Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1096-00-000
Wisconsin Department ref Con f fierce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary tN 4.7 25 _ GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Thielen, Mike Hudson Township 020-1096-00-000 CST BM Elev: Insp.BM Elev: BM Description: TANK INFORMATION I ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. o.z5 /ore.z.5 lees Septic Benchmark 6>r:641' J6oO 1, 7 1OI,7 l6d raimmenmimum Alt.BM A / Fr! L., c 4. : . 1.zi 1f0,'/ Apr.atiiet1 w j.b Bldg.Sewer - / M.IIIIfflgrill2M• — St/Ht Inlet J .1, TANK SETBACK INF•RMATION St/Ht Outlet 16 C4- Pfo,M. b -1 ek- 3• /1 q3. 5/ TANK TO P/L WELL BLDG. Air Intake ROAD 7,,. 3.7( G 7, 97 Septic /60 � g 7 Si — Ge i g L... b u I-- 3.vol ' 7. V/ Dosing Header/Man. q1.7 9 z Aeration C- Dist.Pipe 1,7 cj L Holding Bot.System 46064425 /6.70 9I Final Grade 570 PUMP/SIPHON INFORMATION S'4j6 94, 3 Manufacturer Demand St Coffer / (J GPM it‘I L C.4.vt.J 161-4i- Li c.Y 1. z /do. ii Z- Model Num1441011."-- vet,Led IT"- 41-L0 97. 5 TD. Lift Friction Loss System Head TDH Ft kialve., 0cl4— MA-4 y z 5 9 7. 4/1 Forcemain Length Dia. Dist.to Well q36 G SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length / No.Of Trenches PIT DIM Q1.027 IONS No.Of Pits Inside Dia. I Liquid Depth DIMENSIONS 3 96 2- ) fe....4 ..� �� SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer., ,t� INFORMATION CHAMBER OR TA a"1 Typey System: i r / / UNIT ( � Model Nu r: ���« ,,an,e o /�� DISTRIBUTION SYSTEM ile54—' ZZ,4-Z . Header/Manifold /l Distribufon x Hole Size x Hole Spacing Vent to Air Intake AS Length " Dia 4 Length Dia cin 9 9 � 9 SOIL COVER 1 x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulc ed Bed/Trench Center 5 3 Bed/Trench Edges' Topsoil \ Yes I No Yes El No . COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 671 Bradhurst Hudson,WI 54016(SW 1/4 NE 1/4 33 T29N R19W) NA Lot 2 Parcel No: 33.29.19.388F2 New KI1..— x.•:.,.1.4.•_ Go u CL a... ....- r•-- Loc.L a c. 1.)Alt BM Description= 2.)Bldg sewer length= 6, `I 5 h-)/-, F. k. 4_u- GQ..-.1,4-c.,�_ -amount of cover= Plan revision Required? 0 Yes YNo " ' 2�i 7 � ea 531z7s Use other side for additional information. --J Date Insepctor's S nature Cert.No. SBD-6710(R.3/97) Soi/e'a/ a-6-4i /o,e C.►'/;h i;gra 1 &X I/ a 4i rilm■se-..coseAr. 4g-.71_ 6fr47;d44;eracle/112.fsse 4 b ear.4)-.".72-1-1/el" "also,-! 4,dz 590/4 a:, fm doer, C t4e.6-,"d'l- , P .5 4A))1/ , 5ee.33,7:-2.94.,,Pi9uJ. O ToleI/.dsco; St,dm/A / foe/.4421)/v36-00- 0 X v Q o� N a • EXfS ev a) 3 bedlcvn, to 65;dente EX15'44: 1 ccJee1s Cenci l t/,uOD clot,-, \ e hcgv;ly i • 4 < 5 hed 9x� o; P/1o/0os"/ \\ 950; ,`\�'` t).t—wrig., cw,cstvEC Pto atd �'/�� s�w .. , Pn . y Po. . Ax-s.2.3-74116e. `���a iVC "� keoody \ \ \ o Loaded \ \ 1 i. \ \ \ t 61 � \\ YoEe: s/'iT/j33S< \ , , eps6-a kvxsz'd,sp4crSa/ail. \ ■∎ \ ■\ =n,�/&a6ive Sw-Ace ake:4S4: 2,< 2,iSc�/Sea/PdG. �v 6e \ \ 9 ay S�, V el-fiat") a \ \ 8enc.d w10,k op o/ do ii c4A S P 'n c e�Z�s�d� 6., \ Assumed e kg =/00.a.' -G d S�; u--6/,01i /a-1de. /y \ 972-1 A i .,B.rrl.:Top 0C/6v,•-&0 6/act' lie v=/do.t/: 63 \ EX■:54() 5.7 oc,lti =98.85/,'± , PrePose.d el5/04,54/ee 6. Two(-4/ tlYncl eJ 3 Y 9/',.-3/.22.2774/fe-a. er. "41-414 id/us Sf*.ida,d G[.a n6e7f,°,--- elei/4-Oohs to Sc yr,a'0'9o,a, County ° j Safety and Buildings Division St. Croix S 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 Sanitary it ation State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code,`submission of this form to the appropriate mal unit Na is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS fitted to Project Address (if different than mailing address) fo yazy r j t2 l~ ~t y'' the Department of Safety and Professional Services. Personal information you provide mast be used purpos-es in accordance with the Privacy Law, s. 15.04 1 m , Stats. 7Y v Sarne 1 IJ 1. Application Information - Please Print All Information Parcel # Property Owner's Name r `'QD Mike & Deborah Thielen c'o 020-1096-00-000 Property Owner's Mailing Address ~r Property Location r L ' i3tC 41) ~ 4 L/ d~ Govt. Lot City, State Zip Code Phone Number S W _ Y., NESection 33 (circle one) Hudson, WI 54016 715 549-6312 T 29 N; R 19 E or W II. T of Building (check all that apply) Lot # E 2" r~ Subdivision Name or 2 Family Dwelling - Number of Bedrooms Block# CSM Vol. 5, P ,1220 ❑ Public/Commercial - Describe Use Na - r ;y ❑ City of ac» CSM Number ❑ Vi1 of ❑ State Owned - Describe Use 380020 Town of Hudson III. Type of Permit: (Check my one boa on line A. Complete line B if applicable) A' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New ..