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020-1168-60-000
r INisconsic "lepartmeht of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety 3. 4 n ,iIding Division INSPECTION REPORT Sanitary Permit No: • 538718 0 GE +ERAL 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: Alberg, Jonathan Trust & Lisa Hartwi Hudson, Town of 020 - 1168 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: / d d ` U /00 64, Cale-- �oo 5, ' / ( 07.29.19.1044 TANK INFORMATION ELEVATION DATA A, • y2 / 6b. c/l Q o' TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /a 37 I I A77 ,Db. 6 Septic I� /�— _ ( � � cl � I � J j 0 00 Benchmark /d • ac /10 .6Cp /de • Dosing Alt. BM (Al (.jai r ) ) 67—; Aeration ' eration /_ Bldg. Sewer • l rh4eC.A _ /( 14 _, A o�./ / % / alt i Holding St/Ht Inlet St/Ht O let �r TANK SETBACK INFORMATION �� -- al -Leaf / 7.34 Z� 7 6C, /� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt� s(,j...( cep f VL / a�3 g - v ? Septic 6 ) ( i -$ n / v . °� B— ` 2C 22,73 g3. ( / Dosing L., 1 / r Head- 5. .S 7 Aeration Dist. Pipe / Sl 7 /0S, ! 7 Holding Bot. System t —— /o.c 51 /Frg,tipys Final Grade PUMP /SIPHON INFORMATION &A/L:1- / eel tad. / / O & .5 Manufacturer / / GePM Demand St over � / / Z 5 C O Calif' ,, pia y q l i Model Number / (� • W/ Pi c,/ Z (t Co C I D s/cAiz -r 6 we;) /ZS'! TDH Friction Loss System Head TDH Ft 2/ -1 d .I -1-c 6 6 , s 30 ` o-ao_ opof ), l p -i—ce.;( vi Forcemain Length Dia. y list. to Well 1 -r 2 let 444.01,2_ (.tae cf / ' 6'�c �t�► s. �l.lt - SOIL ABSORPTION SYSTEM „S /// ' , • BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Depth DIMENSIONS /, —.75–/ 1Liquid SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION V` CHA OR Typ Of System: r , / UNIT Mac/An 1 20`4- � • > too M odel Number: DISTRI: - ION SYSTEM ,..,(1 c z - Qee e J Header /' anifol. Distribution x Hole Size x Hole Spacing Vent to Air Intake r � n p / ' 3 l��c 2.. 3 / p¢1//uJ. Length Dia Length /3. / 3 Dia I • C Spacing SOIL COVER x Pressure Systems Only xx ound rAt - Grad Systems Only Depth Over Depth Over xx Dept of / Seeded /Sodded - a , ched Bed/Trench Center Bed/Trench Edges Topsoil ' i I! 4 D n • Yes No / / es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: i 6,4 /d Inspegtii n #2: / / r / /e// 0 Location: 314 Windolff Lane Hudson, WI 54016 (SW 1/4 NW 1/4 7 T29N R19W) Ranchwood Lot 11&12 P N c(, i 044 / 1.) Alt BM Description = -1— if "0 � � M &-e C�)" ii/ ` / 2.) Bldg sewer length = (1S3 i\4 1 f c "1 - 1 - 6 , 1 - 11'.) IP (• '� / x', Ph - amount of cover = ti Gs) Q Plan revision Required? 6 Yes No IIII- dk,, f6(' IIIII Use other side for additional information. // / /v / P SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. L . •FeptaeLina(2(-- commerce.wi.gov Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 S r. J isconsin SPIlisir' D 3707 -7162 Sanitary Permit Number (to f illed in by Co.) Department of Commerce -- __...�, F 7i f Sanitary Permit State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this f �- / 84 5- I 3 1 unit is required prior to obtaining a sanitary permit. Note: Application orms fgb are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you rovide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. S/ I. Application Information =Please Print All Information OCT 22 2� Q Parcel # Property Owner's Name t 30 k AL-8 R (r 4' L J T SN I(d F) KT w.r ( ST. CROIX COUNTY 02.6 ~ 1168 " 40 - t3 C") Property Owner's Mailing Address 'L NNING & ZONING OFFICE Property Location C / y Ir1.r -A/ D o d. FF L- f-� /�E G Lot _ • / ow City, State Zip Code Phone Number 5 t y,, N W /, Section '7 /4u9 5O cox 5 /ta - 7/S-38i- V/? T N; R /' f i (circle o U. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms // 4., Subdivision Name Bloc # R b ❑ Public /Commercial - Describe Use ❑ City of CSM Number ❑Village of ❑ State Owned - Describe Use Town of Pl,A III. Type of Permit: (Check only one box on line A, Complete line B if applicable) • l • A ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System /Component/Device: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade VLjv4ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain / V. Dispersal/TreatmentArea Information: 1/ ; 7 V - W yl' frIA/ld / J OJ)1; i A° Design Flow (gpd) Design Soil pplication Rate(gpdsf) Dispersal ea Required (st) Dispersal Area Proposed (st) System Elevation I I 5-6 I a y 150 it s Y /33 / VI. Tank Info Capacity in Total # of A ` anufacturer B $ Gallons Gallons Units j P _ .= New Tanks Existing Tanks / _ / rTI r u o .) ] l 1 �Cit J 7 i n U v ti v, cr. 0 n.. Septic or Holding Tank 4,011.9 tablif.+• /00'0 1 000 / CO Ci' r Dosing Chamber ' S o . S o / Cam' LA.i+L- $ 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 ca4LrER 11EC.11 vrL.Le ` cA 1' w 32 z21 o 11S 7k 14 - 33 Plumber's Address (Street, City, State, Zip Code) 941 (- Ic.., 4S Acs 6CA.T$ c>_1r Sq aa3 VV County/Department Use Only cil it Approved ❑ Disapproved Permit Fee ' Date Issued ssuing Age Sign re ❑ Owner Given Reason for Denial $ �Z S . / o a s / 6' G %` � %e Ct IX. Conditions of Approval/Reasons roval/Reasons for Disapproval 3 6"1' y�vl . SYSTEM OWNER c hau vu s ai� 1 Septic tank, effluent filter and 0 Jn-,67ki, - �/ f -„ dispersal cell must all be serviced / maintained � (/ as per management plan provided by plumber. CAA4 , 2. All setback rPriiiiremnnts must be maintained as era titONas for the system ands _ 8 t to e County only on paper not less than 1/2 x 11 inches in size p applicable t / a/ t.rLliyti 9'1�/-( P , fade 4*-Pe( � nrn a 4 33 SBD-6398 (R. 02/09) Valid thru 02/11 Qo c Fi N O y 0., (Na 0 Zr E-4 ,--4 CI k L. b 'c.4.)) d M `° o t V W N, . t of E • C o o y t � v le ° `Z o ao o A a II o 11:1 k1 o .Q. 4X / . b0 (21 0 E o tga w Q. a � oa a� Eo k. p ae 11 M ot u b cD o ° �.'gt,. N. 3 erg 0.t �vC7 • 0 O .s 4� U 0. R ..t t) W C a' i '4 i t4 k 0; b cn N `�Ni " 2 ti ' � " M BO II o 1.4 CZ � y Fr rn A o II 0 o v "" r" I:1 11 C3, et ¢ o W �+ > F .2 phi .�, n A 1a =I a a 11 it A .fiCOP1 es v v ,..., I I ! Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.goV HOLMEN WI 54636 o Contact Through Relay 1 C S 1 www.commerce.wi.gov /sb1 www.wisconsin.gov Department of Commerce Jim Doyle, Governor Aaron Olver, Secretary October 20, 2010 CUST ID No. 224059 ATTN.: POWTS Inspector 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: 10/20/2012 SITE Identification Numbers Jon Albreg Transaction ID No. 1865131 314 Windolff Lane Site ID No. 761078 Town of Hudson Please refer to both identification numbers, St Croix County above; in all correspondence with the agency. SW1 /4, NW1 /4, S7, T29N, R19W Lot: 12, Subdivision: Ranchw000d FOR: Description: Three Bedroom Mound System / 12% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1284745 Maintenance required; Replacement system; 450 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Versionr2.0, SBD- 10706 -P (N.01 /01); 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. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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, Condit' , stats. The following conditions shall be met during construction or installation and prior to occupancy or use: APPR.111 Reminders DEPARTMENT 0 101 DIVISION OF SAFET • fr't: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Jr. /,/4 SEE CORI ES • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stets. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection b authorized re.resentatives of the Department which ma include local ins sectors. KEITH E STONER Page 2 10/20/2010 Owner Responsibilities: d' • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 erard M Swun POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code:. 7633 jerry.swim @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. R�C MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN /17 Residential Application QCT j INDEX AND TITLE PAGE SAFE 2 2O /� Tye 8 I CO, Project Name: Jon Alberg Mound 11/GS Owner's Name: Jon Alberg Owner's Address: 314 Windolff Lane Hudson WI 54016 715- 381 -5496 Legal Description: SW1 /4 -NW1 /4 Sec.7 T29N -R19W Township: Hudson County: St. Croix Subdivision Name: Ranchwood Sub. Lot Number: 12 Block Number: NA et/ , t, �'v Parcel I.D. Number: 020-1168-60-000 L Plan Transaction No.: 11,EcE bUiLDINGS Page 1 Index and title g4444-1417 Page 2 Data entry E ; ;- Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Soil Test Attached Designer: Keith 4 ne O • '� % � License Number: Designer# 1575 -007 Date: 10/07 " 0 '•• may Phone Number: 715-653-2324 Signature / d; ,;tei 1, 1 1/4; 4 ' O • Designed Orsuant to the Mound Component �� WT, ersion 2.0 SDB-10691 -P (N. 01/01), and both SSWMP Publication 9.6 r g s9gntizflessure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal ooliform of <= 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 450.00 Design Flow (gpd) 12.00 Site Slope ( %) 104.00 Contour Line Elevation (ft) 35.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = I 6.00ICetl Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest • •int in the distribution Y Pressure Disrrbution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = I 7.501ft /orifice 2.00 Forcemain Diameter (in) 170.00 Forcemain Length (ft) Does the forcemain drain back? I Y 1 83.33 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 27.73 Forcemain Drainback (gal) 20.67 Vertical Lift (ft) 67.32 5x Void Volume (gal) 2.30 Friction Loss (ft) 95.05 Minimum Dose Volume (gal) 0.50 In -line Filter Loss (ft) 24.72 System Demand (gpm) 29.97 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gailons/nch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information V Effluent Filter Information 750.36 Dose Tank Capacity (gal) Simtech Filter Manufacturer 20.28 Dose Tank Volume (gal /in) STF -100 Filter Model Number Wieser Concrete MManufacturer Project: Jon Alberg Mound Page 2 of 8 Mound Plan and Cross Section Views 1 :1/10 $ ;:':' ; -;= �[ J Observa Pi pe .[ L : �� • �4 1 • L.. 1 *:;p ..ti : L : •• f . :: z . lz . r L. a 1 • J : ---- g i r� •' tr: * ..l 4 !,' .. ".1• .,• r , 4 . . .J r • J� r ti • 1.'. 1 L..,...: .ti•:�� ;ti.;:1,. ti ti { ti ti ' � � .ti..: ^ ':•.= L ; •, :ti : • .• 1ti;� r.: .r A .J.r•r::.:.r.. r -..... r..: •:r. .::.r.. r. '� y' ,� ' 1 . : .:.,...1,.1. 1 .1.4.1.1 5 1 .1 .. , .- . : ti ..:..1.1.L.L. ti �i .1.4: :.:•:• r• : •. • .r. r.J. ... W .0.: •r....:.r.:.:..•.r• :•r•:.:-r :���•,:1:4 1.1- •,.1.1.4.4.4 - 1.1.1. 1.4.1.•.•1.1.•..•. �•.- 1.4.1.4.4.1.1.4. \.1.4 .1.1 1.4.1. :•:.:.. .:.:• :.:.:-r•:.r.:•:•:•r.-•..• - •r.:.. r. r .:. r- .••r.r.r.r.r.r.r..^..•.r.r.r.r • • • • • • • . , . 1 , 4. 1 1. 4. 4. ti : . 4.1.• , .1.4.1.4.4••.•4.411••.e 4 X1 ;4�1:1�4_•S �`.:1 �1 �L ;1 �4 _L �4�1 X 1!1:1:••:4 S•:4:•- `' ' - W z • L • Mound Component Dimensions A 6.00 ft E 14.64 in H 1.00 ft K 7.96 ft B 75.00 ft F 9.50 in 1 11.77 ft L 90.91 ft D 6.00 in G 0.50 ft J 3.95 ft W 21.73 ft 450.00 (ft Dispersal Cell Area 1333.01 (ft2) Basal Area Available 6.00 (gpolft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.29 (ft) ♦ H F Dispersal Cell 105.00 (ft) Lateral 104.50 ft ........... .. Invert Dispersal Cell : : : : : : : : : : : : ` Elevation D: S ' a �_y: 7 •, _ x Y '`i t 1 r K4 `t. l - ? .' 5 } i i ,, i LI , i ▪ A} 1.'7 }, . r ,l? . ?.,� t ;+. ▪ 1 / k., .1 ),•� i > '.fx i..l .� ,Q 1 i t • '�.� { x.,, -. i )..7i,} ) -7S ;A >,j •7 { t ti p • .,, .,A, 1. A .. ?... ,1 i z i ,',.:!..e.'-'-.1\e'=.. ..... • 104.00 (ft) Contour Elevation 12.0 % Site Slope -#-- Geotextile Fabric Cover Shading Key a a' El I Dispersal Cell See lateral details on 'a ∎ . . Page 4 for number, size, Q Topsoil Ca ° . ,�ci�ii .1.4.. .•; . ; L : . L •:� r :,ati:.• and spacing of laterals. El Subsoil Cap ° :%r:: : ; ::; • _ ` 4 4 `` �'` :1 " Laterals are equally © ASTM C33 Sand 16 . ` ``:: F < ,,�, � •:i:: Tmical,L � spaced from the m 0 fft : %':; :< Tilled Layer c s: � ::; distribution cell's ti.4. S• 4:t r: :••..ti ,J.7k Aggregate o ; '�' j: f f f...: -r centerline in the © g 40------ -----4 A � distribution cell ( AxB ). Project: Jon Alberg Mound Page 3 of 8 End Connection Lateral Layout Diagram tate fats**mo d own d A&Bdienensron • Turn-up wf bell wtw or of *snout Woo 4 • Al tat.afs ate idNMioai IF X --)1 Hof es *Ord on Own bottom of Ow Wit* 5 equal, spaced 1 • Force mail t: ain:1ti00 tlla tee Or cross to manifold at any point• Laterals & force main of PVC Soh 40 Ow COMM Tat ie 54.