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HomeMy WebLinkAbout022-1021-30-000 I Wiscorpin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 151 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Linehan, Philip Kinnickinnic, Town of 022 - 1021 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: ldv 08.28.18.123 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �` � ' Benchmark Dosing Alt. BM Aeration Bldg. Sewer , f 15. /1 Holding St/Ht Inlet !J St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL PLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom Dosing 7146 Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number x TDH Lift Friction Loss I System Heae T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of Seeded /Sodded ulched Bed/Trench Center Bed/Trench Edges Topsoil r Yes ® No xx M ® Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 407 County Ro SS River Falls, WI 54022 (SW 1/4 SW 1/4 8 T28N R1 8W) 40 acres Lot Parcel No: 08.28.18.123 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = 170 4f b U G4.►ti �� ^"- P`G' -J v_ Plan revision Required? 9 Yes No /� Use other side for additional information. / SBD -6710 (R.3197) Date A s Sign re Cert. No. County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans flWhe llwtsef on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # Check ' ision to previous application 5 I. Application Information - Please Print all lnfgAhqti o •,. Location: Property Owner Name P SF r p ® , SGJ 1/4 SW1 /4, Sec 8 N l R W Property Owner's Mailing Address - ST Lot Number Block Number �NNN � CO 7` O (1• & SS ` � Ip/V/ UN City, State Zip Code Phone Numer /CS Subdivision Name or CSM Number 11 Type f Building: (ch eck one) amity ❑Village 15Rown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public /Commercial (describe use): h n /9 �C- ❑ State -owned N .9arestAb Abaci ss 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) CO 'k Parcel Tax Number(s) A) 1.[- Repair 2.9 3. ❑Non- plumbing 4. ❑ Rejuvenation Sanitation X22-- /evv 30-6 B) Permit Number Date I sued � State Sanitary Permit was previously issued 2- 7 /W,5 V. Type of POWT System: (Check all that apply) /' 11 Non-pressurized In- ground Q Mound z 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. DispeV Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) 99 9Q �� /.1-" Elevation VI. Tank Information Capaicty inigallons Total of anufact er Prefab Site Con- Steel Fiber- Plastic New F -' Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ ❑ VII. Responsibility Statement I the undersigned, assume responsib y for r air /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift rep it or the iristallation of non - piumbing sanitation system. Plumber's Name (print) be' Signa re (no 6i_LMPRS No. Business Phone Number �--- 3479-�/ )5' 2 7767 Plumber's A dress (Street, City, St e, Zip Code) 3a u La., Ca LAD/ . sW-2C VIII. County Use Only Zermination d Sanitary Permit Fee Date Iss ed Issui Agent Sign re mps) Approved ner en Ini dverse �} � co J� �{ IX. Conditions of Approval /Reasons for Disapproval: 3 ) SYSTEM OWNER: : / ✓Jt �i��{ �- A 1. Septic tank effluent fiker and 6o J4,.. b f // dispersal cell must all be sery ices / maihta'rned '7z as per management plan provided by plumber. 2. All sotback requifements must be maintained as per applicable code / ordinances. ...—• � L J i (1?� c>;.� �,�a_ �- �� 1 i} ••�-r► GTTt)IL Rev: 8/05 ♦ t'Xis n �rade Bleu Ph;/ If-6e6 5 CO kd ApProz. &dye or a�Yls SWf'ySwAy, Sec. B, 1 4 0zz 16 21 - 30 -cz2-' I v I P 3 brdr� es,dencx Ex� s-Er„ c I p I EXi;rEinq /Yf;�w <sz���n �� ��;5 /a,� I /of1,27 ca �/t Can r e.-E:e S.T. /%� � I • r Y4/ ,4. s.T. M. 30 3 I ;� s t�- e�c.c✓Q s txis4 J t/ o be ra�ecl. k " V t✓�. z � 7 f - ♦ t �radc e lev Y07 ��� U)/ syo - 4PpfoX. Edge of ° a' , s - � • -xy r�'' // 0 SW` y Swly, Sec.B, T��., - krue As �4� %ding U se 1e. /Qc�? �.o/J�nrlic.Cirin /e O Si. CrGYX ce � � �� [f OZ Z - /D2/ - 30 - 0 - 1 & lot QG/fS ,apPfox. / OCR t� On 6 ' pr 3 5��iom h'(uu nct� Qes�denc.¢, , f'rc C-4 Con c f e. e s, T//J(!.. / � �e slog 1641,27' , � v V ,9.S,T.M.3o3 � 97 87 . �t. , � %+S fa.eQc.�✓a s Co. flw y. 'ss Ek v, =QUO. v �X/ S�inq Cie-It EX/ rice ,� 6 be ra�ecl. Ex�3� Sri vec.Jay � l POWTS - Reconnection to existing Mound Index & Tilte Sheet Proiect Ownership Project Name: Phil & Beth Linehan Owners Name: 407 Co. Rd. SS Owner's adress: River Falls, WI 54022 Project Location Site address: 407 Co. Rd. SS, River Falls, WI 54022 Subdivision or CSM: Na Legal Description: SWva SW1/4, Sec. 8, T.28N., R. 18W., Town of Kinnickinnic, St. Croix Co., WI. Parcel ID #: 022- 1021 -30 -000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 System Management Plan Page 4 Existing Dispersal Cell Evaluation Page 5 Existing Septic Tank Certification Page 6 Septic Tank Maintenance Agreement Page 7 Deed See original State Plan Approval &Sanitary Permit #249787, issued Nov. 9, 1995: Dispersal Cell Sizing Calcualtions System Cross Section Pump chamber cross section Septic Tank Maintenance Agreement Waranty Deed Soil Evaluaiton Report Mater PI her Res cted Service- es K. Thomps Dep't. of Comm. Credential h 300321 Signature: Date: IV Page 1 Of 7 Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01) Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The mound septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10691 -P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System Influent quality into the mound system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Trees or shrubs should not be planted directly on the mound. Plantings may be made around the mound's perimeter. The mound shall be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) on the mound is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the mound and will promote frost penetration during cold weather months. The pressure distribution system is provided with a flushing point at the end of each lateral. Each lateral should be flushed of accumulated solids at least once every 18 months. A pressure test should be performed with the results compared to the initial test taken at the time of system installation to determine 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. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Continency 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 become defective the defective component 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. Toe leakage will be eliminated by increasing the basal area of the system. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the system installer or to your County Zoning or Health Inspector. p i . 3 a-r 7 September 8, 2010 RE: Linehan Existing Septic System Evaluation, 407 Co. Rd. SS, River Falls, WI., SWv4SWv4,Sec. 8, Tn. of Kinnickinnic, St. Croix Co., WI., Pcl. #022 -1021- 30-000 I have conducted an inspection of the existing mound septic system that serves the residence at the above address. This inspection was completed September 2, 2010. Records obtained form the St. Croix County Zoning Office indicate that the system was installed July 19, 1996 under permit #249787. The system consists of a 1,000 /650 gallon Mid - Western Pre -cast Concrete combination septic tank/pump chamber and a two celled mound at 44' X 69'. The system was installed as per codes in force at the time of the installation. An inspection of the observation pipes show no signs of effluent ponding within the system dispersal cells. There were no indications or evidence of effluent discharge to the surface of the mound or to the surrounding area. This indicates that the system is functioning properly and is able to absorb and dispose of the wastewater that enters it. e failure of a septic system is a progressive process, I cannot predict how long the drainfield will continue to dispose of sewage effluent before it fails. The inspection was based on a surface evaluation, so ere may a hidden efec i in the system that were not discovered. J Thamps0 t of Commerce Credential #30021 Cc: file �_ q0-P ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) z1p7 e, e& SS Lj /• located at; SGJ '/4, s cJ ' /4, Section 8 ,Town � N, Range 1_ W, Town of ;,,,�; �;'„ ti , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection;- �o,r�i. �, zofp Did flow back occur from absorption system? Yes No J (if no, skip next line.) Approximate volume or length of time: gallons -- minutes Tank Capacity: L aeI6,0 Construction: Prefab Concrete Steel Other Manufacturer (if known): Z 4 ; o Areea-S A Tank (if known): _wears ermit limber (if kno 02 y�787 icensed Plumber ignature) (Print Name) (Title) (License Number) ,MW/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 P9•sox7 T S . CROIX COUN TY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM U J Owner /Buyer C.1 Mailing Address w-I D �Q 1 V16 Property Address 54WQ (Verification required from Planning & Zoning Department for new construction.) City /State / P Q l/ filly Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /a , 1/ , Sec. , T N R W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St, Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /out knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 6 \ '`dumber of bedroorns SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I - DOCUMENT NO. ; rE BAR OF WISCONSIN FORM 11 -1984 $PAL► Jtestce ►(`R a[co,ecJ DATw i IAND COWRACT ladi.ld -el end Ce"rat* HE 4647 78 iZ° 000 1S S PINAY ED AND N OTHER CONSUMER ACT TRANS REGISTER $ OF FICE ST. Cox CO." u Contract, by and between ..... F r_-a d.- 9.....1.in ehan,...a.l.k /a.. %e d for Uto, ............................-..............---...._........------•-•-----...-_ ...................-- ,.-- - - - - -- OEC1 41990 F: 1' ............. ede. r c- k ... ( 1.