-ry Before Expiration Owner p C~ IV. Type o OWTS Systetn/Component/Device: (Check all that apply) 770- OJ 3 U ` Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of s, itable soil ❑ Mo d < 24 in. of suitable soil anj vice (explain El Holding Tank 11 Other Dispersal Component (explain)_r , !r0 Pud t) V. Dis ersal/Treatment Area Informatio 441nfiltrato 4 Plus' Standard chambers & 4 endca s, Pol Lok PL-525 effluent filter Design Flow (gpd) Design Soil Application Qft~Dispersal Area Required (sf) Dispersal Area Pro:Ft. d (sf) System Elevation 450 Gpd 0.5 Gpd/Sq. Ft. 900.00 sq. ft. 900.40 Sq. 90.00' & 91.00' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Tank 1,000 1,000 1 Weeks Concrete X Filter canister 1 Wieser Concrete X Dosing chamber VII. Responsibility Statement- 1, the unde igned, amum responsibility for install of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignature 7MPRS RS Number Business Phone Number James K. Thom son 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code 340 P lson Lake Lane, Osceola, WI 54020 VII oun /De artment Use Only Permit Fee Date Issued : Is mg Agent Si sture: " i Approved ❑ Disapproved ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: .v a 1. Septic tank, effluent filter and dispersal cell must be serviced /maintained as per management plan provided by plumber. , -Z -All sotba* FAA-1iFPFAPR*Q PA--Q4 hp moilig as per applicable co '---Aft I 'n) apace . m and submit to county a* on paper not less tbou 81/2 x i acne, in size SBD-6398 (IL 11/11) I I Conventional POWTS Index & Tilte Sheet I Project Name: Thielen 3 bedroom Replacement Conventional POWTS Owners Name: Mike & Debrah Thielen Owner's adress: 671 Dradhurst Dr., Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 2, CSM Vol.5, Pg. 1220 Legal Description: SWv4 NE1/4, Sec. 33, T.298N., R. 19W., Tn. of Hudson, St. Croix Co., WI. Parcel ID 020-1096-00-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Septic/Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluation Report Mater Plum Restri Service: James K. Thompson, DSPS Credential #30021 Signature: Date:oG' Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (R01101) Soi/¢!~a/~ccr~lon/oi E EXi;S Ei~ orode QI.eJ. • s 1Qe~ X~ P ~ Swyy/IF~i, ~e.33, r. a9~f,,P. 19cJ; s ky ExiSuc'n~ cJeA' ~ EXisEi~9 , ~ bcdlc~n, od QiSid~rK~G FsXi'sETnpp~~ I~tJPl~ C,Mcft /,lOD syob open ~ h tavi ry b ~ tc)codt.~,l ; ~ ~ 4 ~ 5 {red 9xo 9Xo',~ Propcs~d l.~C direr' ` Po-sssy~J~. ` hZoolly * r(o~-e: 5/"AST 3031/ ' ep-s&n ca/ 2„se</Sea/,or/C. be ' . zca+G/ Ei'vl Sav~act a%o =Ps 22- s o ~ t56 S l oP,~q Assuricd e /e~ _ goo. C/ d 46 ~.T. inSroet~iun/J~;o2. 53 Ex,' :5, T oaI 1 = 926 8s~ propost ddi 4<s4lde6/. Two (4 t~i,~clot 3x9/'~/~.z /LNL~•rlri• /L~^rvC/U(SGCr ,4Ce e, to-a-0i -f to 5c 9i. a'~9ba; THIELEN DISPERSAL CELL SIZING CALCULATIONS 1. (3bedrooms)(100 gallons estimated flowxl.5 design factor) = 450.Q0 Gpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/s. ft. 3. Absorption area required: 900.0 M. ft. 4. Absorption area as proposed: 900.40 sq..(44chambe} totaI Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft. EISA 900.00 sq. ft. -,(4 endcaps)(5.10) = 879.60 sq. ft. 879.60 sq. ft./20.00 = 43.98 chambers required Number of trenches: 2 0), 22 chambers per trench Trench width: 2.83' Trench length: 91. 00, Trench spacing: 9.00' on center Total system area w/ 9' center spacing: 12.00'x 91.00' Pg. 3 of 11 C ) Soil Absorption System Cross Section 9 7.0 ft 4" Schedule 40 Final Grade PVC Vent Pipe 9/. With Vent Cap 9Z•o' ft Leaching ' Chamber 9o v ft System Elevation .2. ft (n ft Soil Absorption System Plan View 9/ ft ft { I ~.f~3ft Leaching Trench 1 Vent Or Observation Pipe rl, Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model ,'/tla aq-C/" dlk,5 EISA Rating ;Z4 . D sq ft per chamber Soil Application Rate - gpd/sq ft 445-0 gpd Design Flow z O. -5--Soil Application Rate T ;L0. d EISA = 40' Chambers 2 rows of -2-2- chambers each. Page of 431" 2 D v nn m~ m--1 --4 m ~ f OmZD y,m r DAN (A - r n l rnA> NN N -1@ Or L pr A r n D = m D a O Z ...L. o m 18° MIN. r r A m Cm N ~ 0 D p O - r ~ O Z z r"" 37" 22" n N \ D m ITl ~ O m l nA D D (A n --i D N Z ~ D N m N w m m D r n m~o 0 ZD O ~ r m C m m D D m C J r= 7-1 (j) Om Un~D D Dz ~ C_ o~ z FILTER CANISTER DETAIL SCALE:3/4" 1' REV NO. [HIESERCOnGRETE DRAWN 6YSWT _ \ z SEPTIC MANUAL W3716 US HWYIO. MAIDEN ROCK, VA 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: SHEET 13 off'/.( 2346 Wisconsin Department of Commerce UATION REPORT Page 1 of 3 Division of Safety and Buildings in au 161A.VN ce ' mm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must ounty St. Croix include, but not limited to: vertical and horizontal reference point (BAS, direction and percent slope, scale or dimemsiom, north arrow, and location and distance to nearest road. I.D. 020 Please print all information. -1..-I -OOO Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 'e vi Property Owner Property Locufta6mli~, Mike & Deb Thielen Govt Lot na °G W 114 NE 114 S 33 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 671 Bradhurst Dr. 2 na CSM Vol. 5, Pg. 1220 City State Zip Code Phone Number City _ I Village vj Town Nearest Road Hudson WI 54016 715-386-2069 Hudson Bradhurst Dr. & Co. Hwy. N J New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD !f Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd/sq.ft./day loading rate. Recommended ' infiltrative surface elevation --90.0o'&91.00'. P-1 Boring # I Boring im Pit Ground Surface elev. 93.52 ft. Depth to limiting factor „ in. Sall Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsdl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "E 1 0-12 1Oyr3/2 none sil 2fgr dsh cs 2fmlc 0.6 0.8 2 12-24 1Oyr3/3 none %I 2msbk dsh 9w 2fmc 0.4 0.8 3 24-43 1Oyr4/4 none fsl 2msbk dh cw 2fm1c 0.4 0.8 4 ' 34 54 7,5yr4/4 none .r' is Osg dl cw 1vf,f 0.7 1.6 5 5472 1Oyr5/4 none s Osg dl aw - 0.7 1.6 6 72-86 10yr6/4 none s Osg dl cw - 0.7 1.6 7 86-112 10yr6/4 none s & gr Osg dl - - 0.7 1.6 r a Boring # - Boring Am Pit Ground Surface elev. 96.15 ft. Depth to limiting factor >1 1in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "E 1 Eff#2 1 0-9 1Oyr3/2 none sill 2fgr dsh cs 2fmlc 0.6 0.8 2 9-15 1Oyr4/4 none $l 2msbk dsh 9w 2fmc 0.5 1.0 3 15-26 1Oyr4/4 none Ifs Osg dl cw 2fm1c 0.5 0.8 4 26-50 10yr5/4 none s Osg di cw 1vf 0.7 1.6 5 50-65 1Oyr5/4 none Ifs Osg dl cw - 0.5 1.0 6 65-118 1 Oyr5/4 none s & gr Osg dl - - 0.7 1.6 " Effluent #1 = SOD 5> 30 < 220 mg/L nd TSS >30 150 mg/L " Effluent #2 = BOD 130 mg/L and TSS <_30 mg/L CST Name (Please Print) Signs re: ST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations----"-' Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, WI 54020 9/12/2013 715-248-7767 Property Owner Mike & Deb Thielen Parcel ID # 020-1096-00-ON Page 2 of 3 I 3 (Boring # Boring t - 1 j Pit Ground Surface elev. 94.89 ft. Depth to limiting factor >111" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Strwure rdstence Boundary Roots GEDile M. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 1Oyr3/2 none sil 2fgr dsh cs 2fm1c 0.6 0.8 2 10.21 10yr3/3 none sl 2msbk dsh 9w 2fmc 0.6 1.0 3 21-34 10yr4/4 none fsl 1msbk dsh cw 2fm1c 0.2 0.6 4 34-47 7,5yr4/4 none Is Osg dl cw 1vf,f 0.7 1.6 5 7-5 - 1Oyr5/4 none - sl 2csbk dsh aw 1vf,f O.B 1.0 6 52-90 10yr5/4 none s,.__.. Osg dl cw - 0.7 1.6 7 90-111 1Oyr5/4 none s & gr Osg dl - - 0.7 1.6 Boring # _I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redoz Description Texture Stricture Consistence Boundary Roots GPDW in. Murrell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfF#2 F-1 Boring # - i Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BODS -S30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fonnat, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) A.C.E. SON & Site EVAUIUM Soi/e{~Q/~cG~ian/o. E 'c~ite~Kl~ora~i't/tn a , /-d ev, es•►r ~°ps,~, iuo, 0 T o{'fludsar~, St iXGo,, cJ/. lo% ~o.~o-~09G-cX1--¢0 H P X~ e,)v5,6;T LOCI E x;s£~9 r3 bcdlc~n, QeSid WrCG ~X 4 ~o•p. Sgob ' hcQv;(y ~ ~ ~ wuadcc/ a ~ ' 4 A,Pa, r~` 5 hid 'j°`, heavily eleN=95:ui • .4sacur~~d a /to = lea. w. e att- : v A Ii. ,8.,,~ : Top o,~~ c 6/ouC' q E g. T. j~,.fpe 'un ~1 ~OQ Pev = i~.7/" 63 Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(lxe). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Ss oil Absorotign Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 3 year anniversary of new system installation. Old drainfield to be utilized for a 1 year period Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Coutinveacv 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 5 of 11 I _I Filters PL-525 EFFLUENT FILTER (~y ° r y'.' :5 3 t~) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm Acce is PVC (gallons per day) making it one of accessibility p the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other fiber on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe' PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the. installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the back into septic tank. filter is not centered under the access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mike & Deborah Thielen Mailing Address 671 Bradhurst Dr., Hudson, WI. 54016 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 020-1096-00'000 LEGAL DESCRIPTION Property Location SW '1A4, NE 33... T29N R 19 W, Town ofHudson /4, Sec. Subdivision Plat. Na , Lot # 2 Certified Survey Map # 380020 , Volume 5 , Page # 1220 Warranty Deed # 393557 (before 2007)Volume 688 , Page # 600 Spec house 13yes0no Lot lines identifiable Oyes(]no SYSTEM MAINTENANCE An 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 §SPS. 383.52(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 Safety And Professional Services 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 bedroo 3 /0 L3 S NA OF APPLICANT(S) DATE ***Any informat at 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. 04/12) 9 0~'// ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 671 Bradhurst Drive, Hudson, WI 54016 located at: sw 1/4, NE 1/4, Section 33 , Town 29 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service August 17, 2013 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): weeks concrete e of T (if known): 29 years ermit n ber (if kno ) 58857 James K. Thompson -(Ukensed Plumber S ature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS October 31, 2013, 2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 OOctIME h N0. , a FTATE BAR or WISCOM 1 -rott 2 vol- fi""D to btu trAMAI a~ K ~aM1i THIS SPACE af"Mo, Fba aKCOat,MO OATO 920MIMS OFFICE K. Jensch and Do~s+othy M. Jestsch, husband tttd vife ST. MIX CO., V M Reed for Record Ads 29th Conveys and warrants to Mjdjftj L. ie1= and Deborah Be Hof nL A.Q. 19J4 ~f'Tl, tnlrx}~ d 1Adfn an 12int M^U at 8.- 3n A s AL a gem etiTUM To the following described real estate la ix County, State of Wisconsin: Tax Key No. A parcel of land in the SalithNest arse-quarter (SA) of the Northeast ona-gtiarb"r (NE9x) of Sectiaat 33, Township 29 North, Fame 19 Westr described as f0110rts: T.ot 2 of a Certified Survey Plop filed Septed= 30, 1962, in vol. 5, P9. 