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 12.36 gpm Manifold Length 3.00 ft System Flow Rate 24.72 gpm Manifold Diameter 1.50 in Total Dynamic Head 29.97 ft Forcemain Velocity 2.52 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight - Electrical as per NEC 300 and 'i 1111���� ' Comm 16.28 WAC I' 4` Disconnect 4 in. min. Tank component is properly vented \ : : . - l011 M' E--- Alternate outlet 1 location 1 I Forcemain diameter Wieser Concrete Manufacturer ■s:_ —0 2 in. Capacity 750.36 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons i B 4111 siphon device A 18.31 371.39 C B 2.00 40.56 i Pump off elevation (ft) C 4.69 95.05 F 84.331 D 12.00 243.36 Ti Total 37.00 750.36 Dose tank elevation (ft) �/ 3" Bedding under tank. ~— ' 83.331 Alarm Manuafacturer S.J. Electro I Note: 2 Float pump control Alarm Model Number Tank Alert I required . Pump Manufacturer Zoeller Pump Model Number 153 I Pump Must Deliver 1 24.72Igpm at 1 29.971ft TDH Project: Jon Alberg Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Ron's Sewer Service Inc. Phone 715- 749 -0153 POWTS Regulator's Name St. Croix County Zoning Office Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other, Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(0, Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 1 6 -8" Diameter Lawn - : : : : • Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution • Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jon Alberg Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01101), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POViTS components. Septic or pump 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 a tank or component. 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. 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shaft be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg /L TSS, 10 mg/L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continnencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective components) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page TOTAL DYNAMIC HEAD/FLOW t2 PER MINUTE 2 PUMP PERFORMANCE CURVE EFFLUENTAND DEWATERING MODELS 57/1521153 MODEL 57. 152 153 45 . Feet Meters Gel. Ulm 0a1. then Gel. LMen 5 1.5 43 183 69 281 77 291 10 30 34 129 81 231 70 265 12 - 40 15 4.6 _ 19 72 53 201 81 231 20 6.1 - - 44 167 52 197 35 25 7.6 . - - 34 129 42 159 - Nisi 10 -, 30 9.1 23 87 33 125 35 10.7 - - - - 22 83 40 12.2 - - - - 11 42 ,�,s 8- Shut-off Head: 19.25t(5.9m) 388(11.8m) 44t(13.4mj 25 016369 rq 6' zo Model 57 0 t- 15 `'_` 3 78 93116 4 1616 10 , -,0. r:;,. 1 2 ��` \. a' 3718 5 57 152 153 f(e: r\ \ 8 \ - 1 4. 0. 11•11111■1■-- t I ..`•%, i:: : 10 20 30 40 50 60 70 80 ' 9718 GALLONS LRERs I 1 T 1 l I 1 I I 1 I.NPT 0 40 80 120 160 200 240 280 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 1 2- - - 1 l hii These systems are not designed for Explosion Proof Environments. .�^ � Please consult factory for special options and requirements. 191,18 � Maximum operating temperature range: %� , Pump: 130° (54 °C) 1� -a 3 r� su1015 Switch: 170° (76 °C) CHOOSE A PREPACKAGED SYSTEM: Model 152/153 Includes Pump, 10 -1526 and 10 -1528 (see below) 940 -0005 N57 Pump .3 HP 8114 940 -0006 N152 Pump .4 HP 3 27132 4 940 -0007 . N153 Pump ,5 HP sua2 �, � BUILD YOUR OWN SYSTEM: (C : ' i N57 Pump .3 HP S 3T/132 N152 Pump .4 HP �, ` I ' i /1153 Pump .5 HP 1 10-1527 Oil Smart® Pump Switch -10 ft. cord with Relay. l 1 10 -1528 Oil Smart® Pump Switch - 20 ft. cord with Relay. . 1 10-1676 Oil Smart® Pump Switch - 20 ft. cord without Relay (requires Control Panel). imemin NMI I 10 -1526 Oil Smart® Alarm System with Lights, Audible Alarms and Dry Contacts. 1 12 118 1101 I. II (A CAUTION 1 •s..firila 5718 All installation of controls, protection devices and wiring should be done by a qualified licensed III rirtm" a electrician. All electrical and safety codes should be followed including the nost recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA) RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2005 Zoeller Co. All rights reserved. r • i i u MI E " O r te -+ c4 i s O n / n' C3 0 to v �°° \•ti at 4 1 a C2 oil 1 h O o Q \ a .. e . ti ftai 1 It a 4k t 4,14 1' ciot bob a co r co V O O• 0 — �AOb r�+�► < ,■ ~ o O tto I- Qs � o::�� - .1 Sy °1 a ao ti `yp b h II A" O .1 `C! ' b co o ':::. Co to .2.. \ T7 a O ► o CZ 00 xlt N 'Zs' : ro o a II 00 ° ° o , Og y 4 b ao °b° t 4 _.„ 4 02..... (-) tz,..- cl--- ---.02, pt. 1 .., CP r.., .... ..4 ,.... O t k cOj "- 'Q CCA n ti co 1... o � "' O O p h oRo ■ CO 1 Womb Depedmento1Cornmerce - SOIL EVALUATION REPORT Pape l or 3 DMeian arridstrard 8aidiigs ina000nienoeedb S5.Wi . Adm. Code ' F A�Chcen silepenanpepernotreesSw81I2x11 inchestnsibe. Han dun -�7 J • M ,, ` , r include. btnotrwlledbcvarisdandbadde dreferenospoipt 4 diedkmand - psslslope.sods rdbrendons .norbancsnardbceionead+ baeaeestroad. p is . m zo -- /lam- Lo - Awe Mane pig tdi ' : Resiereed by Deb Arwos@iNm er eoeyairaeeridesirteerd ails i l y e " " - w � - misH• • frsopertfOoner - taoceir�r. , J /- 're' • Mt.\ Let j , US ,1I4 S 7 T.2 - N R - Eco Suid. NesarCSiti _ s 1 /, 5 T.C ROIX CO QO „� / 1 � • 4 ..' , : i 1 .i.e.- Daly ' a r own - .tbn+utRoad �1J Gf4. �` 1 - ' - . . / a- t , 0 NewConstruclizt UsicarttedrandidiNumberofbetfoods 3 . Codededseddeslanlberrab YSD coo /ice 1:3 1,- aler-12-7:11:G Flood Flab ebsdiontapp/ctte fl/' f t Cannel and and reoofamendoiowt "Mood Vj © PE Sopntiarsfaoeelev. /0444 It. Depth biminpfedar _IC in. WI Ablcdon Rate Nada= Depth Damist '- , Rdon Dasoripian- Tads Slnsd= Coreiebnoe :. , , Rods- in OIL . goat Cotr & $z. 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Code County - Attadtaompietedeplenaapapsraatiess then 8 12x11 inches Inaba Plan must S • adz/ X' inidade.butectiaiied layman! anditmiaorAeimfeeencepoint ; _ , , ; and - Patel ID. -peroentdope.ecdaordimem methanow,amlloodion . , '- tonsisentioad. m ,p — — . -- me f l (-q _ Please peat a� O �►" Dale / pa sa dr imatioarao s•mrm• . '' '� ar>aw. 111:411(1)**, 11 � "`--.• l 0 Q iO O , : Location Al %toe' - O 1 1 Lot , f W 114 w 14 S 7 T.2 - N R - E Mg • - y - GFip� \Xo \N 0 EINck8 Said. Nuns or CMS . , , , _ _ ©City - ■ Wage !