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Home My WebLink About020-1318-60-000 d �r1 o c °: c °.: 1 0 3 CD (D m m m y ID m m Cn -I Lt m z O N r z T m z O U7 Cn 2 N N et ((��1 • 0 `+ O ut 0 co w i O w y O O 0 C (D »- 3 3 C a� N O. CCD N_ O N (0 O 1.r _ 1 m O C CD O O V' m C = O N' w Ul m 3 rn w cnn 3 (°n - I ° 0 0- 0 � (°n CD �' CD 'I N o O O O C m O. 0 C = A Cp K r 3 p -w y C y c D _ m _ m w - a z D _ a m .. N @ m m a J u. D N a CA •� ( 00 En C ..,. o o CA x ;.. c �.,� o a l 0 W m t3 'Or :1 w o \ (° M. o M. 7 co .4 W O co 0 0 O � < O p (D N o a �+ CD a 3 v = v o w !r• 0 o O O O y C O O C 0 A G G �� o0 0 C o rn o - c0 c ° o -1 w -� � w 3 � N y N •• a O G 3 a T 0 p O a CD N m N CD 2 N O 7 Ut C R7 •+ Of 'a CJi y - w 'D cx !� m A N m � O m 3 3 N z " ° z � z z z =� D m o D D o m O O 0 T n (D CD N h • (n A C y m m & m o E o m 3 (, @ m 3 ° 3 CD Z (D (p CD O C ,P Z m y C U) N M M CY z N a CD A P 3 O En p 171 ( N CL n z '0 3 0 3 A O - O - Cn N m o Z CD CD A W W w p _ m O ° w n m CD CO W O CD O° w O p 0_ M. w O. CD '.. m N '(D w O w N 3 3 La- N 7 a � 3 . cr - 7 twig w d CD :: m d O c O cO �. CD a _ C CD a w w C w w m a w C ! 3 d 4. w C (D 1, - O T. N< 7 z O - 0 O 7 a C O Z 0 N ^�. B p Ll O CD w O O. =r CD p w Qsw m Cl. m.3 m 3 cc CD z < a3 m O a O CD - f C C' (D S a 0 N 0 ° d D C S w p> 4 M'c<-nn'�3a - Ic w m a x ° 5 m cc m ° o m o ° CD < CD a O S3 m 3 m co ° w o yn y w am sw 0 0 g aaa T. CD o ° o m Ct N m 3 0 m m < 3 3 =@mo =o= a m CD o o -(D * 0 o l< a -0 CD � =3 �Om o n a F m o.� N a0 N 3 ° - �? j m m ° O . 0 cn O N 0 ! C' CD m Q 0-0 w m `G -1 0 j W m n w O (D O. C A 2 CD CL 'O 3 O Z X Q; w p m a ' 3 `< O m O 3 S V O O n 'O w 0 O fD (P 7 > O 0 �,� A cn o x 3 -� CD CD ° a ! va O f» O o o ° o CL ~' S Wisconsin Depart/hent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506210 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: Schoenrock, Kurt Hudson, Town of 020 - 1318 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 6 / .S' 4 AA,,2. - 12.29.20.1624 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. //o• / - lJUD. v Septic fyDAr K4 C,** /0- � //0. 5 100 0 ( / Benchmark Dosin �.�'�•o A) AI -BM O1e. CA) � ti / Y► Aeration Bldg. Sewer /2 2 � 1, Holding S Ht Inlet .3d y 5. a o S. 9 St/Ht Outlet TANK SETBACK INFOR ATION D 3• ( f TANK TO P/L WELL BLDG. PY Intake ROAD Dt Inlet /. Septic D Botto Dosing T Aeration 1 Dist , Pip `1 Holding Bot. System 7 _t7 --- - Ir /o S 7� 0� PUMP /SIPHON INFORMATION Fj�rade /Z� Manufacturer Demand St Cover 6 -�� GPM k Model Number f 2.� '.'7 ar/ / 0� TDH Li Frict� I r V S Syst ad TD �• J Ft Forcemain Length I Dia. Z f , Dist. to ll SOIL ABSORPTION SYSTEM j BEDITRENCH Width I t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG EL . LA ST AM EACHING Manufacturer: INFORMATION C Typ ystem: / L/ / ) ' / � U Model Number: DISTRIBUTION SYSTEM 1 4v ^4 vAto Header /Manifold Distribution LxHole S/ e x Flole Spacing V,ennttt-t- Kir In Length . o Dia /• Z� Length 0 Dia / • Spacing SOIL COVER x Pressure Systems Only xx Moun r At- de Sy m n Depth Over � Depth Over of /^ _ xx Seeded /Sodded ( xx Mulch J 7 Bed/Trench Center 12, Bed/Trench Edges Topsoil o Y" Yes No D Yes No / COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:�/�/� Inspection #2: / l! Location: 275 Brandon Drive Hudson, WI 5 0 6 (NE 1/4 SE 1/4 12 T29N R20W) Hartland Lot 6 - PQ ( w 'U Parcel No: 12.29.20.1624 P q /Z° ae n i Nom` K/ 1.) Alt BM Description � 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No Use other side for additional information. _ _ � I OT __ �tur-Date Inpcor'S Si Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) �M at t:�ttner� Sanitary ermit A licatio stat T section Number rY PP - i3�13�6� In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap riate ental project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state ed e submitted to the Department of Commerce. Personal information you provide may be us or se 275 Brandon Drive p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Hudson, Wl 54016 I. Application Information - Please P ' ll Information REGEIVED Property Owner's Name Parcel # Kurt & Laura Schoenrock MAY 9 5 2007 020- 1318 -60 -000 Property Owner's Mailing Address Property Location I 1 275 Brandon Drive ST. CROIX COUNTY Govt. Lot City, state Zip Code NE ' /,, SE %, section 12 (circle one) Hudson, W1 54016 715) 381 -0348 T 29 N; R 20 w 11 Type of Building (check all that apply) Lot # or 2 Family Dwelling -Number of Bedrooms 3 6 Sub i ision N Block # d A cres ❑ Public /Commercial - Describe Use V Na ❑city of ❑ State Owned - Describe Use CSM Number ❑ Village of Na ❑ Town of Hudson III. Type of Permit: (Check onl o A. Complete line B if applicable) A. ❑ New System Replacement System g R eplacement y g Y (explain) ❑ Treatment/Holding Tank R lacement Onl ❑Other Modification to Existing System R. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / 3 - / Z 3/1 IV. Type of POWTS Sy stem/Component/Device: Check all that appl Z. y / ❑ 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. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System El 450 gpd 1.0 ASTM C -33 sand 450 sq. ft. 450 sq. ft. 105.00' above in -situ soil 5 104.00' VI. Tank Info Capacity in Total of Manufactdre, Gallons Gallons Units a New Tanks Existing Tanks w/ „y,� �� TF ?/� a U Septic or Holding Tank 1,600 1,600 1 Huffcutt X Dosing chamber 800 - 800 1 Weeks Concrete X VII. Responsibility Stat ement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb 's Si a MP/MPRS Number Business Phone Number Jim Boumeester '` 1 222904 1 (715) 386 -9020 Plumber's Address (Street, City, State, Zip Code) 1070 Hwy. 35, Hudson, W1 54016 VIII. C /De artment Use Onl proved ❑ Disapproved Permit Fee (/u Date Issued uing Agent gnatur ❑ Owner Given Reason for Denial g, l b1 4pprovalllkeasons for Disapproval � � j�fit -e 1 Septic tank, effluent filter and pA rl'/ rl CL Z'K li'd C� dispersal cell must all be serviced / maintained ~I / K- ( as per management plan provided by plumber.�� 2. All setback requirements must be maintained �. � 3 y� t plans for the system and submit to the County only on paper not less than S 12 t 11 inches irx S 3 398 ( . 01107)01/09 - S71 CXi'.suj fi. e %e- o(cJef6 /et 6 z78.8z' L 4 �T0 Std nfoi-nc✓a '/.3.79X72,0 �o'� Q�1` .' ,'� .' c.� di 5 �/i 6u�'0� /Gtera /sat /�i'.Ys�B•s /' — �� Q� .' .' ; % c� JA ``Y y6 0��' {•Gt.S s�oecta�a -� 1.31.' � ,ol l S VV P r0/,OSed tut¢ �'c+,e re�C f 41 f e�' /[..cn� � /fie.: . ,• -. ` o� d ara9� 1 3 b�•droDm � y/';q. S.Tny. Scr✓iG( 6 � • j /dno' O � C s.T /P. e. `� P.C. ba��+ _ /oz ✓� ' e"l,e Q�/✓/o,Y, �OCG.