1220, as Document #380020, together with and subject to a 66 foot mad easetnnt, as shown on Certified Survey Map. TRANS' $ W This is not homestead property. (is) (is not) Exception to warranties: Dated this duel day ofY , 1984 (SEAT.) ft' (SEAL) Cl K. Jem& (SEAL) ~ (SEAL) rmlothy md_je_nsch AUTNEHTiCAT10N ACKNOWLEDGMENT Signatures authenticated this asy of STATE OF WISCONSIN 19.._._.. Hayfield ss. A County. Personally came before me, this 11 th day of s may, 1984 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Clyde R. Jamh and Dorothy M. Jensen (If not, outborixed by 1706.06. Wis. State.) i This instrument was drafted by & (>T1 to ale we to be the person.-, who executed the fore- P.O. %1 54016 going steumeat a acknowl gES1 tbt same. A► , Susan M. Winslow rauthenticated or acknowledged. Both e } runt iidcEs aryl Notary Public $ayf ield County, Wis. My commission is permanent. (If not, state expiratio 't ._lGia E date: Jan. 27, . 195 ) s rr C.1 WARRANTY DxaD-MATE DAR OF WISCONSIN. FORM NO. 2-1971 :y of CERTIFIED SURVEY MAP r LOCATED IN THE SW 1/4- NE 1/4, SEC. 33, T29N, R19W, TOWN OF tyD~$0 STCROIX CO, W I. OWNED BY: CLYDE K. JENSCH. 33.13 N82°42'00"E 546.24 Q .T. H • 51 3. 11 W N w --r •E 481 34'-_ ~ ~ N82p42 00 vl O of c O o~i O z' o LOT I N 3.99 ACRES 173,902 SO.FT. O (121, 663 SO. FT. R.O.W.) OO E/ 65 / %A N 0 MME 3y/ (1)- / .6204 y ihaA ea% Q 00 a- z. a g~ ry f w _J- o~ 223- /ob o Ln o~S% a 0 co Ny2 Zy a~~ O Z N o 3.002 ACRES a W- 1--. O 5~ 131,442 SO. FT. Q: O v • 2 (I it, 208 SOFT. R.O.W.) J. 0 33' 33' f F~ Q. 0. Z Z. a ~ sue CL: pri N N1. NOTE BEARING REFER. ~ M 3I 19 416 I ~ S9 M ENCED TO THE N-S d' p LOT QUARTER SECTION LINE. 'h (ASSUMED O O~- BEARING NO* l? 0 3.27 ACRES 10'00"E). 14Z, 443 SO. . O HI (119,964 SOFT. RO.W.) APPROVE 0 c I TAN. BRNG. NBO°0516"E 0 CENT. # -)00004'44" S 3 0 1982 _ RADIUS = 80.00' \ CHORD - 122.64' \ ST. CdOIX IJ+tTY CH. 8RNG-S49°52'22"£ C©MPRERENSIVE PA PIA ARC =139.74' AM 10=0 t T! Olf 12T. 00' TAN. BRNG. NO-10'00"E 415.68' NO0IO`OO"E 621.20' 1V89°50 00 W 575.68M 576.21'R S89°5000'E 651.60' -RTIFIED SURVEY MAP SCALE I"=100' L. 3, PAGE 692. loo' S0' O' 100' +~w NO010'00"E 1072.20' • = !"IRON PIPE FOUND. N 88 °56 00"k 75-00' M = DISTANCE MEASURED. - N00IO'00'E 1326.70' R = DISTANCE RECORDED AS. N-S QUARTER SECTION LINE S 114 COR. SECTION Volume 5 Page 1220 33,T29N,R19W. (COUNTY SURVEY MONUMENT FOUND) 82_122 Q(O G( THIS INSTRUMENT DRAFTED BY 0 c~ I 3 N -0 0 o C7 ~1 o I c A O fD M 3 ID ~j !D 'p A'+ • 01 3 Mk O U> g z z v z w -i i Cf) g -I z v ° 00 7 c w N • s l = o o N 0 o o o y o o 0 d 01) n ° a n n CC~D N f0-D CD CL CCD: K a y v CD NO •7~ ^ (D (D CD M N a a N N o " I'i -1 w ` 1 o ao O m CD CD m CO Co ' m T ° A7 c (D m '-o OM 3 Q. n 0 Q) N 3 n 0 Q) N O 7 I ca N O 0 !r N N N 0) C W 51 W m v D a d Cl) < D a v CD m a co a a l m m N I a CD r_ 3 n0 ° o o I N 3 p 3 to rn Z a l °o o ao c Q. N N N N CL 0 CD Z co CD N O CAD 0~ 0~ 7 O A co C Q c gl ~ 3 p z a 0001 z 00g0 gg o y n o N s cN N rn o N D (1) 0 o. 2ICD vwo I o 3 c Q co W m m v \y ID - (a (iV 3 m I N ~ 3 N N N CL d cu 7 O Z z 3 °Y y m o D c(D o O 0 d I a o CD o cn ° !r • v N I CD N N d c CD 0 :3. m Oro C D N c (oD N w c a w a tZ 3 N 7 I n 3 7 -q N O o N A o o c A a z O I a I m v Q Cl) -i to W W .o < Cl) 3 o z c 3 I z co N i N z m m I CD c' w w CD C a na o c y _n v c'.3 v c az a o o a fD CD N I I a I ~ e tD ~ N A I I A N I N O I °a II I ti o 0 ° C N W A Efl 0 O O L 0 L Wisconsin Department c# Con fiierce t PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 30 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Thielen, Mike Hudson Township 020-1096-00-000 CST BM Elev: Insp. BM Elev: BM Description: 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 TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 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 xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 671 Bradhurst Hudson, WI 54016 (SW 1/4 NE 1/4 33 T29N R19W) NA Lot 2 Parcel No: 33.29.19.388F2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ® Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Q 1 a PA o County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN Gp In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondajy purpoles ST. CROIX COUNTY GOVERNMENT CENTER CA [Privacy Law. S. 15.04(1)(m)] HuI 101 dson, WI' 54016-771 ~ 0 lop- (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper n 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if r i n tole iosp tion .~•sn 0030 gut ' : a 1. Application Information - Please Print all Information Ap~ ` Location: Property Owner Name 1/4 ~ C 1/4, Sec ?j 3 i { -E 'e.. ✓ 01 N, R K1 E (or) W Property Owner's Mailing Address Lot Number Block Number -71 cc, f_ f G 2 S h~ City, State Zip Code Pho r Subdivision Name or CSM Number 2 170 .5- 2 7z c W 6-4o/4 030 _-J? 6 II Type of Building: (check one) amity ❑Village IfTown of oQ' 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): v\. ❑ State-owned earest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) M I vL r S Parcel Tax Number(s) 33 A) 1.0 Repair 2. ❑ Reconnection 3.