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020-1148-10-000
Illy WisconsinCepartment of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ( ATTACH TO PERMIT) 506258 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Larsen, Richard Hudson, Town of 020 - 1148 -10 -000 CST BM EIev' Insp. BM Elev: BM Description: Section/Town /Range /Map No: lV ` 12 /06 6 l SM 0)t — 33.29.19.789 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic OW W % r � � w • Benchmark ,. � , 0 .1 � a 3.27 X03 ai /(�6 4 Alt. / &num/ - low 1.,�, I , i 1 motion r Bldg. Sewer 17ri1Ti' I - c / Holding 4■1111111— 'St/Ht nlet rtizict) ` 5 I Q St/Ht Outlet / / �_ TANK SETB , CK INFORMATION TANK TO W E I . BLDG. i Vent to ROAD Dt Inlet / — � /Ir, ' e•tic i (�, �'� Dt Bottom � c-10- Of iiiiiiiii rm 1..4.^ der an. ��^ k, lot- �- Z" f Aeration .1111111111 Dist. Pipe ' � ' D ° S3 r , - co Holding , I Bot. System r 3 V ZS/ 8`.2.1 q S,b //' Final Grade " PUMP /SIPHON INFORMATION i s � 0 t 6-3 C( . q 7 Manufacturer 7 '/ Demand over •l4fJ k GPM I) 1 3 Sc l'. 7 Z Model Number -, ,% TDH 11 39 Friction s I IT Ft Forcemain 1Letl / Dia. 2 r , Dist. Well es _ SOIL ABSORPTION SYSTEM ( q/ 0 7 BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3' !Length 1 " C / SETBACK SYSTEM TO 1 D P/L BLDG W LAKE /STREAM HAMBE OR Ma p ' 2 , r & INFORMATION T f S stem: yp� 1 • / 2 o _ SD 0....'" .. UNIT Mo. Number: / / DIST: : UTION SYSTEM l o J . f • i / ' ' ', , � _...a4:44-- 1 Header /Mani i.Id Distribution / G, ( •., . x Hole Size x Hole Spacing t ent to Air Intake '`� Pipe(s) `i Length 7K t, - • ,b,, Dia u 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 1- [ iJ Yes ` 'I No Yes : :1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 3 I / () In pec ion #2• / / Location: 649 Countryside Circle Hudson, WI 54016 (NE 1/4 SE 1/4 33 T29N R19W) Countryside Village Lot 3 ` a4a cel No: 36 9. 9 1.) Alt BM Description = b1 vU L- n4 ( v / 4 '1 (Ak6k l !o4 I i' „,z_ — dm - aaL__ 2.) Bldg sewer length = 1Cf 677 /JC /10■- 4 4; -- -J YV -Y ��n "" Ofixte / - amount of cover = Plan revision Required? ] Yes 1410 No 2 k k 5" Use other side for additional information. 3 l 01 / - i �� Date Insepctor's Signet Cert. No. SBD -6710 (R.3/97) COIThllerCe.Wi.9oV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix tiSC0 � 1 Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) De 5t A 25 Sanitary Permit Application State Transaction Number i o In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are / (� submitted to the Department of Commerce. Personal information you provide may be used for secondary s am e `f Ce.>..4"'M S e�-P 1 purposes in accordance with the Privacy Law, s. 15.04(1)(m), State. /n� - I. Application Information - Please Print A Informer' CI`('�L.2 Property Owner's Name E C E I VE p Parcel # Richard C. & Brenda F. Larsen 020- 1148 -10 -000 ( '78'9 JUL roperty Owner's Mailing Address t- 1 2 Z007 Property Location 649 Countryside Circle sr. CROIX COI,Nry Govt. Lot City, State Zip C Phone Number NE 'b, SE 'vs, Section Hudson, WI 54016 (715) 531 -1139 T 29 N; R 19 w II. Type of Building (check all that apply) # Ot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms ,.,l. • • ,. 3 Subdivision Name k 4 Countryside Village ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of y U ;s)- 61 11/191-19 >H 9 r / Na fown of Hudson I Type of Permit: (ck only one box on line A. Complete line B if applicable) A ' ❑ New System ys ],Replacement System ❑ Treatment/Holding Tank Replacement Only 0 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 / '' .CS-Cr. t I f „ .,4-d IV. Type of POWTS System/Component /Device: (Check all that apply) J lQ O� i 'f L.J 1 .4 t Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: 76 Infiltrator "Q-4 W" chambers @ 20.0 sq.ft EISA / chamber + 4 pair end caps @ 5.8 EISA =1,54320 sq. ft. Design Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area Required (sf) f Dispersal Area Proposed (sf) System Elevation 600 gpd / 0.4 in -situ soil ✓ 1,500.00 sq. ft. �I 1,543.20sq. #t. 7 95.0' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .g New Tanks Existing Tanks g3 it pC l es I„ SZs' f rn ic. L7 g ti fi, c U v� Septic or Holding Tank , ! !.1 1,000 1 W ks C&Icivte X 1,000 1,000 1 Wieser Concrete Combo. X Dosing Chamber 600 600 1 .. loser Concrete Combo. X VII. Responsibility Statement I, the an ■ reigned, assn e r , • ■ i • 0 "''`oe oldie POWTS shown on the attached plans. Plumber's Name (Print) Plumber' - Signature Number Business Phone Number James K. Thompson .►, - / ' 30021 1 (715) 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola ' 54020 -5413 VIII. County/Department Use Only / / '(pproved 11 Disapprov- •'itCFee Date Ise Issuing t Signature 4 . 0 / ii ❑ s Given Reason 1..1 iai $ `� � , OCR 71 � L O A i IX. Conditi ~easons for Disapproval 1. Bs* _t k,i fluent filter an dispersal call must all be services / maintained as per management plan provided by plumber. 