�i� �:; ` Q�'CJpI /Ssi ✓i� � • Off' ¢jtr:stl%� tnClt6.7 vo � Q/lan c%,ec�G S tie�c� E,jra,, coo C' IAL -de Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w www.coe.wi.gov/s sin.go / Department of Commerce iscosin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 09, 2007 CUST ID No. 222904 ATTN: POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/09/2009 Identification Numbers Transaction ID No. 1393663 SITE: Site ID No. 725009 Kurt & Laura Schoenrock Please refer to both identification numbers, 275 Brandon Drive L above, in all correspondence with the agency, Town of Hudson St Croix County NE1 /4, SE1 /4, S12, T29N, R20W Lot: 6, FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1129538 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01/01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. COMB The following conditions shall be met during construction or installation and prior to occupancy or use: APPf Reminders DRIARTMEN N OF • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORE component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. JAMES W BOUMEESTER Page 2 5/9/2007 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83-22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART >code: 7633 (608)789-7893, 7 45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: James K Thompson, A.C.E. Soil and Site Evaluations Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. CIO C? o ® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN 9 Residential Application INDEX AND TITLE PAGE CVZ Co L Project Name: Kurt & Laura Schoenrock 3- bedroom residential replacem mound LL Q co Owner's Name: Kurt &Laura Schoenrock Owner's Address: 275 Brandon Drive Hudson, WI 54016 Site Address: Same Legal Description: NE1 /4SE1 /4, Sec.12, T.29N., R.20W. Township: Hudson County: St. Croix Subdivision Name: Plat of Heartland Acres Lot Number: 6 Block Number: na Parcel I.D. Number: 020 - 1318 -60 -000 Plan Transaction No.: Unknown Pagel Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications tronallV Page 8 Site Plan D VO P age 9 Attached soil evaluaiton report VD 'OF COMIq ERCE TEY NGS .ESPONDENC Designer: Jim Boumeester License Number: 222904 Date: 04/25/07 Phone Number: (715) 386 -9020 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 % coliform of - 36 inches. 450.00 Design Flow (gpd) 20.00 Site Slope ( %) 104.00 Contour Line Elevation (ft) .00 Depth to Limiting Factor (in) Application Rate d/ft z pP (9P ) 0.50 In -situ Soil A Distribution Cell Information 50.00 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.25 Estimated Orifice Spacing (ft) = 6.82 ft /orifice 2.00 Forcemain Diameter (in) 20.00 Forcemain Length (ft) Does the forcemain drain back? Y 98.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 3.26 Forcemain Drainback (gal) 6.50 Vertical Lift (ft) 46.36 5x Void Volume (gal) 0.32 Friction Loss (ft) 49.63 Minimum Dose Volume (gal) 0.50 In -line Filter Loss (ft) 27.19 System Demand (gpm) 13.82 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options J ch fc f 0.75 1.25 x 1.00 1.50 x 1:25 x r'x � 2.00 1.50 x 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 805.12 Total Tank Capacity (gal) 1000 \600 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Huffcutt Manufacturer 21.76 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.12 Dose Tank Capacity (gal) SIM/TECH Filter Manufacturer 21.76 Dose Tank Volume (gal /in) STF -100 Filter Model Number Weeks Concrete Manufacturer Project: Kurt & Laura Schoenrock 3- bedroom residential replacement mound Page 2 of 9 Mound Plan and Cross Section Views :;3 J FK 1 / 10 B Observation Pipe 3 � Sj Q A W ... B .. .. I ... '. . ' ' ' ' ..... I ...' ....... .....................I......... O L Mound Component Dimensions A 9.00 ft E — 3 - 3 - 6 - - 360 in H 1.00 ft K Aft ft B 50.00 ft F 9.25 in z 30.53 ft L ft D 12.00 in G 0.50 ft J 4.26 ft W 450.00 (ft Dispersal Cell Area 1976.56 (ft Basal Area Available 9.00 (gpd /ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.77 (ft) - -� rrrrr... G H ,rririrrrr 2�rrirrrrr... .�rrrrrir rrrrrr�77iirr1r rriii�.. F Dispersal Cell 105.50 (ft) Lateral 105.00 (ft)—► Invert Dispersal Cell t Elevation E D .= . 104.00 (ft) Contour Elevation 20.0 % Site Slope Geotextile Fabric Cover Shading Key a Dispersal Cell See lateral details on 1❑ Topsoil Cap o ° 1.5 ft 77 7 7 Page 4 for number, size, rrrir. Subsoil Cap o /''�!(� and spacing of laterals. ASTM C33 Sand Z F Laterals are equally 0 Tilled Layer c N 0.5 ft Typical Lateral spaced from the �5 0 Aggregate e c Q I distribution cell's centerline in the A distribution cell (AxB). Project: Kurt & Laura Schoenrock 3- bedroom residential replacement mound Page 3 of 9 4 lil End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •- Turn -up vYball valve or cleanoutplug P .1 qP All laterals are identical I*- > C Holes drilled on the bottom of the lateral equally spaced S Laterals & force main of PVC Sch 40 i k (per COMM Table 84.30 -5) S Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.31 ft Lateral Length (P) 4871 ft Orifices per Lateral 22 Lateral Spacing (S) 3.00 ft✓ Orifice Density 6.82 ft /orifice Lateral Flow Rate 9.06 gpm Manifold Length 6.00 ft System Flow Rate 27.19 gpm � Manifold Diameter 1.25 in Total Dynamic Head 13.82 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and �— sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E -- Alternate outlet location Forcemain diameter Weeks Concrete Manufacturer 2 in. Cap acityl 805.12 Gallons Volume 21.76 gal /inch A Weep hole or anti- ' D imension Inches Gallons B siphon device A 20.72 450.85 C B 2.00 43.52 P ump off elevation (ft) C 2.28 49.63 1 99700 D 12.00 261.12 D Total 37.001 805.12 il Do se tank elevation (ft) 3" Bedding uncTer tank. 98.00 Alarm Manuafacturer Zoeller Alarm Model Number A -P 10 -1494 I Pump Manufacturer Zoeller Pump Model Numbe BN151 Pump Must Deliver 27.19 gpm at 13.82 ft TDH Project: Kurt & Laura Schoenrock 3- bedroom residential replacement mound Page 4 of 9 I Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386 -9020 POWTS Regulator's Name St. Croix County Zoning Dept. Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000/600 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundi Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade ...... ...... Threaded Cleanout 6 -8" Diameter Lawn . . . . . Sprinkler Valve Box .. . .:.: :. ;. Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral P - P of 9 Project: Kurt &Laura Schoenrock 3 bedroom residential replacement mound Page 5 1 p 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01 /01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pu Tank mp a The um ins ears. All switches, alarms, and pumps shall be tested to verify proper P P (dosing) g) tank shall be inspected at least once every 3 Y operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 at PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 1511152/153 PER MINUTE 1' 4 EFFLUENT AND DEWATERING 2 MODEL 151 152 153 75 10 152 - Feet Maters Gal, Utes Gal. Uters Gal. Liters 5 1.5 5o 189 69 261 77 291 10 3.0 45 170 61 231 70 265 0 6 25 151 15 4B 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 6 20 25 7.8 16 81 34 129 42 159 30 9.1 - 13 87 33 125 /\ n X X 35 10.7 22 85 f U 10 40 12.2 - - - - 11 42 Shut -oft Head: 30 h. (9.1m) 38 ft. (11.6m) 44 fl. (13.4m) 2 5 0145088 0 10 20 30 40 50 60 70 BO 90 1 DNS LITERS 0 40 1 0 1 260 240 21110 3iO 360 FLOW PER MINUTE 0145W Model 151 Models 1521153 CONSULT FACTORY FOR SPECIAL APPLICATIONS 67132 7 718 4 5/6 3 27Q2 15,6 Timed dosing panels available. - -� - Electiical aRernatm, for duplex systems, are available and 374 32,n2 supplied with an alarm. 