer's Name Site L ioncre refab. Con- Fiber- Steel Exper. Plastic New istin Gallons Tanks tINFORMATION _,... - -,, glass App. Vlll. RESPONSIBILITY STATEMENT I, the undersig assum responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: S 0& �-� .t��� r - � � �' � 1 7 z � . ..v, , Io.,... 7 IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑Owner Given Initial Oau��1 X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 6(18 - 266 - 3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax 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 in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for 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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump ntanufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on '� 1216 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, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) 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 Location of property _ tJt% 1/4, Section, T-RV Township Mailing address t"9f.t V 50Y z�v 4L4 U)-r �; Address of sit Subdivision na Lot number 2�4 I Previous owner of property � J �, Total size of parcel • _ _ �Ae -ire , Date parcel was created Are all corners and lot lines identifiable? Yes N o Is this property being developed for resale (spec house)? No Volume , M nd Page Number -* 0-- as recorded with the Register of Deeds.. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SBAL OF THE REGISTER OF DEEDS. In addition, a certified survey, If available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------- PROPERTY OWNER CERTIFICATION 1(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described In this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. W3 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register, of Deeds, as Document No. 1321 J. a DOCUMENT No. STATE BAR OF WISCONSIN FORM 11- 19ea---, LAND CONTRACT r h InU.Nul and (arrest. 1 4 0220 a ^�,00 la FINANCED AND IN (T F'N N N- COKaUMER - 1 VV ACT TRANSAC171011 Contract, b) and between . Ft? XXl:H t.. 1:.....K4fd14.1pg, Hnd ...Ruky...Ri1��N a sin &le n ............................................... ............. ................................................................. ............................... ( "Vendor "# whether one or more) and.. Saia. k.... I1. ll. le. e ............... ............................... . ................ . . . ........................ . ....... .......................................................... ("Purchaser", ( "Purchaser ", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per formance of this contract by Purchaser, the following property, together with the rents, profits, ftxtures and other appurtenant interests (all called the "Property " ), i n ...... 5t....CKQAX .................... ........................ County, State of Wisconsin: West one -half of Northeast Quarter (10IN04) except the east 8 rods, and the Northwest Quarter of Southeast Quarter (NW'rSF %), except the south 6 rods, all in Section 29, T29N, 19W. .le erACC 019ravra REGi,%TER'S Ot *ICE ST. C CO., WI Rc:c.l trio P:lcord Novqm of 1:25 P M Raglstor of Deods Q Q 0 � a`�. aaruaM To Tax Parcel No ... ............................... 4: "S (O C FEE This is .. nOt,. _ homestead property. (is not) Purchaser agrees to purchase the Property and to pay to Vendor at 208 8th St. i Hudson, WI the sum of ;.256,1SO,OQ .............. in the following manner: (a) $. ZQ.. 000r, QQ .... o ........................ at the execution of this Contract; and (b) the balance of ; 23�s.1 0 00 .................. together with interest from date hereof on the balance outstnnding from time to time at the rate of. nine.., II ....................... per cent per annum until paid in full, as follows: Interest to January 11, 1988 shall �Is limited to $1,320.29. $80,000.00 plus interest on the unpaid balance on January 11, 1988. $50,000.00 plus interest on the unpaid balance on January 11, 1989. $50,000.00 plus interest on the unpaid balance on January 11. 1990. $56,150.00 plus interest on the unpaid balance on January 11, 1991. The above payments shall be made in addition to any payments made for the conveyance of lots until the total price is paid in full. All payments shall be by 2 checks, one to each Vendor for 4 of the full amount. A Lot ,R 1 ase Ag eem nt h so } -en 1. d of 0 11 dat . 11th day of ProvldI mw�ever, F entire ou�s nn lag bill - once e)l �ie pall in lul� on or the ........................ .. ..,)actuary .................... . 19.11.. ( the maturity date). Following any default in payment, interest shall accrue at the rate of 19....... % per annum on the entire amount in default (which rhald include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Aarehnsert ualeee excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay renaonahly antici- patrd annual taller, np.r, ial a+a~mentf, fire atwl re•luireal insuranee premiums when doe. To the extent received by Vendor. Vendor agrees to 4.pply payownts to those ebiitrations when due. Such amounts received by the Vendor for payment of tateA, 114A4 emeatA and insurance will be deposited into an escrow fund or trustee account, but shalt not bear interest unless etl+erwise required by law. Any amount may be prepaid on principal at any time. Payments shall he applied first to interest on the unpaid balance at the rate specified and then to principal. Any - amount may be prepaid without premium or fee upon principal at any time after .............................. 19....... (OR) there -ma be no " '. g prepayment of principal without permission of Yeador."' w In :he event of any prepayment, this contract shall not be treated as in default wit% ►espeet to payment on lent( as the unpaid l,nlance of lrincipal, and interest (and in such case accruing interest from month to month rhall he treated as unpaid principal) is less than tl amount that said indebtedness would have been had the monthly payments been :Wade as first specified above; pr.rvided that monthl payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premiser being thereafter excluded herefrom. Purchnser states that Purchaser Is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purrhaser atrrre. In pay the coat of future title evidence. if title evidence is in the form of an abstract, it shall be retained by Vec.dor until tt••• full purchnse price is paid. Purchaser shall beentitledto take poss"4ion of the Property on t. ht• dntt ht�rEuf .............I If .... •c..... 0A.. n,. 79'ir 50 ,. = w Purrlr...rr pnaniisea to pay when due all taxes and a:+'ens .trit•i levied on the Property or upon Vendors interest sn it lied to urhi,:r bu Vendor an demand receipte si,ow•sug such payment, fi.wl.:cscr sl till keep tbp iniprovvinents on the Pruptrt• inn "red agsrinst loss or damage occasioned by fire, ex- r. • !