❑Non-plumbing 4~Rejuvenation Sanitation L'ZC" ' o cl ` 60 • &00 B) Permit Number Date~ssu State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) [Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: /A )f S"a 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min.1inch) Elevation S_C-~ "1 S'-2o 94,101 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks )ooo ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ If. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/instailation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. ame (print) er's Signature (no stamps): dvM "ts".- Business Phone Number t men ~t 8'(Sff 7~S - 3~6 - Z/ 3o e s Address (Street, City, State, Zip Code) I ©zd► y+~ S ti 1 ~v.-► X1(0 III. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) Approved Owner Given Initial Adverse laJ /a, IL C' /C. Determination J ~op IX. Conditions of Approval/Reasons for Disapproval: ~4 fcd he c&9eeko Mari oar • swe+jpe-(e,d -K.o o .1- Yk.e- ~,~','~/fr.+ f~W jar c .a vd 72-o d Ivii.- fi/N 14,o`ev we c e-14 a►...o~ 2V) -IAA ~rJ~J 4 4%✓ S t/ (Rey -i yef ' o `e4 a.F C4r3/r; b,~~7Ai/d~t~vS~ G41~ ~e t l•ia✓' AOM &K-& 4 A4 fh t - ha/A Fte Fi~sw. 11"t YdyG -1%v doafi.i..+fld~ ~q~i3~ts,-~ l t`~~• a,L.~ lk.~~~+oal k1~6~.rt¢-' s s M.$ ItiGlllrwfi 5wt,~, c~ ~'+~$4 to-4 r -WeLt 41 c~+.aw►.c( Ir t~e~~.htiM rv acd~vc.lr. ta,, ~~tK~ pr~s~vilo 2014W 10maj 13- 641e. Rejuvenation 1. The probe must be inserted no deeper that one foot below the elevation of the infiltrative surface of the distribution/dispersal cell. 2. The probe must be inserted outside of the distribution/dispersal cell and no closer than one and one-half feet from that edge of the distribution/dispersal cell. 3. The elevation of the system's infiltrative surface must be above the estimated highest groundwater elevation or bedrock by the distance prescribed in Table Comm 83.44-3, Wis. Adm. Code. 1. VOL 114IPACE 4 4 659560 " KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Title RECEIVED FOR RECORD St. Croix County 10-19-2001 11:30 AM MISCELLANEOUS Affidavit of System Rejuvenation EXEMPT COPY 11 FEE: COPY FEE: 2.00 TRANSFER FEE: RECORDING FEE: 11.00 PAGES: I Name - (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 4~ Page O cD Document Number * 35nt. Croix County Register of Deeds Office: Recording Area nd Return Address A parcel of land located in theSLkl of the of Section 3 rn Name V t I ~l T Zc% N - R Aa, W, Town of St. Croix (0-11 ~ h 1. ~'1v~ c•5 t County, Wisconsin being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Lv ♦ ' L a CSM \l cs~ T 'P&`p \ ZZ(3 'pvt a ao2U ' Z C3 ' O CS 4 -0<3 - b o u Parcel Identificatioh Number (PIN) As owner of the above described property, I acknowledge that the septic system serving this residence (is/is not) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the pFoposed procedure will be successful. I also acknowledge that 1 will make this information available to any future parties interested in pruchasing this property. Dated this day of T ATI N ACKNOWLEDGMENT Sign e(s) STATE OF WISCONSIN ) )ss. authenitc t s ; day f k St. Croix County. ) Personally came before me this -a_ day of l~U the above nam * nklCt)Pf e~- 11te.l@~ TITLE: MEMBER STATE BAR OF WISCONSIN ( ``%N~Y`HAtbim gown to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) \~.~~\5 , • • ' +ns e* and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY . ~p T.4 sCt ,A Q- ta c, State of Wisconsin ~BL;fX io is permanent. If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are n&,,,, 40ss necessary.) '~r~~rrF,.l ,.1 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter: document title. name & return address, and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the TW%V t -T V~ ,J-.-tA residence located at: 51-1 Y., ;-Je- y" Sec. T 2~ N, R 1 W, Town of _ r4 v.L~ -0-50 St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 10 , fri 101 Did flow back occur from absorption system? Yes No-~< (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: 1 000 Construction: Prefab Concrete- Steel Other Manufacturer (if known): Age of Tank (if known): (Signature) (Name) Please Print (Title) Number) C-e !{~~la'T jc~l (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/MPRS Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County G^91K Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2 o o Please print all Information. Re ' ed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G M • / 7%J `'Gf~ J Govt. Lot 1/4~91/4 2 I 9 /AE S s33 T N R I EorW Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 4(e71 131?412h v~es T 2 cS . i'/o/• S Ps . 2Z o City State Zip Code Phone Number El City ❑ Village )Q Town Nearest Road h~vOSo.✓ syoi~, (?1S) 3~G • of 1/ El /34P oh PRS 11 ❑ New Construction Use:X Residential / Number of bedrooms Code derived design now rate 49 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1,0&-S5 04L !F d 00 Flood Plain elevation if applicable _ N&24= it. General comments and recommendations: S/•~`~' ,S~iL ~(fj¢~~f,f-TJ'~~ U~~~/G~T-~~'t~ O~ G'QOE' /f ca,~~<< f=oe ~P~~v~~~v~-rrav /~io c~sf-" T~~'~•,~ •t~~'i G-- © Boring # ❑ Boring f6 >/O Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z • 8 io y,~ S/L / s ,C' AM-f/• et s _ . i. • 3 31. o s s rr~r~ IS o d, 01, /oo ye M ~S•~t> ~ ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1`12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 AL Effluent #1 = BOD9 > 30 < 220 mg/I- and TSS >30 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number RV 2-7-4,3 -7 We - Address Date Evaluation Conducted Telephone Number Uibricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 e'O, S y$ r-44-N- I ~ f5e; ee ZO iV /i"Ao A0 X S2 ~~S Co f>E Co in / "to 7- Soils ? •~-t 7-s r~!