4 Variable level control switches are available for controlling ® 3 ? � 327,32 single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed QWk -Box available for outdoor installations. See FM 1420, Over 130'F. (54'C.) special quotation required. 15111521153 Series 1111716 12 118 - 151/15?115J MODELS Control selection Yodel VoltThM Am Sim �x Du ax I s e 418 N151 115 6.0 1 2 or 3 BN151 115 6.0 Included 2 a 3 El 51 230 3.2 1 2 or 3 BE 551 230 3.2 Included 2 or 3 SK2444 SK206a N152 115 1 Non 8.5 1 2 or 3 BN152 115 Auto 8.5 Included 2 a 3 E152 230 1 Non 4.3 1 2 or 3 BE 152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 11 5 1 Auto 10.5 Included 2 or 3 El 53 230 1 Nan 5.3 1 2of 3 SELECTION GUIDE BE153 , 30 1 Auto 5.3 Included 2 a 3 1. Single piggyback variable level float switch or double piggyback variable level Float I A CAUTION switch. Refer to FM0477 �� nsrauaoon of controls, protection devices and wiring should be done by a qualified 2. See FM0712for correct model of Electrical Alternator E -Pak. .ensee electrician All electrical and safety codes should be followed including the most , scent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 3, variable level control switch 10-M5 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor Is engineered into the design of every Zoeller pump. -- - MAIL TO: P. OP O. BOX 16347 - - - -- ` k AVI LouV"' 49 47 Manufacturers of SHIP TO 3849 Cane Run Road Lulsvllls, ICV 40211 -1961 p /� (502) 778 2731 • 1 (800) 928. PUMP htrp/lwww.zoellercom L 0 FAX (502) 7743624 © Copyright 2004 Zoeller Co. All rights reserved. ,P 20 Z E 11 ,"? 12"Ce %e l(a) let Line EXi� e /e dGt,�s �Tn z79. bz' A ls �c" �`� �� • .'� /od,co�^ c 3 7A�ec(3� di.S �ii 6u�'o� /o'�e. -a /s a � / %.';Xs/B.s /' — �y� QI .' �' ,• � � i r . tL `rt4 109, M q .'�, rQiSiclsv i 3o3s�Pf { /kti-� ,' /ine 6.e;fwet,.) iice � j / � �•rr �d BIrFC. - ' �' T EXisr`%r�r S,dcwulK= /, 0 �e G �o bt Cc., v� t E {dam SOL flQ� y K�ipY�n9� // t rsGGc6. 7 � Q9an C�N1QG S cede . IAW P>r"an alor7 2062 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. So a Eva Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dions, north arrow, and location and distance to nearest woad. Parcel I. D. o2a 18 ' Please print all Information. RevBy Date Personal inbmw6m you provide may be tax, s. 5.04 (I) (m)). 2 Z ! Property Owner Property Location Kurt E. & Laura Schoenrock Lot NE 1/4 SE 1 S 12 T 29 N R 2 0 W Property Owner's Mailing Address of # Block # Subd. Na or CSM# — 1 275 Brandon Drive 6 Heartland Acres City State ip C e' one umber I City J Village 16 Town Nearest Road Hudson I WI Hudson I Brandon Drive New Construction Use: W,1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement I Public or commercial - Describe: Parent material Glacial till Flood plain elevation, if applicable na General comments and recommendations: Site suitable for m ound syste withX -of ASTM -C33 sand placed on 104.00' contour. System elevation 105.00'. Boring # I Boring 0 Pit Ground Surface elev. 99.41 ft. Depth to limiting factor in. W Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 * ff#2 1 0-7 10yr3/3 none sill 2fsbk mvfr as 2fmc 0. 1.0 2 7 -18 10yr4/3 none Ifs 0 sg ml cs 2fmc 0.5 1.0 3 18-24 10yr4/4 none Ifs 0 sg mi cw 11fm 1.0 4 2 -28 10yr4/4 Ef 7.5yr6/8 Ivfs 0 sg mil gw 1fm 0.4 0.6 5 28 -60 7.5yr4/4 12d 7.5yr5/8 vfsl 2msbk mfr cw 11fm 0.4 0.8 6 60-94 10yr416 m2d 7.5yr5/8 NIS 0 sg ml - - 0.5 1.0 Boring # - I Boring n 16 Pit Ground Surface elev. 97.59 ft. Depth to limiting factor 36 in. Sort Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots III. Munseff Qu. Sz. Cont Color Gr. Sz. Sh. *Eff #1 1 0-8 10yr3/3 none sill 2fsbk mvfr as 2fmc 0. 0.8 2 8 -22 10yr4/3 none sit 2fsbk mvfr cs 1fmc 0.6 0.8 3 22 -36 7.5yr4/4 none sicl 2msbk dsh cs 1fm 0.6 4 36-46 7.5yr4/6 f2d 7.5yr5/8 siG 1 csbk dh - - 0.2 0.3 * Effluent #1 = BOD? 30 < 220 Tk and TSS >30 -/169 m ' Effluent #2 = 800 <_30 mg/L. and TSS <30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson s--- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane O la, W154020 1/17/2007 715 -248 -7767 Property owner Kurt E. & Laura Schoenrock Parcel ID # 020 - 1318 - 60-000 Page 2 of 3 EE Borg # I Boring 01 Pk Ground Surface elev. 105.10 ft. Depth to limiting factor 29" in. SO Apples Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh, Of #1 *Eff#2 1 0 -5 10yr3/3 none sit 2f8bk mvfr as 2fmc 0.8 2 5-17 10yr4/3 none sit 2fsbk mvfr Cs 1fmc 0.6 0.8 3 17 -29 7.5yr4/4 none sicl 2msbk dsh Cs Urn 0.4 0.6 4 29-42 7.5yr4/6 f2d 7.5yr618 sict lcsbk dh - - 0.2 0.3 F-1 goring # Boring I Pit Ground Surface elev. ft. Depth to limiting factor in, 50l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *EfP#2 ❑ Boring # j Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture StnKture Conssterce Boundary Roots GPDMe in, Munsed Qu. Sz. Cont COW Gr. Sz, Sh. *Eff#1 *Efl1#2 " Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg& 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. SRD -8330 (R.O7/00) A.C.E. Sop &Sal' EVaked 115 =s�o CXi's&" I:.cel%re �uJes6 /et Cron ♦ EX /'sue' e /e r/a_, C7 .2788x' ' � P r e v o ' �°`rQ9e 3 bcdco�m , r, + ekc. �i•+ � Sw ✓ +'CC O 6 7 EXiSf% �u2 P, e, bed► : 102. jo of bc�'c -d , , \ G \ • 0 0.,Z. 7 S. ereodw P ra, clon C-"L- de - ,Sac- 0 i 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 �u1n !3,-1,0z P go (,)(- residence located at: 1 /,, S f5 /, Sec. t a T va I N, R ":� d W, Town of AV►p St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 1 a v d�p Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons y minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known) : W\" �� Age of Tank ( if known) : R yL 5 ? (Sign t e) (Name) Please Print (Title) (License Number) s a o (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . M1 Name �� U k h4 R, Signature aT>�s MP /MPRS ;0 a yol ST. CROfx COt1NW SEPTIC TANK MAW BNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address 7 S f�i"��,�#,ti /fir Property Address 4 s 5 -,f- " a (Verification mquited from Planning W Zoning Department for new construction.) - — City/ State Parcel Identification Number LEGAL DEBC ir-nON ice 4q A (;p C - ) Property Location V /, , -15 f' , Sec., T , N R_ W, Town of Zj��!ind, Subdivision a F J I . o nav_ 5 , Lo # � Certified Survey Map # , Volume _ , Page # Warrib end # --.Volume d_ 7 - , Page # Spec house yea no Lot linos identifiable yes no MIEN NaQa NMCE AND OWNER AEU FICMQN 1trVrWer we ad awineauaaee of yoW septic Mk= could result w its prevish re hd= to handle wastes. Pieper maintenance aoesish of prunpiog out the septic tank every throes yeen of sooner, if needed, by a Imeoeed pumps. Nast you put into die system am affixt the fimctm of the septic risk us utatment stage to the .taste disposal rystatm Oww mainte nswe respondWb ics are specified in #ComaL 83.32(1) and in Chapter 12 - St. Croix County Sanitary Otdimme. The property owner agrees to submit to St. mix County Planting dt Zoning Deparu new a oatiftcadoo form, signed by the owns and by a mm Ater Phi► joiatseyman phaober, ma irictod plumber or a Isom ed pamper vordf zW 60 (1) rho oD-aft wnsee vaber disposal system is in proper opomft coltdition and/or (2) after inspection std pvtWing (jf necenmy� tae septic taot is hus than 1131W1 of "V. Vwr, the undersigned have read the abode n gttsrmertta and agree to maintain the private sewage disposal sysim with the ssaodsrd& sec 0x* ham* a set by Deptttfmoat of Corm mice and tae Depmunent of Natival Riesouroee, SIM of W a. Cerdf cation tmttigg that 3M septic sydm hat boo mombined aaiet be completed sad returned to the St. Croix Cotatty Planting Z0*9Dgtarlmeot within 30 days of the dares year eapuation date. Uwe certify that all statements on this form are true to die but of taylour knowledge. Uwe ardare the owner(&) of the property described above, by vir ee of a ww apty teed recorded in Register of Deeds Office. Number of bedroom 1 2_0 2 Q 7 ZGNATIM OF WPU CANT(S) DATE ***Any information dot is rmstepreaCtttr d =By to sgit in rite sanitary pan* being revoked by the P1ano6W & Za" DopwWmmt Include with Wks application a recorded w onmy dead fiwan the ltoguw of Deeds Office and a copy ofthe oaftGad.atnvey asp if (eforerioo is made in the wag" deed. (17EV. 08m) T d Wd9t : LO 2-00-E L 'fi eW 176290U T S9 : 'ON Xkid WOdld POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 _ of FILE INFORMATION Owner SYSTEM SPECIFICATIONS i (�__ __ Septic Tank Capacity Permit # n U al ❑ NA Septic Tank Manufacturer TL4 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 5 M 03 NA [Estimated mber of Bedrooms (average) 3 ❑ NA Effluent Filter Model s l 0 O O NA mber of Public Facility Units _ ❑ NA Pump Tank Capacity UU al El flow t � ` 30 g al/day Pump Tank Manufacturer W Q R ❑ NA Design flow (peak), (Estimated x 1.5) Y S Soil Application Rate gal /day Pump Manufacturer V� Qh 0 N z Pump Model 9 N S gal /da /ft p ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 m /L ❑ NA 9 ❑Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODd 530 m /L 9 ❑ In- Ground (gravity) ❑ In- Ground (pressurized Total Suspended Solids (TSS) 5 ❑ Mound 30 mg /L O NA ❑ At -Grade ) Fecal Coliform (geometric mean) 510" cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. 11 NA Other: Other: - — — - -- ❑ NA E03 NA Other: "values t ❑ NA ty pical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: D month a) ear(s) 7of um 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third k volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monthls) (Maximum 3 years) ❑ NA G� year(a) Clean effluent filter At least once every: ( D month(s) year(s) ❑ NA Inspect pump, pump controls &alarm At least once every: ❑ monthls) 10 year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ monthls) Other W year(s) ❑ NA At least once every: ❑ month(s) Other: ❑ year(s) D NA ❑ 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 The d k for an g Y back up or pondin of effluent on the spersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for and surface. i of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing fires the immediate notification of the local regulatory authority. g condition and requires the When the combined accumulation of sludge and scum in any tank equals one -third (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. Page of 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(sl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. 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. ABANDONMENT 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 chapter 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 replacement system: W 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 surf ace. Reconstructions of sudh systems must comply with the rules in effect at that tirnechr +a < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOTj' ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A` PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name IA Name �:r +r'!' Phone Phone 3 - u a SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 1 Name ri,YL -e, xF r Name 5 t• I' 0 1 - A Z b Ni j NY Phone a S- (t'�� ' Phone 3 0 4" U This document was drafted in compliance with chapter Comm 83.22(2)(b)(1 &If) and 83.54111. 12) & 13), Wisconsin Administrative Code. VOL 1807ma 34' STATE GAF0r*lkdrit1NF4')FthA -P) V,41'Ht,EEN H. WALSH WARRANTY DEED kEGISTER OF DEEDS Document Number I I ST. cRarx co., wl This Dead. made between Ore ory W. WaHh and Brigid M. RECEIVED FOR REMO Conway, husband and wife, 01-03-KOR 1-05 P11 WARRAN1Y DEED EXEMPT and Kurt - E.Schoenrock and Learn A. Scbeenrock. husband CERT COPY FEES and wife. COPY FEF,3 2.00 TRANSFER FIE: 626.50 F[CMING FEE: 11.99 PAGES; L Grantor, for a Yaluable comideration, conveys to Grantee the following described real estate In St. Croix - County. State of Wisconsin (ifmore space is needed, pieaae attach addendum): Recording Area Lot 6, Plat of Hartland. Town of Hudson, St. Croix County. Wisconsin. Natne and Rvaint Addms Edina Realty Title 400 S. 2nd Si-, oils mi.AW Hudson, WI 54018 020- /3147-60-0c Parcel identification Number (PIN) ThIA Is homestead Property. lis) %AM Exceptions to warranties: EagernaM, restrictions and rights-of-way of record, if any. Dated this _ "day of August 2001 Walsh AUTHENTICATION ACKr40WLEDGM. STATE OF WISCONSIN authenticat RRON Notar PU ic . P-sun-Ily come before rn a this day of ty the above named CteRery W-4valsk and Brigild IkOL Conway, huabsed and wife. TITLE: MEMULR STATE BAR OF WISCONSIN - -i " wn to * - - b-th. P.W (lr.*t. t0 Fb; .sonis) who executed the foregoin authorized by # 706.0i6. Wis. Sutts.i- Instrionleni and acknowledged ahe'5.rna. THIS IN2 LNT WAS DRAFTLD BY 9 Notary Public, State of Wisconsin My Co c anent. (if not, state expiration dote: (Signatures may be aujJa;nt4:%(rJ uf acke%swictigcd. Both arc not necessary,) LL . XZf'-' • Names o(per%ons signing in any capacity totist be typed or printed below their Signature. #4s i&A ft•w.WWs Comoaft. Fond Ow I.