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018-1083-40-000 (3)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix .Safety and Building Division INSPECTION REPORT sanitary Permit No: 515300 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Olson, Lance & Cindy Hammond, Town of 018 - 1083 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: W.58 _ AAA— \ 16.29.17.612 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER I; S CAPACITY STATION BS HI FS ELEV. Septic i K Benchmark b t E `15 A..5 A �4—. i t 3.4`7 /62 g8 Dosing Alt. BM 3.17 L • 7 Bld .hew Holding fC. ' ; �.. 1154- St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION (L .9 W. ZS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD y qi/M5 Septic / / / Dt Botto Dosing a 7 56 r AV / — Header /Man. .7 1 54 . /S Aeration Dist. Pipe CC Holdi Bot. System g •°t 73. 45 6k • _ PUMP /SIPHON INFORMATION Final Grade 5.37 y Manufacturer Demand St Cover ® GPM 5� t G� ,o,�„ 34 7 �' •SS Model tuber ` )4i ` 4-.. i",„ 7 IQ 71.57 TDH ILi Friction Loss griPIL . Ft Vol Jt, OJI ` 7 Am 5y. S Forcemain Length Dia. Dist. to Well VCAUe.. ate- /3Q.L..) 7.6z. IV, 53 y SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / • . Of Tren. es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS i j.� JU , '�` SETBACK SYSTEM TO � P/L C = •G WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION -' CI � au Type Of System: n 1 / ' CHAMBER OR '+r/�.. -. � J C A " � 6 / 12, /1/ /\ \-" UNIT Model Number: J ` d 4 DISTRIBUTION SYSTEM ,,I„+4— f- /74-/ 7 0-19z 7 Header/Manifold ength Za Dia // Distribution x Hole Si ;e x Hole Spacing Vent to Air ke PipLength es) ` Dia ` Spacing \ ` N. o i r 3 r � el v i ` /�/`� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ` . - e S Depth Over ' Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3• •$3 Bed/Trench Edges N Topsoil N N "ik . Z . e . ! Ea No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 990 172nd Street Hammond, WI 54015 (NW 1/4 NW 1/4 16 T29N R17 Pheasant Hills Lot 40 ( Parcel No: 16.29.17.612 o V 1.) Alt BM Description = t G. 6 � �/ / c 4Ve. .1-41/4-64-01 2.) Bldg sewer length = - amount of cover = ∎ S + •'1 I-0 . 4 D Plan revision Required? 0 Yes No t ' 9 i b l Use other side for additional information. 4111 A l� l, SBD -6710 (R.3/97) Date Insepctor's 'f ature i r Cert.' Pd f'I tin t • commerce wi v Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST 64 f C Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) F it I.1 6/53 ,, ,_ Transaction Number Sanitary Permit Application In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission adds form to the appropriate governmental AA unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are . Project different submitted to the Department of Cammeroe. Personal information 'on .. a. purposes in accordance with the Privacy Law, s.15.04(1)(m), Stets. 1, _ 7 ■ 1♦ ' ' ; '� L A , , , c Information — Please ' , , i All Information .� Parcel , Pnep�tyLwru= 015e3 f1 D 2 3 2010 1 off / t3- ,-044 Property Owner's Mailing Address i Property Location / _ / ?94° / 7 _ 5 i ST. CROIX COUNTI s (� / PLANNING &ZONING OFFICE City, S Z pease G •n / 's, .. /�(� (� Ad t '� K� '/y Section /6 `��, /1 is (Air /✓ ' -II' '_''/'!9t'J L o T N; R IL Type of Building (check all that apply) Let # f 7ircl co E ■' 1or2 Family Dwelling - Number afB Name Subdivision rKG� � �/_ /� ° � O 2 4 Block # / /�' /. ❑ Publio/Commereial - Describe Use ' 0 City of ❑ State Owned - Describe Use CSM / Vr7lage of own 3 L- : 2 .t. 2- 1.2 4/1,4, toe -r'S 04' laws of / 7/ 000 00 IIL Type of Permit: (Check o>iy one box on line A. Complete line B 1f applicable) A. ❑ New System AReplaaament System 0 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal 0 Permit Revision d Change of Plumber C] Permit Transfer to New Lid Previous Permit Number and Date ( q Before Expiration Owner ........ 1( _ 4i O '1 " i OM1.I,n -i (... CE: w 771 I li it* t J L1 --- � 1/.a. -' Non-Pressurized In-Ground 0 Pressurimd In-Ground 0 At-Grade 0 Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil 0 HoldiUg Tank Obther Dispersal Component (explain) 0 Pretreatment Device (explain) V. 1' u ► _ > N Dispersal Ares Required Dispersal AreaPtoposcd afl Syste evation vt, VL Tank Info Capacity iu Total # of Manufacturer Gallons Gallons. Units 3 . dot New Tanks Existing Tads // !A [ • ,$ 9 a3 i A /14,.. c3 to W 'V a a Ar Septic oataigling-Tinie I • p /Poo % g EAVair IN Dosing Chamber /I VA 1111111.11111111111111 VII. Responsibility Statement 1, the undersigned, _? . " ■ i.,, . s. of POWTS shown en the attached plan Plumber'sjame (Print) s S' :. // / MP/MIMS Number • Business Phone Number / n/sP C a z • HP 13"'9i4 7/5 zW Plumber's Address (Street, City, State, Zip Code) ,5 9 70, Yf e ti✓D/elon/g l,tir SV7J`7 VIII. Conn •/De , artment use • , • 4 1 g ved ' Permit Fee Date Issuing r_ , t Si .' 'M a 2/ 75 7 PCs Realm ReaforDmisl / ` IX. Condit v asons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be services / maintaine4 as per management plan provided by plumber. 