-.1 1. Aehan.................................... ("Vendor Q� 8:30 R. M whether one or more) and ................ ph.i_li.tL._S.,...L1DAhr 11 ................. t' ............and _13.e_t1i any- __S_.. Linehan.,huahand_.anA_.wifa....... L ............ a.ed...ea ch...in. azu..r_igh V 'Purchasee', whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the fcllowing property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in ------------------- ........................... County, State of Wisconsin: acrUaN To Nancy M. Barkla SW 1/4 of SW 1/4, Section 8, Post Office Box 22 N 28 N R 18 W Tax Parcel No .... .................... .... ....... Vendees shall have the first right of refusal to purchase adjoining acreage owned by vendor when same is offered for sale. Vendor is to receive current land rent now due from tenant . Vende -es do not have the right to assign their interest in this contract without the written permission of vendor. This .- ...___f s ............... homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at .............................. ............................... the sum of;....... r?.5 Prescott, Wisconsin s --- •-- --- •-- ......... in the following manner: (a) j. ....... - 0- .... ............................. at the execution of this Contract; and (b) the balance of 55a ._.. . 000 ... together with interest from date .. hereof on the balance outstanding from time to time at the rate of...........s�x E 6 )•••••-•••••- - -- per cent per annum until paid in full, as follows: $500 per month which includes payments of principal and interest. paym.pnt to be trade s`arting Jan. 10, 1991, and each month thereafter until paid in full. Provided, however, the entire outstanding balance shall be paid in full on or before the - ..... 15 ................ day of ------------ pica- weabep --------- , the maturity date). Following any default in payment, interest shall accrue at the rate of ...... 6... % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time of a ..__..Jarivary...L..., 19 --- 9.1 (OR) there may be no prepayment of principal without permission of Vendor.* In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: f no exceptions I I I I r . 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PIERCE COUNTY • �5'/ Goix G'ouny, W�T- 7 /Q c,E ordM Pub /s.I c. 9 f /° e RIVER FALLS COURTESY OF JOURNAL SURPL U S CI TY R /VER FAILS Printing Publishi L UMBER CO. s 9 9 _ - FURNITURE I Advertisin Office Supplies CLOTHING - FOOTWEAR 9 pp North Main Street WHOLE AND RETAIL PHONE: 425 -2484 River Falls, Wisconsin MOBILE HOMES RIVER FALLS "The Panel People" RADIO SHACK WISCONSIN 54022 425 -2563 PHONE: 235 -0466 - MENOMONIE WISCONSIN CO SIN I r _ - + Wisconsin Department of Health and Social Services Plb, h +67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK 10 A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) k it ", i� 2: Ilt"e �"q L" Be LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check TY VILLAGE LEGAL DESCRIPTION N � TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? _/ _ YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY ID C' U Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete A Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY , Cheek One: One or Two Family Residence Commercial Industrial other ( Specify) Number of Persons to be Accommodated / Number of Bedrooms ly F. APPLIANCES, ETC: Food Waste Grinder YES 1 y NO Automatic Clothes Washer ly YES NO Dis` YES NO Automatic Potato Peeler YES NO . crash er Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Name G�C 7 7 8C4,/J T Address 'License Number: 1 Signature of Applicant: L �''-� ,� ?f ,�'t ! MP RSW Address: .�... � 141 H. (T" be Completed by Issuing Agent) Date of Application 91 Fee Paid h n Permit Issued (date) — (7 Permit Number � 1 �J Agent (Name) (_;( Z -/` C �'t 1� \ i ' / n.,' Fori, —tt ' Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of ;1.00 for each septic tarot and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Heaath. Do not write in space below FOR DEPARTMENT USE ONLY L DATE RECEIVED ACCEPTED BY ��1� RETURNED t / (Initials) (Date) Set.,Corres. FEE RECEIVED ✓ VALID. No. I?( a, S �� PERMIT N0. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT N0. 