2. ,AU setback requirements must be maintained as txr aoplicable code / ordinances Attach to complete plans for the system and submit to the County only on taper not less than 81/2 a 11 Inches in size SBD -6398 (R. 01/07) Valid thru 01/09 • .'i - e1/4441-6:0.-- ) Ale t h y ---7- / n e m r) (G /os /e 7 0.SG, /ada- hta -6'on p,e 4 -.T. It Lb. ;ch e /% /os • e):/:56, grade eel; ca/c: D 33.2.s ri 1 s- kc.‘ 4/ &+e...KO IAest*.ylto,od -o"S, /et, P /u.eif /$ale ✓i//e . 1741 %Y, At. 33,7;4 e✓ %4,t.dsan, .St . ern iy 69 u1! PeJ. $ 0 2o -N5 -/a -oot) , 0 -. . li .zfeoryl ofGgr'i ssicIr4 a /l!/.''s /419.CD' O . v 1 r)( S�r�g Mrlon/rr /e cods- Elea,: 0 P6 71�:� .."'"II IQcs;drwcc 1 0 , 1` v E.se:..,dinveri ?9.0 \ � o �` utlet a 95. DD e,1'i3b'e �, aY3 Approx, /aca.6'o op SS `°° _ u = ti axis d,5 mesdce // /�roposc r i- ' ---._ / �, ; "5 97 9 � D d s;n e 1 rf',�veo. fp / J 6/ ,,, /,,arro. con.26/..w.4c•-, At i 1 liZeiZt: 17 .' P,C -s ei /uar 1 � G `� � �' i /�/ o tS.T, dui /L p • , i . w 3 3 c (r'� - VI t al 42- , Aw / ,/ tr ( , ,, w c 2: / / / A /%nes err morornKsz/C. b ■ / , 1 / F r `, l / Proposed d speisa /ce// f ? ✓G ao 4'1‘9,' ' Fou,(4)er•+,citesa ‘,/ A57,11 3o3:111111 33dod � r ; c Q i � 37 �w cico.., • 3 /qFl 213 cc. . e. 8 e c/ l< . 4 - ZieS Wit sZ de l'e - /oca -ic d,.a.-: a/ ep Sy S 1 / 6'o». / � 1►(r S,o/G &et " - / ��� r 1 u/ I • .5oi /eda/uai:o.-, b - �7 oma5 )7 Gyps — /07 0.501 /e dalAta -' , or, P, e 4y —.7: Gc (.b., c 6 /0/i7 /os ♦ e,:is6 9radc eta, ca/c" colt.' • , Po 33.2.5'7 ' /� t 1 po•c4 Cite, 441.'Se nt0,411,60 #"Ey. /e t4 P /ae sf Cot Salt ✓i//e�. /7C V $ ' y , Ad. 33 r eve f+‘dsp,, St. erriy eo (AV. p e _ ! , i d 020 - / /V8 • /0 -o0+0 • - - 1-1, 'P. ,m o 6-i Ad5u'4 - elev:` " /49-CO' , U rig tl Q�[ �X�3� v • ld, du.: ®• o 3(udrea ) A s : ,�►-�We �� Mari i /e CO/e, ; 6/et�' 9 9t 7f'" ' Ai id1ncl - 0 3 � �strr . fn vcr� t /c a 990 t r 1 oufrlct 2 95.00' E,r /.36'07 `_ .'� \a � APP rox, Ai ca.6'o.? o, �' wet l �000 , � , I a /sv:y d i J SsICt // T . i - -. - -- -- ¢X t� A- 0,ms( - '. ._ ` , / % - 77.4' 9 �' k '4IL ' s;on s / !V..- , �. Ira seaWie,Sc, - es7C. / ,�, / C �f e f ✓e ' / ii /OX r al 4LL / , 4 • ' . .. ` ! r • 3 $ A I . in- edttfi1 :�. b�. • ; /107,4 ire.e a ` / r ■,./ Proposed dispr/sa /cd /. scG NO 0,1 Ui ` FO“,-(4) fs�n c. ke s a v ,,,,, b31 3o3aP.vc, 4. )' , 0 ,0 ' Q ' q -�lcJ clio..,t • ✓ G, • i - ' \ ',1, ;,,, 96.0" • v rye- JGCe: /;Zies.fi 4Z- 6e re- /oca -c.d,o.:or � sys£ -- i #7 SO //a- 6?)-i. Cam- yst do Circle Gcl- ate -Sac- #.3,02,1 2080 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Pla County include, but not limited to: vertical and horizontal reference pant (BM), di < < ' St. Croix percent slope, scale or dvnemsions, north arrow, and location and distance to .. • -C, • • Parcel I.D. 020-1148-11 Please print all Information. _ Da te Personal information you provide may ' ∎,. , �7 'iY- �. 15.04 (1) �, 7 /6 d 7 I Property Owner Property Location / Richard C. & Brenda F. Larsen Govt. Lot NE 1/4 SE 1/4 • 33 T 29 N R 19 W Property Owner's Mailing Address JUL 1 U 2 u [Jt Lot # Block # Subd. Name or CSM# 649 Countryside Circle 3 City State Zip aleW6146 AOIefeTY J City _J Village 1 6 Town Nearest Road Hudson ( WI Hudson I Countryside Village e New Construction Use: l e Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 1 Replacement _j Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at Q 4-gpd loading rate. Recommended system elevation to be 95.00' - dosing required to reach sytem elevation. r I 1 Boring # ...j Boring J a Pit Ground Surface elev. 96.62 ft. Depth to limiting factor >93 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr2/1 none 1 2fsbk mvfr as 2vf,f 0.6 0.8 2 10-21 7.5yr4/4 none !cos 0 sg di gw 1vf,f 0.7 1.6 3 21 -38 7.5yr4/4 none sl 2msbk ds cw lvf,f 0.6 0.8 4 38-48 10yr4/4 none sicl /s 2msbk/0 sg dsh al If 0.4 0.6 5 48-65 10yr4/6 none s 0 sg dl cw - 0.7 1.6 6 65-93 10yr4/6 none s & gr 0 sg dl - - 0.7 1.6 H#3 contains pockets of 0 sg 10yr4/6 s comprising 5 approx. 20 of horizon. H#4 consists of irregular, discontinuous lenses of sicl with remainder of r onizon being 0 sg 10yr 4/6 s. r. � 2 Boring # Boring 0 7 1 Pit Ground Surface lev. 96.87 ft, Depth to limiting factor 60" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM* in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr2/2 none I 2fsbk mvfr as 2fmc 0.6 0.8 2 10-32 7.5yr4/4 none sicl 2fsbk mfr gw 2fmc 0.6 0.8 3 32-42 7.5yr4/6 none sil 2msbk mfr aw 2fm 0.6 0.8 4 42-48 7.5yr4/4 none fsl lcsbk dsh aw If 0.4 0.7 5 48-60 10yr4/6 none s 0 sg dl ai - 0.5 1.0 6 60-89 10yr4/4 f2f 7.5yr5/8 sills lfsbk/0 sg dl - - 0.7 1.6 H#6 consists of an undifferentiated mixtu of 0 sg 18 /6 s, lcsbk 10yr4/4 sil & irregular, discontinuouslenses of lcsbk 7.5yr4/4 sicl. Redox con.