2 , AU soback tequirements must,be „maintained as per epc coda l ordwtaiae. Attach to complete plans fortis system and submit to the C•oaty only on paper ant less thaa 8 us i 11 hubs: la site SBD -6398 (R. 02/09) Valid tbm 02/11 Private Onsite Wastewater Treatment System Index and Title Page Project Name: 0 ish3 apt Ace Ake AT cave, Owner's Name: I i k - N C € £ 3 Y ) ) Owner's Address: 99 /1Z T {� tt) S` Legal Description: iitA) r I N 51 b Tz 4 l.7 1.70 Municipality: own Village, City of wttl4 d County: Subdivision Name: 49h-S l ( L Lot Number: 40 Block Number: Parcel I.D. Number: 6 IS'' (083 ''`10 - 00C Page 1 11 b0 7 - Page 2 7 r Page 3 01 $� — S C7?dam Page 4 447.1/'16/Gl GK r /?fixt, 7 4' q4 Page 5 1 Cr def /f1 I :r ! r'sWT Or f%/'� 2i?;/ /L Page 6 46‘ ��1,� "(ilk 7 e ;e " , fee fee- {l Page 7 jl/yr, i ry j)re Page 8 Page 9 / Name of Designer: , / i;; D 1 . „v L License Number: /f x9 Z Signature: Iff' Date: / / 7 2P/ 0 Designed P ant to the o lowing POWTS Component Manual and Comm 81 -85: In- Ground Soil Absorption Component Manual for POWTS (Ver. 2.0) SBD- 10705 -P (N. 01 /01) J _ { y '', c qT c\--- a c5 1 ._ '.:-' or) I `t._ t 4 -‘ .s.i g (3.. \ ---i --)-- -- 'g --- i,,,, -. "�± -a 1l ®� J am ) i . t 4- . '3 1 h r t, V ....S 1 ,s ,:. _1, --. ' 4 P ---2 " Q N 3 — .1 Q"" __ _t ..1 (7-- 4 /\ ,p \\I ___1\. V `1\ to `i y,, !, r rr k 1 .. i r k +fj ?t { ? ;,,V � y .... �/ If:C.1 D _ ^` kmss , � is et � , k XI L c. . .�... 1 il mac() • ors (-÷ I >I 5c(5F tui EL.r . . 01j6 Stfocv,J p 3 . t/1 Nirtpvi se L icyf S. u iw .-�2 i n�-L thcic t u 1 1 r.te-e/r.s 9C 3 ) tc•t: Al I ► we (-?aka-- 0-'-e c 1 0 c ic , p. 0, n • nRSCrdkl DA id-Lai - UN PI// P.00 r ., a k o a�,i , .,i . � � V `C, : .+t 'fi t Pa of FILE INFORMATION SYSTEM SPECIFICATIONS flwite C � . 7 J� Septic Tank Capacity st $ , gal ti NA Permit Septic Tank Manufacturer Acce 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer eg r,, k0 ❑ NA Number of Bedrooms 6 ❑ NA Effluent Filter Model Ff 9 $ #./ fd 4 ❑ NA Number of Public Facility Units f1A Pump Tank Capacity ga ( A Estimated flow (average) zito D gal /day Pump Tank Manufacturer 46 Design flow. (peak), (Estimated x 1.5) &C p gal /day Pump Manufacturer 4211s1A 5011 Application Rate ' f gal /day /ft2 Pump Model A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit .421-14 Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ NA Biochemical Oxygen Demand (BOW 530 mg /L ,fin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L . 0 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other ❑ NA • Other: ❑ NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month � fa .3 ,�iear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA � ❑ month(s) (Maximum 3 years) ❑ NA inspect dispersal cell(s) At least once every: a f�3 Aiear(s) Clean effluent filter At least once every: / ❑ month(s) 4A it' I� $ ❑ NA ear(s) Aft ❑ month(s) NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) - ' ❑ month(s) NA Flush laterals and pressure test At least once every: ❑ year(s) . Other At least once every: ❑ month(s) El NA ❑ yearls) Other: A 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 tank(s) for the presence of painting products or other chemicals that May impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. 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; palming 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: O 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. O 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. g 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. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING >. > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER C./111 POWTS MAINTAINER �! Name 71 - Z )L 1irlar/`l Name 77 ?SIB Z Pif/ 4 Phone 7 4r- 235 26 VP Phone ?(J 2JJ - az 46 SEPTAGE SERVICING OPERATOR (PUMPER) . LOCAL REGULATORY AUTHORITY � ��,/��. Name 72., </� Name � �N L 5 � �ol � . L�'(or- Phone 235 O%' Phone 7� 7D gPo This document was drafted in compliance with chapters Comm: 83.22(2)(b)(1)(d)&(0 and 83.54(1).. (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer / 1C Q f /1C� Mailing Address PO /72 1 - / (. reeZ ib ni, v'I /2 5 Property Address b to? r eee Ahratmi, d th1 016/6 (Verification required from Planning & Zoning Department for new construction.) City /State 14100 044 Gl Parcel Identification Number vl/a87 " D —Oat LEGAL DESCRIPTION Property Location AVW 1/4 !V) 1/4 , Sec. it' , T �) N R fl W, Town of AIM Subdivision f't',1S/xT //.f , Lot # Certified Survey Map # .. // , Volume , Page # Warranty Deed # 4.2.25A ft 7 t , Volume / , Page # S"b Spec house yes ©o Lot lines identifiable 0 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num • r of bedrooms LJ /1//i/ ilt_1(21,X 17 1. / SIGNATURE OF APPLIC (S) 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) C� Jul -13 -2010 09:42 AM St, Croix County Plan /Zoning 715 - 386 -4686 3/4 • • 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 residencew (Street address) 990 /72 located at: MA) f/4, ,t1 , Section 1h. , Town 1 N, Range / 7 W, Town of' � P i '/4 m r , 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 1- J At/ D Did flow back occur from absorption system? Yes No ,2 (if no, skip next line.) Approximate volume or length of time: - gallons minutes Tank Capacity: - /DOD Construction: Prefab Concrete Steel Other Manufac 4 , (if known): 7 � T Age of T -4 (if • ): , / % Permi umb f '�• own) 38l//92- 41 / /. 1,04h L �,c) Z- (L47 sed Pl lr ber Signature) (Print Name) hg4 7;e i P /3996 (Title) (License Number) MP/MPRS '7 / r/ / (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 O 2 . 58 ACRES h NMI - au s o c * 0.1 1 12, 555 SO. FT. 209. 99 150. a 3 o k 0 VOL. 0° y LOT 33 LOT 1 (0 82, 297 SO. ACRES FT. LOT 13 0 2. 49 , 108, 629 CERTIFIED zo ..... 