% can - .Named Road - u4oAi/ lfl; - ,, ( . r ,. > i .l. • 0 NowConsiucion ttsecarReddenlialINumberofbe ooaae 3 - Codededireddestnllowrals YS 'a GPD laReplacemert Pa1rtmated� 4 J 1 _ , p 4' l ioodPlebds+raiontapplcable /f/` /g t Genteel ooae�ea� 136 '!7 and l ID�Lr'2� [71 Wing* p alidng - - © P8 Gioysdandeoedsv. /d(/. lt. Dap& blanking fecior _7 s M. Soil Aepiaian Rate • Halton Depth Dominent r • . Rabe laesotpion- Teedue Swim Condolence Bounder Raab . GPM' • IL i"unsell OmS . Owe -dolor Gr. Sr. Sh. , r e 'fit '111112 i ISIIIIIMI - -- 111111 P 4.o mii i o . MMIIPI — Will se , • NI "Now a Fi eednot . Pit AoudustaaaelsV. /P3. ?P' @. Dephb Smiling fader SI in. Sol Appicalon bete Madam Depth Dankest ; • RedaK Daeaiplan Twine Shogun Oaddenoe : , hods tiPOla' in. Wed 4e.SL CatCoior Gr. SzSh. _ et' 130“ '11112 — IMIP1 _II — -- mil mil •Siluent#t =SOD. >XI= meiLaad IBS , S0_150.gi. - weed 2 1101kcaosagE and TSB sae set CST ---- r _ csrNewb y Alu m A. _. - _7 . /, f -rv- , / 3 1 ------ 6 Address SW/ Date Euelasisn Co dulled Telephone Number r A's Leow lc .-. ,c 1 , .- 1, / C•Ul J1 J s ax."a 4"... / Property Owner /3li • r: Parch ID # / ID- / /LP — ‘19- 00 Page Z of I 3 Boring # Cr), Pit Ground surface elev. /0/.12,e ft. Depti, b uniting factor /, Y in. I Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD1If in. Monen Qu. Sz Cont. Color _ Gr. Sz. Sh. •EtfAtl •E / o -/y ioyr 3/z -- _ sL _. frsrti3 )( _ nrrR s lF o.L r 2 11-2F ?, c'yr '/ f-sL $iIX isrz M �•`/ d''t ? .z( -Gy �•s yr s /y/ — ms os K-- m. 7 /• Boring # ❑ Boring Pit Ground srrfaoe elev. ft. Depth to baling factor in. } Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDHE in. Manuel Qu. Sz Cont. Color Gr. Sz. Sh. •Efflt1 'E1 2 I 1 # ° - ❑ Pn ems. rt own lo ems rear I Sol upon Rate Horizon Depth Dominant Color Redox Description. Texture Swdure Consistence Boundary Roots GPDiY in Murrseti Qu. Sz. Cont Color Gr. Sz Sh. •E1 1 •Et 2 • Effluent #1= SOD, > 30 < 220 mgll. and TSS >30 < 150 rngll. • Effluent #2 2 BOD, < 30 mg& and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or _. need material hi an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. seo eoo ao i 1 •4p *221180 2473 Rolihw Road Sner sy n.,‘ car • 4 = !S'n ye/t/ /7-/dO -r' X = .gaxz'nl 71 ?8/ - T Y9lo • = E• 491 for co/zN " KV > rur =l[ Q "AA s.7: \. O = L rFr sr ,4rto n l A-10 / oy.o r /*r e 4 l loc wren � 1‘1-\., __-- �.__�__._.__�.._.�._. tin(" \ . `? Chet in kn k ooP' CL4r 7'ev'e _ e rlt C 1---- -- ' \ 1 • Z_ ., 1.14 Szt� v�3 ° �. \ \L � 1 .7 / \ ✓ C r \ / 6 d\ ,,4 V / # I Sef}LE j ' = 1.19i ... r t" .. i ;17 Sai ,ox0, 34 94 2 d -1 rs •T s ddOr t Y - i /055.95 .rfr4 5 a✓ller , r slag /#.P k — Z LcVEL, 8'9.s /e3.3� /D /. v 9 .99. `"' (A1 -) ( seer /oy.o mocevD w, )i,e £4/A /00. 2 p.1 • C wisaxviin Department of Commerce SOIL EVALUATION REPORT Page / d 3 Melon of Safety and Buildings _ in accordance m Omen won 85. Ws_ Adm. code • Attach complete site plan on paper not less than 81/2 x 11 inches in s Plan mist SY• 4.v/ X include, but not Wined bz vertical and horizontal reference point (Bt.% direction and • Parcel LO. .percentzlope, stale or dornnslons, north wow, and location anddistance to newest road. 4 1 D — // ir-- & - Pad . Please print all Information. Reviewed by Date Parsoaalbsfarrtreion you provide may be Leeed for roondrry porpoises (Primacy Lim. s.1soa(1) • Property Owner Property Location . Ifi �P '.s Address Y'YJ Lnt 8 Block d Stud. Name or CSi.w 9 N R / j E (ar� City State . zp Code Phone Number ❑ O ' ❑ v DTown .Nearest Road . /7444 it/ I Gd,' 1 s 1 0 /G 1(7z 3 !/ -3 / /kaera.7/ t e-6// nJo /ff Z. Ct New Construction Use 13 i rhsnber of bedgcoms 3 • code derived design flaw rate YS'G GPD El ❑ i>esate: Parentmrateti� ! T t'✓1 / Gm 'C Rood Plait elevation If applicable /U //c Q, and recxwerviendalionte ouf / 'Boring* ❑ Wring D Pit Ground surface elev. (6 9S fl Depth to s' n sea bate - Haizon Depth Dominant .... Red= O ,flan- Texture Structure Consistence Botaday Roots • : GPOdl' • in. Mired! Dm Sz. Cont. cz*r Sz. Sh. 1 Y r t Tan / INIIIWIFIR MIII i� ;l�l/! l•: i1 C o MS ' . , , � OISIMI I it / . M NIA // : - , MN MI row • L_ lj Ground surizce elev_ lc i ft. Depth to inaling factor s I In. • .Hortn . Dominant Calor l Textrre Structure Boundary . Boll APPIkallon GPM ease in. itunsal Qu &. Cont. Color c,_ Sz. at ,-- • / i. , Z C S 5ca .4 a.? 2 • . - Z , r i/ , -- _ G /3 . - r•t) C. 3 ,,i.-5'9 4-5-yr. l V , .— ./,.5: i c s _ rx/= �� ...*fro t• ,, , . 7 . /G . Y yq -sy ,Cyr „�y . ____ . L / c , / 3 A - vFT -- -- `o• y o G • Murat et Q BOO > 30 < 220 mg & emd TSS >30 < 150 mgt. ' Stoat /72 BOO" < 30 mg& and1SS < 30 mglt CST Nen e. (Reese Print) _ CST amber . Address 4d f - r © ,l . D, - tom .2..2./Agar sy .Po/ Dkatiz Evakation Conducted Telephone tuber / p.1 � / ,� -- A:7 - 40 Page Z of 3 Property owner �i /6 r- ✓9 Parcel ID # e s. o — // p • l 3 I Boring # ❑ Bow Pit Ground surface elev. /P /.49,e ft. Depth to limiting factor /rr n• 1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf in. Munset Qu. Sz. Cont Color Gr. Sz. Sh. C 'Eff#( 'Eff#2 r P `t ./Gyr / — ,S rn si3,K , ex J F D.6 1.0 ff_a6 7.c r �� /3 -- r-s4 _2 e. 53.1 n7:7- A1 o.`/ m• 8' 3 .2[ -Z y 7•Z y r S/y — ryr O C - /ti L ' D. 7 l• e 1 Baring # ❑ Boring — to limiting (actor in Ground surface el ft elev. ft. Depth rig Q pit d Soil • ;,• r , Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Bori Boring # ❑ng ❑ Pit Ground surface elev. ft. Depth to Omitting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff • in. Munsell Qu. Sz Cont Color Gr. Sz Sh. 'EM 'Etf#2 • . . Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO, <30 mg/L and TSS < 30 mgfL 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. 5868376 ouvoo) , • , p.1 Focerr Romanic #221180 / 2473 Rolling Green Road Spooner, W 54801 (715) 468-7000 A . 5 m 13 ,a4s* : ."0/7/ /1- /-r' ri 7./.; _?,/- T1 ' ‘ 1 " 41 — // ‘.9 .. .449 - .0.0 • = E L cr c 0 z tv Ez YV = A ..1 ra4L 0 .,.. ', t .5. 7; 0 ..:. z 2-Fr ..s747 or) NN/, ' - .._. r w At o - A C )t c 2 "•.,. .1. -- -1.e Ytel. 0 ear 47.4 7.ree . \ \ \ ' - • . , i , . . _ - - — - ,:,.. 3 : ,- —.7,3.\ 1.),,, \ 4 \ \ ...■ r .... \ \ ` \ ......„. x .....:‘,....,, ‘. .. \ 2. ■ 1.1 b • \ 5 \ ..--- ---- 1- ,. \ -... \ .....,., _.\1.------- 1 • \ . ".. , \ Pte . 1 1 T / \ \ \ ....._ -.. , 5 c f 1-4E i y 7 cif(' or Y. f / .% ',/, 9 ' '.'" 5%7: .• ■ s /a b , / 0 • 19- Le ve 4 . ff - .1. /6 . 