9 9 1Z3 7 5 R Z P 0 R T O N S O I L P Z R C 0 L A T I 0 N T E S T AND SOIL BORINGS TO DIVISION OF HEALTH - PLUMBING SSCTI6M P.O.Box 309, Madison, Wis. 53101 Pursuant to H 62.20, Wis. Administrative Code P Z R C 0 L A T I 0 N T Z S T Test Depth Character of Soil Hours Water Test Time Dro p in Water Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall let Wetted Overnight in Minutes Last Period Last Period Period One Inch Example P - 0 36 Top Soil 10" Clay 26 25 Yes or No 30 l/ 1/2 1/2 60 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B O R I N G S- Minimum 36 Below Pro osed Absot2tion System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 72 72 Blaok'Top Soil 12l'i C12Z 18 Sand 18 Gravel 24 G 42i RECORD DATA FROM MINIMUM OF 3 BORE HOLES YPE OF OCCUPANCYt RESIDENCEt Number of Bedrooms OTHER (Speoify) Number of Persons FOOD WASTE GRINDER: Yes No Dishwashert Yes No Automatic Clothes Washers Yes No E FFLUENT DISPOSAL SYSTEM: NEW _ x EXTENSION ADDITION REPLACEMENT T ' Tile Size No. Lin. Feet Trench Width_ Depth J[: Number of Lines Seepage Bedt Length Width Depth _ Tile Sizq No. Lines / Seepage Pitt Inside Diameter -4:1— Liquid Dapth : 1 I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under mJ super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME L' r �} 7 L- TITLE � (Type or Print G REGISTRATION NO. or MASTER PLUMBER LICENSE NO. 7 O ADDRESS _.b1�I Lt! J 1 DATE _ �t'� ��' �( SIGNATURZ( y z , o 0 O 0 fA Q g - 0 n d p Os p ' M p m Co a t • a ;; xc p' O CD rT Z z o N r- Z 2 m z o co r T o o • C7 Cy O C 0 (o CD O d G2 v N j N N /r N p p a 3 CD V N CD O. W N �- O i�-► `A, o co _2 0 0 C O O n ? O f7 W 0 `� O to m m o f a a o 00 7 N 7 N O N C O N C 7 lr Er O N CD N 4 G? c O N d G C c W m W N C _ x to C O O G O G. O N) 0 0 0 (C`r O` A CO CL OD N N lei cn CD (D ( o c 0 cn J V> N p C CT Ln O O CD Z• Z 0 C 0 C C O C w O CC O C O -n !1 • N =ti n I O n C Q T d D sT O D! 0 a) m .. d o < A A! m CD w m d N _ N T N T N a ni Z ,� i 3 ''• I o D D o D m o O w O O 0 � Z m CL CD Z n m F C C CD CD Cl) N m a 3 3 Z CD CD A Z c O y N a �_ M z 0 Cn - o W m CD C C -. Z 0 3 0 3 i' f/1 -CD tll CD W N W CD D 3 D CL CD cu CL a * '^ * a N N C OZ O. ? O G (D a CD EA N CD N W N fD v O Ul p OD $ y 3 CD I � 3 fi cn N b N co co O A ti 0 0 N O i � b N CD I a I � o s °o CL STC — 104 AS BUILT SANITARY SYSTEM REPORT OWNER a ADDRESS SUBDIVISION / CSMI D �eS LOT � SECTION T N -R ---- W, Town of ST. CROIX COUNTY, WISCONSIN 7 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �66�5'c� f+ `7 J i i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provi� a; - 1 r BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: .�,a✓G�e.S7�,��i Liquid Capacity: lea Setback from: Well S—'; _ House _o?,j Other Pump: Manufacturer - !F,4/z--e Qs 5y,"4,— Me a w Size Float seperation Gallons /cycle= Alarm Location :SOIL ABSORPTION SYSTEM Width: �-e vv ��`�. � � �� e L gth Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconhin Department of Industry, • PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pejalt l�.I�[;sJV [I City ❑ Village [� Town of: State Plan I No.: CST BM El , Insp. BM Elev.: BM Description: J� Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV. Septic Q/ r J Benchmark A lf' �- Dosing Aeration— Bldg. Sewer /D,O,' ' 0 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet ir Septic n4 NA Dt Bottom f�UZ �7 / Dosing NA Homer / Man. Aeration NA Dist. Pipe Holding Bot. System 41 F7 4996 PUMP / Sffi INFORMATION G Pr' Final Grade Manufacturer ' ZQ cE ! Demand S ' g n� Model Number qoQ GPM TDH Lift a,5�1 Friction �S' Msterrl� �� TDH /6, � Ft Fi Forcemain Length 9 1 Dia. " Dist.ToWell '>'5�7� SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a2 D SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEAC acturer: INFORMATION TypeO _p ,rr,r,u! , CHAWElf Mo a Num er: System: n4c OR NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) ,, x Hole Size x Hole Spaci Vent To Air Intake Length a;� f Dia. Length c�o / Dia. Spacing 120 SOIL COVER x Pressure Systems Only xx Mound Or At- / Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kin SW SW, County Road S (i a f)' Z 1. Plan revision required? ❑ Yes B_�o Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. AWIONAL COMMENTS AND SKETCH • ` SANITARY PERMIT NUMBER: i Safety and Buildings Division SANITARY PERMIT APPLICATI BureauDfBuilding Water System! ( 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 812 x 11 inches in size. crd l • See reverse side for instructions for completing this application State Sanitar Permit Number 7V 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)]. State II Nu ber I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION PI `f' 3) 10 2 Pro pert Ow er Name Property Location �t r ` w 1145 ,j 1/4, 5 N, N, R F E (or W Pro erty Owner's ailing A dr s Lot Number Block Number S' S 6T_ ICL- City, State Zip Code Phone Number Subdivision Name or CSM Number ,p ,' 2 IL. TYPE F BUILDING: (check one) ❑ State Owned ❑ it� Nearest Road ❑ VII age r Public tor 2 Family Dwelling - No. of bedrooms Town OF ,- � . ` .•` g e e, S' III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo :j a— f e.2 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. X Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an System System Only Existing -___ 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 ❑ Seepage Trench 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) Elevation / C 3 1 1 6 , 1- 2 Feet Feet Capacity VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 10 rG( eS7`et�.