- rations found within sit material. q SQ *Effluent #1 = BOD 30 < 220 mg/L. a TSS >30 < 150 gA. ent #2 = BOD < mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson ,, - r. .§- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, . r 1 54020 6/5/2007 715 - 248 -7767 Property Owner Richard C. & Brenda F. Larsen parcel ID # 020 - 1148 -10 -000 Page 2 of 3 • 3 Boring # J Boring il d Pit Ground Surface elev. 96.52 ft. Depth to limiting factor 57" in. Soil Application Rate' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#12 1 0 10yr2/2 none I 2fsbk mvfr as 2vf,f 0.6 0.8 2 10-20 10yr4/4 none loos 0 sg di gw 1vf,f 0.5 1.0 3 20 7.5yr4/6 none Icos 0 sg di cw lvf,f 0.5 1.0 4 39 10yr4/6 none s 0 sg dl ai if 0.7 1.6 5 47 -57 10yr4/6 none si /s 2msbk/0 sg dl cw - 0.6 1.0 1 6 57 -88 10yr4/6 none sid/silis lcsbk/0 sg dl - - 0.7 1.6 Clay bridging between sand grains in Hs #2 & 3 . Loading rates re duced due to high content. H#6 consists of an undifferentiated mixture of 0 Y dg 9 9r ' Load g es o g clay sg 10yr4/6 s, lcsbk 10yr4/4 sit & irregular, discontinuous lenses of lcsbk sid. 1 Boring # 1 Boring _I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary r Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # A Boring A Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD <30 mg/L and TSS < 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 (8.07/00) A.C.E. Son & Site Evaluations 1 joi / eda /cet - 41d by .�. TA, m ►') (% SAo 7 • 411,So, /a da./6c.a. , o , , ,o.e 4 --- .. 6cC- 6.,'c1,6 /o/i7 /0S Al gt.36 grade el-et! ca/c� 0' 33.2.5 ' N . ,Q // t 1 k e ,--)cG PS( n,oco,a,"Ey ‘ /et,$, P/44 , 7e . eou,.fi s.df ✓i//ee. 0 till..f E'iy, Sce. 33 T, 0 Ncc ds..,, st . Croiyeo (AP. peJ. W 020- w e- /0 - o0d Assk414 • e/ea,. /49. co,' 64.12 1 4°71341, \40s r V 3 b� d � _ �--wc u h`t. elj ma.,fie a code,- E/e . -, 91.71:' Res Alma 0 / 990' 3 (' �`'` E.sel... µ /c a6 v 614 i s Y.5, o e:/ 6,-11' \o < A �� •t.>e,Ll1s Y700 r - l , :> Ap or /Ica-60r) 0)0 9°`P .5.77 r'& r - . � ax/3.6 . , d resdee /r •:' - _ 97.0 9 � ° e / l , A r; - / , '• • oi� , 1 ' a .� , 2/i -/, , s.l t e G � p , r V 44.....6&/ . /a-6,,, 0 It • � 3 � � � . A E Y c, / %nrs o.-e aP�oX,c b , u , ' t' 7, Al ` 3 3 • 233 ■ X 96.0' ild e 8 r,'e-d a.67,Zies47u s 6e /'e. /out. -6c c l,oi: ai ep sy 5- 1e-.. -, /07 sty //aLf.'o�. .niyS, ole. G'rc/e _ d< -.Sac. Pc.3a 3 r� . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerk err'" tC,'c„I4■•ri e.4( drigel & ? l cse Mailing Address 45'9 Chun rys. oe direie Property Address Sgene / (Verification required from Planning & Zoning Department for new construction.) fp City /State s , () /. Parcel Identification Number ©zo - //S - /e - ems LEGAL DESCRIPTION Property Location /JC t/a , SC t/a , Sec. 33 , T 29 N R /9 W, Town of decds00 n Subdivision an6 y s; Ode (/ / / , Lot # 3 . Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house no Lot lines identifiable e SYSTEM MAINTENANCE AND OWNER CERTIFICATION � Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms '7 / 0. Cka.. 9/ / 01 SI9NATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) , . o .1 . digit 0 _, . , ..... i', ,....- _ ------„- i., ..„:,..... , ......___ _ _ 0 0 0 0 111 ) 1 , ......._... „...._....... 1 , I .... -40 -4-) 9-.) - 17 ,k. I IIIV \. cS ■.7 e ol _. ii Ql --- V C) 1 4 t. .....- 1 ..,,,, ^ ■e) Y1 < ,",----- ,- ,-- - ICI i , - - -- ...._.... _ — i I o 0 _Q_ -Q _ 0 . .., .4--- ---). ' v... Larsen 4 bedroom Dose Conventional Pump Chamber Calculations 1. Force Main: Diameter 2" 1 Length 50' (,d Flow rate 40.00 gal. /min.± Friction loss 1.65' (50')(3.30ft./100ft.) = 1.644 ft. 2. Total dynamic head: Min. supply pressure 0.00' Vertical lift 6.00' friction loss 1.65' Total dynamic head = 7.15' 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge approx. 38.0 gpm @ 7.15' TDH 4. Dose chamber: Manufacturer & capacity: Wieser W1000/600 MR Comb. ST/PC - 51.00" @ 11.82 gal. /inch (602.82 gal. actual) Sizing: A) One day holding capacity: 33.90" = 400.75 gal. B) Alarm setting: 2.00" = 23.64 gal. C) Dose volume: 5.50" = 64.96 gal. (600gal.)(20% Design flow) + (.164)(50') = 128.20 gal. Max. Dose D) Reserve storage; 9.60" = 113.47 gal. TOTAL 51.0" = 602.82 gal. Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and - ---- -► Comm 16.28 WAC u ` 4 in. min. �.- Disconnect Tank component is properly vented Q-[:DE E-- Alternate outlet location f 1 _— Forcemain diameter Wieser W1000 /600MF Manufacturer Q 2 in. Capacity 602.82 Gallons Volume 11.82 gal /inch A Weep hole or anti - Dimension Inches Gallons B d siphon device A 33.90 400.75 B 2.00 23.64 d , Pump off elevation (ft) C 5.50 64.96 1 90.801 9.60 113.47 Total J 51.001 602.82 I Dose tank elevation (ft) 3" Bedding un er tank. 90.001 Alarm Manuafacturer Zoeller Alarm Model Number A -Pak Pump Manufacturer Zoeller Pump Model Number BN53 ce TOTAL DYNAMIC HEAD /FLOW PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERING 6 — 20 MODEL 53/55/57/59 w = Feet Meters Gal. Liters 15 5 1.5 43 163 >-- 4 10 3.0 34 129 0 10 15 4.6 19 72 7/5 ' o Shut -off Head: 19.25 ft.