• •1 .o:tral r: p ►tt! sad ouch_ •,tl.c-r hazards us Vendur may r.•quuc, without eo•srsurance, through insurers approved 1.; \ em:•to, in V.r• :•'1111 of $ :.... . , but Vl'lular shall met require coverage in an amount more l►au r a• I•w:o re ..A. -d tattler ties t:ontruct. Purchaser shall li.g tile. •nsnrance preou•tnis when due. The policies shall r ,' tit• t:,e t•ta!"I.114 cl.titw: in favor of the Veudur's u:tr+est and, unless Vendor oli.erwise agrees in writing, the original •,: all pu!„ n v coecnag the Property aha11 be del ositrd with Vendor. Purchaser shall promptly give nulize of loss to it •: ....... •••n+l'un:es stood Vendor. tnless Purchaser and Vendor itherw1be agree in writing, insurance" proceeds shall t.. ++•s *at:.liun or repair of tl.e Property damaged, provided the Vendor deems the restoration or repair to be ..,I. t.•:t,.1,4:. !'treks . r 1 not t(, •••r:s:,lit wasle near :!i•••s wa•.te to be rur..mi!'•d r.n tote Property, to keep the Pru;'ert;' tai ; , o, it to aant;aWv condition and or ;•air, to keep the Piupert; t•re :rum Refs superior to the lien of this Contract, and t., r• a. omit till hew•!, ordinances aria relrulaturis affecting the I'roperty. Vendor agrees Visit in rase the purchase rice with into-rest and other moneys al.all be fully paid and all conditions O.a,i he fully pert rn1ed at tf.e t.t•irs find in the manner above spec,Lcd, Vcw.,r w:il on demant', execute and deliver to tt.e Vurct.:• -er, a Warrant) !seed, in lee simple, of the Proffers >, free and clear o! all Gene and encumbrances, except any (ter„ •.: et.cmuhrances treated by the act or default of Purchaser, and exc•pt: exist ing or west fences .encroach .on this..alr. adJ(?tninK land, .warranty will. not. -OPPly to lamd... between such fences,.and_true . descriptiuq.lines.... .• . fort• -a-er agn•es thnt time is of the e'-erlre and (r► in t! r . s.•s:t of u default in the payment of •ray principal or inter ^ -t u►ia•h ronUoues fur a period of ..60...da*s following t!:r sicafied riut date or Ib) in the event of u default in ::; , .tiler ohligatio n of PurchaNer Will, , h cunUnue- fill- is IeriuA •.f ..60.. drys •'allowing wrttpn nutire lot.,.. -- .• t •..,. , j tt • :,,.t i, l'..r ! r Id(viccred per:ouuily fir mulled b; certified 11 - : 1 1. it it e c:,tire ovt t:unGng buLuxe under t!:i: r )-.4 re by :,ali tc• n•e c.a:e due tin-] pa}uhle in lull, : at 1'rndur'y ul,tcn, :.!. .%.tiout nut ice (which )ourcha -el- h.reLy •r -'::+II l-1 -o Late tL, dlowinc ri,Lts :u, l r• n't i , :I. • rt to :u1a lunituti prucideJ by law! in 1 . : 1 t. I•ru,ided by law or in equ it y f ii \' - r Ica y.:,• L. l•t1• rerntar tits• t },i: LufaU,. t and 1'ufaha% o _i• t,• , , ,y, t iu the 1'iuprrtc t,:nl r• • ri,r I'luptrt'. n:n'1: tor ; ..h :trice fur+.!" t•:,th arc rqutt} of t•.,. ail,:, . i ..•,N:.; „pa I•',r rGa•pt' :1! t.:: •,I ..' t•. .I' r. ...:, .;:, n,Ga� ►.:d:,lt, V.+ti, interest tl.ereoa from ! ,u.uua l: fpreylaUDl \ tl • .I, !. ; o i l ti.el-:. 1t- L. r ut. is cl.,• .rcefaC:a! •, 1 r••r tt... 1' . .. r -'t1!i 1•t- lure t• i liy', tat ..! ... .. .. . t j i. 1 list. •1 r. .. t o: iail t u•r o redeems: far t u t r i 'r e. lire" l t l•• rturm;ui ,• tl.i? r'oiJr'.r• t., rempcl i;n.,r.