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020-1441-78-000 (2)
r County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division " INSPECTION REPORT Sanitary Permit No: 430626 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson Township 020- 1441 -78 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No 1 - D qc U efil y hu doi.PJI,cbic/ VAX- ? I i i 36.29.19.2804 TANK INFORMATION ELEVATION ' ATA TYPE MANUFACTURER CAPACITY ` STATION BS HI FS ELEV. �r chm4,. S/,t,k) Septic �U ci d � r �Q,QQ,� , b S z---- 2S� )1-64 / 5 O Dosing / 6 v Alt. BM �' 95 OS Aeration �i Bldg. Sewer / , , ,,,,,,r, al A . Alb" r scyyo /2,c9 81,11 Holding St/Ht Inlet / a / l3 Y /3 -of 27 TANK SETBACK INFORMATION St/Ht outlet G -1 ----- TANK TO 'P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , 1 N 3: 2 � / n t / ^L s Dt B tto i h c � On )Rv �; - /o /(•J g 3.5 ) Dosing > 21) Header /Man. c S / / h .., e.ql w•sy Aeration Dispe Holding Bot. System i /1 `' /1. tIr Vt• ti PUMP /SIPHON INFORMATION Final Grade 52 Ida •ei_ s- . il Manufacturer ' / �� /' Demand St Cover G� / �YY✓GR�(�G GPM yam/ 5 I Z cis, D S Model Number 3 Q VS 5' I " S.og °tS 17 TDH Lift Friction Loss stem Head TDH Ft G ' / VS- /V s A & r _ cufi-a�f- 3.2g '7. 0 Fordmaip - . Len & 2 J Le f Dia. u D' t . to Well _ p / r j - SOIL ABSORPTION SYSTEM C�u�.e� C�ra�k..�.>o/�r/ — /7 dot- eGt,eie.6 Nett) ,,„...„&"6 BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 i O ' SETBACK SYSTEM TO o P/L E BLDG WELL LAKE /STREAM LEACHING M a ct L am / INFORMATION CHAMBER OR j ► J r Q -G k -r p O Tyf System: U 7\ ^ 1 5 / > � 5 , 1\ UNIT Model Number: DISTRIBUTION SYSTEM �/ / Q,( a , ��, .:= G Gl an/21-A/ Header anifold Distribution x Hole Size x Hole Spacing / enf to Air Intake 1 / / Lt pi / ) 7 .S Dia 7 Length Dia b Spac 1 Length ng 1 1 _Jy` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only S Depth Over , ,, pn, Depth Over h xx Depth of xx Seeded /Sodded xx Mulched / f ..v ges Topsoil B ed /T renc Ed Bed/Trench Center (0 (J -- v p� Q� Yes No Yes No COMMENTS: (Include l cod"e discrepencies, persons present, etc.) Inspection #1: / ,2 / Inspection #2: / / Location: 655 Mary Jo Court Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge lst oof 7 ', f/ Parcel No: 36.29.19.2804 1.) Alt BM Description = S1 CO vex. >N/� j a y t. 1(,(.d T Gt 51 .Jed / I ?i i n 4 i 2.) Bldg sewer length = 20' ' �7 a 14 l }7 Q kX o-yt JD tjt-,:iz- , - amount of cover = 765 b 8 2. -� 12te 1 y. 5 „Ca , z V'.wti' so i s 44 , �rtsFu'`, Plan revision Required? Yes No y / b , �, / , f �C� Use other side for additional information. ;_ -_!_ -L_ -_ — __I 1l/t!Yti �!�f / Date Insepctor's S nature Cert. No SBD -6710 (R.3/97) • A 4 r Co.mty S Safety and Buildings Division C ' 201 W. Washington Ave., P.O. Box 7162 r t f V S COI1 SI f Madison, W 1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266.3151 �� Z� Departme of Co mmerce PIanLD.Numb Permit Application in accord with Comm 83.21, Wis. Aden Code, personal iformation you provide OS L s15.04(1xm) Project Address (if different than mailing address) . may be used for secondary Pe�°fCf Privacy Law, # 65-5' Abell tT«s Gov g T 1. Application Information - Please Print All Information Parcel Lim q p Propeny Owner's Name C �� � �� A da F r RECEIVE 0p y 1- ovation Property Owners Mailing Address ��, ,Q n 1 1 8 y�4'� f r� c e F- 2 n 2004 $6 /, A)1,01/4, Section 34 Zip Code Flame Number City, State circle e) /P 54 tfdG�FFIG T- °--iN' R Eor 11. Type of Building (cbeck all that apply) Su vision Name a m Numb�r 1 71 or 2 Family Dwelling - Number of Bedrooms ' A' n t ( K� ooe _ , /❑- Public/Coa nercial - Describe Use 2 t III';iAI ❑Cis y Ulagy�u of _�!1 r ✓ oV z ! ❑State Owned - Describe Use /�[ r'r ��7 """ ' Gb � �, (� O PP TZ 111. Type of Permit: (Check only one box on line A. Complete line B If a livable ) O2 / t I t) A. fir New System 0 Replacement System 0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System f ,.