Loading...
HomeMy WebLinkAbout020-1315-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERM T 538717 0 Personal infomration you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No: Permit Holder's Name: City Village X Township Parcel Tax No: Maki, Jeffrey & Sonia I Hudson, Town of 020 - 1315 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 28.29.19.1597 TANK INFORMATION ELEVATION DATA Z. Z 5 116"2 L r TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. p A . 3 3 10 Se , � 1 � � nchmark 60 J 1 ,. 5 Z 106-:5 Z gad Dosing ( 3 Alt. BM r, e; �, ` 43"1. Z Bldg. Sewer ` Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO Pi WELL BLDG. Vent to Air Intake ROAD SWRIe6— ^' Septic � ! � Dt Bottom Dosing i (0 (v Header /Man. �e Aeration Dist. Pipe 17 Z'9 Holding (Q bs 9 7 ZT Bot. System PUMP /SIPHON INFORMATION Final Grade zB Manufacturer ® Demand St Cover d• S GPM `l. ��2.,.: 7ci. 73 a+l Model Number ` q C oNt - ou c JS• TDH L -7 Friction Loss 5 System Head TDH Ft S % _ Forcemain Length Dia. Z Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Tren es DIMENSIONS /62— PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO p BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: i CHAMBER OR �^ $!I 1d UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold o/ Distributioon / / �I f x Hole Size x Hole Spacing I V; e no Air Intake Al Pipe(s ✓Q 1 6S / • 3 .5 Length Dia Length Dia Spacing z SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/ odded .. Bed/Trench Center Z� ' Bed/Trench Edges Topsoil C $ xx Mulched Z • �-�� =- Yes � No Yes FZ--1 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / p � / L Inspection #2: - 7/ (- / // Location: 520 Joseph Circle Hudson, WI 54016 (SW 1/4 NW 114 T29N R1 ) St. Croix Estates Lot 11 G� Pa ceI N 8.29.1959 1.) Alt BM Description 2.) Bldg sewer length amount of cover �C: � 1 +``y„ (cam i A) "i CJ� �.- - Plan revision Required? Yes No Use other side for additional information. r` SBD -6710 (R.3/97) Date Insepctor's S nature F - Cert. No. it Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538717 0 GENERAL INFORMATION 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: Maki, Jeffrey & Sonja I Hudson, Town of 020 - 1315 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 28.29.19.1597 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head r UH Ft Forcemain T4th 7 Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -7 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over x Depth of Seeded /Sodded xx Mulched T Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes ® No ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 520 Joseph Circle Hudson, WI 54016 (SW 114 NW 1/4 28 T29N R1 9W) St. Croix Estates Lot 11 Parcel No: 28.29.19.1597 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Fu Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. It commerce.wil.gov Safety and Buildings Division County n ! M 201 W. Washington Ave., P.O. Box 7162 ( f E G S C O n s I n Madison, WI 53707 -7162 Sanitary Permit Number (to be illed in by Co.) epartment of Commerce Sanitary Permit Applieatio State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to ap nronriaL ovem�mentat 8 3°Z °� unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. Application Information Please Print All Information Property Owner's Name Parcel # 3)5 F /A P K (300 Property Owner's Mailing Address oul Z Z Property Location a �z� SaS 9P l-1 C�� �. L E (.�s9�� COUNTY Govt. Lot City, State Zip Code p AMF4 g4NING OF S V y, ^IW /y Section ;Z8 Ll Ck D S Q 1' W r y `� 0 7 (circle one / � T 7 R 1 4 E o II. Type of Building (check all that apply) Lot # 1,1 or 2 Family Dwelling – Number of Bedrooms t t Subdivision Name �p(i� � �� / Block# 5 ❑ Public /Commercial - Descci�R; U J ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of n _ ® Town of III. Type of Permit: (Check one on box on line A. Complete line B if applicable) A. ❑ New System XReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) I ❑ Permit Transfer to New B. ❑Permit Renewal ❑Permit Revision ❑Change of PI List Previous Permit Number and Date Issued umber // Before Expiration Owner - 2 5 1 q 51 - IV. Type of POWTS System/Component/Device: Check all that a 1 ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ($ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of sot of ❑ Holding Tank El Other Dispersal Component (explain) nt Devic (exp ) V. Dispersal/Treatment Area Information: " Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Yea Required Of) Dispersal Area Proposed (sf) System Elevation b oa /.a .42 1 !0 /ooc / %5 /l o4 9 ✓� VI. 'Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a E 0 '8 U New Tanks Existing Tanks y c i a U in H rn Septic or Holding Tank ® C, loc Dosing Chamber / O ts Q I I t r D V VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number t� R LT�R IVC c_ V _r U E I I A;( - 7 2 b wr Zq'4 - Plumber's Address (Street, City, State, Zip Code) VI . County/Department Use Onl Approved ❑ Disapproved Permit Fee Date sued suing Agent 'gnature tv O � ❑ Owner Given Reason for Denial $ 62 S I IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: y e "� I ` ' 7 Septic tank, effluent filter and � /J d�u t-O dispersal cell must all be serviced /maintained , / D,,/ �k id as per management plan provided by plumber. h `/ /` �/7 } , and submit to the Couny only on paper not les an 8 vz x Il inches m size as per applicable code /ordinances. IT, "" �rl L �zx ue- loOD4ae SBD -6398 (R. 02 9) Valid thru 02/11 ..... U tl y � o � rr�_ n t N ` b n � a A .A a � � O � � ► II A A. N k M A es Ol