(5.9m) T.v 2 — 008837 0 5 3718 f..._ 83/18 45/8 112- 1112NPT 10 20 30 40 50 '� � � .-1 3 7l8 GALLONS 38,0 . 1 td, chse7. - `-,• ` �. LITERS I d .C�`i + �.Si // ERS 0 80 160 l 1 1: -5_�✓ �� FLOW PER MINUTE k•� �� ~ IlLY, 1/1110"4 i CONSULT FACTORY ! ! I FOR SPECIAL APPLICATIONS i i l • Variable level float switches available. , II ' llf.- • Variable level long cycle systems available. 1 A. .- • Available with special cord lengths of 15', 25', 35' and 50'. ' i i _ • Alarm systems available. 101/16 I • Duplex systems available. I I _,,' ^: ■_ — , a _�� ■- mil 1 1 I. ��'l • J i�� 3 r SKIM Single Seal Control Selection listings SELECTION GUIDE Yodel volts Phase Mode Amps Simplex Duplex CSA UL 1. Integral float operated mechanical switch, no external control required. M53/55 & M57/59 115 1 Auto 9.7 1 — Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55 & N57/59 115 1 Non 9.7 2 3 or 485 Y Y float switch. Refer to FM0477. • BN53 115 1 Auto 9.7 --- Y Y 3. Mechanical afternatcr •M -Pak' 10 -0072 a 10-0075. • BN57 115 1 Auto 9.7 • --- N Y • BE53/57 230 1 Auto 4.8 • -- Y Y 4. See FM0712 for correct model of Electrical Alternator. D53/55 & D57/59 230 1 Auto 4.8 1 — y y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. • Single piggyback switch included. I♦ cAunorr I Farinformaionmad66anszoeuerproduclsrefertocatatogon Piggyback VariableLevelFloatSwitches ,FM0477; All installation of controls, protection devices and wiring should be done by a qualified BectricalAlterra tor, FM0488 ; MechanicalAltertlator,FM0495; Sump /Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Control/Alarm Systems, FM0732. most 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. - MAIL 70: P.O. BOX 16347 �� ® /o�,A`- uislle, KY 4 02 58 -034 / /i/G+' /j SHIP T0: vi 3649 Cane Run 7 Road Louisville, KY 40211-1961 Manufacturers of.. ratan' PUMPS SAVE /939 / http9/www zeal /er com • PL/MP ! O_ (502) 7 FAX 31 • ( 774-3624 928-PUMP © Copyright 2004 Zoeller Co. All rights reserved. • 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 k e.-X , ro✓ C. c` ere-r) c✓ Loeser? residence located at: 4 f ' /4, se - '/4, Section ss , Town £9 N, Range ,'y W, Town of Actisan , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), Y to the best of my knowledge, will confouii to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service rz.3 /07 Did flow back occur from absorption system? Yes f No (if no, skip next line.) Approximate volume or length of time: gallons 30 minutes Capacity: Construction: Prefab Concrete i/ Steel Other Manufacturer (if known): Gc)ec s Co4Cr A °- • ank (if known): 4',J /983 censed Plumber Signature) (Print Name) 3Ct��2,/ (Title) (License Number) IMPRS 6/36/6 7 (Date) Form to be completed by licensed plumber (s. 145,06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) 7 SI7E.45 t � U 2822 P 999 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO. , WI Document Number Document Name RECEIVED FOR RECORD 06/15/2005 08:30A1[ WARRANTY DEED EXEMPT # THIS DEED, made between Karen J. Huftel f/k/a Karen J. Hanson ( "Grantor," whether one or more), KC FEE: 11.00 and Richard C. Larsen and Brenda F. Larsen, husband and wife TRANS EE COPY FEE: 807.00 FEE: ( "Grantee," whether one or more). PAGES: : 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property"): Name and Retum Address Lot 3, Countryside Village in the Town of Hudson, St. Croix County, Wisconsin. River Ile Abstract & Title, Inc. 1200 Ho .d Street, Suite 201 ' Hudson 54016 F t3 f- f so 020 -1148- 10-000 Parcel Identification Number (PIN) This is homestead property. (is) Exceptions to warranties: easements, covenants, restrictions, and rights -of -way of record, if any. Dated (O' I0' �005_ (SEAL) 1 _ (SEAL) * *Karen J. Huftel 8 (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on . STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on —1144‘ 10 • ?j°u (If not, the above -named Karen J. Huftel f/k/a Karen J. Hanson authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: � Brent R. Johnson - Lommen Nelson Law Firm * Hudson, Wisconsin Nota ' ic, State of My Commission (is permanent) (expires: / a/ h ) (Signatures may be authenticated or acknowledged. Bgle tttl[ necess4iy ) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS 't . 04,EARLY IDENTIFIED. WARRANTY DEED m 2003 STATE BAR OF WISCgfi j . � � FORM NO. 2-2003 * Type name below signatures. N0��t0 x800- 655 -2021 www.infoprofomts.com �,S 0 .. 3f a 1 N '-`i`t► 1 .� X � ' f y" X ca-'.-•-,-.. # ' � � � YC¢, r _ l h tt a 3 h , a+R 1 YYY ,yam .? y}.. g t ti Y w a y ! + `', ` 2.43 ACRES � {' x t . . , 1 { $` . ,. ,� .. t. •' . , , , , •• ' ... `, 2.17 •V . 4: o �je k ' . 4 Z ° ;; 1-:-- • ' «1S L� , f * J rf } 1 gA . r a .w + t s C `/� ' N ; ` a < .s ,n, c r ' w� roi rt x �• e�' }'tom :h � .