– . - F ✓list Previous Permit Number and Date l ued e of o Permit Transfer to New B. ❑PermitReoe 'Permit Revision ❑ Chug / o j Before Exp ton Plumber Owner 430 6�.( 23 03 1V. Type of POWTS System: (Check all that apply) a Pass Sand Filter ❑ A Non - Pressurized In-Ground 0 Mound > 24 in. of suitable soil 0 Mound <24 M. of suitable soil 0 At -Grade Single Constructed Wetland 0 Pressurized In- lding Tank 0 Peat Filter O Aerobic Treatment Unit 0 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching ❑ Drip Line 0 Gravel-less Pipe 0 Other (explain) V, Dispersal/Treatment Area 1 or•matlon: s Dispersal Area Required (sf) Dispersal Area Proposed (sn System Elevation Design Flow (Bpd) Design Soil AppTi�`on Rate(gpd n pe O Manufacturer Prefab Site Steel Fiber Plastic Vl.Tanklnfo Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or.lL+Wing4nnk woo woo ' 1 I. P g r - ei 1 - Aerobic Trestmcn Unit Dosing Chamber ' • &MU-0 Al N____ 11 U�t Statement- 1, the under; • ed, ass ., nsiblllty for installation of the POWTS shown on the atta tans. MP/MPRS Number B Phone Number 7����,� Plu s Name (Pr 60 L PI ,. , %s S� to L -I �Z 'C l Plumber's A (Street, City, State, Zip •• � L /n�-� CEO1 '748• 'zit " etayiet ct (.c)x VIII. County /Department Use Only 1'e` .proved ❑Disapproved - Sanitary Permit Fee (inc t yes Groundwater Date Is ued 'sling . -ent Signa e ( 0 Stamps) Surcharge Fee) �� • it ❑ 0 - et Reason for Denial 1.0 4 • - 1X. Conditions o' ApprovaU 'exsees (JtS/ - Ovl ap o� .� �� � n 3 41- a -- 4r-- (�Q�"w` , / fit-. -6 Attaeb complete plans (to the County only) for the system oo paper not Less than 8tt2 x 11 lathes In else SBD -6398 (R. 01/03) • T.L. Sinz Plumbin g Inc. 1 1 E5609 708th Ave. / �� 2 Phone: (715) 235 -2644 Fax: (715) 235 -2592 715 Menomonie, WI 54751 ��� �� N ti MO 31 ? 9 ii'ln) www.tlsinzplumbing.com AM D I v � ps4-I � 1-ar78 oo� � , s r f A 1 r 'i 0,,) ��Nw y /\ / / WAS , , p0 t G O" , ' � 0 3 \ / yr a t l o ,ue S za 0 Ldp AI' 1% q sS- ‘00 lot �,�.F ( ., Z' 7 0 1Or� Il k t s 4 / 7 ` J L I,6 4 'b) \ \ 1P ' • • o' kAfi A k e Ti ` �� � S 1 ST. CROIX COUNTY r-, " ..,\ WISCONSIN f+�"' ZONING DEPARTMENT . �-` � ` � ST. CROIX COUNTY GOVERNMENT CENTER ,' a ir / / M / / N ■ M • ■ —'�� 1101 Carmichael Road �' =± . — 1 ' -, , ��� �;Ijili�ii., Hudson, WI 54016 -7710 �;,.�. '�' ' •�! ' 64,1 ~ r. /� ' Phone: (715) 386 -4680 Fax (715) 386 -4686 • www.co.saint-croix.wi.us __,____ _,.....--- _ Fax To: ( From: 4 OVA y>�/4� 7 Fax: ( l0 — 2 5 Pages: 3 Phone: - 7 ‘,.,(0. - D' 7 1 Date: y 3/Q 1 Re: ) I o ( 4. 5 CC: ❑ If this box is checked please submit a check for a $5.00 fax fee made payable to "St. Croix County Zoning" along with a copy of this fax sheet to St. Croix County Zoning Department, 1101 Carmichael Road, Hudson, WI 54016. • Comments: ` 4 f 4 , 1 w �fi�l y wa yam -i.6vv 4€ -1 s -AaAite. Ltzei., 614,a--/ fdri- /1 / / s . WI Aad JD de- - a—at/a -eitr / . / s e tex, �- l e-�" 4i (o � t,f,i, ' G�� �-�Ce�'`-s m Azi -4411- Pai 17_t.G11 0 way - s4 - guile ug 1 1 0 r - )24/ , l- .�-i- .g__ az- Shi a 4.eio l wad/ ca al SA wa.A /of eepiryti,e, / d Atatie *Mit- b t4:_rizt-ilt-itvh: y tu-e di-catZ 4 - - e - el i di;-- -- it - (141 .,,1,a€4 46} Q.da4 dig 04 ao , cGv�.e- �u - l Sh y a 1_ SG(,�liY q t ��SwZ -�- 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County e to (. ), 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. ) �d - /'/'/ 72-60 Z) Plea = priy e , . vett/L - e ewed by ' Oat= Personal information you provide : y be used for secondary purposes (Pri = cy Law, s. 15.04 (1) (m)). I! _ v $ 2 0t9 ) 4 Property Owner Property Location k C ( no atot �" b 1 6 2004 Govt. Lot 5F 1/4A/4j 1/4 S T N R or E (or ut i Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# T CROIX COUNTY ■ it .DINING OFFICE 7 0 (Noo• / bl• I -_...,. City State p W: •e • one 1 um• : ❑ city ❑ Village ® Town Nearest Roa. va5o WI 0/ , ( ) •. • m/. - Oct ® New Construction Use: Ea Residential / Number of bedrooms 3 - y Code derived design flow rate '/So /6 00 GPD ❑ Replacement ❑ Public or commercial - Desaibe: ✓1 Y. Parent material 4U k Flood Plain elevation if applicable r/ A"/ 4 � ft. and rek rrrmendatiorrs: sy ..SL +''‘ k • (0. 