32 2. .:97 yc not e , /:),:: X - 3 ( ) c, , 4 r / e ,,,,:, „, ,,,,,,,, ,... Ar.E. ,E. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer 1 Mailing Address _ .3 / / 1.1).:.,a,„Pig Property Address (Verification required from Planning & Zoning Department for new construction.) City /State t 14., Parcel Identification Number 0 - / t 6 9 - 60 - d 0 LEGAL DESCRIPTION Property Location Si- 1/4 , / . 1/4 , Sec. `] , T N R / Q W, Town of Subdivision Plat: 1 p.r.L�u.,�p -o-c4 , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (0 4 (before 2007)Volume ° ° , Page # � 0 . Spec house Cl yesKno Lot lines identifiableXyes i7 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 Tess than 1/3 full of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. • Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedro r . Ag i.�. 1 ( l2 IGNAT RE OF APPLICANT(S) DATE ** *Any information that is misrepresented may resuld e sanitary permit being revoked by the Planning & Zonin g Department. artment. * ** 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) `' V 2005 P 580 STATE BAR OF WISCONSIN FORM 1 - 2000 ea '9 Document Number WARRANTY DEED REGISTER OF DEEDS This Deed, made between Lisa A. Hartwig_ and ST. CROIX CO., MI Jonathan M. Alberg, wife and husband, as RECEIVED FOR RECORD survivorship marital property 10 -09 -2002 9:30 AN Grantor, and Jonathan 14. Alberg and Lisa A. Hartwig, Trustees, WARRANTY DEED Alberg Hartwig Revocable Trust, TA DTI) 12/26/00 EXEMPT # 16 TVA REC FEE: 11.00 Grantee. TRANS FEE: COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CERT COPY FEE: described real estate in St. Croix County, State of PAGES: 1 Wisconsin (the "Property") (if more space is needed, please attach addendum): Lots 11 and 12, Plat of Ranchwood, Town of Hudson, Recording Area St. Croix County, Wisconsin. Name and Return Address John E. Rupke Schmidt & Rupke, S.C. 17100 W. North Avenue Brookfield, WI 53005 -4436 020- 1168 -60 -000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This i s homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and general taxes levied in the year 2002. Dated this 28th day of September , 2002 ^ --(4e---7- , * Jon has H. Alberg *Lisa A. .' Hartwig * s AUTFIENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signatyue(s)of Jonathan M. ��saz _nd ) ss. isa Hartw County. ) uthentic • d 0 !. 41 October , 2002 Personally came before me this day of _ 0 , the above named /•'hn E. Run,,,' ITLE: MEMBE STATE BAR OF WISCONSIN (If not, to me known to be the person who executed authorized by §706.06, Wis. Stats.) the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY John S . Rupke Notary Public, State of Wisconsin Schmidt & Rupke, S.C. My Commission is permanent. (If not, state expiration date: (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. 1 -2000 Schmidt& Rupke, SC 17100 W North Ave, Brookfield WI 53 00 5 -443 6 Phone:(262) 814 -0080 Fax: (262) 814-0085 ja T6929769.ZFX Produced with ZipForm"' by RE FgmsNet, LLC 18025 Fifteen We Rood. Clinton Township, Michigan 46035, (800) 383 - 9805 0 cn O 0 vi O ui -. • -0 fD 'v (D m `° c „,, to 1g o — 0 Cn o 0 0 3 - v, a Z i ti Z D c tr c O co y - V N • (D d C O C co C .O co V C O N 3 0 O- N 1-1 = a) 0, V A s Z C l' m p a9 01. 0 o CD -• C1 a w a c m a y V m c• 5 o ' 7 (•° a) C wit N N N 2- O -0 O S 7 N 7 ' O 1 N O N c (D 3 O 5 n 3 ID 1 c 41. p 2 O 3 O o d O ?".• a cn VI C _* C CI co W D a (f) v > a ,� (D � ' m 0. 0. c5 W a ` (q rn cn c o . c o o ' l o o c r A OD ITZ N N 0 0 ... 0 = p ." N N O O p_ W O) (D 0 (A D) ' (O V � i N r Ca t (D n O O O. 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Y1 13 CO G CD N 3 m I a, _ rr n I z ° zcoz O ` CD 0 1 d O D a l o CD N N �f c N C N N W N a I Z CD C p N I o N p Z ro at c -I 7J .. a IF z o I o 03 '0 t a -I -, z a 3 la 73 I o : z 3 ` N z W g a I I rn a I o 7 m I v m c I a o a 0 I t • A v I N CO I ° a M I o ° < CAI 1 A N I En 0 ti O ; 1 . • X e, Owner : Aic hoe ! I cef )) )an li GOG I'ofd, N•i P/6f P - `As Eul1f" t . 4 OZo —1)b 8- -eo -Ooo w ,' if 40 well s, 1- thss Il'in ,,1j 014ti , A l „ . .. ______ , . . t i t 70 4, 31 /o1/ • t, V /014,0 A `0 3,if . n ;r Sl \ \ ' No � \`\ L o/ 11 . \\ 4 t 8 ✓ (y 8 / .t 1i: 6rov�,e ,E/eY, /10 r ,1± it ti ‹... _._. /L• ;+ S I I " = 561' o 0 < -- ' (. ..m,4. .4. sy)� - e,., F1c v• ion, 4 r ,, DE DARTM* JT OF INDUSTRY, SAFETY & BUILDING INSPECTION REPORT FOR 'LABOR B OX 7969 & RELARELATIONS P.O. ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION B SON W 537 7 State Plan 1.0. Number. ' U� , I�1W , S . 7 , T29 –R19 CONVENTIONAL ALTERATIVE (If assigned) Town of Hudson Lots, 11"" Windloff Lane I I Holding Tank I I In- Ground Pressure I I Mound Q 6 a7 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI Michael Rutz 606 Ford St. N. b11,Hudson,WI 54016 S /o3 /0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E14 t . Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Paul C.J. Steiner , 6780 , St. C o3x 135417 SEPTIC TANK/ e / < ;4 ,' Y , MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING CO / .- / PR VIDED: PROVIDED: 4 (j > ' ` _ / . . . i -./ /e3, 9 /dam, lo YE S ❑ NO -ErYES= NO BEDDING: VENT DIA.: ' VENT MAIL.: HIGH WATER NUMBER OF ' ROAD: ' PROPERT WELD,:_ BUILDING: VENT TO FRESH if , / ALARM: LINE: C /���) (2 / / AIR INLET: ❑ YES O L ii ❑ FEET FROM YES (NO NEAREST ��' DOSING AMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: ' PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑ YES ❑ NO NEAREST —* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: , WIDTH: LENGTH: ' NO. OF ' DISTR. PIPE SPACING: COVER ' INSIDE DIA.: # PITS: ' LIQUID BED /TRENCH TRENCHES: ,, MATERIAL: PIT DEPTH: DIMENSIONS ,f 3 / 606 - ry ( , ',,- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO.9I TS R. NUMBER OF PROPERTY WE L: BUILDING: VENT TO FRESH BELOW.PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: , PIPES: LINE: / 2 AIR INLET: o O �� / �' NEAREST �♦ , (G'3 >-.25- / a /0/5 io .as /CI, — MOUND SYSTEM: t, _! _ ,: ill Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING' GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ♦ r , - - I 1 L' f • LI� ¢ y , .‘,..1.k ,� 7 / Y 61,2.— ,>9._-_3 ,, - ^ 6' .4.& ,7/..02 C – 56 ei G CK z. a_ 5109/ r- ' CD ..' , Y-.1 ,5 - r 4 Z/? 