/ Cc ~e&w# 7- 4oWh e pF ~.v 2rs~ ~PE~ v vf v~-rte Property Owner Parcel ID # Page of ❑ Boring # Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell GPD/ft Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 f ±EEP I Boring # ❑ Boring Ground surface elev. ❑ pit ft. Depth to limiting factor In. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Rate in. Munsell GPD/ft Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 m _ 9/I- • Effluent ff2 = BODs < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) } r • 111 v~ O Ulbricht & AssociatesConsultants e 7 private Sewa9 855 O'Nell Rd•18 Hudson, Wis' 540 ~GNµ~ r1 D 1 ~ 4U 2 ~ T-0 -r4 A) filt T' 5K O f lop o 51-01 , s ~ S TES - ~ o0(.7- 11 _ c-~X 1'S7 /,VJ fle!0 tm 7 /O ti ~ st a 4 y y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1&-e- _7 V\ ` --f- \-t N Mailing Address rl~ c L fi - Property Address (Verification required from Planning Department for new construction) City/State a Parcel Identification Number 0"2-0- )094'60 '(32c) LEGAL DESCRIPTION Property Location t/., hi 6- Sec. 33 , T 2G N-R_LC Town of ~a tA c~ sow ' Subdivision , Lot # Certified Survey Map # , Volume Page # / Z Zv Warranty Deed # 3 t) 3 1 Volume Page # & o 0 , Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has be n maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of three ear ex on to r DATE S N TUBE OF APPLI OWNER CERTIFICATION I (we) certify tha all statemen oa-this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of pro rty d scribed A y vi e fa w my deed recorded in Register of Deeds Office. DATE SIGNATYRE OF APPLI Any information that is -represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i • DOCUMENT NO. t 1, t STATE BAR OF WISCONSIN-FORM 2 /tyv I °~?+l i WARRANTY CEEO THIS SPACE RESERVED #OR RECORO'NG 7AT• ( RBG46TL'R$ OFFICE Cede K. .Tens-h and Dc,~thy M. TenRch, hustxtnd _ wife _ ST. CA+OiX CO., anti tl. go-.'d. for Reccrd this 29th 9 -ray x - - .1c.- of May AD. 19 4 ~€1leiei~_-3i,-[)ems=r] ---s j conveys and warrants to i j _IYllelt'11~_f11LS I]d ~DS~_1di a ~i nt t F+n~,n ~ - Cit 8: 30 M. i _ RETURN TO J the following described real estate in ~'lx County, State of Wisconsin: Tax Key No. A parcel of land in th- Southwest one-quarter (SW;) of the Northeast one-cTUart er i (NO,-) of Section 33, Tbwnshir) 29 North, Range 19 West, described as follotrs: wt 2 of a certified Survey Map filed September 30, 1982, in Vol. 5, pg. 1220, as Document #380020, together with and subject to a 66 foot road easement as shown on Certified Survey Map. z e This is not homestead property. (is) (is not) Exception to warranties: Dated this day of _ May 19 84 (SEAL) (SEAL) _ Cl}rcle K. Je h A-C (SEAL)-(SEAL) i - T)orothy b Jensch - AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN } 19_ l ss. Bay-field _ County. ` N/A Personally came before me, this- 11th day of + _ may, 1984 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Clyde K. Jensch and Dorothy M. Jensch - (If not, _ authorized by § 706.06, Wis. Stats.) This instrument was drafted by Hugh F. (Xvin, (TIN & (WIN- to me }c4 own to be the person- who executed the fore- T.0. BOX I~ going'ilistrument and acknowl d$ed the come. wi 54016 ! h„ f ' ; I It r~., final y-bt authenticated or acknowledged. Both no tirrno~ deices$ary.a Notary Public @? ~ _ County, Wis. My Commission is permanent. (If not, state expiration j I t v date: - J a'. rt .t' _ y WARRANTY DEED-STATE BAR OF WISCONSIN. FORM NO. I-1977 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T a y N-R i13l W ADDRESS ./?171. Z4Dee lj,. ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT - LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LH,R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - _ _.....W_ 57 ~L ' i i r S ii 0 o INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,4!~"l/ e' Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: zej Number of rings used:' Tank manhole cover elevation:,- vyw Tank Inlet Elevation: -3 Tank Outlet Elevation: U3 Number of feet from nearest Road: Front, Side ,o Rear, O / feet From nearest property line Front 10 Side, 0 Rear,0 ~-Q feet Number of feet from: well 04o.1 ,5 d building: a d (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: i Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: .52., Number of Lines: Area Built: Fill depth to top of pipe: oZ Y Number of feet from nearest property line: Front, O Side Rear,O Ft. 2 Number of feet from well: - CJ-0-4-Number of 'feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: I Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:-4 Dated: U Plumber on job: License Number : 3/84:mj t DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7Q69 BUREAU OF PLUMBING MADISON, WI 53707 [NCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: M. & D. Thielen R. R. 4, Box 40, New Richmond, WI 