00 / a c ..c / . CJ' q l Boring # ❑ Boring Q / ® Pit Ground surface = ev. ( 7.90 ft. Depth to limiting factor 1: in. Soil Application Rate Horizon Depth Dominant Color Redox . _ = Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i = — .‘t_ - J 0s 1yr 11'i11111 Z — - d – 1-. S WM yr‘Cr C,5 - NB / Z d i ,4 IIM43 01('113 QinAlf V /(_ S L 2Pk mfr C5 - ...s . 9 q -I, 1 -rPYllp .S 0..s ,.vt t - _ ,7 /. Z --- 4o •c ��_ c / S / °• ■IIMP Boring # El Boring ! o �, i QSI Pit Ground surface = :v. 7. 7 Oft. WI . ting fact. _124_ in. Soil Application Rate Horizon Depth Dominant Color R: , ox Deskxipti • • Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. S . -• . Color Gr. Sz. Sh. *Eff#1 *Eff#2 nil I ll 1EI M' �F 1T�l� - ' 1 1 EIN 'Ili - v 6Mani e! > - -s MI =UM •LID - MOIMIXEME - - • /io • Eng • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si! ture �/ CST Number ..s .s. .e r %/ . _ ��33d Address / Date Evaluation Conducted Telephone Number 0-4s 8(3t` , `S11 4.1.5 1- 2 -0 y 7 /S - 7Cra -a0-7g o k L!\ Property Owner F //\ Parcel ID # Page Z of 3 Boring # ❑ Boring Pit Ground surface v. f6 • S O Depth to limiting factor / 3/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 (›-1L nyr3(3 - -SL .,71r75.b/ mfr C5 l ,, , 2 - fig S >ins j rr'-�r. . �.S —. 7 A z / 3 tmtd layr 1 / 3 . G1 y , y / r o sL Z n / n'1-(r `{ to - f l o y ri/( — 5 a_s kn ( — - I er 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/ff in. Munsell 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/ff 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 < 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. 580.8330 (R.6/OO) PAGE Z OF3 NAME: &5-I- LOT# 78 LEGAL DESCRRIIPTION:SC 1/4 1.041 /4,S36 /7 E(ar W 4 SCALE: l "" 70 w\ ELEVATION /0 0 . 0 [111',4 BM 1 DESCRIPTION: d tc.¢ 'r G y BM 2 ELEVATION: BM 2 DESCRIPTION: .....- SYSTEM ELEVATION: fa a 0 ; SYSTEM TYPE: Co Au c r∎-t-.% c) -.0..-( il 0 pp 4 ' -7 ° <T 1 Q ) 1 5 9 - l‘ \ . . C-vad 4, ' I . / ; I � � C k/ s\ b el 40 SIGNATURE: /4 _ DATE: / " -' "c `/ VI- i 7 T.L. Sinz Plumbing Inc. E5609 708th Ave. /44/10k/ % Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 t M) 31 ? 9 /71 www.tlsinzplumbing.com L 7 ��. e Nw�� ? 4E 4 r, o �.J / /'t' ,, ,,,,x p0 4e ,, i( 2a ,„,, ,,,,, ,...6%,,,,) 1, „1/440 r„ ro ,- , �n, ,'' ,,,A , fz- it; s - ‘ 4 60 titi d X45" -b) \ \ V • ' do 1 `?, 'FROM 1 CERTIFIED SOIL TESTING FRX NO. : 715 233 0398 Jun. 14 2002 @5:52M P3 . is. . ,‹ 7. . 1:: X i • I`1n1K 1 W a: A'Y4 E R PRo . .JU•CTION LACKING COVER GuIcK Psac.Qh %ICf —\ i ,�1,4, ° ^�>� . ; . _ _ b > 1' I+, 1 ...,, • 4 3 •-•-- ,. �.. i7r, ,/7 T 4, n s.4 • _ • ' Puc 1 4. * G1Pt 3' . IQ NDIbTLJReE0 � 4" 40 t $O11.. 24' Z.A. � VJ: M1)tu0J.E J • -• t . , E - ' , milL • 116 I /MLA r • _ � uc�. i / 4 " P� . i App..... I + 4 n (ET 30100 FL S 1 AL , i 3' oar0 Pi". 4 Z •� ON — A I v ��w c- rtEtTlOi•l..S C T "`/ - .i., �\.? 4 ' • [` \ ` u- {1i.1U*+0 wT `Y - 60-" I 1 1t\ �4� :M O ` 11 > ----- O‘P A I a 4 , • , .1 .--- „„ , t ,„„ J t a+ . ' „ . ._...1 bk•oGC SEPTIC f A 5PEG 6.--- 0 T Aw.,5 LAI UFACTURCi'(,: l- c• � 1.JLSMSER OF 004E5: _ PER Ow TANK SIZE: (t flA M trams *ALLOWS • .00SC VOLUMC - ALARh1 MJWLJF/►GTIJ>�1wR: S r V1 �c.Irv, INC LUO1RiG SACK FL 10 c...,..,,, "O0EL uu cR:._ . \ ° 1 w �. .... tAPAC T S; A le a ►JJCH(S OK " GALL.OuS 31wITGH "'dn.! S ti. b 6 G IkiGMfS OK GAL,LDUS PZ,lMP !•1AWUFACTURG Pi: . #42/I7 1 / _ Ca i1JOIES OR � LA�L.CL:S 'r MODEL. ■JUMDE,R ` : 5HP DIN 6 4+4: 4ESCA �R N5. L3, 5W ITCH T kiPE: �' ' ''" "• .Vyr : PUMP Aw0 ALARM ARC ra b C 11 a� INSTALLED 0 SEPI.0. C4K ATE C:.IT MIL+I1P11Jt". 0IS4►M.1R4E UTL, ay C Grin / yERTItAL DIFFERCiLICC btrWCt1J Pl1MP OFF AUD DISTRI UTI4l PIPE.. l 1 FEET + xIl.1LKUM AJcYWORK SUPPLY PRC UR 11''�� >: // _ fi FELT � - + r�� ,FEET OF FORtr moo,' X �� F ,�6p t r ;F>K1CTlau fALTOR.._..