`'4 Y� / Y r '� � �"' �� '��, .. a i.� r x�; *'� 3 �'� �4 '6"^*.- t, ♦ t .F S k 4 •�j % '3''.. �t y+ 'C Y 000 gt x a � • , iii z ; g'z .. , .' - ' ,- '.Ei - -- .--, ,:-. '. :--,_: :','''',w2;.-4,...*t -'`,,-;7* S 0 12 W 428 Op fi ya. +. 4b j y 7.::::,',.."4..T.:.=., rr, R+ t Via" 1.�r "` x ° '0 .P Y z t :t ' '-5- d\ ie,� ?2 ,.",•0'. - ..hY 4 t a , x �,�d g 15 a , �, _ - r ;.% � i �. , "' d ,�. y z fi t 4 >�" �� ,'� k A " gs a .t.,' ; i .� zv � ,� � t* s �. � _� s Sys �'' r £af � � q .r tl v +' $ } .r '¢ y rb _ Pe 9 y `'" r • y,'` .. ; ,'.} '';',‘'.'1,. `r » r " ,rte ` • Dose Conventional POWTS Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank 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. lithe 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. PUmD Tank The pump (dosing) tank shall be inspected at least once every two 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. Soil Absorption 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 not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) 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. Contingency 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 removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to Jim Thompson at (715) 248 -7767 or your county zoning inspector. a RECEIV D p a I. l AUG 0 3 2006 Wisconsin Department of Comrilerce ST. CROIX CO NIX OIL EVALUATION REPORT Pagel_ of Division of Safety and Buildings in ac Gordan • - with Comm 85, Wis. Adm. Code _ County Attach complete site plan on paper not less than 81 x 11 inches in size. Plan must S I C include, but not limited to: vertical and horizontal ref nce point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and • • lion and distance to nearest road. 02_ + -1/ L.-1- - - 0 - 000 Please print all Info ation. Revie • by Date Personal information you Provide may be used for seconda purposes (Privacy Law. s. 15.04 (1) (m)). / ✓`• 13 /U d Property Owner 'r Property Location / BRENDA LAl2S kI R, Govt Lot NE 1/4 3E1/4 33 N R 17 E(or Property Owner's Mailing Address Lq# - Block # Subd. Name or CSM# (''I Con.NTR.YSio6 $ ✓OL• 3 N E I City State Zip Code Phone ❑ City ❑ Village JZITown Nearest Road 1�1D t W) ( 5 t (•7/S' N u Dscvv C z) I Co✓NTRVs IDE C)rt eLP ❑ New Construction Use: [Residential 1 Number • bedrooms Code derived design flow rate 6 00 GPD ( Replacement ❑ Public or conmerdal Describe: `_ r Parent material 5 A Nay b v?'W Flood Plain elevation if applicable N/ ft. comments and recommendations: d /A'S 141'A 6 5 vu% e f S; i 4 L 1 Boring # 1,;.! Boring - ® Pit Ground surface elev. ;7.8"8 ft Depth to limiting factor) 92. in. Sod Application Rate Horizon Depth Dominant Color Redox Description y, Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 IbtR . 2ne r Vf1 C S 3v4 .to • 2- 2$ 7.5Yk 4 /(1 - 5 1 L C K m C 5 2 3 28- &7 ID YR. SI± - 51 ,0 ►mfr 0.5 I v-F .2. IF . 4.1 -q2 I nYR 5 /4 - S 1#4 -1 — — • - 7 I . (o I 2 ° " # bl aming 94 t G r ound surface elev. • �O� ft. Depth to liimIting factor ) 5 in. Sal Application Rate Horizon Depth Dominant Color Redox Desciption Texture Structure Consistence Boundary Roots GPDIf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I b -6 1 I n YR 2 /2 •Q 9 rnn bk ►)Fr 0.5 3 ■ • !f • 8' Z q.2$3 1 weft 4 /0 - tS i t^ / 2, rr tic i .1-i a. 5 .'ti 3 2S -9410 YA `I /41J — S 1 ni_ ,i r •. - . 2 .i A7 ( , 5 j A '-+" 8 Ate/ D I12REer o -412 Fov/l.' /Jo c T+}s'25 4=t2/7•)D. • ,kPPRox 2r " W / DE • I,/, //R OA Si L- . )nn Rcr/ oX m aSZ i ice. • Ell lent #1= BOD > 30 < 220 mg/I_ and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mgR. and TSS < 30 mg/L CST Name Prim) Signature CST Jenne,/ / /b -,• Cht LA — "59974 Address Date Evaluation Conducted Telephone Number 2_2')2.-- ! o ?' Aoe S ?2 0h V>w1- t.t.vr W) 1 d • 1-7 - a f -7 16 - 772.344 -2 ORIGIN _IG INA 1 Property Owner L a P3 o n Parcel ID # 0 2 - I ► `t"° -10 -4)(34 Page 2 of 3 1 3 1 Boring # ❑ Boring ® Pi t Ground surface elev. 4 7 57 0 ft. Depth to limiting factor 79 A t in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ( Rate in. Munsef Qu. Sz. Cont. Color GPD/fP Gr, Sz. Sh. 'Eff#1 'Eff#2 1 0 -1/ 10YR 2/I — ' 2 mcyr Mil e s 3 K ,to . I 2 II 1, vYR /40 - sic/ 3 m 6 m-f C s 9 v . <,L 3 3u- 0 - _ S l ni _ ‘ /Y1fr - _ 1 1 1 I # ❑ Boris ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description , Texture Structure Consistence Boundary Sod ff Rate lo. Munsell Qu. Gr. u. Sz. Cont. Color rxlary ROOD GPD/ff Sz. Sh. 'Eff #1 Eff#2 I I Boring # ° Bmi g ❑ Pit Ground surface elev. ft. Depth to buffing factor in. Soft Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary, Roots GPD/ff in MunseN Qu. Sz. Cont Color Gr. Sz. Sh 'Eff#1 'Etf#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 rng/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. sao l33ov 6AO) L 4 R50 1 P I D 02.0 - 11 `x -/v, 006 0 UciNTies /oE 44^/C C/.