1 ''' n ° ,-- Sketch System on Retain in county file for audit. Reverse Side. SIGNATU• E: R / 40..,_____' � TITLE: SBD -6710 (R. 06/88) I ""' �` r op , -� ST. CROIX COUNTY WISCONSIN .�� ZONING OFFICE of " ST. CROIX COUNTY GOVERNMENT CENTER • a ,"t,, -t `'-. +4I ii:�iri:.' 1101 Carmichael Road n '"'= - - Hudson, WI 54016 -7710 (715) 386-4680 kz 18 March 24, 1994 02_,o--//6S- &6) 7, .iq. / V Pat Collins /0' `?j Department of Natural Resources �% /Gc/ L01 990 Hillcrest St., Suite 104 Baldwin, Wisconsin 54006 Dear Mr. Collins: Enclosed is a copy of the VOC water test results for Michael Rutz located at 314 Windolff Lane, Hudson, Wisconsin. If you have any questions, please feel free to contact our office. S'nc r e ely, '0,Alk (-4,' Marilyn il Administrative Secretary mz Enclosure C 0 PY ST. CROIX COUNTY WISCONSIN te - -_� _ ZONING OFFICE " " " "w ST. CROIX COUNTY GOVERNMENT CENTER '% '' `'" gki 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386 -4680 March 24, 1994 Ms. Andrea Kary Century 21 706 19th Street Hudson, Wisconsin 54016 RE: Water (VOC) Inspection for Michael Rutz Address: 314 Windolff Lane, Hudson, WI Dear Ms. Kary: Enclosed is the original test results from SERCO Laboratories for water (VOC) inspection of the above property. If you have any questions with regard to said report, please let me know. Sincerely, Mary J. Jenkins Assistant Zoning Administrator mz Enclosure r(orp I iir . JP SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 40909 PAGE 1 of 4 03/23/94 St. Croix County Zoning DATE COLLECTED: 03/14/94 1101 Carmichael DATE RECEIVED: 03/16/94 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins SERCO SAMPLE NO: 33284 SAMPLE DESCRIPTION: Rutz ANALYSIS: Benzene, ug /L <1.0 Bromobenzene, ug /L <0.2 Bromochloromethane, ug /L <0.4 Bromodichloromethane, ug /L <0.2 Bromoform, ug /L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n- Butylbenzene, ug /L <0.3 sec - Butylbenzene, ug /L <0.4 tert - Butylbenzene, ug /L <0.5 Carbon tetrachloride, ug /L <0.2 Chlorobenzene, ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 2- Chlorotoluene, ug /L (o- Chlorotoluene) <0.2 4- Chlorotoluene, ug /L (p- Chlorotoluene) <0.2 Dibromochloromethane, ug /L <0.4 1,2- Dibromo -3- chloropropane, ug /L <1.2 1,2- Dibromoethane, ug /L <0.2 `z: (Ethylene dibromide) u r, :''\ Dibromomethane ug/L <0.2 1,2- Dichlorobenzene, ug /L <1.0 (o- Dichlorobenzene) 1,3- Dichlorobenzene, ug /L <1.0 �° (m- Dichlorobenzene) ` - \ F s „ � \c_, ; i t F * ii +t� \� \ / e'-:-. ,_,. , ___,..iy,"(k < means "not detected at this level". 1 mg = 1000 ug. —;__.. `c`.,17 JIP SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 40909 PAGE 2 of 4 03/23/94 SERCO SAMPLE NO: 33284 SAMPLE DESCRIPTION: Rutz ANALYSIS: 1,4- Dichlorobenzene, ug /L <1.0 (p- Dichlorobenzene) Dichlorodifluoromethane, ug /L (Freon 12) <0.5 1,1 Dichloroethane, ug /L <0.1 1,2- Dichloroethane, ug /L <0.2 (Ethylene dichloride) 1,1- Dichloroethene, ug /L <0.2 cis -1,2- Dichloroethene, ug /L <0.1 trans -1,2- Dichloroethene, ug /L <0.1 1,2- Dichloropropane, ug /L <0.1 1,3- Dichloropropane, ug /L <0.2 2,2- Dichloropropane, ug /L <0.2 1,1- Dichloropropene, ug /L <0.2 cis -1,3- Dichloropropene, ug /L <1.5 trans -1,3- Dichloropropene, ug /L <0.9 Ethylbenzene, u7/L <1.0 Hexachlorobutadiene, ug /L <0.3 Isopropylbenzene, ug /L, (Cumene) <1.0 4- Isopropyltoluene, ug /L <0.5 (p -I sopropyltoluene ) Methylene chloride, ug /L <5.0 (Dichloromethane) Naphthalene, ug /L <1.0 n- Propylbenzene, ug /L <0.4 Styrene, ug /L <1.0 1,1,2,2- Tetrachloroethane, ug /L <0.2 1,1,1,2 Tetrachloroethane, ug /L <0.1 Tetrachloroethene, ug /L <0.2 Toluene, ug /L <1.0 1,2,3 - Trichlorobenzene, ug /L <0.2 1,2,4- Trichlorobenzene, ug /L <0.2 1,1,1- Trichloroethane, ug /L <5.0 < means "not detected at this level ". 1 mg = 1000 ug. MEMBER J r SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 40909 PAGE 3 of 4 03/23/94 SERCO SAMPLE NO: 33284 1 SAMPLE DESCRIPTION: Rutz ANALYSIS: 1,1,2 - Trichloroethane, ug /L <0.1 Trichloroethene, ug /L <0.4 Trichlorofluoromethane, ug /L (Freon 11) <0.7 1,2,3 - Trichloropropane, ug /L <0.2 1,2,4 - Trimethylbenzene, ug /L <1.0 1,3,5- Trimethylbenzene, ug /L <1.0 (Mesitylene) Vinyl chloride, ug /L <1.0 Total Xylene, ug /L <1.0 This sample's analytical results - /-ate 3� below the U.S. EPA's SDWA Maximum Contaminant level of 1/30 •1 for those requested compounds which are also on the SDWA MCL list. < means "not detected at this level ". 1 mg = 1000 ug. d ry * _ /: .!..s'f- MEMBER SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 40909 PAGE 4 of 4 03/23/94 e The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. A derson Project Manager d w y es; MEMBER rte, ST. CROIX COUNTY WISCONSIN 4 : - -t ZONING OFFICE ' „) „•••■ „ ' •.. lee ST. CROIX COUNTY GOVERNMENT CENTER a P , X41, ■.��■...: 1101 Carmichael Road �-' Hudson, WI 54016 -7710 (715) 386 -4680 March 21, 1994 Ms. Andrea Kary Century 21 706 19th Street Hudson, Wisconsin 54016 RE: Water Inspection for Michael Rutz Address: 314 Windolff Lane, Hudson, WI Dear Ms. Kary: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. Sincerely, /s/ Mary J. Jenkins Mary J. Jenkins Assistant Zoning Administrator mz Enclosure r COMMERCIAL TESTING LABORATORY, INC. • 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 5227 alik 6 pp FAX ST. CROIX COUNTY ZONING OFFICE REPORT NO.: 58835/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE: 3/18/94 1101 CARMICHAEL ROAD DATE RECEIVED: 3/16/94 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Michael Rutz LOCATION: 314 Windoff Lane, Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 3 -14-94 01 / 1 TIME COLLECTED: 2 :15pm ,/ SOURCE OF SAMPLE: Outside faucet �� • - C4 �gg4 YZ : b 94 DATE ANAL ED 3 1 2. � TIME ANALYZED:2:Oopm `. ' s- 0'0's UNTM COLIFORM,MFCC 0 /100 ml �vN►N O FFIG INTERPRETATION: Bacteriologically SAFE. \ G/ NITRATE -N: ( 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Cotiform Bacteria /100 ml Nitrate - Nitrogen, mg/L { LAB TECHNICIAN: Pam Gane V WI Approved Lab No. 19 - },.N - It ( Means "LESS THAW' Detectable Level Approved by: l "r. g n4 . 