m p o A V � O b t A z 0 b d 0 m b N Safety and Buildings 3824 N CREEKSIDE LA commerce.Wl.gov HOLMEN WI 54636 Contact Through Relay 'sco n s' n www.commer www.wisconsin.gov Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary October 13, 2010 CUST ID No. 224059 ATTN. POWTSInspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/13/2012 Identification Numbers Transaction ID No. 1863256 SITE• Site ID No. 760841 Jeff Maki Please refer to both identification numbers, 520 Joseph Circle above, in all correspondence with the agency. Town of Hudson, 54016 St Croix County SWIA, NW1/4, S28, T29N, R19W Lot: 11, Subdivision: St Croix Estates FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1283669 Maintenance required; Replacement system; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The exis ting septic tank must be i nspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform, a state C 9 i approved tank must be installed. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. DEp`.cT Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and O0 ki dispersal are prohibited. f Eta C( • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c i KEITH E STONER Page 2 10/13/2010 r • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of See. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which mqy include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance - verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 `J Charles L Bratz POWTS Reviewer II , Integrated Services WISMART code: 7633' (608)789 -7893 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Walter F Nechville (Plans Mailed To) i j Page 1 of 7 Index and Title Sheet �77�C Project Name: Jeff Maki 010 Property Owner: Same$ Address: 520 Joseph Circle Hudson WI 54016 i Legal Description: Part of the SW 1 /4 -N W l /4 Sec. 28 T29N -R19W Township: Hudson County: St. Croix ty Subdivision Name: St. Croix Estates Lot: 11 Comp. # /Parcel ID: 020 - 1315 -10 -000 CONTENTS Page: 1 Index and Title Sheet Page: 2 Plot Plan and Sizing Calculation Page: 3 Mound Plan View and Cross Section Page: 4 Lateral Layout Page: 5 Pump Chamber Cro ss S ection Page: 6 Pump Curve Data Page: 7 Management and Contingency Plan Attached: Soil and Site Evaluation Mound Comp Manual Used = Version 2.0 SBD- 10691 -P (N.01 /O1) Pressure Distribution Compone� �vlanual Used = Version 2.0 SBD - ]0706 -P (N O1 /01) g a nttrttr�ty Designer: Keith E. St r wISCO - 007 ,y'�,, gn License # Desi er 157 Signature: = Phone # (715) 653 2324 Date 9 -29 -10 d s, - OV �' •�'�•.fpF C M ER lLD! f EsppN® 0 (lot x � � IZ, IZ, ° 11 sz, PI to IF m co A. \ 0o co N fy F Ct m eb o ;J Page 3 of It Mound Plan View Observaflon . � J A W L Mound component Dimensions A M61-f E 15 72" H 12" K 8.09' B F I L 118.18' D G 6" J 3.82 W 22.93' 600 (ft. sq.) Dispersal Cell Area 1911 (ft. =) Basal Area Available 6 (gpd/ft) Linear Loading Rate 10 (ft) 1110 13 Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.00' G H G ft) I F Dis rsal Cell Lateral Dispersal - Invert Cell Elevation 95.50'(ft) Contour Elevation 13.5 % Site Slope Detail of Typical Dispersal Cell Geotextile Fabric Shading Key Cover ® Topsoil Cap Subsoil Cap ASTM C33 Sand Typical Lateral F Tilled Layer XNAERKHRI [[ Aggregate a— A Page 4 of 7 Center Connection Lateral Layout Diagram Alternate force main location. A L— r -- - ! :=I .91' �— P P �' .91' 6 S Laterals and Force Main of PVC Sch. 40 per Comm Table 84.30 -5 Holes equally spaced on Turn w/ball valve or clean X X bottom of lateral out plug X/2 X/2 102' i Number of Laterals 4 Orfice Diameter .156 or 5/32" in Lateral Diameter 1.5 in. Orifice Spacing (X) 2.33 ft. Lateral Length (P) 50.09 ft Orifices per Lateral 22 3.00 6.82 ft2/ Lateral Spacing (S) ft. Orifice Dennsity orifice Lateral Flow Rate 11.88 gpm Manifold Length 3 ft. System Flow Rate 47.52 g p m Manifold Diameter 1.5 in Forcemain Diameter 2 25' Total Dynamic Head 10.80 ft. and Length Lateral Turn -up Detail I Finished Grade Threaded Cleanout Plug or Ball 6" to 8" diameter Lawn Sprinkler Box Valve Long Sweep 90 or Two 45° Bends Same Distribution Lateral Diameter as Lateral Page 5 of 7 Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & COMM. 4" Sch. 40 Vent 16.28 WAC > or = to 12" Above Final Grade IDiscon Discon t Alternate Outlet Location W /Approved 4" Sleeve Inlet Approved Force Main Diam. = 2 Effluent Filter < or = to 1/8" Weep Hole or Anti Siphon Device Baffle Particle Size A B Pump Off Elev. 91.50' W600I1000 -MR Wieser C Tank Mfr. Concrete D Dose Tank Elev. 90.50' Vertical Difference Between Pump Off and Distribution Pipe = 5.00' Minimum Required Supply Pressure ............... I ............ ........ .. = 4.55 25 FT. of Force Main x 4.99 Friction Factor /100FT.... = 1.25 Total Dynamic Head .................... = 10.80' Number of Doses ... _ —6 Per Day Gal. Per Day / #of Doses = 1 00.93 Gal. Volumeof Backflow ..................................... ............................... = 4.07 Gal. Total Dose Volume ...................................... ............................... = 105.00 Gal. Pump Tank Capacity 1000.11 Gallons Dimensions Inches Gallons Pump Tank Volune 19.61 Gal/Inch A 31.65 6 20.66 B 2 39.22 Pump Mfr. Goulds C 5.35 104.91 Pump Model. Model EPO -5 D 12 235.32 Minimum Discharge Rate = 47.52 GPM Alarm Mfr- S. J. Electro Total= 51 1000.11 Alarm Model 101 -OIH. Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyant forces per COMM. 83.43(8xg). Note: Pump Controls and Alarm Switch require seperate circuits. KKR IMIM Page 6 of 7 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head Gallons Per Item Description (ft. of water) Minute No. EPO4 EP05 1 impeller 5 53 - 2 Base 6 10 46 62 3 Pump Casing g 15 36 55 4 Mechanical Seal 20 21 46 5 Ball Bearings 6 25 0 33 6 0-Rings s 30 - 11 7 Power Cord 5 8 Oil Filled Motor 4 Motor Housing/ 3 1 9 Stator Assembly r 10 Motor Cover Z METERS FEET 10 9 30� S GPM B +-- 2.S FT 25 4 7 x 6 20 v z 5 0 15 Q 4 EP05 O ~ 3 10 EPO 2 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 1 12 m CAPACITY 3 i Page 7of 7 -1 of 3 Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) Shall Include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with Comm 83.54, Wis Adm. Code, and the Mound Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10691 -P (N.01101) And the Pressure Distribution Manual SBD — 10706 -P (N 01/01) Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms 4 Design Flow (GPD) 600 Soil Absorption Component Sizes . ft.) 600 Septic Tank Capacity Gal. 1600 gal. Combined Tank Volume Dose Chamber Capacity Gal. 1000.11 Lift Chamber Capacity Gal. Type of Wastewater Domestic Table 2: Soil Absorption Component — Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (GPD ) 750 600 Max. Influent Particle size NA 1/8 Inch Maximum BOD 5 (m g/1) NA 220 Maximum TSS (m g/1) 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 every 3 years Dose +Lift Chambers Inspect once every 3 years Soil absorption Component Inspect once every 3 years Page 7of 7 -2 of 3 Septic Tank An individual certified to service septic tanks under sec. 281.48, Stats, shall maintain the septic tank. 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 septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of 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. Pump Chamber The pump chamber also requires monitoring once every three years or the time of problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. The dose chamber may fill due to flow continuing during um malfunction or Warning: Th d c y g g P P Po wer outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, a licensed pumper should pump the pump chamber before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber 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. An effective locking device to prevent accidental or unauthorized entry to the tank shall secure exposed access openings greater than 8- inches in diameter Warning: 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 or 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 accordance with Comm 83.33, Wis Adm. Code when the tank is no longer used as a POWTS component. Page 7of 7 -3 of 3 Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential 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 3 years. The inspection shall include recording levels of ponding, if any, in the observation pipes, and visual inspection for any evidence of surface 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, clogging of the soil. Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In case of septic or dose tank component damage, measures shall be taken to repair or replace the tanks to they're original operating condition. Upon failure of the distribution cell component, the system shall be inspected to determine the cause of failure. Steps taken to repair or replace the dispersal cell may involve the removal of a bio -mat, which requires cleaning, or replacement of the distribution network as well as replacing the aggregate system and clogged portions of sand fill. Component Owners Contact List Walter Nechville Plumber 715 749 -3322 St. Croix Co. Zoning 715 386 -4680 Wieser Concrete Products Maiden Rock WI (800 ) 325 -8456 Septic Pumper Ron's Septic Service 715) 749 -0153 • C QOP V Womnsin Deparbnent of Coourte w SOIL EVALUATION REPORT pa / of 3 Division of Satety and WUngs in accoubume vudh corm a% Vft Arlen: Code Attach oornplele she plan on paper not less than 8112 x 11 in size. Plan must inckide. but not untied to vertical and ha ftntai reference point (W. dreclion and Peroel LD. percentslope. scale ordmensions, norlh arrow, and location andt tistarxetDneare52road. 0.20 — please prmf an hirom afibm Revd by Date PommAl m yna pmvWemWa mad for ) twpm= (Pdwnc y tAW. & ts.04 (l)( $nu- PropertyOwrw Properly Locakn Govt. Lot -w 91V41 V4 S,>,f T-2 9 N R / f E (or)IV Property s 9 Ad*ess Lot# I Blodt # Subd. Name or CSti19 pp Zip C'ocb ❑ C4 ' ❑ Vftge WT ovm Nearest Road GrcCfoh 1 — O tr m ml c El New Conshwbon use: WRedden6d 1 Mmiberof burs code dwired des- How rate doa GPD or cotrx wdal - - Pamd matey -� ° a.•� Flood Plain eieradon if apperebte .t/ /,� Gerd conments and �cLris�/ /mom as �Y � of ms < /r 7 b y r :l Boring Y5 E '( © Pit g - �- Depth to anw aclor �_ in. Grourtri surFace elov. SA A Rate Horton Depth Dotratrent Colo Refloat Desoipfiarr Testae ShEtwe Consistertoe Boundary Roots • GPQM &t. mtmsd Ott Sz. Cons Color GL Sz. Sh, y rt 'EM1 'EW t r 2 CS Z -/f 7. 3 19t — 3 - y! s — ..SL ❑ Borigg L Pic Ground surface elev. 9s ; 9 , n. nepm,D wnb factor _ in. SO AppBca Rate Motimn Depth Dorrrirtwtt Ookw Raft Desert ion Tafte Strucftre Cie B=Wmy Rods GPO fF in. Wirlsell Qu. Sz Cont. Cdtx Gr. SL Sh e 'ewi *ew L c - -53 — IS • Mott 8t " > 3D< 22D not and T85 > = iS0 , #2 - BOC < 30 ttgL and TSS <_ 30 nXYL CST Nerve (Pleast: Rk4 CST Narrber 1 /1 rr '' -r$001 Date Evalumdon Conducted Telephone Msnber CAU WS —t1X ,0010 0 I I Property Owner �sr kr' Parcel lD # 410 - /.3 /S /!