388 °27' 17" E 363. 27' � ...... Set �; 3. 02' � 330. 25' X - - 115. 09'- - - - -- ` S88 17" E w 478. 38' -•• ` N88 ° 27' 17 "W w 475.82' S �g• u 330. 25' • \ � � `. � 4 1N 3. - -- 112. -- -- - �'�. F 1 88 ° 2 7 ' 17" W 363. 27' ti 1 � . ' � ........ F SURVEY E5 ®, , , �T �� z3g 6 9', O --- I ' \ 93 • - F 6 3 `- Z c � y g • 9 j. LOT 2 o o � _ o PUBI ® PAGE - LOT 4 F (Al 4. 13 ACRES • i•• 179,858 SQ. FT. --,— MAP - - - - - - -- -4 . . 4 HIGH WATER ELEV. = 1045. 00 ;' N DRAINAGE LOT 3 o I W 1 0 o 3 6 1 6 25' DRA I NAGE AREA 7 / o A -1 0 ___ _ S88 ° 27' I7 "E 363_27' -- -- 488.62' z - NOTE: THIS PLAT IS LOCATED IN AN UNPLATTED LANDS AGRICULTURAL AREA. HOMEOWNERS SHOULD EXPECT TYP 'CAL FARM RELATED ACTIVITIES BENCHMARKS THAT INCLUDE SMELL, NOISE, EXTENDED HOURS OF OPERAT ION ETC. WEST QUARTER CORNER SECT ION 16= 1037. 78' NORTHWEST CORNER SECT ION 16- 1052. 58' NORTH QUARTER CORNER SECT ION 16= 1100. 79 BENCHMARK DATUM IS ORTHO BY JIM WEBER HEIGHTS GEOID 96 NC. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 %s x 11 inches in size. Plan must St. Croix Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 018 - 1083 -40 -000 Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. Reviewed/ *ate Please print all infor l : ' ' / Personal information you provide may r sliza ,;, 3• . ;y i 1, .. ■ r (Priv cy Law, s. 15.04 (1) (m)) _4. A 4 lb /b Property Owner Property Location / Lance & Cindy Olson Govt. Lot NW 'i, NW �v, s 16 T 29 R 17 w Property Owner's Mailing Address J U L 1 6 L U 1 u Lot # Block # Subd. Name or CSM# 990 172 " Street 40 Pheasant Hills gT (ROIX COUNTY City State Zip e NNING &>G_ 0 City 0 Village 0 Town Nearest Road Hammond WI 5 1 1- 651- 269 -2998 Hammond 172 " Street ❑ New Construction Use: 0 Residential / Number of Bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement ❑ Public or Commercial — Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: 44IL i , i Cat G5T 5 L w � �. we,cc,1,�_ 4-e, ,n,�,aA�:.,c... 5�1- r.,�1,.tt2., o� ❑Boring p Limiting >72" in. recauw.eca..4. •4 4 Boring # 0 Pit Ground Surface Elevation 95.31 ft. Depth to Limitin factor 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 -5 10YR2/1 - SIL 2 -f-gr dh gs 3f 0.6 0.8 2 5 -12 10YR2/2 - - SL 3 -m -pl mfi cs 3f 0.0 0.2 3 12 -17 10YR4/4 - CL 2 -m -pl mfi gs If 0.0 0.2 4 17 -23 10YR4/4 - CL 2 -m -bk mfr gs If 0.4 0.6 5 23 -30 10YR4/4 / - SL 2 -m -bk mfr cs If 0.6 1.0 6 30-41 10YR4/6 1 - s.., LS 1 -co -bk mvfr aw - 0.7 4 1.6 7 41 -72+ 5YR3/4 i1 ��, t LS 0 -m mvfi - - 0 D21•.6 ❑ Boring 5 Boring # lei aPit Ground Surface Elevation NA ft. Depth to Limiting factor 32" in. Soil Application Rate Horizon Depth Dominant Color Redox Description - Texture Structure Consistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont. Color _ Gr. Sz. Sh. *Eff#1 *Eff#2 A 32-43 10YR4/4 10YR5/2 &7.5YR4/6 c -2-d SIL 1 -m -bk mfr gs - 0.4 0.6 B 43+ 10YR6/1 5YR4/6 c -2 -p - SICL 0 -m mfi - - 0.0 0.0 * Effluent #1 = BOD, > 30 5.220 mg/L and TSS > 30 <_ 150 mg/L * Effluent #2 = BOD, <_ 30 mg/L and TSS <_ 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 7 l.2- /o 715- 796 -5664 Lance & Cindy Olson Soil Evaluation Notes July 12, 2010 This evaluation was completed to confirm the soil conditions within the replacement area following failure of the original system. I recommend installing the system 27 inches below surface, just below the CL encountered in B-4 and SIL encountered in B -1 & B -2. This would place the system in SL and LS observed in B-4 & LS observed in B -1 & B -3. The bottom horizon in B-4 consisted of massive loamy sand with very firm consistence. The original soil evaluation had the soil at the interval described as strong, medium, subangular blocky structure with friable to firm consistence. These two descriptions represent the compacted layer beginning at 30 to 48 inches below surface. Because the depth that the bottom horizon is encountered at is so variable it is likely that that this horizon could be at or near the infiltration surface of the replacement system. Therefore I recommend that a conservative loading rate of 0.4 GPD /sq. ft. be used for design of the system. The following elevations were established or supplied by St. Croix County zone during completion of the confirmation boring. Tank outlet elevation 95.3', existing header 93.0', existing system elevation 91.7'. Mark Iverson, Professional Soil Scientist 07/05/2010 17:09 FAX 715 235 2592 T. L. SINZ PLUMBING, INC Ij0005 /0005 May -10 -2010 10:00 AM St. Croix County Plan /Zoning 715- 386 -4686 2/5 . ,. f • FLAT-- Mi"k.-1 *, J rz,..sinziN roc. or 140 p ;s r r- dais 1.314 ups It* ti. - _ ,,, __ • ..c•o EM804 708dI Ave. Phone: (715) 5E6.2644 Menomonie, WT 54751 Is= (om) 2351592 .11.=.140.L. tj t" % Sc a_l e r e h ax Q ..- s' \ I P PAS /.IrQ�:rldet lz //(/a 0. ! r \ ° :11 / il k A - � o �� ZQb) 3-5 • I I; 0 gs 3I < - 147 DP g p Q`+� ' � y . . . „Rai N. 1k I 4 �� 11)j1/4. f fri • 1 t 4 46. ■°°°' ill 1 * 14, Nj ROM SMIMMISMISIZ se$$Btr TLt 174 RsIaD TOOS00 /00 li " 2326P 263 7315tl9 1/ STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO. , WI RECEIVED FOR RECORD This Deed, made between Justin P. Nelson and Sadie L. Nelson, husband and wife, 07/22/2003 12:45PN WARRANTY DEED EXERT # Grantor, and Lance J. Olson and Cindy M. Olson, husband and wife, REC FEE: 11.00 TRANS FEE: 749.