- p EC S r,... TOTAL OSIJAMIG. HEAD . 1/140 Ff.ET LITERWAL AJ1�1ElIati a TAUI.: L� , \ � _ ;W OTH y ; LIQUID DE 1.4 PaI...c 6 ...._ • ". ' . .. Pump runs but delivers only Motor runs for short time then 3. Pump impeller may be small amount of water. stops. Then after short partially clogged causing 1. Pump may be air locked. Start period starts again: Indicates motor to run slow, "`J and stop several times by tripping overload caused by resulting in motor overload. plugging and unplugging cord. symptom shown. Clear impeller. Check vent hole in pump case 1. Inlet in pump base may be 4. Defective motor stator: return for plugging. clogged. Remove pump and to Authorized HYDROMATIC 2. Pump head may be too clean out openings. Service Center. high. Pump cannot deliver 2. Impeller or volute openings water over 24' vertical lift. may be plugged or partially Horizontal distance does not plugged. Remove pump and affect pumping, except loss clean out. due to friction through discharge pipe. I I 3. Inlet in pump base may be ,I clogged. Remove pump and clean out openings. I 4. Impeller or volute openings 20 1 may be plugged or partially plugged. Remove pump and '�1 ;p, 111:i N — 2 clean out. 1 9 tii'IA , -- 5. Pump impeller may be ,� 4 1 • _k ill's \��\ partially clogged causing � �_3 motor to run slow, resulting 16 , � r 1 in motor overload. -, � sl 4 Clear impeller. 15 1 1 5 '.O,% _ 1 Fuse blows or circuit breaker 14 i � cl;,•,. �� 0 trips when pump starts. _ %∎���`=w�� ,`II 4Ik\X ' \.,& ■ ∎ 1 Nj iii ;,, id l y - viii _ i \ �, � 1. Inlet in pump base may be 1 r�G�. r.ataP� � k 1 - 1 12 13 1 illi 1 clogged. Remove pump and ' 1 \ - 11 � j\ 8 clean out openings. 23 22 21 10 \ ■ 9 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and SHEF30 Performance Curve clean out. 3. Pump impeller may be 9 — 30 partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. a - 20 4. Fuse size or circuit breaker is too small. 5. Defective motor stator: return 3 — g- 10 to Authorized HYDROMATIC Service Center for verification. 0 0 ',mi../ CapadlyU.S. G.P.L. 0 10 20 30 40 50 I 1 I I liters/Second 0 1 2 3 4 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety arlci Buildinq Division INSPECTION REPORT Sanitary Permit No: 430626 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson Township CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 36.29.19. 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 I 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 E Yes ri No h Yes ` ; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 655 Mary Jo Court Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 1st Lot 78 Parcel No: 36.29.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required ?i Yes A No Use other side for additional information. SBD-6710 (R.3l97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County S �D �� 201 W. Washington Ave., P.O. Box 7162 \*Is'colisin Madison, W P t Number (to be filled in by Co.) (608) 266 3t z� `�o� Department of Commerce State Plan W. Sanitary Permit Application r0o3 In accord with Comm 83.21, Wis. Aden Code, personal informat»n you rite (if different than mailing address) may be used for secondary purposes Privacy Law, s15.0� 1 Xm) Proje t Address (' r ST. CROIX (:eft %..: ■ r @ • 1. Application Information - Please Print All Information *Pam ZONING OFFICE ( Al. ' 55 Irby ,0 C ALIZ ' Parcel # t k Block 'N Property Owner's Name / n PS S Property Owner's Mailing Address Is ' l if 8 �, xeg i. ;; iad �h, Section 6 4/ City, S e .b ff C Zip Code Ph / one Numb r p / q p( . y $ 7(S - /� O , "'� / N; R' / c E o 11. Type of Building (ch all that apply) /, •k� ' 'vision Name CSM Numbs I or 2 Family Dwelling - N • of Bedrooms ��� ' 6 ' � rt W 1 fi �, , ❑ Public/Commercial - Describe U• t sir ��WVv • 2 3 ' . ( 0 r - -� - W ❑City_❑Village JeTownship of t /6. ❑ State Owned - Describe Use n!' ; y /" ■n 2z 111. Type of Permit: (Check only one • on line A. Complete line B if applicabl 7 A. *New System ❑ Replacement Sy ❑ Treatment/Holding Tank R.., ' meat Only ❑ der Modification to Existing System - •st Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ■ Change of ❑ P. ' -. •t Transfer to New Before Expiration 0 11 , 1V. Type of POWTS System: (Check all that apply) ❑ it > 24 in. of suitable sot ❑ •.d < 24 in. of sw e s ❑ At -Grade ❑ Single ilter Nov - Pressurized In-Ground ❑ MQund Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank • 'eat Filter ❑ Aerob' talent Unit ❑ R- - ting SAg F Aecimulatirr- S • thetic Mafia Filter ❑ -: •' • t Chamber ■ DEL R. ❑ Gravel -less Pi. ❑ ', • •. _ ∎ J V. Dis.ersal/Treatment Area Information: .2,1' • - co +Reiff [ M�∎ =' t tr D41? Flow (gpd) Design Soil Application Rate(gpdsf) rsal Area ..uired (sf) Dispe ' (� .. G 3 4: J 9. . _1 pjmiaihilia ,rte VI. Tank Info C Gallons m Gallo s ' - •struct V. r Plastic I New Exininy Tarka ks A I. Septic orb' Moo Ter L t=om rANIIII� drs d AIIIIIIII Aerobic Treatment Unit Nth _ __ 1111 101i IA Dwinx Chamber VII, Responsibility Statement - 1, the under ponsibWty for Installation of the PO S shown on the a ched p .s. PI MP/MPRS Number B • • ss P Number Plumber's Name (Print) '' ell /5 ek Z 2/ - 43f 6 Z sac o.»LS..vv - z ' I Plumber's Address (Street, City, State 'p ' 4e) 6 g 0 70 S M{ / 402/4✓ Gilt' S II t/ VIII. County /Department Use 0• . Sanitary Permit Fee (includes Groundwater Date Issued ■ su• g Agent Signature (Ns Stamps) tit Approved ❑ Disapproved Surcharge Fee) 1 ❑ Owner Given -. .. for Denial $ 3U _— Dec. 2.3 1-ax) '� ' _ 11 / IX. Conditions of ApprovaU' asons for Disapproval 3\ S't!M^ c�f °` I T/ So .�1!! — IecAAM2C) SYSTEM OWNE / l fdz4 °mil 641- = " ' ill. t • 1 Septic tank, e'tuent filter and - , . I ''. q� Q, dispersal cell must all be serviced / maintained U as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) Cot the system on paper not leas than 21/2 s I I inches le size SBD -6398 (R. 01/03) • v, t 4 • '44 ,Y • s . APB 4957 3 a� 1 j .E' / ,vw % 5.36 y „ �►�e r Tom ,v /9 ,--,/ '� . \ —J -7 o 11S +weu. 4: 7- 3//EF A:,,,.ss /\ p ao •+O fentE 1" - „ 2n 1/y/ • �oKg mw. a / ' r f,,,,p, , - I I- R `� ,'/ /kv6 Sr sd� �- � \ . G . yo9oe i :iv l \ 1 - roe ------------ \ ( P - — - — 7 .): - L a e / 0 e -2 99 ; ., ,,,,,'.:1' /4-650c 9rAtie /629.---d% �A // , , s (7 ‘12.1X G8, y .7.4 n4//i.4,4,,c, CE / . 3 (09 ,SNE //s a -3 5F', 9r ys' / 98.36 y ' yr A=4 ad o W . 78 3.3.4cr•E ,, d 4 ' . 0 8 -1 - 99. y3 � / �� mob , 1 , P 111 . V /0/ty rT 644,-/- 4 / &1,$ 3 IiQcir oaM yE / 1 , 1 .,..___ '') X, "Ad g, 5 ilG y Ca" se "7 Al /9 w \_/ Uli /N 0 /6150 +WELL %/4_344/4/19-42, 4, A 2A16/, • - 4 -.6 F.• /4, ' Ill ' ,1 fc YFP jo a.,,i v ` i ' /\ O o 'o S.` IE 1" - 40' f rOK MAIN / 9 � � i Pfta/ "� -ii- RI A 'F gr ime Av. u fa Y G rL / .- - ' 1 l a � /, Abb)Egr ).-m 4 01 99,98 '.0 q4\411A‘ a �A/ / f , 1 S _ (2) .2, del, `1 f srp , , a -. S . (a swells 1 a- Ilk 1 5 c. 9.r = ' 98.3 4r°' , 'Iow9''AdE 1 k H L Lot 78 3.3 Atcr E , / n/ . pa - - 5 ,y3 � c , q" N ClIA * , ' 0 . U 1 / %, ,ey. . Cdrf /30 ya ; ©6- p : KERNoA) /3,4 r 3 2 SPEC?? /3 ,45 r 'Pik /A• 1311'/ 6-E RP • 1-100s0 A), zw. -s'// Ce ' • • Wisconsin Department of Commerce SOIL EVALUATION REPORT P age / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code /� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 57-: G/ ` O 1(-- include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 52t...- 4?/6 Gv 4-- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. ' evi by Date • i Personal tnfo•malion you provide may be used for 5.04 (1) (m)). �� ' • 1 Zil03 Property Owner "' -, RE C E i v G D Popery Location f o u ' / 'Y - r N511 L w /1•GoX5 - OA) Govt. Lot 5 114 ,VGJ114 s3 ' T 2 N R /9 & (or) W Prope Owner's Mailing ddress JAN 0 9 2003 L• B subd. Name or CSMIf ,f f Pew r' err `ma y. P/ 1 5 Fi 4 04) kz4z A The City State Zip Code Phot3E • City , Village F Town Nearest Road ,,, 041 Gtr /. S+/D/(,� a, •4,4,- Cir /f I/PSt' ) " w / . Al tp-+new Construction Use: On Residential / Number of bedrooms 3 - y Code derived design flow rate y5 — lP er GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material 4-'SS 0tzw $,9g2 f r9U /4117 ? Flood Plain elevation if applicable N J - - ^Y.