4 PROFESSIONAL LABORATORY SERVICES SINCE 1952 I i �`�'�w►�. ST. CROIX COUNTY WISCONSIN � `L ZONING OFFICE vamomr ; �, •� ST. CROIX COUNTY GOVERNMENT CENTER . - ' ; -r-`1 r u : �A r�.; � 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386 -4680 March 16, 1994 Ms. Andrea Kary Century 21 706 19th Street Hudson, Wisconsin 54016 RE: Septic Inspection for Michael Rutz Address: 314 Windolff Lane, Hudson, Wisconsin Dear Ms. Kary: An inspection of the septic system on the property of Michael Rutz located at 314 Windolff Lane, Hudson, Wisconsin, was conducted today, March 16, 1994. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken on March 14, 1994. Once we receive the results, we will forward the same on to you. Should you have any questions, please do not hesitate in contacting this office. Si rely, f l Mary J. Jenkins Assistant Zoning Administrator mz ,--, c- ST. CROIX COUNT WISCONSIN t ........- ..,.. ,., --%% ZONING OFFICE .6,;..,-1:14., , - . 1..,-Iv. • :-. a 4 -: ....f—fi 't + *** i.;,. rr, .,..:,,titi : . 0 %,■:PO 4 : 4... ! ...,, H ipoo, hips, ........ 4 Itl - ST. CROIX CO 1 oUitsiTYcarmGOichVaTNAM0aEdNIT CENT ER ,... , - . p.....:„:0....- ....,_-'...L.-:- Hudson, WI 54016 ,(2>,________ ,. —.--..... (715) 386-4680 e‘ SEPTIC INSPECTION / WATER TEST REQUEST FORM /-' !P Please specify desired test(s) & remit appropriate fee with . , application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. t- n) Water (VOC's) $185.00 Septic $50.00 Water (Nitrate & Bacteria) 45.00 e fNitrate & Bacteria retest $15.00 Owner: /1 4,C.,,_ g cl r - z - Requested by: AN 6A k A} p....,, Address: ?;14 1,,,,?fuebt... t'Ait)C Address: 76(Q /1' f-kv 5 / if ZIP /4-0060".) ZIP5e/0/(., Telephone N ( ) - Mb - r2t5g Telephone 1.1 ( ) ,SVO "F--07 Property address (Fire Ng & Street) : 5/4 4-0""dlOOLFF Location: k, 3, Sec. , T N, R W, Town of 0‘)D-564) ii ii-i /2._ IN 1. CF giVoc Realty firm: C 2,./ Lock Box Combo: NON V. Closing Date: ---- TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* ,— r • / Water sample tap location: itpAir (arov. 6 a o 74) r Ahee./ 14,47Zve- Si Is the dwelling currently occupied? A- Yes 0 No If vacant, date last occupied: iiM Age of septic system: Z (490 - Septic tank last pumped by: .(00,4 i t4,4,i, - -fa,:fids t Date: 5 p 1 t"-my `13 Previous Owner' s Name (s) : N ol Have any the following been observed? A DY Slow drainage from house. DY ;.' Sewage Back-up into dwelling. DY ;.,, Sewage discharge to ground surface or road ditch. DY Foul odors. ah ,, •.? • -r comments relative to system operation: :-, ilij .14.„ , .. ' ert-if, . that the above informat • a ztomplete . d o f -- -atramr . , ,.. ' .• :: l o ■ Acnowrellge. , .... OWNERS SIGNATURE: / • ,, : 11 / 9 4 ./ - i . ,- '. ....."" to3 1 N OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION , * 1/4 • f • 4 ' .1 ! TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? °Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: °Below grd 0At-Grd °Mound ,- Approx. size _'X' °Gravity ODose °Pressurized Ft. OBed °Trench °Dry Well °Holding Tank DOutfall pipe OBSERVED DEFICIENCIES °Other OUnknown Septic tank Setbacks: °House °Well °Prop. line °Other Dose tank Setbacks: 0House OWell OProp. line °Other °Locking cover OWarning label OPump/Floats °Alarm °Elec. wiring • Soil AbsorRtion System . SetbaCks01 OW614 : TProp. line 00ther OPonding: °Discharge: General comments: p . INSPECTORS SKETCH OF SYSTEM LOCATION N Inspect or Title 1 i c" A Q 1 g L. 1 :-< 1 , :,, • , 6 OL FC) i ,.,. N ll 21Qji )_(-] A -‘ 11,58641 0-- s.. ,.. s,.. . . . . „..., . . .„ . , . . , . ilio we 4 . a 1 I - thi y ;in € , .;•• f, ... 'y .,• • • • ... ;, ________ — . _ . . . r.: •f: •:.:;; L. c , t 12 .:.: .. . il .:., 0.;,...-.: . , . .1i 1 .:. . b -...,,.. 1.1 /7 jo g "it 11 . , , 1,:l 1041,01 !..,... - I ;,. . 0 . %.... il 1.,. Nor j I iit , \ . ...ii. .L 2AI 5,,..., tpi,.2.3 I:, 0 toohr . 6 . 'ic go' / 1.i • 4 ... I • 1C SCO le I" c ,.,G■ ,i , r 0 0 < - — C * El V• 10a • : ' --}0<- .). ' — i 5.. 1Al .. t . . ------...--...— r O w,u ner here' R 6 oG [` Or<J s f N #» Jd t H c4 I r i Lot /z r10use • \ \ \ fc, Id \\ v .9Z Noah 7c, L 01 l l c S r i 8 M S jee! c'4•2` ri, G roc,hI ,E le y , IX L SANITARY PERMIT APPLICATION �� y couN �! ��LHR A m. ode In accord with ILHR 83.05, Wis. d C / Cam, STATE SANITARY PERMI # — Attach complete plans (to the county copy only) for the system, on paper not less than ❑ �Y� 8% x 11 inches in size. Chet rev sion o pre lous application –See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Michael Rutz SW% NW' / S 7 T 29 , N, R 19 01 (or)® PROPERTY OWNER'S MAILING ADDRESS LOT # ' BLOCK # 606 Ford St. N. #11 11 & 12 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson, WI 54016 ( 715 ) Ranchwood 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD TowN oF: Hudson Windolff Lane ❑ Public © 1 or 2 Fam. Dwelling– # of bedrooms 3 R L 1T`AX NUMBERS) 030 ` !, n/ / o - o o o 111. BUILDING USE: (If building type is public, check all that apply) 7 -29 -19 -1044 1S 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 1 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 in line A. Check line B if applicable) A) 1. © New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 450 945 960 .47 26 100.5 Feet 104.0 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New fisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 1000 - -- 1000 1 Weeks ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum Si nat re: o Stamps) MP /MPRSW No.: Business Phone Number: Paul C. J. Steiner 6 ( # 6780 MP ( 715 ) 594 -3032 Plumber's Address (Street, City, State, Zip Code): Rt. 1, Box 138, Bay City, WI 54723 IX. COUNTY /DEPARTMENT USE ONLY 0 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial / Surcharge Fee) Q co Adverse Determination . / `'3 7 6 Jityik1if} n. �v ` -��Q� d 1 . CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: in Division, Plumber SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Build gs D s ion , 0 wner , INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 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. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 3:% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a numb,ar of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring gror i,dwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) DEPAR'i`IV(EN`T OF �__ REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS L ABOR T AND' GG P .O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION ::NN�� SECTION: y T OWNSHI 1 LOT NO.: BLK. NO. SUBDI / VISION N E: $ & ' !4l / 7 /T ZLI M/1 I ( Or % 7 a � / /�i z , L ;i5 /� c i�'S ;, irS COUNTY: OWN- R'S /BUY R'S NAME: / MAILING ADDRESS: sI C-- d /J: i ' , / qc i S a e st t /64 4 / g' W"‘ USE DATES OBSERV IONS MADE NO. BEDRMS.: COMMER IALDESCRIPTION: IPROF / PROFI D RIPT NS: ERCOLA 10 TESTS: Residence 3 / /( 1 � {f lew ❑Replace / 5 9A /-t / / n . ,0A9 � irif fJ RATING: S= Site suitable for system U= Si � te unsuitable uitable for system CO VENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM :(optional) C'S ❑U JAS ❑U OS DU ES/ U OS 52U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /� under s.H63.09(5)(b), indicate: 257 24 Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH , ELEVATION OBSERVED EST. HIGHEST j �0 BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ► I 15' 2 .5"A ,'•. 5 — F 6,1" X92' /S B- I 9 AV, 9z i >99� ? 3'',i ' /o , 9,5 ' , 75'a /4S�,92'en3 r J 92 'Bd /S Le' 6/71 /,‘," 'Ls :, / es , 92 ' 6 . , 5 / • .17 ' O A A p / ? . � A /s B- . 0' X05..5 > 3,0 B- y 753 /02,is' i 7 g3 , a' //s s/ .5; / 'en /s , B -s J CM 7)-' \i/ > So , 92 &'4sl ,i Q:, 2�6n/, 3,/77,,/5 B- f f . &.e4 J1 5 / ku., /54 0 &/ c1 0 5 ./) /-/5" � i PERCOLATION TESTS TEST DEPTH! - WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER LNGFFEB' AFT §R SWELLING INTERVAL -MIN. PERIOD 1 P R OD 2 PERIOD 3 PER INCH P- / ' ,y) ' /VC AL 30 .3, 1, 34 ,P- I 3 s, 30 /J.' /4-' / L,. 7sz‘ '';'1 P - -3 5;0, 45° 3 , ' » 7 ,, zJi,,. J/AVJ P- _ P kP- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /'' 2, S 1 ! r " i ' l i I 1 1 ik 6: .5 1 j fiaL). / A : i e i j � " � _. y s i I i 1 _ J s � I � 3 1 �rof� � � t__ I- .� l I iy d i r i t / � Q r i. i f f oft ht Ilet ,. ' i ' 6 30 , E I i , 1 i F 1 i ' ,, , i i 5 _. ' _ I - [ i .... 0-4:--- 1 :$11 i L i1. 11 ! ! ; 1 i i i 1 1 ., i 0 1 , i � / E 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS ER ` COMPLETED ON: / i ^ 4T , , / ✓1 I `� ' o / Y ( I / r 1111.'/ / / 9C' tf" co„?i, • ADDRESS: / CEr I'ICATION NUM: R: 'HO IE NUMBERIoptiona : 0 c/ '4 1 .s 4 irk k LJ: 5' 1 Ar 31 4' e P3/ C T SIGN '� / L DISTRIBUTION' • d to Local Authority, Property Owner and Soil Tester. DILHR- — OVER — t , y r' INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete anti accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM- number of bedrooms or commercial use planned; 4, Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE 1S SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations, Drawing to scale is preferred. A separate sheet may he used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9, Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A- in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") f3R -a Bedrock cob — Cobble (3 - 10 ") SS -- Sandstone gr — Gravel (under 3 ") LS -- Limestone — Sand HGW — High Groundwater • cs Coarse Sand Perc Percolation Rate med s — Medium Sand W -- Well fs -- Fine Sand Bldg -- Building - Is — Loamy Sand > — Greater Than sl --- • Sandy Loam < -- Less Than I — Loarn Bn — Brown 'sil - -- Silt Loarn 51 -- Black si — Silt Gy — Gray "cl - Clay Loam Y - -- Yellow scl .— Sandy Clay Loam R — Red sic( — Silty Clay Loam riot -- Mottles sc - -- Sandy Clay vv,/ -- with • sic — Silty Clay fft -- few, fine, faint Clay cc common, coarse pt -- Peat rnm --- Many, medium rn -- Muck d — distinct — prominent HWL -- High water level, Six general soil textures surface water for liquid waste disposal BM -- Bench Mark VRP --- Vertical Reference Point • TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit: issuance_ A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to Obtain a permit. The sanitary permit must be obtained and posted prior to the Start Of any construction. l j APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property p rt P P Y is sold and submitted to this office with the appropriate deed recording. Owner of Property Michael Rutz A .p R.-it. I Al R() 2 Location of Property SW 1 . N W 14, Section 7 , T 29 N -R 19 W Township Hudson • rh,44 t Nailing Address 606 Peed- St. N. #11 Hudson, WI 54016 Address of Site 314 - Windolff Lane Ht1asc)r, WT 5401Q Subdivision Base Ranchwood • • .Lot Number 11 & 12 • Previous Owner of Property /Wa, N,L lV jndj /ff Total Siae of Parcel . 51 52 q 571 _ f t 1 Date Parcel was Created Jep,l. . /92/ Are all corners and lot lines identifiable? ,x Yea No Is this property being developed for resale (spec house) ? Yes —__ No Volume fS 9 and Page Number £ 3 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 refer- ences to a_Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (we) cetti6y that ctU 4tatement, on .th,LS 6ohm cute time to the but o6 my (owl.) knowledge; that 1 (we) am lake) the owne (4) o6 the ;mope/ay descc,ibed to thie .in6o1mation 6o&m, by viktue o6 a wankanty deed neconded in the 06 Lce o6 the County Regatek o6 Ueedis ais Document No. sun the pnopoaed d.i.te Got the zewage di�spobae. eye.tem (ohc ( an casement, to kun with the above deautibed II/cope/ay, b , N j,,,,, es,, on the conatAuc,ti.on o6 aa.id system, and the same ha.d been duty neconded .in the 066..ce o6 the County Regihtex o6 Ikeda a4 Vocumen.t No. I. , • SIGNATURE TURK Op OWNER OF CO- OWNER (IF APPLICABLE) r 4 PD DATE SIGNED • DATE SIGNED I _ _A H • z • • cn 4' • S T C- 105 SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z OWNER /BUYER Michael Rutz rh iFv�r ROUTE /BOX NUMBER 606 Fed St. N. #11 Fire Number CITY /STATE Hudson, WI ZIP 54016 PROPERTY LOCATION: sw 1, NW 1, Section 7 , T 29 N, R 19 W, Town of Hudson , St. Croix County, l i Subdivision Ranchwood , Lot number 11 & 12 • Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix. County residents may 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o F ., I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ment �d of Natural Resources. Certification form must be completed and returned to the St. Croix Count' Zoni Office within 30 days of the three year expiration date. SIGNED DATE 9I D St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715 - 796 -2239 or 715 - 425 -8363 Sign, date and return to above address.