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the NW 1/4 of the NW 1/4 of Section 16, Township 29 North, Range Name and Return Addre s 17 West, in the Township of Hammond, St. Croix County, Wisconsin, FLi described as follows: Lot 4 of Pheasant Hills filed May 5, 2000, in Volume / 0 t. . 7, Page 86, Document No. 622544. r?44.1/,i 444 bar syo �Z- 018- 1083 -40 -000 Parcel Identification Number (PIN) This is homestead property. (is) i, XOO Exceptions to warranties: Easements, restrictions and rights -of -ways of record, if any. Dated this 1' day of July , 2003 * * Justi '. Nelson * * Sad' . Nelson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Justin P. Nelson and Sadie L. Nelson, husband and STATE OF WISCONSIN ) wife, ) ss. 1 County ) authenticates th' ay of July 2003 Personally came before me this _ th * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who instrument and acknowledged the sa authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisco Hudson, W1 54016 My Commission is permane (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 o aro� ro� c � °p O a 0 o a; s tlY MoD O ¢ `D' Q Q� • ti R o � o o " $� Q' end Bu J °n sin Depentnent of Commerce PRIVATE SEWAGE SYSTEM Count Sebl Buildings Division t INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal Inloima6on you provtoe may be used for secondary purposes (Prhracy Law. 8.15.04 (1Xm)). 384192 - Permit Holder's Name: j 0 City 0 Village fa Town of: State Plan ID No.: F. i' 8M nn Hammond Township CS E v ' , . I limp. BM Elev.: BM Descript.on: Parcel Tax No.: W•D t 09 ' 8.D .cc ' — NE 144.4,...../-44 ,/ ni R -t nRS- an -M0 TANK INFORMATION ELEVATION DATA 1 e r Z c k ' rt t GA a TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV. Septic kuir-b„k_44— itiZcr Benchmark f. 2.2 Col .2 l .0 _ � AIL BM 2.•t `f '39. or 3' . Aeration j Bldg. Sewer 44 S' 96.2 ?' Holding / St/ Ht Inlet s.:80 •Rs,.i2 TANK SETBACK INFORMATION St/ Ht Outlet 5-• `T 7- ' 2S' TANK TO P/ L WELL BLDG. V Air ent Mt to ake ROAD lot Inlet - --- Septic > 9p' "' o2A r NA Dt Bottom �---- Dosing NA Header/ Man. 8 ' 20 83.02 Aeration NA Dist Pipe I t 3 .o zj 1 Hot . ' • Bot System �� 9 /.g/ PUMP/ SIPHON INFORMATION Final Grade �S�'e►S.Q�.S � 4 "9 acturer Dema 610 • . e ( ` 8. St covor Model N bar GPM -7) 2 / a 1 i / rI D ,55- q -- 6 TOH L 'coon I Headm TDH gU4 ?,t c11- 0 '. Z 4 ,'' • 3/ of�f+c I Length Oia. at.Towell ( ( 1 . # 1 I lea , SOIL A : ORPTION SYSTEM • M b4Y l v't y. 2 4 - yL �7L� I i `Le l � Width r length 1 No Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth • , YIsIa+ 3 `)3� CDC) DI MENSIONS SYSTEM TO P/1 BLDG WELL LAKE /STREAM LEACHING Man cturer_ � SETBACK INFORMATION CHAMBER r r ,., . tt • r} E ( ' � lcO — OR UNIT _ � .:.r�- System: 4 DISTRIBUTION SYSTEM Header Dia I Manifold tr f Distribution Pipe(s) g x Hole Size x Hole Spacing I Vent To Air Intake Oia Spacing ( S , Le SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth De h Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched P Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0 °f. / O I Inspection #2: / t Location: 990 172nd Street, Hammond, WI 54015 (NW 1/4 NW 1/4 16 T29N R17W) 162917612 Pheasant Hills -Lot 40 Ift-J 1b f t� C v ?S ''" 1.) Alt BM Description 4- 1 4th 2.) Bldg sewer length = 2(o u - amount of cover = c..> I)3 + out' Cr+otQl Plan revision required? ❑ Yes 0 No Use Qthe r side for additional information. `o(I ° E 1 • 1 I . . _ 1 ` . S 3) � � 14 --tOD . Date inspector's signet re Cert. No. 880-6710 (R.7) - 4- - w tt 4 f 1 Z --i ca J ,A • ioi rf_ -o, PL A•44.) T.L. Sinz Plumbing Inc. 1-'r 40 pyeAs T Al, ((s N pi o.J (6 ;-.4 IOW fm. 10 E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 147=401 1 ..) JP- t)A \ \\ c-- coAg . • ,--- , _ . . • . , .1 § ri-o k � n i I P eoituc� ,� elk t . 1 1 1 A a7'� pc. 1 1 , .' . / D t7` 0�3V ■ lop z 4 -1 - VI 0 ' ■ :-.' ti) ! . 0 3t Giwb 0 ,-../ N A 1 i ■ ) ' ,Q‘ I A s� �� 4 \ / NMI DNIM1'IdZNIS'I,L Z6515£Z9TLT 311 22 :8o TooZ /to /90 4- ri - . c -°. �P . l ,, e ,� 4.0. ( � ,A, P,.2'1"� ."-) cloa- 94— Ic 0 , l • Sanitary Permit A safety Se BollelbsgS Division In accord with Comm B3.111, Wis. Ada. Code 201 W. Washington Ave, ee r Rde for irlsvttetio ecxnplc9 thn SoL 7303 e:parae.erli ae•CrOi p� inf i tioi yo provide ns me be used for ng steam is sppli s Madero. WI S3 7A7 -7302 era Yfor +a eario ®r [Privacy Law, a, 1S.Oa(1)(m)l (Submit complorod form to county if slot Mach mom • low — lasts w - CONn eo • ors ') for the Rte cam awned. Sari p m, on D • or no! le th in 9 -112 >< 11 inches in sCc. r'O� Sanitary o�gt�l� r Mock tl raYlsioA to prof C �c+-I p tits apph oh • -, re-A. I. A • - tication information - Please Z zinc all Information !Property Dwhsr Name _ Property Laeeoc FM M - aim, I L 0 )�iin -)�cm 114'144, S /1' T/r7 N pr £ • hl� Properti{ 1 Mews Mailmy A r • y. State Rip Code Phone Nara r Subdivision Nano or C.Shplonther i i 1 5 b (S 7( D Ale 4 s T Alit Type of Blnllding: (cheek one) ? CI Cho l or 2 Family Dwelling - No. of Bedroot'nr : / ❑ Village ACM PablriCon ngreisi (describe uso);,.. ifTown O Stare-Owood ill i /ir d r NoloWit Road a 3 x 13.1s . affc Peal T z1 .c.) m. 1• r of crmft: Cheek only One box oa line A. Check box on lino B if a • iiczble A) 1. New 2. 