- VA WARRANTY UZED STATF SAR OF WISCONSIN MORM No. 2. Me Fd Wd2t L00Z LT 17629MLTS9: "ON XbJ WMU , h � Y iif J r m�5 r 777 V/138 3Nl d0 till 3N.L AO Will 1831A ' Mom M.KAJON .0099 ,Z8'8Lt `c0� �. CA m 0 Q! a 0) � •�� _) O w a 21,30 0010O.W A I c C g /ti 1�,� / ,O ►'Fr8 4.92,21 At OD OR z "is Z y� / m W. A n W N K) O i 2 M �� I I � ( ^� 4 t6't9Z M.91.60.ZON w 2d WdLV:LO 2 00Z 2 T 'fieW b629022 TS9: 'ON Xtid W021d O �p c .. > > n 0 0 3 �—, c o N r_ o O N c N N • ° 3 c n ! a o -4 m n O ^ C CD L y !, ? ` 1 0 0 0 O 0) CD � ° N 90 O I O O 3 _ 0 .�-► C N ID D a c M n v W d : N 3 a0 = c ° A ° O m w I w � z � v I ° co co m n o c V J ; CL 0 000S I ry o =; Q. c rn ! a N CL ` �! rr z ° z -i z O I O D m C , n Z1 (n y CD m m c t../ .. .m0 N S . cc a (J (D n 3 m 7 Z cy � -� N ° Cl) A Z a C s ;u •► m a A z 0 Z w T m N co I a m — z C A �7 O :► fn FJ 3 m o H m w � a I o o c� so '0 o e a 1 3 0 f m� �' 3 a a mo m W� m a o r 1 77 �v i... v x�C o m ° CD �p w CD y Z O m r.00 m m O IN 03 �03 g y � c o m� -,,. ID c fi m 1 14 1, c m I c c o = y 3� ° ° a > c 3 w v 3 M 0, q� n o r7°.m m' =3 ccn m . .. O(A ?a O \ N m Cc V —a I a s o b I m c 14 V V ° Cl ~ `n. CY) STC - 104 AS BUILT SANITARY SYSTEM REPO 1 Go Q� GpprX ! OWNER ADDRESS g SUBDIVISION / CSM # LOT # SECTION T N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 30 ` o � f 1 i INDICATE NORTI ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. c �J BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /000 Setback from: Well House a © Other Pump: Manufacturer Model # Size Float seperation / 0,7 9 Gallons /cycle: Alarm Location A/*- Z&� SOIL ABSORPTION SYSTEM Width: � Length 7 Number of trenches Distance & Direction to nearest prop. line: 7 / Setback from: well: -"' House SS Other v ELEVATIONS Building Sewer V, ST Inlet: Q, 002 r ST outlet: PC inlet a ( PC bottom Pump Off f Header /Manifold Bottom of system �/ % y� ` /�, 4 /3 7- T :: Q, sa - T a = 9, S 7 3 = /,D, 31 � Existing Grade Final grade DATE OF INSTALLATION: ,5--- �?- y Z PLUMBER ON JOB: LICENSE NUMBER: A A 7yS� INSPECTOR: 3/93:jt O v STC 104 -� RFC 0 AS BUILT SANITARY SYSTEM REPO OWNER ADDRESS g 5 SUBDIVISION / CSM # �-� C LOT # SECTION /'2- T Zq N -R I / W, Town of �- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 30 INDICATE NORT ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Safety and Buildings Division e.• ■n.r■r� SANITARY PERMIT APPLICATION Bureau of Buildin water s 201 E- Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. O rel { • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency pro rams ❑ Check if revision to previous application (Privacy Law s. 15.04 (1) (m)]. 75 Qrandon Dr State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr erty Owner Name Property Location _ AJE1 /4 1/4 S T a� , N, R �QE (or Property Owner's Mailing Address Lot Number Block Number 1a Ct , St at Zip Code Phone Number Subdivision Name r CSM Num er l ( ) !� II_ TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms 1 Town OF 111111. BUILDING SE: (If building type is public, check all that apply) arcel Tax Number(s) , ^ • �Q. V . / &kA p( 77 1 ❑ Apartment/ Condo 0 c — 1 _6 1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3. [] Replacement of 4 E] Reconnectionof 5. ❑ Repair of an System System Tank Only -------------- Existing System - --------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ry Seepage Trench 3 5SC 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑`+Seepage Pit 43 ❑Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./i ch) qa, 94.0 Elevation ( 4 �b G© �} q , Fee q7 Feet VI{ TANK I gallons Total # Of Prefab. Site Fiber- plastic Exper. " - " - is Tanks Manufacturer's Name Concrete Con- Steel glass App. strutted Se - 3 ❑ ❑ ❑ ❑ ❑ Lit ❑ ❑ I ❑ I ❑ ❑ V 6� , )stallation of the onsite sewage system shown on the attached plans. F n ure: (No Stamp) /MPRSW No.: Business Phone Number: 0�' pis ary Permit Fee (IndudesGroundwater O ate Issued Issuing Agent Signature (No Stamps) Surcharge t ee) l 1 7v. ►NS FOR DISAPPROVAL: SBD -6398 (R. OS(94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Divolon, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application' must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DIIHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. I ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings Division :L� : SANITARY PERMIT APPLICATION Bureau BuildingWaterSystems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. 975 J 8t 0/ ) (— &,) ) V y"' State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pr erty Owner Name Property Location ' 4 (`f `, i 1/4 <: , 1/4, S T x j r N, R ,�`(. E (or IV Property Owner's Mailing Address Lot Number / Block Number City, Statq Zip Code Phone Number Subdivision Name or CSM NumF7er II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF t. +' r J.r.. / 1 ;CF t III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) r /! - i 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2 ❑ Replacement 3_ E] Replacement of 4_ E] Reconnection of 5_ E:] Repair of an System ________System _ __ Tank Only______________ Existing System Exi sting B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 NSeepage Trench .� : ; l 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) tj ,9,y6 qW, 0 Elevation C -j ) (. , r C_ ' P a 3 r Feet l Feet act VII. TANK in cap ltos Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank %! C. —~ C_ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ,17Q ❑ ❑ I ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signal re: (No Stamp) PRSW No.: Business Phone Number: r m , !'_) D iv �� Plumber's Address (Street, City, State, Zip Code): U IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) A roved ❑ pp E] Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD -6398 (R. 0 - DISTRIBUTION:: Original to County, One copy To:. Safety & Buildings Division,.Owrrer, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax nuniber(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete sped fications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. sj } p , \ Z + t\ v , It .l f \ Vn r� en P�6E b HEAD CAPACITY CURVE 3 7/8 6 1/4 aF1 MODEL "98" 4 5/e ` e e I 2s 3 5/B m 6 t + _ / 0 15 4 3/16 e 4 10 1 1/2 -11 1/2 NPT 2 5 0 GALLONS 10 20 30 40 50 fi0 70 so 1 N ' 80 160 240 0 FLOW PER MINUTE TOTAL OW&MAC WADI IOW PER 141114RE EFFUrEtrT AND OEWATUROW CAPACITY 12 HEAD U INTSAI1M FEET s1ETE/q OAI S 1.71 5 1.52 72 273 10 3.05 61 231 i 15 4.57 45 170 3 5/16 20 &10 25 95 La" V4M 23 CONSULT FACTORY FOR SPECIAL APPLICATIONS ;caieal alternators, for duplex systems, are available and o Mercury float switches are available for controlling single and ,l,l,lled with an alarm. three phase systems. iiCal alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for It 1( )tit alarm switches. variable level long cycle controls. SELECTION GUIDE 1. integral poet operated 2 pole machanical switch. no eraerrlal coouol requued. Standard all models - Wei ht 39 lbs. - 1 1-a H.P. 2 G"le p+ggyback mercury poet switch or double piggyback mercury, float 96 SsI ConLd Se swi". Mer to FMO477. ,il i _ Volts -Ph Mod* Amps srm let Duplax 3. Mechanical alter Let 100072 or 10-0075- 1,11 115 1 Auto 9.0 1 or 1 & 7 — 4. Gas FM0712, tcx correct model of Electrical Alternator, "E -Pak" ,n t l} 1 or 2 b 6 - 3 4x 4 j 5. Mercury sensor pail wwdch 10-0225 used as a control activator, speuty 10 : dQ 1 Auto 4.5 1 or / & 7 _ duplex (3) or (4) 11" system. 