� — m00 Page Z of -� [il Boring# ° Boring Pit Ground surface elev. • / ft Depth to Srnitiag factor 2C 3� In. Sol Application Hate Horizon Depth Dominant Color Redox Description Texttue Structure Consistence Boundary Roots GPDNf: in. Mrnsell Qu. Sz. Cont Color Gr. Sz. Sh. 72W 'Eff#1 'Eff#2 — v 2- _ y — hrfB 3 S — s i .7 L2 Boring # Q pl�odrun9 Ground surrface elev. MY it Depth to Wting factor � _ in. Sod Appl ication Rate Horizon Depth Dominant Color Redmr Description Texture Structure Consistence Boundary Roots GPDM in. Munsell (3u. Sz. Cord. Color On Sz. Sh. `EfM 'EM ;Z> LS C 7 /'2 3 V.2 - .s s — . 7 A2 . y `— — • 7 I I S.� /- s e S B'bs Grand surface elev fL Depth to gmitirg factor �� in. Q ❑ Pit Sal Application Rate Hortwh Depth Dominant Color Redox Description. Text SUucbxe Consh once Boundary Roots GPQM In. Mtnsefl Ghu. Sz. Cont. Color Gr. Sz. &L ZZME 'Eff#1 'Eff#2 2 LS E c 7 /Z via: /0 2• /�- D is s S rL .� c y — �S S F .7 .2 e- 74 M2 7 2. I • Effluent #1 = BOD, > 30 _< 220 mgk and TSS >30 150 mglL ' Effluent #2 = BOD, < 30 mglL and TSS 130 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. seo.s�wtrc.awo) fR A , � L— o -C? r � t k4 Lo I w a Q '1� l Nr C h !, 3 i i 60 ° N CAI rii (W 9L Q 90N 0 � 08 1 � CAI \ � 99'Lbl 66 — M��80. 9 o Gu 1 01 a3- L-:)ia3a w po'oZ S ^r es 83 4 ! 09'$bl . gos N, IM Q _- N ij OD N \ \ tp 0 -3 v R� "_4 •O co Of V O 1 t ' \� y n • v D SS �F`✓ �O i � m N� O m F14 \ C , w O \ 0co LA a 0 /� Ot 3, g15 ` M LS .,gQ w // A to -i �n i D N N 41 tP '4 o m 0+0 A C ,� O T n H p� O ri �w _ 6 o x fJ N n N Go co 0 m � O • \ \ O "AVM3AI80 3alM , 09 © O -- ---- -- / I >0'9Lb - -x x C_ 85 0��1 ,�£ £9t V M.. 91 , 10 o 00s 9Z '33S `IFAMN 3Hl d0 1N3W3SV3 SS333%f /AWAAMA,.,,, i r - s PAI D d� SOIL EVALUATION ART P opm d -3 �wic�ai�jrande� larch a #�aasmpeper�otfesafistrBllZ�c fl idresiAaimmommast iadada;batnc+tfeeiedt tietiwlaadi�orim�ai nanospoiat is IN nSW- LM - peaaeafstaQ�sraisardmeaa�om� #�orUta�mdbceUm bn�st�oa�l. — O — OD . / Plies a pry# aff t�etadi�ow�e�aNpori3sma�t �! t1S.0tm�. v /� U . /u it�ocettan VW4V 14 S ? T_2 J N R / f E tW ,ems GRp1 XG© �fm Bodc#P SubtNsmerarCSW i .Z WS' ( MY Z& ❑ Viisys ImIcam .Nlm"Itoad tta�f8n — o 7 :J i z © I*wCmftuclm tftwM'RMVMld scf6 Codadsdreddestm*wtab O, GPO or posit eater •t Rwdpift radaniislpkdb R Gonad aoaametMs / f/ and a /r t� — �rr, 7� fir• s � .S-?R` / q �O� Clh, - Ill �l ®u� as �r.�✓� as �esf d/r �r�,�,f f r:l E•rJ°.� ®! .rte -W S E Q _ Q pR gmmdsodaosdw. :9 - I. YO h ad Rds tlotiaon Dept DWA=*Cmb iiedaicUssainian TWM Sbrocime Canoe Bmulmy Rods.: b. ll CA SL OWL cdor GL 9z. Sts —d AF vr 2 At. , = . e l 2 7. - 3 y S G JW/- er S F SL Xa EE a Q' c�a.daadsseels+r. _ �s; 9 i� brnteaar - soi Rsb blsdm Osplh O d colm RsdaxDescdpion Tw*= Sraclms Oowldnos Rods OPDR in. Yeas! tr. Sz Cast Odor 6� St Sb. *ON '1NSZ Or AoEE t - S ' S y AV MJX) . •Eiitaeet#t =BOD >8d:�>u�ard'!5R :160 #2 =80D �9Dasgl:aadT8S:31aapIL GKI' �'� - _ CSTNueber J *km S Dde Conduded TelelAo I NUWAW _ s . c' "A M m mWo m ���ee■■��r m; Mrs =� 1 w -i_ A "I . i . A . 11 . Dui. . . I .. :.ri , I t A r r v Q. A ,i Vrf 4s '\Q ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Bu er �/ Y _ Mailing Address Property Address 5s?CJ ..JUS'ee;ldtll Alpo& (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 54 '/ , /W ' / 4 , Sec. A9 , T 9 f NR j 9 W, Town of tv "' . Subdivision 5 r. _ , Lot # � Certified Survey Map # , Volume Page # Warranty Deed # G f A'71 , Volume / 99 , Page # Spec house yes no Lot lines identifiable G 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms qq , �2 A PLICANT(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) �l STATE BAR OF '4ISC0 F'ORrii I- � 2 6 9 1 H. 4 WALSH WARRANTY .DEED KATHLEEN H. REGISTER OF DEEDS DEEDS CORRECTIVE ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Robert C Goodlpaster and Tammv 09'23-2002 9:30 AN L. Good aster, husband and wife WARRANTY DEED EXEMPT A 3 Grantor, REC FEE: 11.00 and Jeffrey H Maki and Son 1a L Maki husband and wife TRANS FEE: COPY FEE: CERT COPY FEE: Grantee. PAGES- 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsi (thc "Property ")-. and Area Na e a and Return Address frey H. N ki Son3 L. ,�ki �`Z 1J. bt)rh St, This Corrective Warranty Deed is given to correct the 5zo circletpC,>?trurn m/' legal description on the Warranty Deed filed. as Hua n, wi 4016 Z,V�� Document No. 667815, Vol. 1811, page 598. The correct legal description is shown below. n�niziS�0000 - p arce l Identification Number (PIN) This i (�t s homestead property. I,ot 11, St. Croix Estates in the Town of Hudson, St. Croix Cou Together will all appurtenant rights, title and interests. none Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except 2001 Dated this da_: of new a-=ar (SEAL) (SEAL) c� Robert C. Goodpa er Tammy L. Good e ster (SEAL) (SEAL) r AUTHENTICATION ,i ` ACKNOWLEDGEMENT' OFFICIAL SEAL" L � 7 DANA A. SLATTERY Signaturc(s) tate Of W' tic, State <nf Illinois Commission Expires 6 12 -2004 nsin, «r✓1 yam,} — � ss. County. authenticated this day of Personally ca�mnue before me this �voQ day of p �C.t yt F3c�✓ -I" the above named Robert C Goodraaster and Tammy L. Good aster husband and wife * T1TIEL MEMBER STATE BAR OF WISCONSIN to (If not me known to be the perso who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY _ Coldwell Banker Burnet 01- 12413 1301 Coulee Road NZ — + Notary Public, State of Wisconsin Hudson wI 54016 _ My commission // is �� permanent. (If ot, state expirationdate: ( Signatures may be authenticated or acknowledged. Both are __ —t C� not necessary -) V,nnus or ,eru,ns si mine in any capacity must be !3Med or printed below their Signature. tsconstn tan Co.,lnc. DTA r, BAR OF WTSC SIN \ \',1R1LAN "i'1' Dl-,ED FORM No. 1 - 1999 Milwaukee, Wis. L 0 lA O y v 0 �1 c 3 d �1 a d (D ^ O N Ui t!