� [] ❑ ❑ El El Lift Pump Tank /Siphon Chamber o7 r t E 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 Signature: (N t raps) PRSW No.: Business Phone Number: � Plumber's Address (Street, City, State, Zip ode): d of IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue IssuingA ntSi nature(N amp Approved E] Owner Fee) Owner Given Initial cc I Adverse Determination l X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -6398 (R. 05194) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 orthe State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. I 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 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. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations �. ,. November 30, 1994 1340 East Gre 19 SUITE 300 Shawano WI 66 WEGERER SOIL TESTING ARTHUR WEGERER 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S94 -31162 FEE RECEIVED: 180.00 LINEHAN SW,SW,8,28,18W TOWN OF KINNICKINNIC COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above- referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, ff � Keith Wilkinson Plan Reviewer Section of Private Sewage (715) 524 -3627 SBD•6928 (IL 8191) r t • Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE Sw 1/4 OF THE SW 1/4 OF SECTION S ,T N, R 1 % W, TOWN OF N_0 - r N 1 C ST, CZptX COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION. PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE ONSITE SE�NF,GE SYSI RED FOR 15 3 �.• n tk t � � blf �A� i C PREPARED BY WEGEF;ZER SO I L TEST I NG ®® AND se c c ON ��'e AF WO o� 'ti ► �Z F.O. B01 74 421 K. KAIK ST. ® ARTHUqL. •_ ® WEr: N:ER � RIVEP FALLS. VI 54022 c -sfs p ELLSWORTH. Ti 715 -4 c.r b5 was. i �!AliYO�� S94 -31162 311 JOB NO. y-Z9� PLOT PLAN . . Page Z of 6 Scale 1" 30' N ti S Z S � D / p O OD DoT cu*'L�Rc -T c�R r o�S�v�z� �i1S ►'i1z�R / `�� 91 , i i ,9 o C BE t�$AI.�Dor�NOw S E•p : � Ply C t:FL a J d� 2 I� pNS 1TE SE "\NA SAS L�VI 34 s T10 a, tA 03r? _ � 4'1162 0 S9 NOTES F 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. required) 3. Install 4" observation pipes with approved caps. (_� required) 4. Septic tank to be loo0M0 gallon capacity manufactured by 1 LpW e5T�1•J 1 ��:�1 - sT� ITV c_ � cap- ►.8►�m'f�o�1 `�Y�•►Ll 5. Bench Mark _�. tU0 0 WT 1vP of 1MSQ't &J-wA-tL C 0 F: S)D1iuG') P1T �tF iv dt� `T� - s T' �`1o�s � � � 6. Divert surface water around mound to prevent ponding at the uphill side. • � Page 30f b Approved Synthetic Covering nS cry c.. 3 Distribution Pipe Medium Sand H _ — LG Topsoil F Elev. . Z D 3 E Z % Slope Trench Of i "-7 2 -' Force Main Plowed Aggregate From Pump Layer Undisturbed D t-QI Ft. Soil E 1, Ft. Cross Section Of A Mound System Using F o - Ft. 2 Trenches For The Absorption Area G O Ft. A __�_ Ft. H \- 5 Ft. B q Ft. C _ �__, Z G Linear Loading Rate = 4.8 GPD /LN FT s \Z Ft. Design Loading Rate =o.3 GPD /SQ FT ,7 Ft. K \\ Ft. L 69 Ft. W F 4 L rcc:va� B K A Observation Perm C Pipes Markers hor securely) Force °IS GE U� -- - - - - -- -- -- -- _ - - _ - - --- Main N istribution Trench Of 2 - 2 2 N r' Pipe Aggregate -! fij k �Tlt]NS 1 EiE Mound Using 2 Trenches For Absorption Area I • • Page Of b Perforated Pipe Detail End View Perforated End Cop o � \ PVC Pipe Install permanent marker f � � s`o� at end of each lateral �- rn Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cap 1 End Cap / P Z Z Ft. Distribution Pipe Layout Z� r Ft. ONSITE SEWAGE SyS VEN i X '4$ Inches Y u S Inches , Hole Diameter Inch Lateral I Inch(es) r } t Manifold Z Inches ,. g r''\� ( Force Main Z Inches #of holes /pipe 4 Invert Elevation of Laterals —`1 Ft. 6 l l - ) = 1. x q = Zia. o8 rpm ) tl S94 Place lst hole Zl E from center of manifold with succeeding holes at q�5 "intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUNI.CHAMB -R CR SECTION AND SSIFICATIONS ' PAGE S OF 6 WEATHER PROOF JUAICTIOAI BOX G� '1 'C.I. VENT PIPE' APPROVED LOCKIMCP ' 2- MA1JFiOLE COVER wJ"M _ FROM D00R. w AR t..)I NG L.i>4 WIMDOW OR FRESH WMIU• AIR IWTAKE CMiDUIr sL, OJ GR I `f�MItJ. � I s— 15 Alm. IB "MIN. \ ---- - - - - -- PROVIDE I ----- INLE T AIRTIGHT SEAL APPROVED JOtIJT A APPROVED JOINTS I I I W C.I. PIPEOR i i i I W /C.I. FIPE��C / Tank construction EXTEUDIUG 3' EXTENDIUI. 3' shall comply with _ I 1 ALARM ONTO SOLID 601L OWTO SOLID SOIL ILHR ('13.15 and 83.20 e I I I I Ow AUE 51 r, tM C EL pq�51TE ��- a I T PUMP -� OFF 0 COUCRETE " - �' •�'+ 3" APPRWI RISER PERMITTED O y IF WK URER HAS SUCH APPROVAL g€pD SEPTIC f�k' &rr C AT I CAJ S DOSE 1�LDW �LR1J p l` ►DUMBER OF DOSES PER DA4 TAUK MA N UFACTURCR: TAWK SIZE: tiZ �00 `6S0 GALLONS D05E VOLUME r 131, 3 ALARM PkAWUFACTURCR: S ' S ' �' -� S`'LS`fL'Y S IWCI- UDIAJG BACKFLOW: GALLONS MODCL WLIABER: CAPACITIES: A= 1 $ IMCHESOR GALLOAIS SWITCH TtJPE: �c�CV� B = Z IJJCHES" OR 34'o G( LLOIJ5 PUMP MANUFACTURER: Zags`- C ��*cN`[ � OR 'S (;ALLOWS MODEL NUMBER: qS D- ti0 INCHES OR -S GA7LLOU5 SWITCH TYPE: IJOTE: PUMP AMD ALARM ARE TO DE MINIMUM D15CKARGE RATE Z X3.0$ GPM INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD- D15TRIBUTIOW PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . 2.5 FEET CO + 'I lI FEET O F FORCE MA X `' F � or,. FRICTIOM FACTOR_ FEET • TOTAL OtJUAMIC. HEAD -- I � FEET 9 Pump chamber DIAMETER IAITERAIAI_ DIMLWSIOKIL OF TANK: LEklCvTH — ;WIDTH ;LIQUID OEPTH 3a�� BOTTOM AREA — 231 - GAL /INCH AS PER MANUFACTURER �_ 0... GAL /INCH Aduk of 6 4. • L ' HEAD CA ITY CURVE 6 I/a MODEL "98" 30 4 5/8 -�-{ 8 6 25 3 5/8 = 6 20 + 0 r1.� 1 O o 15 4 3/16 _J 4 Q ZB.o 0 10 NN 1 1/2 -11 1/2 NPT 2 5 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 l i t 16 20 6.10 25 95 Lock Valve 23 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1 /2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10-0075. M98 115 1 Auto 9.0 1 or 1 &7 — 4. See FM0712. for correct model of Electrical Alternator, "E- Pak ". N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 — duplex (3) or (4) float system. 6. Four (4) hole "J- Pak ", junction box, for watertight connection or wired -in sim- E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10.0002. 7. Two (2) hole "J- Pak ". for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, tied licensed electrician. All electrical and safety codes should be followed includ- FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN S94 `i 1 1 6, 2 For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. O MAIL To. P.O. BOX 16347 SHIITO. 32W KY 40256-0347 ON ON M hems Lane t Manufacturers of... Louisville, KY 40216 QUAL /TY /SUMPS Si NCf /9.�9 rJ (502) 778 2731 • 1(800) 928 PUMP 1=AY 14A91 77d - '2h'2A EG FEE FcEF: E; C3 I L TEST I tVC P.O. BOX 74 421 N. MAIN ST. D RIVER. FALLS. WI 54022 DES I G SEFG 715-45-0165 ATTN: DATE Z? CC: SUBJECT: WE ARE ENCLOSING THE FOLLOWING ITEMS: NO. OF COPIES DESCRIPTION SENT TO YOU FOR THE FOLLOWING REASONS: ❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED [] INFORMATION DESIRED [FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES ❑ NOT APPROVED [:]FOR REVIEW AND COMMENT ❑ �ocum6 L6 u S Y-i Ll l'� L-fi kj WEGERER SOIL TESTING AND DESIGN SERVICE 2-1- Wlsconsilj Department of Industry IL AND SITE EVALUATION G' � O R T Page/ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. de 1. „. COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 ' s n must include, but S T not limited to vertical and horizontal reference point (B r e, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance t road., ? �. APPLICANT INFORMATION- PLEASE PRINT�AL.LINF,QRM'�►'� �.' REVIEWED BY DATE Fs PRQPERTY OWNER: LOCATION �p GOVT , *r, SW 1/4 SW 1/4,S $ T 2 �' ,N,R ��' E (or) (0 PROPERTY 0 NER':S MAILING ADDR SS y LOT BLOCK # SUBD. NAME OR CSM # yo 7 COVA T &I S' CIY, STATE ZIP CODE PH ORE NUMBER (a VILLAGE FFOWN NEAREST ROAD It t e a �� S U/T S 4 /6 2 Z- ( rl"IS�.?s . O �� < K 1 ;7m I`Q i !� r C CT SS [ ] New Construction Use [oq Residential / Number of bedrooms [ ] Addition to existing building j01 Replacement [ ] Public or commercial describe _ Code derived daily flow "VS and Recommended design loading rate _2 bed, gpd /ft .,, trench, gpd/ft Absorp 2 2 tion area r vireo, S bed ft 7 trench ft Maximum m i n loading r p eq � _ � � Ma u des g oad g ate Z bed, gpd /ft �� trench, gpd/ft Recommended infiltration surface elevations 10/. ft as referred to site plan benchmark Additional design /site sidera'ons '�'� /Vea. ex f /oe.� Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ICU ELS El ❑ S RU ❑ S EW I S ❑ S fN U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 1 / - / /-Z S a S`Ye4l3 Skc4 &ft elev. / dk9.z ft. Depth to limiting factor Remarks: Boring # C` .2075 0Y Allrl q-S (/i Z G round;;:, 3d -,'�/ �"- � I � vv 7 ft. Depth to limiting facto � J Remarks: CST Name: —Ple Prin 4 1 S ,, j Phon� fs .2 P C ` 3 A ddress: 7x 1y6 -rx ST Signature: �ate: 9y ST,No ber: .�srnuo S5� r � PROPERTY OWNER L� OIL DESCRIPTION REPORT Page PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # FHor�iz ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench y _, 2 Ground 3 7 - y� �.5�/IQ y y Si 'e4 - 9 elev. / Qa3 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor FT Remarks: Boring # Ground elev. ft. Depth to limiting factor -- T J Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) L r /0/1 In /00 N & goo o/b Sys reo --. x,10 a cre S parc�c T 6TV sS Es v � SS /� o� U 9 H 19rive -WaY Mar Nocs1 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT �J St. Croix County OWNER/BUYER ,; a MAILING ADDRESS X4 ZQ Ad .ss I ,` 1' et ya6�S' 41C PROPERTY ADDRESS 5 9"0 57.7— _5* A,' 14 (location of septic system) Please obtain from the Planning Dept. CITY /STATE R, 'U ev ioc:--, C. S v a �– PROPERTY LOCATION -$ W 1/4, 1/4, Section T _-Zr N -R Z W TOWN OF a ST. CROIX COUNTY, WI SUBDIVISION s 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 complete and retun d to the St. Croix County Zoning Officer within 30 days of the three ye xpi at da . _ � 1 SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property /J Location of property_ 1/4 1/4, Section T 2r N - g_� Township �',U,�/<<e c- Mailing address &e 7 G e led S_' If e., ll f Y- rya Z lg ed Address of site 5;% ,,.. Subdivision name �/ � 1 L1 �� s Lot no. Other homes on property? Yes No Previous owner of property � d � ,•,/� a d2 Total size of property Y4 el, Total size of parcel Yd rq� c v ,9 4 Date parcel was created I-Rlla4 p Are all corners and lot lines identifiable? Yes < No Is this property being developed for (spec house) ? Yes _ No Volume ZL Page Number c;?