6. FOur (4) We - .1-Pak". Junction box for watertight connection or woad to atm- ut 230 1 Nod 4.5 2 or 2 6 6 3 or 4 i 5 _ pbx or duplex operation. 1"(W. 7. Two (2) hole "J -Pak ". for watertight connection or spllca. CAUTION n uun on addAntal Zoassr pradtrcta ratio to Wake an Combirmoon $tartar, FW514; AN installation d controls, protection devwss and wuutq should be done by • quslt —,I, Mercury Swok. S, FMD477; Elagr" Amo nalW, F%0466, kbeharucsi AbrtWa, had 1wenaad aMetrrciam AN ateeb" and rarely codes should be fuil..rved in4ud- +_r Aaarm PaLltapa, FM001>; 8wopOstsWe Badrs, FMO467; std Birtlpbs Carttrd Elm, i^6 the nto*1 recent National Electric Code (NEC) and the Uccupebunal Salary and �.L //atasA Ad (0.%HN. RESERVE POWERED DESIGN f For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAY. TO: PA 001( 16347 LaisvNe, KY 40256 -W47 )Narwlacfarers of. f 1iJQq 731 r: a� GkiNn+ra Le na N „ � , , .,.. %';� .,,.•; „r• /nom ' 4 ++" CI VENT PIPE 12" MIN. ABOVE GRADE t WCATHFR PROOF 2S' FROM DOOR, WINDOW OR JUNCTION Box APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE C FINISHED GRADE 4" Cl RISER W/ PADLO( i" MIN. WARNING I ABOVE , G ADE -•�— 4" tlI1� 18" IN. b" MAX. •w INLET WATER TIGHT SEALS GAS- 14 @0 _r TIGHT 4 1 s CI PIPE BAFF'Lt A SEAL + APPROVLD " ALM JOINTS W/ 3' ONTO PIPE 3' C SOLID �� ON SOLID SOI COI L PUMP OFF ELPV . M � OFF RISER 0 PERMITTED IF TANK MANUFACTU 3" APPROVED BEDDING UNDER TANK HAS APPRC SPECIFICATIONS CONCRETE PAD !EPTrc DOSE TANK MANUFACTURER: NUMBER POSES PER DAY: 'WANK SIZES SEPTIC --- r',_ GAL. DOSE VOLUME INCLUDING DOSE c c GAL. F'LOW9ACK: ALARM MANUFACTURER: i ,,`, � � GA L. ' CAPACITIES : A s MODEL NUMBER: _ �� INCHES z - =� � 1 SWITCH TYPE: ;., ►'UMP NANUFACTURCR . 8 s ... INCHES = MODEL NUMBER: C = G. INCHES SWITCH TYPE: . INCHES : EOU I R EA DISCHARGE RATF GPM r7( +� PUMP ' E ALARM WIRING AS PER ILNa I CRTICA L D I FF =RENCE BE?1iFFp PUMP OFF ' MINII�U" NF7�10RK SSURE SUPPLY PRE AWD DISTRIBUTION PIPE FEET FORCEMAIN X . • . . . — rCET 1 FT /100 fT. �FRICTTON FACTOR -.—, FEET IYTCRNAL OIMEHSIONS of PuHP TANK: TOTAL DYNAMIC HEAD _ ' --r-�� FEET � -��B FEET LENGTH WIDTH DIAKCTER _ LI QU ID DEPTH IGNCD - - LICF.NSF IRiMapt: 4�! DAB, 44, rf .R <o� C# � b� n^1' O ki Tj c V i e L v P i Z� ;sh'"� . a4- -yruwn -re,6 1( REAL ESTATE TRANSFER RETURN - CONFIDENTIAL completion see e "Instructions for Real Estate Transfer Return" PE -SODA. ViS CONSi ,�„ �,V s u b m it all parts to Register gister of Dads with document be r s) to be recorded. _ I. J3RANT.QR: V. PHYSICAL DESCRIPTION AND PRIMARY USE BY GRANTEE 1. Name Debra J . May 15. Kind of properly 16. Primary use 2. Address - New address if property transferre4 was prima residence ® Land only a. ® Residential: t s aq N ' V-- ❑ Land and buildings ❑ Primary Residence for Lottery Credit I� ❑Other (explain) ®Single Family/condominium rn �. � M l -� 17. Estimated land area and type ❑ Mu*fsmiy - ! units 3. Grantor is x❑ Individual ❑ Partnership ❑ Corporation ❑ Other a. Lot size x ❑ Timeshare unit b. TOTAL ACRES b.❑ Commercial 11. GRANTEE: c. MFL / FC / WTI. acres c. ❑ Manufacturing u. budnmun 4. Name Grace J . LaCasse d. R. of water frontage d.[:] Agricultural 5. Address CALL adjoining land within 3 miles? ❑ Yes ❑ No I e. [ (explain VI.TRANSFER 18. Type of transfer. Sale ❑Gift r Exchange ❑Other (explain) 6. Grantor /grantee related: [I None ❑Corp/Shareholder/Subsrdlary ❑ Partnership ❑ Financial ❑ Family or Omer, explain 19. Ownership interest transferred: 0 Full ❑ Partial (explain) 7. Send tax bill to: Name and address 20. Does the grantor retain any of the following rights ?❑ Life estate ❑ Easement Same as Grantee 21. ❑ Deed in satisfaction of original land contract? Dated? 22. Points (prepaid Interest) paid by seller $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? 23. Value of personal property transferred but excluded from (25) $ ❑ Yes ® No Exclusion codek77- If W -11, explain 24. Value of property exempt from local property tax included on (25) $ - VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV. PROPERTY TRANSFERRED 41 500.00 25. Total value of REAL ESTATE transferred S 'r 9. ❑City ❑Village ®Town HiJdSOn 26. Transfer fee due (line 25 times .003) $ • 0 County St . rrni x 27, TRANSFER EXEMPTION NUMBER, sec. 77.25 ? 10. Street address 11. Tax parcel number 28. Grantee's financing obtained from a. ❑ Seller 12. Lot no.(s) elk no.( b. Assumed existing financing If box a or b is checked, ❑ g ; Plat name complete Part Vin - c. Financial institution / Other 3rd, 13. Section Township Range Financing Term � party d. ❑ No financing involved 14. Legal Description metes and bounds: (attach 2 copies V necessary) Lot 6, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin. VIII. FINANCING TERMS (FOR SELLERIASSUMED FINANCED TRANSACTIONS ONLY) _.. n. 29. Total down payment Z ` ` � ° � � (Line 29 a Line 25 minus Lines 30a and b excluding payments for personal property) 30. Amount of mortgagelland 31. Interest 32. Principal and Interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum . a. $ % $ - -/- -/- - $ b. $ % _ - -/- -/- - $ i 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above } Enter the date of change - -/ - -/ and the amount it will change to $ i IX. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief It is true, correct and Complete. Grantor or agent Grantor's social security number or FEIN Date Grantor's telephone number SIGN 4 - = ; r : ( ) HERE a or agent Grantee's social security number or FEIN Date Grantee's telephone num ber 6 Q ti . ati - 1 Y. ( 471 � 38 1204 • ,. , - Print na ad re o ran s ent Agent's telephone number j Document number VoIJJac. Page/lm. Date recorded Date and kind of conveyance Cony. code FOR Parcel number Assmt. year 19 _ -] Field Sales number ASSE L County USE _ _ ❑ Parcel classification l Tax disc _ _ _ Use ONLY RES COM MFG AGR S/W FOR 1 2 3 4 5 6 T Assmt. disL E] Reject Wisconsin Department of Revenue PE -Enn fR 7.981 .�,n�..... +n...•r.