� (.71 +n 2 Co N < s N N N 0 (D O c O -` (�D `2 2 A O CD 7 7 O N y O �c �c � c o R 111 C N 0 C C w m n j O O O 7 N 6 O� O N C CD C d (D G3 G CD C N CD c a O n w (m " U N N PO N 0) m o c c o -� p r r _ ry1���11 3 a O m � W . fA A O •► m a o x (o ( = m N K .. (A O W d N N (D (D CL N N z .r o z z O D m O v 0 > 0 � � � !r • CD m CD N (D c �f C v (D w CD n CL 3 Z O Z m y C Cf - =3 Z O 0 W K) OD a z a 3 z (o z m w F � zt o CL CL 5 z x CD m o � N (D 7 O 0 � s y CD A N x O O C , o% Z I O ' O O b A (D dq O Efl 0 o CD a C) CL �' STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 4 ADDRESS T qkc nr d� SUBDIVISION / CSMg j �� s LOT l� SECTION T 2T N -R /F W, Town of A�_d&.*7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D /Sff ucc� l� /al�c �r /5ti� 4)e f6 �(F r2 6P7, y 4 s 6 �q INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: i SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: G</eE,�S C:� Liquid Capacity: /dclo Setback from: Well 7` House /f Other Pump: Manufacture Model# Size Float seperation /1/ Gallons /cycle: Alarm Location I SOIL ABSORPTION SYSTEM W idth: 5 Length 6a Number of trenches 2 Distance & Direction to nearest prop. line: ree- o ?, ' Setback from: well: /io /1 House 6e) Other I ELEVATIONS i Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ZZ PLUMBER ON JOB: �-- LICENSE NUMBER: 22.! INSPECTOR: 3/93:jt Wiscgnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ,labor and Human Relations INSPECTION REPORT ST CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: []City ❑ Village ❑. Town of: State Plan o.: GOODPAS'1 ER , ROBERT X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax o. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 8'' Dosing 2 ,�3 Aeration Bldg. Sewer Holding I St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet rr. 35 Ventto TANK TO P/ L WELL BLDG. Airintake ROAD Dt Inlet Septic ,� NA Dt Bottom Dosing NA Header /Man. 3" E o n NA Dist. Pipe e3 6 2 g9.5r' ng Bot. System �� 9g" g8' PUMP/ SIPHON INFORMATION Final Grade 9a.i 0, Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H ead Dist. To Well SOIL ABSORPT N SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 (1 0 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: - INFORMATION Typeo / CHAMBER Model Number: System: r -rJ- °Z 3c) /la' I OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a ` Depth Over p xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 3 Bed/ Trench Edges 36 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LUCA'1'lUN: HUDSUN.28.29.19, SW, NW,. LOT 11, JOSEPH CIRCLE 101�L 0 7 �v , 6�, / ""I0 Plan revision required? ❑ Yes p'No Use other side for additional information. 5 1 0 '� k�. c�c cv SBD -6710 (R 05/91) Date In p ctor's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System, 201 E - Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. .r. • See reverse side for instructions for completing this application State Sanitary Permit Number a59�5�2 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property wner Name Property Lo r f` d1�/ S�1/4 lK0 /4, S Z r T N, R Propert Own Mailin Address Lot Number Block Num ierr m I -+l P /AGE City, S e Zip Code Phone Number Subdivisio i Name ocCSM Numb r II. TYPE OF BUILDING: (check one) ❑ State Owned E] Cit Nearest Road VIllag 0 /-, Public 1 or 2 Family Dwelling - No. of bedrooms Town OF oyl •e �r� III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo I 4 0 4,� — O -coo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line 8, if applicable) A) 1 � pQ New 2. ❑ Replacement 3_ [] Replacement of 4_ E] Reconnection of 5, Q Repair of an ______System System Tank Only Existing System - --------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12;jo Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6.O ystgXrl flev. 7. Final Grade f/ Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) ? C� Elevation 1 & 0 . 4.;t S . � rz 67 • ?' Feet ���� Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Ex per INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A p p New Exist in s Tanks Tanks Septic Tank or Holding Tank X j &A"Oi j C: IN ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber E] El 1:1 1:1 E] 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name: (Print) Plumber's ignature: (No tamps) MP /MPR O.: Business Phone Number: Plumber' ddress (Street, City, State, fip Coq): IX. COUNTY / DEPARTMENT USE ONLY s /�yw•,, w ❑ Disapproved S a tary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) y � v [' Approved ❑Owner Given Initial Surcharge Fee) Adverse Determination �°� �� ^ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & 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 a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained_ The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -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. Ili. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V.. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information_ Fill in the capacity of ever;; new /or existing tank, list the total ga!lons, number of tanks and manufaC name, indicate prefab cars nstructed and tank mit-riai Co�,iplete for all septic, pump /siphon and holding to �Ics for this systern. Check experirr : r�tal apprnval rnly if t i,f s receiver± experimental product approval from DILHR. VIII Responsibility staternent. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sic, n applica form. IX_ County, / Depal'Lment U >e Only. X. County i Department Use Only. 7 .:'i'iCc3t:. ,5 f R x (j!