-5_d 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 that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. �,/��� , and that I (we) presently own the proposed site for the sewage disposal system or I (we) 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. I '�/ - fA �LL - 1 /1) Adk Signa re of Applicant Co- Applic n DOCUMENT NO. E BAR OF WISCONSIN FORM 11 —if a eI Wb nseeaysD Few ac conal"o DATA LAND CONTRACT leJhld +d and Cerverste BE 464778 it6000 19 FINANCED OT ERNNON- WHE.-IR OVER CONSUldta /y,'D/ O FFICE �`0• ACT TRANSAQTIONS REG'S • 6 Contract, by and between ..... E re .d..A.....1.inehan.,...a1kLa.. AA a fer NOeold .. ............................................................................... .......... ........ „-- ._........ DECI 41990 .............Eredex ic.k._ �._. Gixtehan ................................... ("Vendor'. at 8:30 A, whether one or more) and ................ . ................. .._....._. and_.B_et n.an,r..H._.- Linehan.,hus hand-- n_i..w_i fa.. _.... ..._...._... at d ... ea- Gh ... in..ow- a ... CighVIPurchaaer'•, whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per• formance of this contract by.Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in---------- •----- - - -- &t r --- CP4D;L - -- - °---- ---------- -- ------ County, State of Wisconsin: souftN To Nancy M. Barkla SW 1/4 of SW 1/4, Section 8, Post Office Box 22 , N 28 N R 18 W i T ax Parcel No .... ............................... Vendees shall have the first right of refusal to purchase adjoining acreage owned by vendor when same is offered for sale. Vendor is to receive current land rent now due from tenant . Vendees do not have the right to assign their interest in this contract without the written permission of vendor. This ....._._ i 9 ............... homestead property. (is) (is not) Prescott, Wisconsin .Purchaser agrees to purchase the Property and to pay to Vendor at .. ......... ............. .... ................. .. ..... _ ..... , the sum of $-- - - -.55 : --- -- ---- - ----- ---- ----------- in the following manner: (a) ;- - - - - -- - at the execution of this Contract; and (b) the balance of ; .... 51L000 ..................... together with interest from date hereof on the balance outstanding from time to time at the rate of .......... s ... ( 6')""""”" - .. per cent per annum until paid in full, as follows: $500 per month which includes payments of principal and interest. payment to be .made s- arting Jan. 10, 1991, and each month thereafter until paid in full. Provided, however, the entire outstanding balance shall be paid in full on or before the... 15 ... ............. day of ------------ plo embe- p.......... 1P2 -410( the maturity date). Following any default in payment, interest shall accrue at the rate of ..... 6 --- % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor. Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal- Any amount may. be prepaid without premium or fee upon principal at any time of c< _...Janll.ary..l__., 19 -_ - -S11 (OR) there may be no prepayment of principal without permission of Vendor.* In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: no exceptions Purchaser agrees to ay the cost of future title evidence. If title evidence is in the form of an abstract, it shall BT P ' be retained by Vendor until the full purchase price Is paid. Purchaser shall be entitle to take possession of the Property on.... I ............................. 1990.. -. -Crow Out One.. aCtelle.bw♦rb® v STATF. BAR OF WISCONSIN •-.- FORM So. If — 1982 Stock No. 13011 k Purchaser romises to a when taxes and assessments levied on the Pro pert u doe' ` ''Pin it and to deliver W Vendor on deraat�pts showing such payment, p ��11 Purchaser shall keep the Impprovements on the Property Insured against loss or damage occasioned by lire, ex- nded coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved y Vendor, in the sum of =..