+...n�nr� .. n.... AD Cry N DRE S - JAGE SYSTEM County: ON REPORT ST. CROIX G �' TO PERMIT) Sanitary Permit No.: 284318 Permit Holder's Name. ty C] Village Town of: State Plan ID No.: LACASSE, RICHARD Ann, JDSON CST BM Elev.: Insp. BM Elev.: BM Desu,,__ Parcel Tax No.: 020 - 1318 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss m ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil [I Yes E] No E] Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) ✓' LOCATION: HUD50N.12.29.20,NE,SE b �� Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 g 3 E F 3 e E v a � E s ;t^ Safety and Buildings Division �.p`'■ -'■ : SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count T than 8 1/2 x 11 inches in size. / C • See reverse side for instructions for completing this application State Sanitary Permit N yWber The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pr caner ame Property Location Jv41 /4 SZ7 /4 S /a T,-2 '7 , N, R 30E (or)�D Property Owner's Mailing ddress Lot Number Block Number City, Sta e CJ Zip Code Phone Number Sub ivisi n Lame o CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned I L ity Neaest Road II Public 1 or 2 Famil Dwellin - No. of bedrooms own of 7 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) (� 1 ❑ Apartment/ Condo O 8 — "' O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2, ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an _____ System ____ - ___ System____ __ _______TankOnly___________ - __ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed C 21 ❑ Mound 30 E] Specify Type 41 F] Holding Tank 12 C( Seepage Trench 3 _S,) 7 rJ 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. Final Grade ��© Required (sq. ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Min. /inch) cj�,Q0 / levation D O * cl ,D, Fee Feet Ca acit VII. TANK in g allon s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existin strutted Tanks Tanks Acl Septic Tank or Holding Tank — Qa ❑ El 11 El 1:1 Lift Pump Tank /Siphon Chamber ❑ El El El 1:1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' ignat e: (No S MPRSW No.: Business Phone Number: Plumbe ` Address (St�t, City, State, Zi4oc(e)� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing A nt Signat re (No St ps) A rOVed Surcharge fee) pp ❑ Owner Given Initial Adverse Determination $l (� ee j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Div ,on, Owner, Plumber - C INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever - necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a// septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction -loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county, E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER • SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater - The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. n i I l� � I S S Qn Ull C o� Wisconsin Department of Industry SOIL AND SITE EVALUATION a of 3 Labpr and Human Relations P a g e Divi sion of Safety and Buildings in accordance with s. ILHR 83.09, Wis. `Attach colnplete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and S _)� 1 �0 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # & �a sN ��m APPLICANT INFORMATION - Please print all Information. Review Da �fi ' Personal intonnetbn you provide may be used for secondary purposes (Privacy Law, s. 15.04(1) (m)). �I Property Owner VeVA115 A g J10 PTV Sr�D AND Property Location v r- Dflrf5 Ni'6LSE�tJ Govt. Lot AVE 1/4 SE 4 t3�y ,N,R E (or Property Owner's Mailing Address Lot # Block# Subd. Name, 997 11111A v RIP (�, City State Zip Code Phone Number 7 /S_ Nearest Road If uD.soAJ w1 S401 ❑ Cit ❑ Villa �,/ e Town p q�voo�7 die - L7 New Construction Use: &Hesidential / Number of bedrooms 3 + Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: ySd ItlIR = " f2ECOnH4<N Code derived daily flow Coed gpd Recommended design loading rate. Zbed, gpd/ft _ _ trench, gpd/ft Absorption area required bed, ft /20 trench, ft Maximum design loading rate bed, gpd/ft ' 7 trench, gpd/11 Recommended Infiltration surface elevation(s) 5 N eTE �e 10 w fi • 3 ft (as referred to si(b plan benchmark) Additional design /site considerations Parent material _ 5c5 3 7 4WMA0 0 ' �/.y� S� Ussr�1�" $ Flood plain elevation, if applicable ft Conventional Moun S = Suitable for system In Ground Pressure AT Grade System in Fill Holding Tank U Unsuitable for system ❑ U L`1 s ❑ U L'f S ❑ U L� S ❑ U ❑ S 0-� ❑ S Elv SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /11 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench YX Zlz /f S!,' A4--F/2 CS - `f • �{ s .......::...:....::..... Ground 3 2 Z d Ve cy/ L / A" X4e 444 - F/L e w Z f S - 6, elev. Depth to limiting factor 7 00 In. Remarks: Boring # o 10 2 12— 0 1 & 3 Sale 1 ,6 e C s 2`F :_5 3 /o YR sAe 2 Ground 31- /O �$ / s �k ,,,. fp, � � ' • S elev 3 &0 ft. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature - . Telephone No. R ot T - 24 L13R i c T � J� �l`� 7 /j� = 3 ?6 — 9 1 RS Address Date CST Number i tee 3 - �/ - 1��0 �'S >M 2- L/ Private Sewage Conlu tilt► s 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL NOTE: Because of snow /ice cover over groundr the installer (designer) will need to determine exact system elevations for multiple long narrow trenches only after he can verify actual surface elevations and contours (currently buried d f Insfialler will need to carefully •n ay • test under anew) layout trenches using transit /level before he can propose trench system elevations for sanitary permit. 4'l ._ SLHIP I i_N F1�t �3N 1 Page L of PROPERTY OWNER GO % CQ - OA RTC A ,O PARCEL LD.fI Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z / I aY l e 3 - /, f S� nM s ,3 f ' , S Ground 3 / 3 lo — Si �.t.1 S/J 7 e (.t� Z f i J� ; • c. � io Depth to limiting factor Remarks: Boring # f s6 f cs 3-F ; S J '114 foe— cv Z-f- S Ground la g lt'v elev. 7• ft. Depth to limiting factor d" Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots T t2 In. Mun sell Qu. Sz. Cont. Color Gr. Sz. Sh. Bnch Boring # -,5- /a Yk 2 -/L — 7S� /k"Cri2 .2 A" she 4WFP_ ccv i-F • 5 ; •G Ground 3a g 3 - M^T I` C w elev. ft 0 S — ' 9� /� — Depth to ; limiting factor Ig8 - -in. Remarks: Boring # ' Ground elev. ft. ' Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All fhe;.rine:r. soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 (4), the installer MUST be very careful to properly hand rake the sidewalls & bottoms to re- expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. V Gj D w - N Lo N - rn rn � R, NA � v w w^ w N N y � 0 Ul b r -ILI CA O m G � 0 r y n 1b p - 1 L9 o p m p J W � c v � � � N ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, W1 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants I Re: Soil Test Sites, and Siting Your Home. To Owners/ Developers, Please be aware: All of the systems for lots #4,5,6,7,8 in Hartland Subdivision (tested under winter conditions March 11th & 12th, 1996) will require very large TRENCH TYPE conventional systems because of soil permiability restrictions.Conditions across other parts of each lot can/ and may require entirely different on -site treatment systems. Also, as required by state codes, an equally large replacement