__ ft. anG al recommendations: • 14 ft~A s7 1 /s 5,/ 7 4 MAP ,4.1 /,v y, • co,u tl',v770.04(-- P D , w . 1 S. zrs /,v&— • 3 Co Pr fFuSe �.eee'S • lam- • - # p Boring �T/� / � ® Pit Ground surface elev. 9 ?. ft Depth to limiting factor y•D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stwcture Consistence Boundary Roots I GPDaf in. Munsel flu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 / o • f3 /o y / z 3 / 3 G / , e s / - d i e 1 1 0 ,2 --- . " . 2- /3.33 /C Yeef /v - - 5/L 2 4., ,t� ,mot - f/�' .'4) /7c . S . • El 3 33 .3 1 S YR - sL Z s�,wvf ets • S 7 3810/6 YR5 /y ------ 5 ©, 5 ,&,e .- 7 1. . . aif 9S /t Z I Boring # Da ping Ground surface elev. 9.9 3 Y R. Depth to limiting factor 7 n in. 1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff M. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. • ER#1 • E##2 l 0.15 /0Y/ 3 83 G /S 4vi jw 2 f • y r,G 2 - 1,5 3i- ioYR , — 5 / G 2 s i — ' cw /7 • 5 . 3 32' V o 7 . 5 Y R Y _ — 5 Z,wtsht 4 4 E �s — .. 5 . 7 y Yo • g? /O Y/R 5/ --- 5 0, n GP_ --- . 7 /• Z, . 11-`1/3-q , . • • Effluent #1 = BCD, > 30 < 220 mg!L and TSS >30 < 150 mg4. • Effluent #2 = BOD, < 30 mg& and TSS < 30 mgll. • CST Name (Please Print) Signature e A L ,' _ 21c,•3•7 CST S Ro13ERT Zl/h/riGhT Address Date Evaluation Conducted Telephone Number Ulbricht & Associates »f.. 7 - 0 o 2-. 7/S • 3 P(� • g/ ?S 6• tivdl(3 t,wayn G1niuttalil.. C55 O'Neil Rd. ►lurinon, b ^Jig. r inlri -(-- pi■v ---- , j 4 ) o a0 . 1/09 - yo . se of No o - //09. . . K. �.I3 /T ,---- 1 0 3.0•I /0 f. yo' Property owner Neil. tu/ l co X 5o A i 0).0 - //by • Z o• aro 2 3 Parcel ID # Page of f 31 Boring ft ° Boring g'. 'f2-- talleLpit Ground surface elev. ft. Depth to limiting factor in. Sou Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDRf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • •Eff#1 •Eff#2 0 - 9 4 9 v 3/3 1_ ifs»e Aufg cu, .,.... f , y . 6. - 2 g./6 /o ye // --- S'/L, 2MTS% At+ c s / . . 5 . 3 /4 • /owe s/y ,'ux1- ,►Q. S 01 SI 4 a--c; . , — - - 7 /..Z '' /De f/e of GAS /c fe d 5 a,C; . 5' . f f f ng ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff Rate Structure in. Mu nseu Qu. Sz. Cont Color Gr. Sz •Sh. •Eff#1 'Eff#2 f I� ° Boring El Pit Ground surface elev. ft. Depth to limiting factor In. Sou Application Rate , Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •E0#1 •Eff#2 • _ t f f Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description. Texture Sirudure s istence Boundary Roots GPD/ff in. Munsel Qu. Sz. Cont Color Gr. •Eff#1 •Eff#2 • Effluent #1 =BCD. > 30 < 220 mg& and TSS >30 < 150 mgA. • Effluent #2 = BOD < 30 mgt. 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. 3804330 (116/00) 1 .lo /7- 3 iI PP . G /N�' / 9 z �, Lo or A � poS LY (9b 2 piP- / r 5 f 1 D LOY o � ____ --- y g 30 , i G � 6° / LIo sib SI D . • • /00 5 3 5C/14e, : / a _ z. 0 D Ai cK4 Pi T$ �-- 4 r Coca a2 : 0, ID O qi 13' -I 5 r: for OF yy ' S/.. i 1,, 6 / 950-e Pp / 6 /00 i G 7 t 1 Or T �. - - , G , _.__________„...---------- (z. (9 7 is) For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road Hudson, WI 54016 715- 386 -8185 or 715-772-3442 / CRT SOIL TESTING - FAX NO. : 715 233 0398 Jun. 14 2002 05:52AM P3 H IM Wk 1►T►4 E a PR�t3 p // ' 3UNLTtaN y WC K►w16 COVE gcx IA41r44). A A49E4 . G1uicA pi•co 411V - C --- N f , •vinimmin ': I, b ? 4 „ y I Y4)f , . 44 I'YC ■ 7//77/77 4 A -A 4- m Di Pt 3 1 10 Npiwrae;ED 4" 40 Sail 24" x.A. 1 , • , . 1 .. 1- 7 1 I = � Y�IvTI l ith M1)IU41.E _ ' •' t 1 - ' r () 1AALAF 1- —11 lib uc. i p`. 1a �. ApPcravto + 4 l..T V:3114 �A s FFI�E 4 ""'"""" , 3 """" 1 AL - A � i ' oft r0 PLPS. - R .. ON -� ! v :.;w�- KEtTI OPiS • T "`/ -4.,..\...Q. 0 . \ v„ = I O%.D1JmC NJ- 7 . i—e"Aia n il" Y I „ ..„ [1:0-ecAre4 ,.......±. . 