€& A =cot -n U L/ k.., , . I „_ 3o , al 82 2o> 9 4 /4(,, SYs - (..E\J= 9 /., C 7 -I-So 7o WEs? {� Rc.�PFR � - �/N E 11p' q�� 83 _ 950 10> ° t x /sT rN &-7 6 E 13 , 'ST /MATe!) LUL4 T/o."✓ 81 gM # 2- � -1. ►g oPUF0LD VENT coVE 2 10' A gM *I "TbPOF : 100 •c.o u'� 5) EFFUL- ni T � — 9 6. 5 ( WE 2e Z :' $ 200 NI Hv ras A -a cD 13 g 9 (1), .r Cm) 3 3 1 M M du — u O W C C W " N F�1 N N N O p p : rn 3 m W 5 2 ? co co.... O N a o o N 1 Og K O al 3 p a O g go o . C (O `3 C N a 9 N co .. W W N CD w Tolftm CO CO n I n r N I y w w (D 3 c z 0 'O 0 a a Ni) • Z O O O O l�l cn 'U w I o F C v o 1 - 3 m m 0 D c o O I 2 o a 7 o u• co o c N G C CD 4 91 1 w CD a Z C N O N C -4 53 • v a .. GI o j .. Z -� w I co CD m w z 0 3 � 7) G " z m 3 z m I f a FE • I \ 1 CA A 1 CT \ . • • i I .143 �0 CO EA ti CT O � p co ti • • • �C o ob o 0 0 a �.. u ci N 01) U a a o0 0 (29 0 N Ga C 614 .r o h N r • , A o 6 C Q a a a> o to u O • 6, 0 0 O 4 n N L LI1 O m 3 c g o O � c c C. 1 • ai f m o m w E E a od co co V) C N 0 0 ✓ � � .- V . A ►' • 1 t' a 0 • ••4 c3 O • o ... • c • . Q • o 'O c >. r U U '1 M Q\ r--1 0 > ) r\ o a) 0 s co a) ,.o ct W 3 - 0 b -O 0 c/) O\ 0 •r1 O 4) S . x U) P v JN ^ C4 p, 4..) CIO W 1 {4 4 P cn 0 • Z Z 0 .0 \ f+ A W 1 W N 0 A Z H 3 0 0 U H M M M u co N O I I ,--I a M U N P I (NI . I U co a) A • TS W W . r7 • co y W •rI N Z d n`� a , H a ^ a • ka o r1 Z . g`-)O H 0 • 0 4 • 0 N 0 ° ' o W a) [1 m • D v7 • b A 0 rd O w x V1 U Parcel #: 020 - 1148 -10 -000 02/23/2006 07:49 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.19.789 020 - TOWN OF HUDSON Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner O - LARSEN, RICHARD C & BRENDA F RICHARD C & BRENDA F LARSEN 649 COUNTRYSIDE CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 649 COUNTRYSIDE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.170 Plat: 0215 - COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 3 3 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 33- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 06/15/2005 797645 2822/499 WD 12/12/2003 748999 2473/409 QC 08/29/2001 655132 1708/620 QC 07/23/1997 1027/433 (c mor ... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 92657 260,700 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.170 75,700 190,200 265,900 NO 05 Totals for 2005: General Property 2.170 75,700 190,200 265,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.170 30,900 155,500 186,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 125 Specials: User Special Code Category Amount 018- RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 47 ' - ' 4 44 . - 77 , .. . ) S ..-- . AS BUILT SANITARY SYSTEM REPORT .... air N 4iir ' ' OWNER ,4/9/240(../ 4'i TOWNSHIP A4,4130A- SEc ..-33T ziR iel ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION eeMb 5/ 8 LOT SIZE •2 , 2. a, el‘e/e- , PLAN VIEW Distances and dimensions to meet requirements of 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - , . . - 11.110.101WAlaralrelliMill . . . . _. ...._ 1 • ' .j - 1(2 : / / 0 - ...._, , • . , , , ' . ' - \ A6111 , ' oto , , ' ■ • 1 . 4 , Indicate N■rth xraw , ... . - , BENCHMARK: (Permanent reference Point) Describe: P- Elevation of vertical reference point: i9,00 Slope at site: SEPTIC TANK: Manufacturer: Wea5 Liquid Capacity: ink, Number of rings on cover : L Tank manhole cover e1evation:I6NA,00 Tank Inlet Elevation: 11,4 Tank Outlet Elevation: _laig • 9435 PUMP CHAMBER . Manufacturer: AO Number of gallons 40 Number of gal. pump sec for a cycle Alk gallons; Total capacity of distribution lines A4A, gallon: size of pump A.0.14- head; gallon per minute Al/T ; horsepower /VA ;brand name of pump and model number AA A ; Type of warning device HOLDING TANK: Manufacturer 41/1 Number of gallons Elevation of manhole cover 4414 Type of warning device '/V/f • SEEPAGE PIT SIZE; y Number of pits il4 feet diameter l" t feet liquid depth A1/ seepage pit inlet pipe-elevation ,4//1.• . bottom of seepage pit elevation AJA feet. SEEPAGE BED SIZE: number of lines - 4 width 2:1- lengthZi tile depth 86 er SEEPAGE TRENCH: width /t4 length /11 PERCOLATION RATE ...? AREA REQUIRED '/5 AREA AS BUILT 4;72— , INSPECTOR . . DATED PLUMBER ON JOB LICENSE NUMBER /24 fo_ 5- . , IIIIL . .11 114( lir) &. ...... _ _, 0 -,.) S: I i 11 4 ., . 'i s-..1 c■N\ L:1,11— 0 11 , 0 r 14 ( A . W SSAT""4 IAA- — eir0 te--- r Cr ...,„ 1 , , 6itl nou , , I, - 1 ...„) ....,.., . pleA v.,t, 4 ,--- 4. 4, Lif i c\is-k-Evi aLl x "0 Vi I i 4 .• ‘ , f o \ ‘," . -• .., 4 c5 - . ..., s.......... 1 ° la ........... , 1 \ \ flif., Lfclet,L4 ,, 1 3- 5 iLL , loo .0 / - .. Nj 2 E.J., , A C z-44ErVe.. Q P" poi- ...4 ; -)e- 7 -4 A e.Pin i cirLd' 0 VIII . 