_ The plan, mu s c,.. , o! a' , �, o; vv . ing tank(s), septic - 31� .. _ :. '? ._•'.i/ _ I .i) i' _ _ _ _ t�.- :.'>, i.' -, !� •:.0 �.� t _' building L', c nto!ma,,on CR(IUNDWA'tER SURCHARGE 1983 Wls(_o! - -m A<t d10 :nrluded the crec). (;J-,u-charge,, i 'Pest gi.iated practices which can ette�,C giOiJn � "J r71�nseS CJO._�Ce., t vL. j J'(_ _ ;ee � n,J�_ !r "lj3_'st!gat!ons 0.` yStab!5sh} er i of Stu dS . JOB ✓ (� �� l�r_✓ �/ TIMM EXCAVATING SHEET NO. / OF Z Route 1 Box 192 T WILSON, WISCONSIN 54027 CALCULATED BY F ' ` DATE ZZ (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ............... i ............<. . ........ .. ...... ... ........... .. .. .. ...., ..... ........... ................ . ... .. .... .... .. . .. .. .. . ..... ... vJ d ......,,�;... ... i� .. 0....� .......... .....� :...... \ 3` ......p J'o W .. !� ..ti 1u.., h �•� .... V ._ V- .... ... N 's N ...... ....... ..... ......, ..... ...... �� ... ......... �. , 5 ..._ . ... s t ..: _...... ,..... . j � .. q. .. .. . PRODUCT 205-1 Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE I- 800-225-M SOS TIMM EXCAVATING SHEET NO. 2 OF a Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY �`' DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ktt KTJ --- 91--tt- -E ........... ? ......... .... A lf L7, f L ........... .......... kl d,� .•,r . .......... . ....... ....... PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1. 800 - 225.8380 Wiscab, Department of Industry SOIL AND SITE EVALUATION Page 1 of 3 .�abo cl Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Robert Goodpastor Govt. Lot SW 1/4 NW 1/4,S 28 T 29 N,R 12 W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 8845 Johnquill Lane, N. 11 St. Croix Estates Ci State Zip Code Phone Number Hudson Nearest Road aple Grove, MN 55369 ❑ City ❑ Village ® Town ( 612 ) 425 -2321 Joseph Circle >E] New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft Absorption area required 643 bed, ft 562.5 trench, ft Maximum design loading rate ' bed, gpd/ft ' trench, gpd /ft Recommended infiltration surface elevation(s) 88.6/87.4 upper /lower ft (as referred to site plan benchmark) install 2 - 5' x 60' trenches Additional design /site considerations Parent material sandy / loamy outw 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 [K] s❑ u 10 s❑ U U s ❑ u Q s ❑ u ❑ s IX u El s Q u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots Mir` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench j 1 1 0 -6 7.5YR 3/2 - 1 1 m sbk mvfr gs 1 f 2 .3 2 6 -14 7.5YR 3/3 - is 1 m sbk mvfr cs 1m .7 .8 Ground 3 14 -25 7.5YR 3/4 - is 0 sg ml gs 1m .7 .8 Of, 7 It 4 25 -90 7.5YR 4/4 - - s 0 sg ml - - .7 .8 w/ occa iona Depth to limiting factor r > 90 in. Ile 'O Remarks: `�`�_ =• Boring 9 1 0 -6 10YR 2/2 C y �. 1 1 f cr mvfr cs 1f /m 2 .3 2 6 -19 10YR 3/4 s 1 m sbk mvfr cs 1m .4 .5 2 3 19 -29 7.5YR 4/4 1 m sbk mvfr cs 1m .7 .8 Ground 4 29 -92 10YR 4/6 - s 0 sg ml - - .7 .8 elev. w/ occasional inclusions 7.5 R 3/4 cs & w/ occasi nal f gr 9 1.1 ft. Depth to limiting f in. Remarks: CST Name (Please Print) Signature Telephone No. Henry F. Grote 715 - 665 -2681 Address Date CST Number PO Box 57, Knapp, WI 54749 -0057 2/10/96 3065 Robert Goodpastor SOIL DESCRIPTION REPORT 2 PROPERTY OWNER Page J � „ . PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench F«< 3 1 0 -8 7.5YR 3/2 - sil 2 m cr mvfr cs 1f/m .2 .3 �. " 2 8 -29 10YR 5/4 - sil 2 m sbk mvfr cs 1m .5 .6 Ground 3 29-4C 7.5YR 4/4 - sl 1 m sbk mvfr gs 1m .4 .5 elev. 93 ft w/ occasio al gr 4 40-96 7.5YR 4/4 - s 0 sg ml - - .7 .8 Depth to limiting w/ occas onal f gr factor sr in. Remarks: Boring # r ' Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground " elev. ,< ft Depth to limiting factor in. Remarks: Boring # .r Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I I I ! + b 1 i Ir ri cA t p 1 • i , i 1 I f , � ( -- - - r a f VA rhe LJ t i , - - !- , ! Y , - _ i I ! 2,6 Wi gsin Department of Industry SOIL AND SITE EVALUATION La d Humhn Relations Page 1 of 3 0,'Asion of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Robert Goodpastor Govt. Lot SW 1/4 N 1/4,S 28 T 29 ,N,R 12 W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 8845 Johnquill Lane, N. 11 St. Croix Estates CiN state Zip Code Phone Number Hudson Nearest Road Maple Grove, MN 55369 ( 612 ) 425 -2321 ❑ City ❑ Village ® Town Joseph Circle M New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft - trench, gpd/ft Absorption area required 643 b ,ft 562 trench, ft2 ' 7 .8 rp eq ' Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 88.6/87.4 upper /lower ft (as referred to site plan benchmark) install 2 - 5' x 60' trenches Additional design/site considerations Parent material sandy /loamy outwash I "plain elevation, if applicable NA It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U El S ❑ U S ❑ U Q S El [Is [X] U ❑ S Q U ION REPORT Borin # Horizon Depth Dominant Colo Mottles Structure GPD/ft g in. Munselt Qu. Sz �bnt Co r lure Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 1 0 -6 7.5YR 3/ c� 1 m sbk mvfr gs 1f /m .2 .3 2 6 -14 7.5YR 3/ ,- z 0, icy 1 m sbk mvfr cs 1m .7 .8 Ground 3 14 -25 7.5YR 31 m s; 3 0 sg ml gs 1m .7 .8 eeIIee ` . 0 ft 4 25 -90 7.5YR 4/4 - 0 sg ml - - .7 .8 w/ occa i:�T i r Depth to . limiting factor _T > 90 Remarks: Boring # 1 0 -6 10YR 2/2 - 1 1 f cr mvfr cs 1f /m .2 .3 2 6 -19 10YR 3/4 - sl 1 m sbk mvfr cs 1m .4 .5 2 3 19 -29 7.5YR 4/4 - is 1 m sbk mvfr cs 1m .7 .8 Ground 4 29 -92 10YR 4/6 - s 0 sg ml - - .7 .8 , elev. w/ occasional inclusions 7.5 3/4 cs & w/ occasional f gr 9 1.1 ft, ; Depth to limiting factor 92 in. Remarks: CST Name (Please Print) Signature Telephone No. Henry F. Grote A -' Q I 715- 665 -2681 Address 2te CST Number r PO Box 57, Knapp, WI 54749 -0057 Robert Goodpastor SOIL DESCRIPTION REPORT 2 PROPERTY OWNER Page of PARCEL I.D.