1 A- •Q. e./1- , SEPTIC iPEC�F!'CATIO L AIS DOSE \-i TA1.l. MA►IUFACTURCR :, IJ1.1M6ER OF DOSES: PEit 0, TA1-JK S1zE: 3 r (111r-t 6ALLOUS • .DOSE VOLUME - ALARM MA#liJFAtT6ii�T.R: s J Lrl a, \r,.. (IJCLUOIL G 6ACKrLOW: �� Go.tLOr.,s Pk ODE L 1•1LL1A4,E le l 1•-k ra LXPACIT)ESI A= a „ 8 t1JCHES OK 7/? C..r.,_'�ot5 T. c ttiGM£S OR 2��g GALL CUS PUMP MA►JUFACTLIReet: y4/O/!7 1/G _ C. iULr+ES OK GA...— tr'S ' MODEL IJUMDtR: ��jj--�� 'In .6, � C`� D. I HES GR .� O 5W VI - CH TWPC: CW�ry b�..l�. £YTE: PUMP AL'OALAR!•I ARC TO 6C I ILIIM1UPN DISCKAAGE RATE, a �Cr *M 1NSTALt.ED 01.1 SE P#- TE C'KC: T VERTICAL DlFFCEC&1Ct CJETWt =U PUMP OFF Ahab DISTt bUTIOtJ PIPE.. /l FEET + M'kIII tJM 1.1C1WORK SUPPLY PR£LLUR>: . , — FEET ± 490 FEET OF FORtt MAIN X � � r ',ten IniKlcTlalJ sACTOK. 3 FE[T -_ ,s r.-. 1 — TOTAL O HEAD = --Z — FE.ET • 'VI l% 2 i 't �. 1.77ERIt1AL. AJMJr1L16iQ1.1t; 4 / TAs.�rC. L, r~iGTN - ;WiOr}i .___..^.___�;LIQU1n DEPTH ? 6 ....3 /Pump runs but delivers only Motor runs for short time then 3. Pump impeller may be j small amount of water. stops. Then after short partially clogged causing 1. Pump may be air locked. Start period starts again: Indicates motor to run slow, j and stop several times by tripping overload caused by resulting in motor overload. plugging and unplugging cord. symptom shown. Clear impeller. Check vent hole in pump case 1. Inlet in pump base may be 4. Defective motor stator: return for plugging. clogged. Remove pump and to Authorized HYDROMATIC 2. Pump head may be too clean out openings. Service Center. high. Pump cannot deliver 2. Impeller or volute openings water over 24' vertical lift. may be plugged or partially Horizontal distance does not plugged. Remove pump and affect pumping, except loss clean out. due to friction through discharge pipe. 1 1 3. Inlet in pump base may be ,1 clogged. Remove pump and clean out openings. 11 4. Impeller or volute openings 20 1 may be plugged or partially • . • plugged. Remove pump and 4, :r clean out, 19 dI'` s 2 Su ‘‘k 5. Pump impeller may be 18 1 iI��� , � � \� partially clogged causing 17 ,3 motor to run slow, resulting 78 1-,....100., ' A ` _I in motor overload. . - — 1 4 Clear impeller. 15 1 s \,,.i il 4 rim Fuse bl 1 ws or circuit kreaker 14 - �`. : = i1Li ' trips when pump starts. —:�: _ ,_ _ \ 1. Inlet in pump base may be � �r� • • clogged. Remove pump and 1213 ,. I'; - �_- - - - 1j 111 8 • cl out openings. " —— 2. Impeller or volute openings 23 22 21 ,0 7 ■ 9 may be plugged or partially plugged. Remove pump and SHEF30 Performance Curve clean out. 3. Pump impeller may be 9 — 30 partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 1 — :o 14k ii.„........... 4N , 4. Fuse size or circuit breaker is too small. : 5. Defective motor stator: return 3 — 10 to Authorized HYDROMATIC Service Center for verification. .,.,i 0 0 Capadry•U.S. 6.911. 0 10 20 30 40 SO I 1 I I tilers/Second 0 1 2 3 4 II1 r • POWTS OWNER'S MANUAL at MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,erx m is j Septic Tank Capacity � w gal ❑ NA Permit # .3 © 6.2 • Septic Tank Manufacturer A-rev/7— ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer f,3 ❑ NA Number of Bedrooms 3 ❑ NA, Effluent Filter Model it— /DO ❑ NA Number of Commercial Units ,I21AA Pump Tank Capacity 640 gal ❑ NA Estimated flow (average) F'D0 gal /day Pump Tank Manufacturer 77 --- ❑ NA Design flow (peak), (Estimated x 1.5) L(g gal /day Pump Manufacturer Otry,x,E-fd ❑ NA Soil Application Rate 7 gal /day /ft Pump Model i;itIeGJ D ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit irNA Fats, Oii & Grease (FOG) _530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter 5_220 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) 5_150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) 5..30 mg /L Affr In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 5_30 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) _510 cfu /100m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 3 ❑ monthsear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludg and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months A'year(s) (Maximum 3 yrs.) Clean effluent filter At least once every / / ❑ months Al year(s) DL /0 et 'e e - ge"v Inspect pump, pump controls &alarm At least once every 3 ❑ months Jeyear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) " NA Other: At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretrjatement cbmpoliedts; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall -be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents ..a .