•: +: �.,1::.il(a,;. u:rr,t of the untie oat- t:.r••`. h. wrtii ,•,t. t i r•• n •,t flit r:,• r'`e• tl• elute of .I. ':nil- au! 'titer :u.:ount: due hereunder, in a i:it • ci. !.t tl a Pr pert) sLa!1 he :rs stir: d lot "tole ial ':de anal 1'urcha!er .I:,!1 t..• !tilde for Busy deficiency: fir I iii ► Vvvid �r n::,; - 1• :,t ;-., t•,•• . -,It a ;..:d pare: a, pti fir : Ft% portlnn lie, Vta:dor way declare tl•iv Ciattruct :,t :ter tfad a:: 141111A.- till t ••a•racta +aclou on title in a quiet•title tt.. :tittle"!. inter, t ..t I'urrLa•er i, hi -`.c V,::.1••r n; I:at• Pit.,i.st: a ect-A from p"'es +inn of :le Pr-+ r'y :,fail I:ave a rerviver tappoint I to cu!hct •,n•: rest -, i•• :•- er t- 1.:.'t: dar: ti•• pestle ►1l-} o! an) action and. r t i r, r ii i .•• I is r ul•oce. Not frig tar.;• a.r fir ,iro1 it •!:,tan. tit+ air art ion= of \•, •A , ir. se., elr•clion +d tiny of f t a• 1' s; ••. • 'hall only he !•n, nl•• r V. r.di.i if :,t,.l r r ... pin urA in IIf Iv :.t.A e r• and erpen ir.clu•lifag r• i, :,ttnrs,..= fee' or Vel.dur fix irra•,I t•. • •tore :•t n r , •i> t • re ,fad r r e ••ctl.er ah:,te t air net I to the eat. t..• t : it ;full by L•rc anA expcn':•- of title vi-!, rre -1, a ll 1... •; :, ,( t•, pr.far:pal :ni.1 paid I•;: Purc6a <cr. as in- ^unea, included in any judgnn fat. !'pun fete cnn:mpncement far during t}:e penAeuct of an} a ct of 'et•riu.ure of till* ( act. Purchaser consents to tl appuintnitnt of a receiver of the Proper %. includ:nc ! e•r•e•t••ad t.t .t. to rvil.•ct t'-f- rr nisi I. !a and profits of till- Property darinc tie pendency of such urtuuo, slid '•urn rear , is <,u• =. at ! pr,fat wi,en so collected shall be held and apP!icd a< •• ' -hall din 1'7ircl.ast•r sl,all not tran!f.r• sell or ea>rtyry me :vial far r•,aita! :merest in tilt- I'ropt•rty thy asp of any of P ircha• richt= under thi! Contract or he W; fi lnt:g•to -I L :: -r• air in arc other w:ic ► without tl r prior n I t t•• t enn<ent of Vei,dor utileste either the outaandin� b:A:.nce p::> u!de tit, !.-t v i- - o.truct i± first p:,i,! in full far tb... intrrr!t run�pced i+ :, Plod: ^.• far a` iCnnient of I'tircl.ast r% iota:, st r ;!: f'. •.t ra••t :fah r• sa •�t:•'.ua) fur ua indchto•dn• -> of 1'urel:nser. !n the ec.•nt of • tiv sail•`, transfer. 'ale tie eur:t.yare u.t!.u.t Vtnd written r..n 11. theentire eautstandir:g balance pac;ade order tai- Contract shell he;untt• irrtnt. , 1iaa 1} d it . and i awe. in full. at Veml• ; nt•h without nutire. \'••udry 01all make all p: -• ment. w! • r dn•• trod, i in . n;ortiag•• out= tandirz ntrwn >t v a 1•ropertc nn the date of t l i` I'ontract lesrer•t fnr any mortgage granted by Purchaser or wider tiny r•rdc <vc :n•A ti,• fat•., provided Purchaser make= t is clt pncinrnt ni the nnu.unt! tr,: n d ,e and• e t i- f'o ntr:.rt. Pure! a rr n: r. n site a•.. • ;, i i•a':nvnt! ,!irtrt!y to tie �1u;: •s:• if Vrndur fails to do !a ar•1 all 1 n,er.t: so .aide I 1' ir:•' :, .,it 1..• rot. red p:, }meat! mode on tt.ji fn•ttr:p•t. \'.fad• r may waive tiny default �rithout wai%;nc su1;: other •ul ,.:: • r •riur dr•fu:,lt of Purchaser. All t,•rme o1 this Contract shn!l he hinClnc upon anti inure to the bene3ta of the heirs. legal rerr"entaticr. , sueep• ,r.:md "toirns of Vendor and Purchnser: IIf not nn owner of the Property the spou Vendor for a valuable c,m!idernitnu ininot herein to relea•p homestead rirhts in the !ubjecr: Property and agrees to join in the execution of the deed to toe rradp in fulfillment her-of-1 t: 16th d.,y of November , 19 87 . c'" ll ,. i L4 £:e..1 arrest) E. Rossin / Sari ! . "tiller t � ISEAL 1 Ruby oiley AUTHENTICATION �i� , ,, r, • , all parties i . .. 