4 , ,.....,. ,k ■ . DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING M 1DI WN :WI 53707 CCONVENTIONAL ❑ ALTERNATIVE ;at te P ID. Number: f assi ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: I N PECTION DATE �' 2 6 Harland E. Huftel Countryside Circle, Hudson 57:3 i ,A, AJ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT/ELEV.: NE NE,Sec.33,T29N- R19W,Lot 3,Countryside Vill.,Town of Hudson Name of Plumber: MP /MPRSW No County Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 38492 SEPTIC TANK /HOLDING TANK: / MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLETEEV.: WARNING LABEL LOCK G COV' �' 1 ( ^ 6,3 n P Y E S PRO •ED ' t/ / f� ^ ( � / O s�+ Y ES ❑NO It = ❑ O BEDDING: VENT DIA . ( VENT MATL HIGH WATER U 7 ERKIP E ROAD: PROPERT WELL BUILD G: V NT TO FRESH ALARM. LINE: AIR NLET: BEET FFlPl{A ❑YES i_ ❑ YES ❑NO EAREB ° ° ► C � 5 /� DOSING CH R: MANUFACTU R: BEDDING LIQUID MP MODEL PUMP /SIPH MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED El YES NO P' ❑YES El NO ❑YES ONO GALLONS PER CYCLE: . CONT BLS 9P£' •TIONAL B R O I` LINE ° PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN f FE F RM AIR INLET PUMP ON AND OFF) m . ES ONO NEAREST'' *' SOIL ABSORPTION SYSTEM. Check the soil moist a at th= depth of plo ing F ° LENGTH DI or excavation. (If soil can be rolled into a wire, col truction shall cease ntil MAIN . the soil is dry enough to continue.) CONVENTIONAL SYSTEM: ®®� y� "' WIDTH LENGTH NO. OF DISTR. PIPE PACING. CjadLER'' INSIDE DIA.. . ° ie�F1 / TRENG4IGS.. MA T RIAL' #PITS LIQUID ' PIT DEPTH: � T .� K] // RT GRAVEL D TH DEPTH L IST. PIPE IOISTR. PIPE IDISTR. PIPE MATE' IAL: NO. D R* QF" : : EN BELOW PI S AB FILL OV D V V R INL T E ENDPIP , F EET FRO 4)PLF.10PER AIR T TO FRESH I `�. �rI7s,�� 227 NEAREST.. to` / WELL f BUILDING V � � y TY MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material f- PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound r 1-ms to make certain tr . ON REVERSE SIDE. SHOW ELEVA- mee rteria for medium sans TIONS MEASURED. ❑YES ❑NO SOIL COVER 'TEXTURE ill , r ERM AN EN MARKER:- ES ONO OBSERVATION WELLS ❑YES LI NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED aEP H OF TOP OIL SOr .ED. SEEDED: MULCHED CENTER. EDGES: ❑ ES •NO ❑ YES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: tl r`WIDTH: LENGTH. ∎ RE O HES: LA ERAL SPACING GRAVEL DEPTH BELO PIPE: FILL DEPTH ABOVE COVER: ENSIONS °. "... MANIFOLD PUMP ANIFOLD D ISTR. PIPE MANIFOLD MATERIAL: O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &MARKING: ELEV.: ' .IA.: , LEV.: 'IPES: DIA.: E LEVATION t AND DISTRIBUTION , 114 . #01441,3014 `• _ HOLE SIZE HOLE SPA I ■G. DRILLED CORREI TLY OYES ❑ COVER MA ERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. NO OYES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBS vOF PRO WELL: BUILDING: "`E^.'ET F� ' LI NE: 3 OYES ONO OYES NI NO f41ARST.' -- g. Cy° Gr S - I G = 1 I A 1_0 6 1,6,1 gcf.ta 453 9 or` 17)7. °/ G 9 7, G e .5. 1# s • Sketch System on l 2_ r?) Z ° tr A ,) , 01 o ' etain in county file for audit. Reverse Side. � 2 U Vv SIGNATURE , 01 TITLE: DILHR SBD 6710 (R. 01/82) '-'l S cli W'S` °nevi APPLICATION FOR SANITARY PERMIT D ILHR .. /oZ .COUNTY (P LB 67) == DEPRRTmE?TOF UNIFORM SANITARY PERMIT # IrlOUST j LRBOR & uumRfY RELRTIOne .-iff 411 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT . PROPERTY OWN R M LING ADDRES J U( L.4 T c PROIPERTY LOCATION For': pEuiti a /4, S 33 , T2IN, R 0 (or) W T OWN : if ad$ LOT NUMBER BLOCK NUMBER SUBDIVISIO NAME NEAREST ROAD, LAK OR LANDMARK STATE PLAN I.D. NUMBER 4 3 _ ow? Pi sae W G ist#ify Ci ta" r TYPE O BUILDING OR USE SERVED Ad , 0g4 - lJqi--1 _ p Go 1 or 2 Family Number of Bedrooms: LJ Public (Specify): THIS PERMIT IS FOR A: Ltd New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF T p9 p HIS S A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Ti t See a e Bed ❑ Seepage a 9 Seepage e Trench ❑ Holding Pit ❑ Holdin 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 1 p g d i f� Lift Pump Tank /Siphon Chamber AT t Holding Tank capacity N Manufacturer: Ili/ A ft S c M 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 Wit Lift Pump /Siphon Chamber N,*' Manufacturer: AM, PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): �, 3 r I�Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plum er (Print): Sign e: MP /MPRSW No.: Phone Number: 1 Plumb Pew 's A ddress: Nam of Designer: 't WO 14, 1d? it 644 �1 ($ ri ®/7 0a4f it0 Mite's COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �-�,� �p �A� t - 4 2 3 „ 2 K ❑ A dver wner Given Initial �a • P 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 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 perm it; 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. H 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS 8 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 O • : ty- l 6' ( t) t LOCATION: NE %, NE 'h., Section 33 ,T?9 N,R 19X (or) W, Township-or- Miinisipality Hui Pi Ito , Block No. - -- Countr Village County S ' ' Lot