{...,.,L / -\ .e.,,.,.,n.1 I,.. , cant,ara can.irin0 nnarmtnr nrinr to nca Page of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons: and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPA IRI.F_ ADDITIONAL COMMENTS POWTS MAINTA POWTS INSTALLER I L SINZ PLUMBING, INC. Name TL. �►NL PLUMBING, INC, Name F56fq 708th AVE. E56 09 108th AV t. Phone MENOMONIE WI 54751 • • Phone MENOMONIF WI 5 47S I SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY I Name Agency 5( Volt' f 0 1tjel Phnna Phone Its" Silo." y[bbo Dec 11 03 01 :10p Chad Bleaker 715 381 8296 p.1 • ■ w ■ DE 11.2003 "hEDINA REALTY HUDSON 715 3tl1 n` NO. 243 P. 1 P• 1 s 1110 09 03 11:34. Dante Euaavatint 1715179 -2519 P- a aaa 1 a ■ sr at= coliOrtlf I SEPTIC TANK itamituNds A CAVNERSREP CERTIFICATION FORM . . 4 t ',; / aa Co 55 Amo. 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DATE ..,.tea;_ 41.^:.4r1.1, ► 11)1. =WY Gm ell sa tam tas it ban ratan Is IlleW char (wall lorwole • 1(nn) am (W is eirae(a) at •/'►, deed ' - -. ,deedteoeadrdla arafDec&Mot. • , , . ce i rai DAIS Any ielamatke dat it saitimpatastedastywoult IA doaaotaty yank ia mind byNA Dep t- i to 1•116 ttdr fy/ia aria a a messaw000dy dead data Ala fsddvalDaada alaoa a awe ea dEtt t" mop ltaaQawasis eras to dr waraty deed i . . J 2 1 3 S P 3 5 5 ®$$8ga KATHLEEN H. IiALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO. , wI Neil L. Wilcoxson a • - • - • ' oxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilc • = on, husband a d wi e, onveys 02/07/2003 02:00Pf and warran . to Kernon J. Bast the ollowing EXEMPT t described re estate in St. • ' ' aunty, State of REC FEE: 11.00 Wisconsin: TRANS FEE: 2880.00 COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20 1109 - 40 - 000; 20 11 - 9 - 20 - 000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 Name and �� �!yt� t0: A parcel of land located in part of the Southeast 1 /4 of the Edina Realty Title Northwest 1/4 , part of the Southwest '/. of the Northwest 400 South 2nd Street 1/4, part of the Northeast ' of the Southwest 1 /4, and part Suite #115 of the Northwest'/, of the Southwest'/, all in Section 36, � WI 54016 Township 29 North, Range 19 West, Town of Hudson, St. , ? `� Croix County, Wisconsin described as follows: Commencing at the South' corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north - south ' /< line, 1634.77 feet to the Northeast comer of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North -South 1 /4 line, 1977.22 feet to the South line of the North 350 feet of said Southeast '/, of the Northwest '/,; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. t/C Dated this �� day of J6/-7'0_0-7 , 2003. ‘0,09„„ /Z-C( . ilcox on Mary J. Wdf n ACKNOWLEDGMENT STATE OF WISCONSIN ) 4 P � COUNTY OF ST. CROIX ) -ti'- / O P( As, Personally came before me th day of a 1'? 2003 the above : med Neil L. Wilcox ol� d Ma . i Wilcoxson to me known to be the persons who executed th fo oing instrume - • acknowledge the #ime PRESTON . Nota Public �� M commission expires: This instrument drafted by Robert F. Wall. Wilcox ontoBastWD03 -1 1f hi OF reap 4. 1011.411011.141311* 444.41t* 110Xf it LOT' Tr 1st r . .. '•` `" . 14t11,11411110 1 4.4' " Aitelle 1; I tot /cow » • Its, M 1J111 it 141111.11 i , \ 0\ , , "#4, 4 . \ s il.k.' / "4 . %,....... *-- - /.. ...."..,..... till.......... .r �7v„5Z A- ,a::v: + : ..,. „ sL�x?Zo.can.,a,Zi ` w v v ✓m3n) staff _ r,... }_,,,,., ,..ra 1 E 1E 1':,.., , .:_