area has to be left intact UNDISTURBED with proper set -back distances to the well, other structures, etc. as deemed by code. Less space is required if the owner were to install a mound type system (i.e. no replacement area is required for mound type systems). Please understand, that in the process or procedure of selecting the actual homesite, if the owner will be using the soil test areas as provided and recorded by the seller /developer, the following s very critical: The ' Y installing lumber g p you select, or a registered designer or engineer should meticulously layout and plot the system as indicated from the soil report. And an equally large replacement area should be plotted out. Further information to be supplied by the owner is necessary in order to determine the actual exact size of the system. The final size of the system is dependent upon�the gals. of wasteflow to be generated from the proposed size of the home. The County Zoning Dept. must review the owners final house - plans', only then can the installing plumber determine the final size of the proposed system. All of this has to be carefully addressed before a builder and owner can safely choose one's precise homesite. Often times the original soil test area, provided for subdivision approval by the seller as required by County Zoning Dept. ordinances, is not in an area prefered by the eventual buyer, or perhaps the size of the buyers home may require a "larger test area. New or additional testing may be required, since a septic system by law has to be laid out exactly within the recorded spot tested; it cannot be shifted out of the area recorded with the zoning dept. Finally, it is our recommendation (and of most consciencous installers) that when soil permiability on a site is very slow (.5GPD /ft or lower) to install a presurized, dosed mound -type system. It is the concensus Of most officals that mound systems will generally outlast in- ground conventional system (average life 10 -15 years). This is a very important option to cautiously consider. Remember, the two most important systems you will be depending upon for many many years to come is your well and the quality of your septic system. Robert Ulbricht Pg. 4 of 4. r N m _ rn N o• TD b /13S 3H1 AO b /13N 3141 d0 3N1'1 1S3M � ,ZZ'809 M ,00'89 ,Ob'ILZ' ' 16'81 tP��e � t0 � � �� N —, �► C CND i - C c �r•• I v I -I iv a O) N I o D — I N - r as s G7 CD N Ob'£bZ M „9£,ZI 1 �' cn n -- - -- - -- % - q OD w / CD m 0 jo Q W N -1 N p of m I 1 V z m p j I I ,b9'19Z M „81,60 ( 0OT m �� :) --10 o l Z m I Z yv 1 �� ” °j -- rn I — iU ul Vi 0D / N 7 N —1 6 W n a OD Z O W > Z / D O IQQ m IT! r i' w Im ,91'81£ M „61,Qb r a►�� ► s V) m / m 1 rn -- � �£ •� I m Z rng I �7 ro �� g r,>) m y CD c �� S T C - 100 This application form is to be completed in full and signed by the owners) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Z0�6P- Location of property N E 1/4 1/4, Section / oZ , T o� y N -R R 0 W Township k4c,,4 yr, Mailing address Address of site 7 Subdivision name Lot no. S Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel _ ). Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes /b No Volume and Page Number 5S-e as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition a certified survey, if available would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify hat all statements tements 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 NoOy 55 3 / and that I we presently a ( ) P Y I � own the proposed site for the sewage disposal system or I we g P Y ( ) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. r Signature of Applicant Co- Applicant yl �� 7 Date 6f Signature Date of Signature STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C:M MAILING ADDRESS PROPERTY ADDRESS Ao (location of septic system) Please obtain from the Planning Dept. CITY /STATE PROPERTY LOCATION t J L _ 1/4, 5,5 1/4, Section T y N -R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three y expiration date. SIGNED: DATE: Yl l x St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i `y STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED DOCUMENT NO. Debra J. May i *T. CRCut 00, Wt p�L'dforRttoad I D EC 10 1996 j� conveys and warrants to Grace J . iaCaSse, a married person,_ 11:45 A. M THIS SPACE RESERVrD FOR RE OATA if NAME AND RETURN ADDRESS �i -he following described real estate in St. Croix Cwr..A State of Wisconsin: fCA Bank` II ��1 000 Second Street p.0. Boot 71 i Hudson. MR W1t if ,._ PARCEL IDENTIFICATION NUMBER Lot 6 of Hartland in Town of Hudson, St. Croix County, Wisconsin. li II t ii I This _ is not homestead property. I )(KK (is not) Excrtptiontowarrant Ea sements, restrictions and rights -of -way of record, if any. i! Dated this 3rd day of December _ . A.D., l9 L6 I (SEAQ•,. (SEAL) • De bra J. Ma (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin. St. Croix County Per authenticated this day of , 19 sonally came before me this 3rd day of 11nr -P nhor , 19 the above named Debra J. May i TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by $706.06, WIS. Stars.) 8 '�► f me lurowtt to be the person who executed the forering �Oj" and acknowledge t rr . THIS INSTRUMENT WAS DRAFfEO BY ton L Attorney Kristina land t tC Hudson, W1 54M Public, ' • ( ✓c)iX County, Wis. (Signatures may be authenticated or acknowledged. commission is permanent. (if not, state expiration date: necessary.) •Names of persons signing in any capacity should by typrd or printed blow their s>gLarsa —^ WARRANTY DEED SIATE BAR OF w1SCCr%SL% we=W Leper ft* Co.. h - r – Fonw `ro. 2 - ilea Miwa lee. we. 1 ` ;.A- >Z 0 " =. .- PMReuLW 411 ;.'-r lltt " L�^t[�eLxv- _w.:• .. -..._ { w STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED DOCUMENT NO. i Debra J. Ma conveys and warrants to Grace J. _LaCasse, a married person, THIS SPACE RESERVED FOR RECORDING DATA the following described real estate in NAME AND RETURN ADDRESS — S t . G of x County, State of Wisconsin: PARCEL IDENTIFICATION NUMBER Lot 6, Plat of Hartland in Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. XIM (is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of December , A.D., 19 (SEAL) (SEAL) • Debra J. Ma (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix authenticated this day of 19 County. Personally came before me this day of Dpramhar , 19 x--, the above named Dpbra-J. May TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Slats.) to me known to be the person who executed the foregoing THIS INSTRUMENT WAS DRAFTED BY instrument and acknowledge the same. ttorn v Krictina Ogland 'dso;54016 _ Notary Public, County, (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 •) • Names of persons signing in any capacity should by typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legw BIer*Co Inc Form No. 2 — 1982 Miwedcee