# a Bolin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 3 1 0 -8 7.5YR 3/2 - sil 2 m cr mvfr cs 1f /m .2 .3 2 8 -29 10YR 5/4 - sil 2 m sbk mvfr cs 1m .5 .6 Ground 3 29 -4 7.5YR 4/4 - S1 1 m sbk mvfr gs 1m .4 .5 elev. 9 1.9 ft. w/ occasio al gr 4 40-96 7.5YR 4/4 - s 0 sg ml - - .7 .8 Depth to limiting w/ occas onal f gr factor :> qr,_ in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor ' n ' Remarks: SBDW -8330 (R. 08/95) , ! , w �--�- _3 , 1 I A I t qq I I I , I i I 7 i I I , LA c d i 1_ t � r ] I 3 I t _ ' 1 ti4E- a60 rin Department of Indust SOIL AND SITE EVALUATION REPORT -�� ' � � e 1 of 3 Libor an:° Human Relations °� " !3ivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code C �+ �x X Attach co site Ian on not less than 8 1/2 x 11 in Plan must include but P not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or EL I. dimensioned, north arrow, and location and distance to nearest road. 1 p A z49 5 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION WED BY CFA DA NTY PROPERTY OWNER: PROPERTY LOCATION .S' John Rauchnot GOVT. LOT SW 1/4 Nw 1ia,s (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CS - -_,.._ 527 Co. Rd. #W 11 na St. Croix Estates CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 (715 386 -3052 1 Hudson Judy Circle (x] New Construction Use Residential / Number of bedrooms 3 ( ] Addition to existing building ] Replacement (] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft •6 trench, gpd/ft Absorption area required 900 tom, ft2 750 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 95.66 ft (as referred to site plan benchmark) Additional design / site considerations alt. area - 95.41 Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem I KI S ❑ U RI S 0 U ®S ❑ U ®S O U D S (a ❑ S fl U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bourxfary Roots in. Munsell LCu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& `... 1 0 -12 10yr2 /2 none 1 2msbk mfr gw 2m .5 .6 2 12 -22 10yr4 /4 none sicl 2msbk mfr gw lm .4 .5 Ground 3 22 -48 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 elev. 4 48 -84 7.5yr4/6 none S Osg ml na. na .7 :.8 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -7 10yr3 /3 none 1 2msbk mfr gw 2m .5 .6 ` 2 7 -26 1.Oyr4/4 none sicl lfsbk mfr gw if .2 .3 C� Pvm 3 26 -52 7.5yr4/6 none is Osg mvfr gw na .7 .8 -- -_ - - eGlev. 4 52 -84 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 98. ft Depth to limiting factor +84" Remarks: CST Name: — Please Print Gary L. Steel Phone: 715 - 246 - 6200 Add ress: 1554 2 . Ave., New ichmond WI. 54017 Sgnature: Date: 11 -5 -95 c CSTN 0229 PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. u pending Boring ry # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft in. Munsell Ou. Sz. Cont. Color I I Gr. Sz. Sh. I Bed iTrerx� 1 0 -6 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 3 r.- 2 6 -22 10yr4 /4 none sicl lfsbk mfr gw if .2 i .3 Ground 3 22 -72 7.5yr4/6 none is Osg___ ml gw na .7 ;.8 elev. "- 99 ft. 4 72 -84 7.5yr4/4 none sl 2mgr mvfr na na .5 '.6 Depth to limiting factor +84 "' lb Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr gw lm .5 ::.6 4 2 10 -28 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 3 28 - 7.5yr4/4 none sl 2mgr mvfr gw na .5 1.6 Ground elev. • 4 42 -80 7.5yr4/6 none co s Osg ml na na .7 .8 97. ft. Depth to limiting factor +80 Remarks: Boring # <: >: 1 0 -6 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 5 2 6 -22 10yr4 /4 none sicl lfsbk mfr gw if .2 .3,' 3 22 -80 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 Ground elev. 97 ft. Depth to limiting factor +80 Remarks. Boring # Ground elev. ft. Depth to limiting factor i Remarks: SBD- 6330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot 1554 200th Ave. CSTM2298 WIWI S28- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson 715 246 -6200 lot #11 -St. Croix Estates f N 1 =40' BM.= top of 1" steel pipe C e1.100! Alt. BM. = nail in tree C el. 104.20' �i V x " e� 3 3 1� 5 Gary L. Steel 11 -5 -95 W�nnsn Department ofIndustry SOIL AND SITE EVALUATION REPORT , =+ 1 of 3 �Wr arn: Human Relations ` Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code YA Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but R � AA q E L :ti!"rivC X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or I. ;; *• dimensioned, north arrow, and location and distance to nearest road. Jndi APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION WED BYC+ PROPERTY OWNER: PROPERTY LOCATION John Rauchnot G . LOT SW 1/4 NW 1/a,S2 (or) W PROPERTY OWNERS MA!I_ING ADDRESS LOT # BLOCK # SUBD. NAME OR CS - .....