0 ' - •laeelahmt 3. ■ Replacement o 4- 6. • A. Unto System S 'Mom Tank Only : S B) ' 1 Nombor Dore � A Sanitary Permit was previously issued 9 Z ky, Type of POWT System) (heck all that apply) 4G flop . KNon-prossurised b,—ground 0 Mound 0 Sand FFter O Canaocvaed Wetland ❑ Pressurized In CI Holding Tank ❑ Single Pass ❑ Drip Lioe O Ar -sede ❑ aerobic Treatment [.tit ❑ Raoirculuin - 0 O•her: V. Dispersal/Treatment Area Information: 1. Damp (gri) 1 /. Minna) Asia. 3. bayonet Am 4. Soil Application 3. - Percolation Este - 6. System 3lavauon 7. Rol Gress Rootarsd Proposed Amu CGo1a eq. R) QMinJk h) Elsweiori 4'J D 400 Co & r / Q 3 VII. Tank � Capacity in Total $ of Manufaeosv Pltfab Site Steel Fiber Mastic information Gallons Gallons Tanks Con- Cot- Stan NCO Existing Tanta Tanks croft atrltc[ee S61PT / G. /oo o (too I , ❑ ' 0 ❑ Q ' d CI ❑ 0 VIII. Responsibility Statement ( the amdorsi _ , . • assume - • � or installation o e POWT shown on the a :ached -Inns. • 1 .• - arse - a ' a : MP • a. Busbies;?boos 111aeobs ie . Phernbefe Addict Stn e; City. S p ...) 0 ZL IX. County/Departmer Use billy dd • ❑ Disapproved Sodery Poems Poe (hncludos Grou nd"..0 • Date trsudi w gmh (N natnPs) +ppav"c4 0 Owner Given initial Adverse Far 60 t D etermination I . Zee 1,K X. Conditions of Approval /Reasons foe Disapproval: * ( - a r cri___ 1 � , ... -ee l , aIvb �t . 1 sue . kettiae l Ati20,,, '' Zs13oq it f4 w-1-l..6 _w a.n p.t. &pp( C-44r Crt.CI Ao4(.ce4 , 313D•63 91 RO7ro0 Al Pb, g 1j DNItilIfl'IdZNIS'I,L Z62ZSCZ3TLT XV,d 92:80 TOOZ /b0 /90 , , , ! • T.L. Sinz Plumbing Inc. E5609 708th Avenue Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 1 FAX TRANSMJTI'AL Date: y'D/ No. of Pages: 3 (including cover) To: S r era t 1 ' Z i ,.l 3 Attn: -5/kIa. From / trA — 4" - 7---- Subject: , /fd79 goy/ r (::Jii:Ai /Ua m) lo r ya Message: Airifr gG C,Rs/S e° O c- 4,000.0 ge lid✓( c5eif r4eS y e-) )7 (/e S IrAIP p.i.P.!C 04 S z-/ —0( At y QL.,s %et s 1hc.rs e.4 Signature: c -e/e- 1 Tolj DNIoJIT1dZNISZL Z89Z9CZ9TLT %Vd 99 :80 T00Z/60/90 r Iroa Tt. Ro r 1�LN 4J • T.L. Sinz Plumbing Inc. Lo r `-to p ' 7 ,` (I s M w ow re 2.4 ii 140 mom o E5609 708th Ave. - Phone: (715) 235.2644 Menomonie, WI 54751 Fax: (715) 235.2592 N_ , ,J 1 • • P 1, I/ ae � ry � , i � , � � Vv 1 eo n . 4 a , wc- Its . I DV , ilitr J 0 I A X e� a 1 IA- , M V £OIJ DNIWU1'IdZNISII Z85Z3£Z9TLT IVd 55 :80 TOOZ /b0 /90 r %Macon& Department of Coerce SOIL EVALUATION REPORT Page .J._ of —3- Division of Safely, and Buddmgs in accordance with Comm 85, Wis. Adm. Code e ' t County � T. Co 1 Nk Attach complete site plan on paper not less than 81/2 x 11 inches in sine. Plan must include, but not limited to: ved is al and h • • , ,ii, ., (BM), and Parcel ID. percent slope, scale or dimensions, north = • •` ., ��',., :,, .,, . • : tc nearest road � by � Date please print o , anon F., � . , ■ /' 6e ,. . _. I ( ' • s. 15 (1) (m)). ', , .ol Pmsanar irdonneia► you provide maY �� 1t► ' _ Property Owner _ Property Location Z or1 ° x 2'3 t Govt. Lot 1/S Name or CSI11 T 29 N R I ? E (or) Q Property Owners Mailing Address \ 51 C Lot # Block* I loll l 7c t . - ' ' ' , ' y0 PheaSan4 I4 i 11S State zip , , ' ') i, • _ ❑ City ❑ Village [3'Town Nearest Road City state ® New Construction Use:®' Residential / Number of bedrooms 3 - 'r' Code derived design flow rate ' -rev /G O o GPD ❑ ant ❑ Public or commercial - Describe: Flood Plain elevation if applrcablo *e.//// Parent material 0 (.14 a s t1 G ,. w -� ► ' Q 3 57:2 General comments S y$ it e w\ c It. V. let Q y. co and ins: ❑ Boring _ 1 1 1 # 1 Pit Ground surface elev. q 5 . (6 R Depth to limiting factor 117 in. Rate Soil AppTcation Horizon Depth Dominant Colo Redox Description Texture Structure Lure Consistence Boundary Roots GPOIN in. Murrsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2 1 b -S Io 13 IIMIIINI .5 . . ..�•. � 5 .9 2 • -Z 10 y14 • c5 -, 3 2.b-'4( to yr5/4 LS 2m 55 m-cr (S . 1 1. yio-S0 10 --- LS 2 a s` c5 - / .2 • 5 s54)-(12 54)-(12 Y 2 t.0 r .311 5 L . 3 r sb k m ,5 . q , ,, 31. C r f; A ?,.�; - g c. .� , =rfut/. w - 4 , .. /� J ✓ 2 Boring # ❑ Boring Ground surface elev. C I I .16 ft. Depth to Cirbling factor l 10 in. soil Rate 121 Pit Color Redox Texture Structure Cor ence Boundary Roots GPD/ft Dominant Co D'�n Horizon Depth G Sz. Sh in. Mansell Qu. Sz. r. z. . 'OM 'Eff#2 Cont Color _ C S V g I b -$ t.0 yr313 — Si1 2nr,abk rr r' 2 B -- Se, 16 y ly . — Sit 2 rr bk._. (-)-N Cr c 5 -- . 5 . S 3 30 10yr31Lp — SL 3rr,5bk m4 _ 5 .9 Effluent in = BOO, > 30 220 - < and TSS >30 < 150 mgr- ' Effluent #2 = BOO, < 30 mg/-and TSS < 30 mglL CST Narne (Please Print) Signature CST Number A 4.l m c < Chl.l rYri ker ._- 25:)30 Address Date Evaluation Conducted Telephone Number 2113 < Q N n r r Y I , (,c )t 61462, y- Z4 - u 0 /5) 2 1 -UCH$ , Party Griner e ner 36t Parcel ID # Page 2 of 3 . • 1 3 1 stving# RI Pit Ground Stir rao elev. G q. S R Depth to Waling factor / / 3 in. Sal Application Rate Horizon Depth Domirent Color Redact Description Textwe Sbucture Consistence Boundary Roots GPDIW in. Munson (2u. Sz. Cont Cobr Gr. Sz Sh. *B IC 'Etf#2 ( 0 - 10 lb yr3 /3 -- Si/ 2vrc bk rn'r CS I vi • 5 �/ 2 SL 2 mSb k m -C r cw _ . 5 , 6-210 loyr4J4 , - 7 I. 2 3 2(0 -4'6 10 yr 4 i In L S I rnS5 mv C ,y 98 -I/ iQyr3lco S L 3 m 5bk _ rr -C't . 5 • cl 30 /4,L ❑ Boring Boring # ❑ pit Ground surface elev. ft. Depth to limiting facbr in. , Soil AppGCation Rate Horizon - Depth Dominant Color Redox Description Texture Simla* e Consistence Boundary Roots GPDAW in. Mansell Qu. Sz. Cord. Color Gr. Sz. Sh. *Eff#1 Eff#2 ❑ Bores Ground surface elev. ft. Depth to limiting factor in ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Desaipticn Texture Structure Consistence Boundary Roots 1 GPDHE in. Murrell Qu. Sz Cont. Color Gr. Sz. Sh. *Eft #1 *Eff#2 ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD <_ 30 mgA. and TSS 530 mgll' 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 deparhnent at 608 -266 -3151 or TTY 608- 264 -8777. SBD.