9 -1~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SW NE, Section 33, T29N-R19W, Town of Hudson, Lot#2 Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: 6382 St. Croix 58857 William Schumaker i I I SEPTIC TANK/HOLDING TANK: S ,5MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER . I _ /E A L.s PROVIDED: PROVIDED: f/J %~`J~( YES ❑NO ❑YES ❑NO BEDDING: VENT DIA. VEN_TM AT HIGH WA E NUMBER OF AD: PROPER WELL: /BUILDING: VENTTO FRESH 14 ALARM. FEET FROM If LINE / AIR iN YES ❑NO ❑YES ❑NO NEARE RO ST OJ-- DOSING CHAMBER: 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 SOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN(,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF DISTR. PIPE SPAYING . COVER INSIDE DIA.: -PITS. LIQUID BED/TRENCH rr TRENCH AL PIT DEPTH: DIMENSIONS (/1_ GRAVEL DEPTH FILL DEPT J I DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL N R. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PI ES. 1 1 ABOVE CO,~ER. ELEV. INLET. ELEV E D PIPE LINE: /0 AI INLET yr ~0 FEET FROM ry / ~f NEAREST --i► OC. LI MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED: CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH: TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: 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 INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER PROPERTY WELL: BUILDING: FEET FROLINE: ❑YES ❑NO ❑YES ❑NO INEAREST::F:::~ Ske tch System on Retain in county file for audit. Reverse Side. 117 A S N T RE. /W I TITLE: ~'7 DILHR SBD 6710 (R. 01/82) ~C/ f ujsconsin APPLICATION FOR SANITARY PERMIT COUNTY z DILHR oEVRRTmEr1T OF (PLB 67' UNIFORM SANITARY PERMIT # In0uSTRV°LR60R6NUTRn RELRTIOnS -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER _ MAILING ADDRESSES /V h ! jri►4 i' _ 4Z I' 4~ P R Y LO ATION CITY: IL S 1XVAS:F ,T 9CYN, e E V (or No LOT NUMBER BLOCK NUMBER ISUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair J Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. M Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 1-2 4 l 49K M 3&', Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: IMP/MPRSW No.: Phone Number: A/ S" Number's Address: Name of Desi r: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Q Q~ ❑ Owner Given Initial d, Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber w INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. R a. PPP_ Form - 5 T C 100 Owner of Property Michael L. Thielen and Deborah K Thielen Location of Prop®rt *See lie w Section 33 _,T 29 N R 19 W u: Township 7A North Hn9snr Mailing Address _go„ t-,_ I Bnx- 339. Hudson. WT, 4016 Subdivision Name` y hot- Number Lot 2 Previous Owner of Property Clyde K. Jensch Total '.Size of Parcel-3.0 2 Acres Data Parcel Was Created Are all corners identifiable? x Yes No *Description: A parcel of land in the Southwest one.-quarter (SWQ) of the Northeast one-quarter (NEB} of Section 33, Township 29 North, Range 19 West, described as follows:. Lot 2 of a certified survey Map filed$'~September 30, 1982,. in Vol. 5, pg. 1220, as'boc. #380020, together with and Seclude with this application one of the following: subject toa 66 foot road easement as shown Certified Survey Map on Certified Survey Dead Map. } Laud Contract, or Other Uaga1 Document which describes the property PROPERTY OWNER CERTIFICATION 1 (We) olwify that all statementsmon this form are true to the best of my (our) knoWleoge: that`! (we) am (are) the owner(s) of the property *scribed in this fnfcmm-~,4arm, by vivtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 39-3951- - and that 1 (we) - Vol. 688, page 600 preaently'own the proposed site for the sewage disposal system (or 1 (we) have obtained;an aasament, to run with the above described property, for the cansttuaVon of said system, and the same has been duly recorded in the Office of the County f Deeds, as Document No. )F i MQ TUOka of" q c N.e anl=M s1 T16ME of CO-0W (IF APPLICABLE) Deborah K. Zhielen DATE Jay 25,-/1984 July, 25, 1984 slapao DATE SIGNED a rakryy Sift. Al r-~~ 5~ i_. s h r 3 E w~ V E_. A J>~ r P1 t ( i 429N, R Jc,,.'i l'liJ OF fit)0 j0Wa 1 3 24 I M_ ' t C\, t, 1 jig 131,442 SQ; FT, E (1 11, 208 S Q. FT. RA W) e-- S x, , , ~ L a . t s r. A i F&T. 00 04 '4 4 Cif CH. SRIVG ~"4 °U.. 2r"C co!;APPI-tit?ilY,IV . P.n" PUr i(NZi ' ft C ! 9 '4 ' l1tdD ZONING CO hi (TE T "O r)', to ^,G"~: 68'. - n~ y _ _ 4 E> {''V:~~_ri l'> = 1 "l{tChd f I P V F-C,1rPJ;). - r PI S7AlJf, t OOCUMENT NO. , STATE BAR OF VSCONSIN-FORM 2 t WARRANTY EEO 5r? Vu1- 9n ' ~oo THIS SPACE RESERVED FOR RECORDING DATA Clyde K. Jensch and Dorothy M. Jensch, husband RWASTWI16 OFFICE and wife ST. CROI'X CO., *10. Rec'd. for Record this 29th ~ conveys and warrants to Michael L. Thielen and Deborah K. day of-- y - ~ X9-.