- .f.4(II _11S.e.._.Yallit :.. but Vendor shall not require covera in an amount more t ?flan the balance owed under this Contract_ Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor'• interest and, unless Vendor otherwise sgr-4 in writing, the original f all policies covering the Property shall be del, _sited with Vendor. Purchaser shall prt -it tly give notice of loss to urance companies and Ven�or. Unless Purchaser and Vendor otherwise agree in writir. , insurance proc"ds shalt be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be nomically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Prorerty, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to thi lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and In the manner above specified. Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and cloar of all liens and encumbrances, except any 1:ens or encumbrances created by the act or default of Purchaser, and except: ....................... . .... . I . ... . ........... - ..................................................................................._............................_._...................... ............................... ............................................. ...........................• - -- .no_.-- excegtt- ens__-...----....... ............................... .......................................................... ......... - .................................................... » ...................... » ».. » »............. .... ...... ... ....................••------ •- •- .........__.......... -.... ......................._....... _.......-.._.._.....................I...._._.................------ Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or Interest which continues for a period of ........ ..days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of .......... days following ritten notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shad become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (I) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance. with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in whicheventall amounts previously aid by Purchaser shalt be forefeited as liquidated damages for feilure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of ' default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser : shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchasa price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract asacloud on title in a quiet -title action if the equtiable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession .' of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whe!her abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment ." Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser Consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shalt he held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or ey-eitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term ]ease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid is full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatly due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execut;on of the deed to be made In fulfillment hereof.) Dated this ......... 23rd day of -- November .. ............ .. . .. ..... ' it ... .90' (SEAL) ! -ice L -. 1 . ... ...... .......... .... 1�: JSEAL) . Bet an .Lin an Fred A.Linehan .... - ....................................... ........... ... ...... ....(SEAL) -- .. - . .. - - •_..........- -_.............__ ..... ....(SEAL) Phi kip S. Linehan • ... .... ........ . ..... •- •---- .... -- ......- ._.... -... -. ............ ........ ........................................................ AUTHRNTICATION �ACKN O W L1gDGMBNT Signature(s) Fred -_- A.___Lillehan- z........... STATE OF WISCONSIN Philip g, Linehan sa. • ................ °- ........._....-- -••--- `_ t r county. .............................. ..... authenticated this _L3..day of. ........ ........ 19 -y�. Personally came before me this ................ day of _.- __--- __ ..._. ' 19.2_`__ the above named ariC ._ Ml1r - r ._ Bar_kla .................... .. ............. • - -•• -- •--...................._ ...............--- --......_._.. TITLE: MEMBER STATE BAR OF WISCONSIN (If not . ....... .............-•-•--•---- .........•--•••••-•-•-._____._. ........ .:........................................................................ authorized by 706.06, Wiz Slats.) VI to m known- to be the person ............ who executed the ` -foregoing Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - • - -• - -� ..._- _- - -_ - -_ -. - - -- ...................•-••-••-•---._-.-__._ _....- ••_._.._ /......./T.....�. /�V. / . - ..._...._... ... ' c Tom. ro ...............•-•....._...__.._...__......-.. _...._..__.._._...._........... 1, • Notary Putlic ......... -'. : ........... .._..11(..... county. Wis. (Signatures may be authenticated or acknowledged. Both ; My Commission is permanent. (if no; state expiration are not necessary.) date : ..... .......... •--._- ...._......... . / •ame+ of p*_M signing In any capacity should be typed or printed ................, N lfi._.._...) below their signature•-