$330 (RO7/00) <- I Property Owner 3brl4 a Parcel ID # Page 2 of I. j 1 # © Pint Ground surface elev. q , ft. Depth to &Mktg factor 1 / 3 in. I Sod Apprication Rate Horizon Depth • Dominant Color Redox Description Texture Structure Consistence Boundary Rom GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. *Ef *Eff#2 1 Si/ Zmcbk mCr CS 1 v., . 5 . B' O — Ib 16yr A/..3 . L 2 rn5b k mfr cw . 5 .`i Z t-2(,) lay r414 s 3 26-1f i y r &. lr, L S I mS5 mv-Fr c.. 5 1 1. 2 4 1 48 -ii i S 3 rr, sbk rr , • 5 ' 9 3 G I Boring # ❑ Bming ❑ Pit Ground surface elev. ft Depth to limiting factor in. 1 Soil Application Rate Horizon Depth Dominant Color` Redox Description Texture Structure Consistence Boundary Roots GPD/tf in. Munsell Qu. Sz Cont Color . Gr. Sz Sh. "Eff#1 •Etf#2 I I I Borin' # ❑ Ong 9 ❑ Pit end surface elev. R Depth to limiting factor in. soil Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Struchne Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz Conk Color Gr. Sz. Sh. •Eff#1 *Etf#2 I • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL * E18uent #2 = BOD < 30 mg/t. and TSS < 30 mg/l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266-3151 or TTY 608- 264 -8777. SBD -8330 (ROM)) PAGE 3 OF NAME Lao h t LOT# yo LEGAL DESCRIPTION ti w 1 14 ,') 4,S /6 T2 `f ,N,R / E Wig SCALE: 1 "= yd BM 1 ELEVATION /(76 .d 1 BM 1 DESCRIPTION lope / ' V /c ,01 0e BM 2 ELEVATION 9 7. /C 1 S 2C . /6 BM 2 DESCRIPTION is e o 4 z jOrc P. 0 SYSTEM ELEVATION -Q 9y'D (.ow r 73 SC ALTERN ATE ELEVATION i(.1//0 CONTOUR ELEVATION 94e. oo , 9'S_ cyd rimp O I 1 • 3 -3 • a . ► � 3 '4 ■ g -Z __- SIGNATURE C' �^- 4-- -- DATE � .3 4 M 1 S • t °- -9' �4 � °‘ - ro 13 _*-. `' \ 4 -, --7 Sanitary Permit Application Safety &Buildings Division 9‘4 / In accord with Comm 8321, Wis. Adm. Code 201 W. Washington Ave. o . See reverse side for instructions for completing this application PO Box 7302 Ceparri • ,gotrinterea r 'personal it fonnadon you provide may be used for secondary purposes Madison, WI 53707 -7302 __._. _.- [privacy Law, s, 15.04(1)(m)J (Submit completed form to county if not At h com.lere •lane to the coup coy and for the s stem, on . , • cr not Iess than S -1 x bps in size. state owned. Courd. ✓� /� o, T 1C State 2 :in ^• t ' -er • Che . i revision uo previous appbession Sine ' an I. * . umber IV AO I I. Application Information - Please Print all Information ormation Lo mien; "r lmpe • Name • rcv}�scY • � ---- � , ! , (zusrif4 �y Stri, , / 11/44 1 01/$ • s �1 - Location repeny •wee . kigAd. 70 SST bY/ x. k • ,li /01/ ., Wto Hloe Ci ,Slate Zap Gods _ ---- Phone Number ��7'7! /s 11 /j' M/2 / S , /r � , II. Type of Building: (check . .) 0 Cit ❑ 1 or 2 Family Dwelling - No. o dreams : 3 ❑ villa / ni,f1DA/o 0 Publlc/Commercial (describe use) li(T of C State -Owned / 74 " C2-) r.J x ZS t Nearest � Ogg -40-404 III. T j• a of Permit: Check onl one box a. 'nc A. Check box on ' B if a• •licable " Va ar ,,� El 1. i' ew 2. i• Replacement • Replacement of ■ A S stem 5 tem ank Onl ll 8) mi. , P '. t was , issued , ' emit • ' � ' IV., Type of POWT System: (Check all that apply) s a'• w-11.--* ; 4, . '. l / � 0 , P,ressurizo gr and amd 0 };3o j g Tank 0 ; • " • 0 Donsuuc4c eland , 0 At-grade ❑ A Treatment Unit 0 . +,...., - O Other: V. D' . • ersal/T>reatment Area Informadota: i I. • gn " • u' 1.. • . ispersal Arca 3. Dispersal Tr 1 Appliesbon tattoo 1 3 14 ,/ Itegtured Proposed sIday /aq. t.) - ) Elevation 0 i0 Sao -� , 'd , t---. VII. Tank Capacity in To # of factual. Prefab ", -' Fiber- Plastic Information Gallons 0: Tanks Con- Si . • glass New th mete strut Tanks Tanks 1 Ci f L ODD --- r 'Pe / F 0 MI • Sill ❑ 0 ❑ VIII. 'Responsibility Statement I the un d assume r - . onsibi' iff,r =Aation or to POWTS shown on the attache • is. Plumber's Address (Stmt. Ci s Zi • • A � _ c609 Ipir Mil oipiolig, GI:" t /75/ IX. County/Department Use )ly 0 A veil 0 Disapprove ' e unitary Permit Fee (Includes Groundwater Date Issued Ak ppro Owner Initial .Adverse lz t� ► , i \ ' 1 2. 2e�o( k•___,, • X. Conditions of Approval /Reasons for Disapproval: Pill •••ken C to.Nal C tre! 4J QAQ1.5. -+-° v`N.a.N)Ca v+ et C e 2e et4A st* • .U � ` tits s `P .t r %', 122 cov sls - -s' 83 . SED 98 RI' ri a kila. 1 . tivt.LU.A az p i I t . r • ` re.c.6,�„ RAAc a.:4614S . TOO /T00415 ZNIS QQOZ 4 -4-4- INDWO'IuAaa A1tIf10O N1111Q 660t ZSZ 2TL 1 XVd 9$ :17T au 0002 /I'T /TT • • • • • • • • Is • • • it • • h d ` 3 e. • ORIGIkND SITE EVALUATION 1 3 "Wisconsin Department of Commerce Page of • Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, ,. and'(oca ron'a pd.distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all information. Personal information you provide may be usedidfSeco (Privacy Law s; 15.04 (1) (m)). dewed By Date zap Property Owner r Property Location Bonte, Ron 1 i p r G'vt. Lot NW 1/4 NW 1/4 s 16 T 29 KR 17 W Property Owner's Mailing Address ` Lot # Block # Subd. Name or CSM# 1011 170th St. CH:-..;; / 40 Pheasant Hills COUNTi City State Zip Code z ,t] City n Village Town Nearest Road Hammond WI 54015 715-796-52 0 i THanmond I 170Th St. X New Construction IX Resi�ential,( Number of drooms 3 I (Addition to existing building _ Use. Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .3 bed, gpd /ft2 .4 trench, gpd /ft Absorption area required 1500 bed, ft 1125 trench, ft Maximum design loading rate • bed, gpd /ft . trench, gpd /ft Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design / site considerations install 2 - 5' x 112.5' shallow trenches for 3 br • Parent material till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® ❑ U ® S ❑ U Z S D U Z S E U ❑ S 'Z U ❑ S Z U SOIL OEStRIPTION RE ORT J _- .3 ', p 69: -t. Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D /ft2 1- Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -3 7.5YR 2.5/1 - sl 2 m gr mvfr cs 1 f .5 .6 , 5 2 3 - 7.5YR 2.5/1 - sl 2 f sbk mvfr cs I f .5 .6 .5. Ground 3 7 - 22 7.5YR 4/4 - sl 2 m sbk mvfr cw 1 f .5 .6 , S elev _ _ 99.0 ft 4 22 -60 7.5YR 4/4 - Is 0 sg - dl - - .7 .8 •� Depth to limiting / factor t 9Z = U /S.vt .t c.4,---✓ Remarks: considerable gr /cob /st below 7" 2 1 0 -3 7.5YR 2.5/1 - sl 2 m gr mvfr cs If .5 .6 . 2 3 -11 7.5YR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 . S Ground 3 11 -29 7.5YR4/4 - sl 2 m sbk mvfr cw If .5 .6 , elev _ 100.0 ft 4 29 -46 7.5YR 4/4 - sl 0 m mfr cw 1 f .3 .4 , 3 Depth to 5 46 - 59 7.5YR 4/4 - is 0 sg dl cs - .7 .8 ,,q_ limiting 6 59 -64 5YR 4/4 �� � . sl 0 m mfr - - .3 I . , 3 factor > 64" Remarks: horizon 4 has occasional 7,5YR 4/4 Is inclusions (0, sg, dl); considerable gr /cob /st below 9" CST Name (Please Print) Signature: _ Ci t (' - Telephone No. Henry F. Grote ` 715 665 - 2681 Address Certified Soil Testin Date CST Number Ref # P.O Box 57, Knapp, WI 54749 4/13/2000 222774 1050 1 . :S)1Jewa ioloei of 41daa Aela puna0 ..H Moran 'siaooiiB :sNlewal .t9 < Joloei 6uiliwil - . • 8' L' - - Iu1 2s 0 s - tit 11A0 179 S of 4ldeo 't' 8 L' 31 S3 IP 2 s 0 Si - 17/17 2IAS'L i7S b u £ OOl S 9' S 3 i so .gntu 1gs 111 Z Is - £/17 2IAO I 9£ I E nap puna0 �• 9 S' 31 so .gnu1 Ngs3 Z Is - I /S'Z 2IAS7. £I Z , S' 9' S' 31 so .I3nW .I2 uU Z is - I /S'Z' IAS'L 17 I S ..b7 Mo1aa 1s /qoo /.I8 aIQ J Disuoa :s)ewad .09 < ioloei 6uwpwiI 17' £' - - 3tu m 0 Is - tit 2IAS 09 S 01 Uldaa 8' L 3 I Mo IP 2 s 0 sl - ti/i7 2IAS'L 6£ b 4 t7 66 ` 9' S' 3I MO *um xqs W Z Is - £/b 2IAOI 8Z E nap punoi0 `S • 9 S' 3I SO .IJAUJ ) Igs 3 Z is - 1 /S7 2IAS'L I I Z S • 9' S' 3I SO .JAW 15 w Z Is - I /S'Z 2IAS'L S 1 1 :smiewei olA • b E - - 'Jul UJ 0 is - t7/t7 2IAS 09 9 ' < Joloel 6uiliwii 1. • 8' L' - SO IP 2s 0 Si - 17 /b 2IAS'L 6£ S 0141dea h C b' 3I SO gip )Iqs in 1 Is - PIP 2IAS'L EE 17 u 9'66 --S' 9 S' 31 so .gnw xqs 111 Z Is - £/b 11A0 LZ £ nap punoi0 ' 9' S' 3I so IJAU *Is Z is - 1 /S7 2IAS'L 8 Z r S' 31 SD ijn Id w Z Is - 1 /S'Z 2IAS'L £ I £ ¢ . youail 1 peg sioo�i ,Uepunog aouais!suo0 y8 zS iS amixal J0100 'WOO 'z8 •n0 pasunW u! uozuoH Zi} /4dJ a�nion�IB sa�I}oW 10!00 iueu!woa yidaa Sunsa I Hos P33!7.3j WTI 13021Vd £ io Z e6ed oaoi. laOd321 NOIldI I3S3a 1IOS uoll 'aluog :H3NMO Al213d021d 1 • 0 i 0 1 -�$ ! I tli r fj \ 4j -3 ! J 2 0 d Q In , f- J2 1 d c i r a 0 , ___. . \ G o ■K pi ft 4 g \ 4 NJ � , o r g ot s (4. r Q1 1,` d I � a a te' 3 Y - e - � ' - a te < J • • 7. y Prte Onsite Wastewater Treatment System Management Plan peptic Tank And Gravity In- Ground Soil Absorption Component ),C • t1su -t • Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment Syster P• , shall include information and procedures for maintaining the system within the ,, omm 83 and 84, and the conditions of approval by the department, agent, or 2 i eft al unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) I!$p Estimated Flow - Average (gpd) /5 . 3ap Septic Tank Capacity (gal) /4004 Soil Absorption Component Size (ft') /Spp , '__ Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) /49,00 /Soo IT Maximum Influent Particle Size (in) NA • • 1/8 Maximum BOD (mg /L) NA 220 Maximum TSS (mg /L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule _ Septic Tank Inspect and /or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The utlet filte s all be - - 1 - , -s necessa to ens - • • • -r operation. The filter cartridge should not be removed unless provisions are made to retain so ids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component: Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residenilal facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 '4Y „, ::,/, ~' Y. ; ST CROIX COUNTY - . �;,= , 1 SEPTIC TANK MAINTENANCE AGREEMENT d + i AND ° � . _ -, ' ,,� • 4F� ° I i OWNERSHIP CERTIFICATION FORM co w v.. er , � �. C C. BEA'�e. t erBuyer` O Mailin Address �'� �� St &TAM° W ` I J 70 1 5' g Propert Address 990 7 a St a 40J. ` WI” (Verification required from Planning Department for new construction) IQ"' City /State H re o , WI Parcel Identification Number 012 / 0 3 — LEGAL DESCRIPTION 1 /4, N u r 0 N -R 17 w, To of HOIY1 \O . Property Location PI �" /. Sec. 11 . T Subdivision Vskuxsosst Pt I 1 Is , Lot # 4 / 0 . Certified Survey Map # , Volume . Page # // . . Warranty Deed # to 94 q , Volume 7 , Page # g l.0 . Spec house iil yes ❑ no Lot lines identifiable 16 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal syst em. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da . of the • year e • iration date. r AI O p C.. � 4 , 3,841 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of property • cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. I P 1 I A 0 C VtOY4L, ' 3 /S / SIGNATURE OF APPLICANT DATE s•s « «« A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *'` Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • - ' vn1.15OIPAGE372 6096 KATHLEEN H. WALSH DocumnntNumber TRUSTEE'S DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 1 ` { \ Dine M. Bonte, as Trustee and Ronald C. Bonte, first alternative 04 -10 -2000 10:30 1d1 �� � Trustee of the Karl M. Ulferts and Katharina G. Ulferts Family 1�:. .. Trust, for a valuable consideration conveys without warranty to E ESTEEM �,/ DEED / IP Q 4 ' Ronald C. Bonte and Dine M. Bonte, husband and wife, Grantee, CERT COPY FEE: - pG. + the following described real estate in St. Croix County, State of COPY FEE: N.A..:' t "" Wisconsin: TRANSFER FEE: 240.00 �Qt RECORDING FEE: 10.00 PAGES: 1 �D ; y ;:#.4 4-‘` Recording Area / Name and Return Address ` L \ r '. Thomas A. McCormack ♦♦ 10'" Ave. ., r r -'' Baldwin, WI 54002 '"�+ 1,,,,- 018 - 1034- 60, -70 (Parcel Identification Number) The North Half of the Northwest Quarter (N ' of NW %) of Section Sixteen (16), Township Twenty -nine (29) North, Range Seventeen (17) West. Dated this 24thday of March , 2000. • , • 'Dine M. Bonte Trustee Q C.. - --trvs—tee " *Ronald C. Bonte Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 24t�ay of March 2000 the above named Dine M. Bonte, Trustee and Ronald authenticated this _ day of C. Bonte, as first altemative Trustee of Karl M. Ulferts and Katharine G. Ulferts Family Trust, to me known to be the person(s) who executed the foregoing instrument and signature acknowl ge t same. type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature R (If not, type or print name Dale T Jensen authorized by § 706.06, Wis. Stets.) Notary Public St. Croix County, Wisconsin. * .- My commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DR4E , - ) Thomas A. McCo a ! ', , 'Names of persons signing in any capacity should be typed or Baldwin, WI54odZ .' a' $ • k : printed below their signatures. '> o ;► Q. .r Infonnatten Proku.wn.r Comcury Fond du L.. 'Aldo"n 800-655- -- (9\ 1 ----. E \ o �, . z li 1' • / 471/.6. � a 0 z cn 1 _ ,l^ 7 ` 't� �T� G Z / t 1 : p ■ r 6 Z2 17 I " ) Sr , " - t t/' " E r _ �I 0 J rt- o g 4. k> Z. LA ‘ s_ t ._._ f 0 6 ,1/4. L 1 ,,,,..1/4 - iIN .... 1 .., 7......, 1 , .iteIAL ■/_•. , g -, . _ N .0 1. Ito ro.-t ,.SE 1 /4 OF THE NW I /4 AND PART OF THE SW 1 i4 OF THE NW 1/4, AND PART OF THE NW 1 /4 OF THE NW 1 /4, ALL I N SECTION 16, T. 29N. , R. 1 7W. , TOWN OF HAMMOND, ST. CROI X COUNTY, WISCONSI J 1 IOOTN AYENUE i j M ! T i TN1S u1. «E • a.. • . \ �' , WSW • I n i PLAT Sr-41I j fE.�t i \ t . Cq�X LOT 23 II _______. i , u FF , • Z le . + . . - ; * T ^' ! �r sr 1 of -Sr w s( at t[ 1) f C _ 1 LOT 1 7 ---t I _ . parr Ir Ny7 lr -3� m •- LOCATION SKETCH .i. A StCTIG S. r.Z .. R. 1 MP.. Wow 0 *I p ".!..____S E f 1101 TO SCALE 1 p - E -- _ _ UT IL STY EASEDfNTS NO POLE CR BUR 'ED CABLES ARE TO BE PLACED SUCH THAT T• +E INSTALLATION MOULD DISTURB ANY SURVEY STAKE. OR OBSTRUCT VISICN ALONG ANY LOT LINE OR S TREE T L INE. m THE DISTURBANCE OF A SURVEY STAKE BY ANYONE 15 A YIc ATM.', OF . SECS ION 238.3E OF WISCONSIN STATUTES. UTPI.1TY EASEMENTS A; HERE IN " SET FORTS! ARE rOR THE USE CO' PUBLIC BODIES AND PRIVATE JTILITIES HAVING THE RIGHT TO SERVE TO AREA. \�`' L 0T 15 v LEGEND f • FOUND 1 IRON PIPE SHEET _2 0 • SET 2'x30 IRON PIPE WEIGHING 3. LBS. PER L INEAR FOOT NOTE: SET 1 IRON PIPE NEIGIHIN6 I. 13 LBS. PER L (NEAR F00T AT ALL OTHER LOT CORNERS _____L!.... - UTIL PT? EASEMENT ( TYP. ) —� • SETBACKS ' ' = r �' �� . -�_ _ 1 DA1VEWAY LOCATIONS B I �� t ♦ �4� 3 / - L �r�r✓ 4 - — -•- _ _ i �srERs of no. StcaoiX CO. w1.% .. RAL,ngd fa Rmard tELS� r . +ig al Chn y A 0 affiLQ SE_E ...,mot, t: i. z rs �, R Regsw i rolf . J.11. „, , 5Ufr 3 -S -oJ LOT 8 ., SHEET �� • M E n t C •,''l , t' ' �Pp'''91� 3T.' / / '. �( D. ` 'v J. l ' C ~ �� , �` " `, . • s �3_ t 1 - —i , +, \ y \ � \ 8 ..46 ,� yy •� t ! ' 4,1 + d � j ' � % AA r ' r ti, . t 0 .0 \ \ \ / p�tr- ,,a >,z d r " , 'y n � 3, C Y f � ' '. ' 1 y J / r I. ( i i p A :r ` ...- % ' q . x \� 10548' • T <. t om , `x \ 1 4.7 % y: • s s r•. � ' , `� C 1050.E / _ y , ,.s 0 �� - < LSAT 40 • \� A \. 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" �, w ( 2I /6. 215 FT. / .' \. • k , P . :� �p ' �r�''; ' 3 .67 A CES) a @ •`32 „;, ' , :k 1 / I ,• I O A O sw n ' '4 • Y i 414. 1 , .. I !/ . o , y + • 384 °3 ' 47+W ...... ....... / / ,•,-x , �+ a ioso.8 , h � V r E._ i 4 • ' F�° * ti, y v, ��. �r.;:i,.�,,' / r t : �k� '4t t.. � . LOT 37 ' i , <Il 1 • . �`- - _ -- — — — — _ _ , i ,v. ± 4+444 � " a • 105 .2 J SW NW, � x ` �,, . s �` cT f ' t hi s 0 In54 S E T .. +., • � 8 -2 8 -, �� +, r f .. , , . - ; r .' 1 ` p , . \Br4 `� „ ; tla' a^ '' 105' x \ / \{ Y - . ” - ,. 4 r + 1 3 . .. �q k . 'Y � , ' R J t o , I i r ] .. ` '- g a yy t �, ' s 4 1 :, r r.' !=. ';'''' ':'','; '. ;1' a: // ., x 1066. . . + i ' dj l ., "r . , , - ,, r I,. * �?F s ° • k�"r k$ r , k Y LOT. J6 T ! { g „ ` 1 tei:44 , .-rli c1. -. 4 . , ;.:, 2, •,!: ,.-t. --- -- , ', , : 5 ` fl s ' � _ .,4; $ v� ; . t ,yam 4• 4. ,{ v, r t . J yelr M ,, 0 , ♦ • � . '.• Mt/ rt 1' T. L. Sinz Plumbing Inc. E5612 708th Ave. Phone: (715)7 Menomonie, WI 54751 Fax: (715) 235 -2592 jle _er 6:0•Y / " 4 4 ) 1 Keit‘ i 1)P , CAI 1/ IP r S I/t 41 P 7 1 - ) / /9- ..,„ e i ,'M 1 , / i . I .. ' i s