$4 Thy elen, husband and wife as joint tenants wt 8: -30 A R '~~gt I t~Ytar of DNd. RETURN TO the following described real estate in t. Croix County, State of Wisconsin: Tax Key No. A parcel of land in the Southwest one-quarter (SW4) of the Northeast one-q ' uarter (NE4) of Section 33, Township 29 North, Range 19 West, described as follows: Lot 2 of a Certified Survey Map filed September 30, 1982, in Vol. 5, pg. 1220, as Document #380020, together with and subject to a 66 foot road easement as shown on Certified Survey Map. TPANSFF FM This is not homestead property. (is) (is not) Exception to warranties: Dated this day of May '19 84 (SEAL) (SEAL) F C1 de K. J h (SEAL) (SEAL) noroth Jensch AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 19 ss. N/A Bayfield County. Personally came before me, this 11th day of * May, 1984 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Clyde K. Jensch and Dorothy M. Jensch (If not, authorized by § 706.06, Wis. Stats.) I This instrument was drafted by Hugh F. Cain, C4UN & (EIN _ to me own to be the person _ who executed the fore- j .0. BOX 106 going ' strument and acknowl dged the same. ' v e~ i~, 111 54016 r Sit wbe authenticated or acknowledged. Both * Susan M. Winslow no nec s ar ? BaVfield ~ Y Notary Public -County, Wis. My Commission is permanent. If not, state expiration date:- Jan. 27( 19 85 ~ i WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 2-1977 :c ' . N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County x a (O:WN:E~BUYER 9+LEL~ ROUTE/BOX NUMBER S Z Fire Numba CITY/STATE ugyPM W~ ZIP PROPERTY LOCATION: aW'14 NE ;4, Section 33 T 29 N, Rt„TM, Town of 9,'Mo yo , St. Croix County, Subdivision Lot number Improper uss and maintenance of your septic system could result is 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 f unction 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. , M 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-$ite 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 s: I/WE, the undersigned, have read the above requirements and agree (A to maintain. the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED j a nQJ DATE q~(~ f 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. D y = n a o o' g r.:g~-i w~Nrnro3O 7C A C (D 7 S oo a3 www'~w ~co•c° :r Z3 0 '(D 1 z 2D 0. 7R c :,r CA :E o c"o a p o w0 m w ;r w ' cw w (D N~ O (3D a C.► C OM QWD owo~ 0o .mac-c Zvi ~ r c~ a m On »,~r N .a(D w .w►L O~((DD O-LOa~ SD m -.0 7~ A < (D (A or A m Q 0 (o,? ~om°•of wok O ;am~w r 0Na CD w~vwU(A Z w = a(D 0 3 a ~ a (n~ ym (D o?~~C) m a F2 w ° Q N (D (D- (D 0 7 M W CL to ?wn aC0:* (D~ C IT1 p 3 O -0 (D r W N? ° a (D q y a .O►O w wQw _ 0 06(o ca o (A C C m 7 0 fA w = m o w 0. r aO* cCC.F0O m w w (D - M Co (D C16 C" 06 ? a° cr r ID ~ p N c l< ~ 3 SA' 'A'O I(ca OvioNO o O. a C w m (D C (c Boa irm=o ac _?r- (D = o 0 a= s < y (p O ~ CCD Z 0 DE°:~r~i►7Ef~;T Or REPORT !Y INGS ® I1~i.~1AND SAFETY & E3UILC INDUSTRY, ISION LABOR AND 1 BOX7 ON HUMAN RWATIONs PERC (115) (H6 (1) MADISON 101 53701 &CMa4pt .0 - LO ATION: E r ) ION: TOWNS AU Lit)". LOT NO.: BLK. NO: SUBDIVISION NAME: ~~vu '/aN164~ /T?- -)NZRf9 E (6') 1 2 e.s.M, v 9- P. 1-?-Z.0 r COUNTY- ~)VvN r fi'SI3UYER'S NAME: - - - - - - - (a It I G AV S v I S - i ~'f+d- DATES OBSERVATIONS NIADE I I INO.E3EOFIMS.' COMMERCIAL DESCRIPTION: PROFILE ESCRIPTIOi'v~s:TrcRC L IOV FES7S: J i~Flesid>nce ~ A I ~Ne~v t r- _~Repfac~ I 1 ~1 Y' 1 t_ T c~ "j tt C-a (c 0 1 L S; -e-, 'J CC-K 44-4` I p T 15X p Z rIATING: S= Size snit lble for system U= Site unsuitable for system It`fjN~'ENTIOtiAI ^atOLf"JD IN-G(ROjUNDPRESSURE: SYSTEA4-IN-FILL HOLDING TANK RECOMPaENDED SYS-rEM:(opt or,•, r - C7S_muinS Percolation T ;r -t Yr required JEATEIf a~ y portion of the tested area is rn the Floodplain, indicate Floodplain elevation: j t7EG.l ~i~t--- - PROFILE DESCRIPTIONS I ?OFtINUt TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, ANU DEPTH 3ERipEFrTr± I ELE'✓ATION - OBSERVED ES . HIGHEST TO BEDROCK tF OBSERVED (SEE ABBRV. ON BACK.) S-! 0.70' /o.to' BN M E-6 i1, 0.3O' BL L-5 (fora( y U-Z-0' MEn S r~~r`-~~ 1.4v' ~D 'I - d M S ' '52.0, LT. Stj M EO IEL L; t.7C~' Iz o (~.1 LS w ~7R 7, Sd' ~ r'*It I f30' t3 L 1-- j 3. / 0' 3~J ME'D L ~ O. 30t3nl L W 6; 13-1 A c~ 775 ,7s aL- t_, (3,j L5 1,.s0' 6'j I" 5 w r r DECIMAL. - - F-EG T PERCOLATION TESTS - NUMBS Co)?Q~SP~vfDS of 1T'N AWAC-E0-r _E rE5'f DEPT-H, t3 WATER IN HOLE TEST TIME DROP IN WATER LEVEL-JNCrfES RATE MINUTES f•'UMBER 4 G.k~S AFTER, SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P RE 3 PER INCH iIEV ' - 7.5 6- rJ J i P13T PLAN. Shov., 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 Wevation,, at all borings and the direczioa and percent of land slope. SYSTEM ELEVATION TO'i'A t_ o F Z500 S .Fr ' - 1 O boil. l~ot,~. ; Ttc S .1. su ITf~E3 L.E ~ii 41 ; 04 LOT Z 5li O Pa?"cod. A:ni )tj i -rF-S7" s iENC-f{ MJt&:K!- Tit' ~s~. __-.j T moo . N ~Sj, '^•41, ~ to M , J 46 1z - „ Slop J _ v I NOT E.' =14.115 ¢ - tZr Tf~ G tl-C3F .!r_I, rr, 3 ~a ~7 l NJ AD F-;a-TEn(T -Y Dc>,4 AG(zOSS ~r ✓ N (t~ LpT L n/ '551 - 51t'E t"' ~ I, the undersigned, h::raby certify that the soil tests reported on this form were made by mein accord with the procedures and met d.; specifies! irr-the isco'nsirt J dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, '6F-NCH MARX i w t7 i PL Ar -50u . L.,ar. Clow... EL-160.00; rdAMF (print): ~p TESTS WERE COMPLETED ON: 'ADDRESS: CER1' Fl ICATIUNNUMBER: PHO E vUINBER(optionat): 4--2. i_Z a P S -r. .50 t j OJ I . 4 0/ . l?° 7/5 3~a- 4U80 CST IGNATURE; i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. h`'LHR-SBC)5395 (R. 02182) - - - OVER Sea, l ~ t J ~A\ a ~J 777 ft .6 e YdY B .i~ A'~ h O c7~~iA~a• l =h ~ ~ w I i s I~ II ti i