16th!:: r.f Suvvtmber iq 87 -John Hc\•wood ST\Tt: 11:\II OF WISCONSIN ACKNOW LEDGMEN f STATE ()F \\•1Sl'l0N`IN I t o.tnt�. Prrictr. calve bcfer•c rite *Vito: .. too: of tt:c :,b; ce na ntd t n•e lit,.,.,:: t ,' t•., t.. rt ,',a,. e c ..., , STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER ROUTS /BOX NUMBER ,eOY FIRE NO. CITY /STATE /y* ZS-On Lv� __ ZIP PROPERTY LOCATION: 5 L 1 /4 1/9, Section , T R — LJ ---mod Town of D VU , St. Croix County, Subdivisions Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after Inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNE � J L DATE f V J u St. Croix County Zoning Office. St. Croix County Courthouse 911 4th Street Hudson, WI 59016 (715) 386 -4680 Sign, Date, and Return to above address DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (ILHR 83.09(1) & Chapter 145) SAFETY & BUILW DIVISI P.O. BOX 7 MADISON, WI 53 5% A 1 /4 NIL V4 Z9 /T N/R A E (or - - -- - U &S o Ry vrtu 1 COUNTY: , / Sr C ea• SAIV1 M 1 LLCA ,ecx rr P_&J K � � lit/ ,&S(>, t s4 o / 4 USE DATES OBSERVATIONS MADE �NO SEDRMS.: AL DESCRIPTION: � esidencs , 1 N � New ❑Replace *hLCc A IV I) <<- 5 17 3 lJl � °t IC CyJ SODS BkCt 4U+eKNarQ RATING: S ' Site suitable for system U- Site unsuitable for system BORING NUMBER TOTAL DEPTHS ELEVATION P H T R BS RV D -INCHES CHARACTER IL WITH THICKNESS, COLOR, TEXTURE, AND DEV TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- , 7 /oz t 4a > tz " gLL TS /C 5,�� "IRP.,CS� GIS�$.�� C1 G,e B- Z l,IZ /oS.�o > Z 11,7 'QLf_ ' ,e�,:S, 2Z csi�z�cob�$aNr�s66 ✓ 8a. B. 3 1 � z � /os. €s > 1 2. 3•' . crs 0 "6Q►,, s,L 26 "8eNCSf6k 1 QN ols B- Q 6.06 / 0 07 �o > �O.Op 3 S � z''4a,� SQ 3s'' IRONL< 34^80"1 fir; r 66tti Cs,c G �- B- 1-7 / 49 . 00 > /0.1 q "A&90wCU&k 30�$!2«,CSfC.le�cafA gSB P�v�1 S 3k B- nfcGr PERCOLATION TESTS TEST NUMBER DEPTH . d5 WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL-MIN. A LEVEL-INCHES - PER100 RATE MINUTES PER INCH I PERIOD2 PERIOD 3 P b 3 > z > Z > z < P. 2 t3o > P_ P_ LE I N A 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 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 per of land slope. SYSTEM ELE TION. 47. D - _ - 7 r-- – - — , -.. - -- --T—,- i I'I toN 1 u sof • • I I i I y � S S Tf �'1 I i .._ . ; - -'- - -. 1...._ _._.... .._.._. � I g4 6 I ; If Percoation Tests are NOT required DESIGN RATE: V If any portion of the tested area is in the If s. LHR 83.09(5)(b), Indicate: �S$ . I Floodplain, indicate Floodplain elevation: A N Ft- PROFILE DESCRIPTIONS I , y E i Z`tz.1&0 I q - Z--< � N ' . N - �c rN LU f I 4u Q I q - Z--< Y`o 4 4 0 N c fY� moo✓ � O O vi a o `i— �- c Y kA 0 j lac va���� -s V a N 2 it 1 J E-- �V.t � N ' . N - �c LU 4u Q W W � Q Q 1!� ACS Y`o 4 4 0 N c fY� moo✓ � O O vi a o `i— �- c Y kA 0 j lac va���� -s V a N 2 it 1 J E-- �V.t .I 1 l� oft :T d . r . H d • I N1. I ;! J e a ' 0 , is M cL •— ' d � V � � . 0 JL ' N ril • . .I O T • d/ r a s a d s . off' 0 • Q 1 l� oft :T d O T • d/ r a s a d s . off' 0 • Q 1 J :T d . • I N1. I ;! a ' 0 , is ' d � V � � . 0 JL ' N 4 s 4- J d A H C J i t.l Fm