No. , e <4 Subdivision ame �,� Owner's /Buyers Name: Mary F3 kens 0"� 1001 Li Lane, Hudson, WI 54016 1 `' Mailing Address: > > , TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 4/25/81 PERCOLATION TESTS 4/25/81 SOIL MAP SHEET 66 NAME OF SOIL MAP UNIT Sattre PERCOLATION TESTS BOTTOM OF HOLE ELEVATION 93.0 TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL - MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P -1 50" 8" Bl Ts, 36" Bn L, 6" cs & Gr 1 NONE 5 3 1/2 3 1/4 3 1/4 < 3 P— P 48" 8" B1 Ts, 36" Bn L, 4" cs $ Gr 1/2 NONE 5 3 1/4 3 1/8 3 < 3 P— P 77" 10" B1 Ts, 46" Bn L, 21" cs f Cr 1 NONE 5 3 7/8 3 3/4 3 3/4 < 3 P— BOTTOM OF ORIGINAL BED ELEV. 93.0 BOTTOM OF AT,TF.RNATF. RFD F.T.FV_ Q; f) SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, GROUND TEXTURE, MOTTLING AND DEPTH TO BEDROCK ELEV. NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B 1 90 NONE > 90 8" B1 Ts, 34" Bn L, 48" Bn cs & Gr 97.5 B 2 82 NONE > 82 8" B1 Ts, 34" Bn L, 40" Bn cs & Gr 96.7 B 3 113 NONE > 113 10" B1 Ts, 50" Bn L, 53" Bn cs & Gr 99.5 B 4 102 NONE > 102 10" B1 Ts, 44" Bn L, 48" Bn cs & Gr 100.6 B— 5 96 NONE > 96 14" B1 Ts, 36" Bn L, 46" Bn cs & Gr 100.0 B— 6 96 NONE > 96 7" B1 Ts, 41" Bn L, 48" Bn cs & Gr 99.3 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 945 sq. ft. Bed _Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. - NE COR. k NW COR., t ' 1 . _ _ e 1 , VS � LOT ,3 3 - � ' ORIGINAL s , , 3 00 v E � 2 i LOT p �2 P i , a i, ' i 5 i j 1 � i � _ _ : _ T h � E _ , i. ' I 1 ini f N I 1 Ill ' III r ---, iss ,- , . , I -1— , , , 1 4 lt! 1 .-- f gym. , , t , . . - / i - - 1 e __ . i 0 '. I ,._ 4 r 11, l , _,,, ., a S 1 ; � I, the undersigend, hereby certify that the soil tests reported on this form were made b I' - in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location o t holes are correct to the best of my knowledge and belief. Name (print) FRANCIS H . OGDEN Certification No 565 Address 123 E. Elm Street River Falls, Wi. 54022 Name of installer if known . Copy A — Local Authority CST Signatur As- -, . ` .- �., • Form - S 1 C 100 Owner of Property r r E U ( Yyxreq. , Rt l - 1 f A IV .Location of Property 1- 1 JVF 1, Section 333 ,T aq N R 17 w Township t'rlilb • Mailing Address rk)baQ. ( ) etra j-ktkdr\ , UAL SZ4 (j 0 Subdlvieion Nam f O(kYNtr-t.►S;CiP VI IIGgL. • Lot Number Previous Owner of Property fnotrLi C KenS Total Size of Parcel I (a ►(fr-q Date Parcel was Created viirie ) r (q1c Are all corners identifiable? `r\ Yes No Include with this application one of the following: . Certified Survey Map peDeed• .Land Contract, or . other Legal Document which describes the property PROPERTY OWNER CERTIFICATION 1 (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No 335 td 1 ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Qs51a.1 ). SIGNATURE Of OWNER O a � SIG ATURE OF C 1 ( AP PL.ICAB<_Ej 0 r q &� DATE SIGNED DATE SIG D I • DOCUMENT NO. ,'F ' i r STATE 13AR OF WISCONSIN —FORM 2 ^)5:( VOL � FAGE1� WARRANTY DEED THIS SPACE RLSERVEO FOR RECORDING DATA 4 T ' ' Mary C. Eikens REGIVir :RS OFFICE ST. (.. CO., W16. Rec'd. for Record !f"ts 3rd day of June A.D. 19 83 conveys and warrants to Harland E. Huftel and Karen 3, Huftel, husband and wi fe as jnint tenants at 9:30 A , M.. Rook:or of DocJi RETURN TO ' the following described real estate in St. Croix County, State of Wisconsin: Tax Key No. _ • Lot 3, Countryside Village, located in the Town of, Hudson.. • Subject to an easement granted to Northern States Power for the installation of underground.electric utility lines and appurtenances, including a small pad mounted transformer, limited to that part of Lot 3 which lies within 10 feet, measured at right angles from the right of way line of Countryside Circle, as recorded in the office of the Register of Deeds for St. Croix County, Wisconsin on December 2, 1981 in Volume "638 ", Page 521, Document #374721. .__. - TRANSFER $_ /_P_.� -- • . I I This is not homestead property. (is) (is not) • Exception to warranties: Subject to easements and restrictions of record. Dated this 3rd day of June , 19 83 I 1 (SEAL) M c r). C t . �1,_n� �� (SEA!_; ar j Mary C. Likens (SEAL) (SF Al..; AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this 3rd , of STATE OF WISCONSIN ■ lone , 19 — .8.3 l ss. County. ..:' "t.:71.._.-- �+- A---e_- Personally came before me, this day „( * William J. Ro the above named - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 706.06, y § Ms. sacs.) Till:, instnimcnt was drafted by - - -- � I W_ l 1 fn j. RadoseViCh ____ to me known to be the person who executed the fore- Attorney at Law going instrument and acknowledged the same. Hudson, Wisconsin 54016 (Signatures may be authenticated or acknowledged. Both *_ — are not necessary.) Notary Public County, Wis. ' `• My Commission is permanent. 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