__- 527 Co. Rd. #UU 11 1 na I st. Croix Estates CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 (715 386 -3052 Hudson Jud Circle [x] New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 5 bed, gpd/ft •6 trench, gpd/ft Absorption area required 900 bed, ft2 750 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, 9pd/ft Recommended infiltration surface elevation(s) 95.66 ft (as referred to site plan benchmark) Additional design / site considerations alt. area = 95.41 Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem KI S ❑ U ® S ❑ U ®S ❑ U ®S ❑ U ❑ S au ❑ S :E7 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bondary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed Trerxft 1 0 -12 10yr2 /2 none 1 2msbk mfr gw 2m .5 .6 1 M"Mg 2 12 -22 10yr4 /4 none sicl 2msbk mfr gw lm .4 .5 Ground 3 22 -48 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 elev. 4 48 -84 7.5yr4/6 none S Osg ml na na .7 1.8 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -7 10yr3/3 none 1 2msbk mfr gw 2m 1 .5 .6 2 2 7 - 1.Oyr4/4 none sicl l fsbk mfr gw if .2 .3 maw 3 26 -52 7.5yr4/6 none is Osg mvfr gw na .7 1 Ground elev. 4 52 -84 7.5yr4/4 none sl 2mgr mvfr na na 98. ft. Depth to limiting factor --t 7— +84 Remarks: CST Name: — Please Print Gary L. Steel Phone: 715 -246 -6200 Add resc 1554 2 Ave., New icbmond WI. 54017 Signature: Date.. CST Nurnbsr: C 11 -5 -95 cstm 0229 PROPERTyOWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 cf , 3 PARCEL I.D. # pending Color Gr. Sz. Sh. Boring # Horizon Depth Dominant Color Mottles I Texture Structure Consistence �ftrubry I Roots ed D i Munsell Qu. Sz. Cont t n. t. 0 -6 10yr3 /3 none 1 2msbk mfr gw 2f 1 .5 .6 3 2 6 - 10yr4 /4 none sicl lfsbk mfr g�.* if .2 .3 i Ground 3 22 -72 7.5yr4/6 none is Osg ml gw na .7 ; . 8 99 ft. 4 72 -84 7.5yr4/4 none sl 2mgr mvfr na na .5 '.6 Depth to limiting factor +84 111 Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr gw lm .5 ; .6 4 2 10 -28 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 3 28 -42 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 Ground elev 4 42 -80 7.5yr4/6 none co s Osg ml na na .7 .8 97. ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -6 10yr3/3 none 1 2msbk mfr gw 2f .5 '.6 >5 2 6 -22 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 A,...... 3 22 -80 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 Ground elev. 97 ft. Depth to limiting factor +80 Remarks: Boring # Ground elev. ft. f Depth to limiting factor i Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot 1554 200th Ave. CSTM2298 SW4Nw4 S28- T29N -R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #11 -St. Croix Estates f N 1 " =40' BM.= top of 1 steel pipe C e1.100,'- Alt. BM. = nail in tree @ el. 104.20' cd f 610 3 5` 3d �' arm 50 a �a� Gary L. Steel 11-5-95 540.85' 48.34' N N pt� 530.26' ' v 1.88 AC. EXC. ESMT. / N -! N 82,187 SO. FT. 1 r _ W 19 ACRES s 2. N �` 4 95,581 SO. FT. m m N / r M m = 2 (p i m m ma ty 1 Zo c t � ' � q2T • / u = � rn �7' 1 10 ' m h 6 10 •w /� `/ 0 w t 14 tv - Z 3,36 ACRES/ A i w 146, 319' S0. FT. N L t 2.03 AC. EXC. ESMT. /� N 88,598 SO. FT. 1 _ ' 13 � y F / �,� 1 0 � $ 1r) v 2.96 ACRES '_ G O rn 1CID 128,780 SQ. FT. 0 0 O o To _ < c. ZA; I m N N A'Z ? 41 q _ L , 0 0' I I 1 s m Z O z � O 3.08 ACRES 134,301 SQ. FT. L Ln p (D 2.62 AC. EXC. ESMTS. I h 114,245 SQ. FT. N 12 9.7' 1 N rt 2.09 ACRES 91,197 SQ. FT. ' * 0 1 33 x i c A x " 9 Q m < 8 1 0 i l OO �� 2 .78 ACRES a w ICA,TE� 121,296 SO. F �� w i T. GG x J O 2.11 AC. EXC. ESMT y 92,082 SO. FT. N rn 2.14 ACRES 3 Q 1 93,214 SO. FT. m N o0 0 W r z z U1 N m �►.. m o 1 ti N •n SOU LINE OF THE SWI /4 O THE NWI /4 -a 14.4 T � 462.00' — 644.31 182.31' C A0 IA "W 71n F, 7 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT & L7 — St. Croix County OWNER/BUYER IF MAILING ADDRESS `-� L.� "emus PROPERTY ADDRESS �✓ �v �� sp C w L (location of septic system) Please obtain from the Planning Dept. CITY /STATE 9�1 tk.A..s� k. V -� �y f PROPERTY LOCATION S4j 1/4, VIJ& 1/4, Section = Z if T _2j_ N -R _ W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER l CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 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 60 % 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expi rat' n date. SIGNED DATE: Za y A/ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 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 16Lr � �4� Location of property S l,J 1/41/4 , Section N -R / 4 W Township ALtq on Mailing address �� A rye /jai' _1� 346 l Address of site 6 Subdivision name St. 45i 5k_� Lot no. Other homes on property? Yes X No Previous owner of property Total size of property C2.4. Total size of parcel �; o Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes __ No Volume _ //&I and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. y v and that I (we) presently 53 9 � P Y own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. Si natu of q plicant Co- Applica� Die f Signature Date of Sid ature • DOCUMENT NO. STATI�BAR S FORM 1 -19 PAGE SPACE RESERVED FOR RECORDING DATA 539450 DEED 2�O Bridgeland Development Company, a Minnesota corooration 1 a llci li U I r RL old 1 conveys and warrants to Robert C. Goodnaster and FEB 12 1996 Tammy L. Goodpaster, husband and wife 8:20 A.,� RETURN TO V4 _ �l the following described real estate in St. Croix County, State of Wisconsin ( 9 d TAX PARACEL NO. Lot 11 , St. Croix Estates in the Town of Hudson, St. Croix County, Wisconsin. TRAN This is not homestead property. FEE (is) (is not) Exceptions to Warranties: Dated this 30day of Ja aru , 19 96 (SEAL) (SEAL) * * Nealltriy ani 4499"Z (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 19 Dakota County Personally came before me, this 30 day of * January. 1996 the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 706.06, Wis. Stats.) This instrument was drafted by to me known to be the person who executed the foregoing instrument and acknowledged the same. C�7�C GL4'�aJ a_ A� (Signatures may be authenticated or acknowledged. * Darla J. Bauer Both are not necessary.) Notary Public Dakota . County, MN My commission expires January 1, 2000. w� fq'Ti RY DAKOTA COUN My Commission Expires 00 *Names of persons signing in any capacity should be typed or printed below their signatures. sB2 NTF 0021 WARRANTY DEED STATE BAR OF WISCONSIN, FOR M NO. 2 -1982