Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
022-0126-95-300
0 to O 0 to O c o o � c 1 O CD A fD �j (p 'O • I 3 rT I _ � r: �; to Q cn z - p a cn cn N z o cn _A o j 3 3 o � � • r� C 0 N N rn - a n y Ca _0 3 c s c -. \, o) �. N CD a) o a(D 3 3 o m j Qo rn CD O O 0 7 {(D a O f9 (D -� 'O ' N CD a n N ' U O i w a m a it O O d to W d CD W p (D C7 m v v D a -4 w u D m a t� (D t� z < I m « y a w i C w co O O N c 0 0 0 N O m < N - O O< �� ( CD 00 A !� 0 D o o 0 Eh rn N °m ! to a c a a C 0 0 0 0 O O O m �• � c N N N N CA 0 D cr T O G O ry N N (n N fD fD N V M _ O N 3 - N N H d CA Cd s V co I M j i V7 A p Z -1 Z -N A A 0 Z - I Z O N = D (D 0 N N N we D N 0 ty O n = Q n O O O n z'z O n = (V N N • �- S - N N N a LV :7 S h • CD CD 0 O cn @ 0 M � N O N !V CD m CD CD _. C C 'O N m o a (Q a CD (D CD CD w o `� Z CD C o I CL a A Z O I � 7 a 0. 3 A z 0 T 0 0 3 3 m °� N to Z N (D A CA 0 0 W I I j I 0 x 0 CL (E CL G o �00� o: (D O T 3 N N N C f9 CD d O C O a N p O CD m VC cs n (0 Cn (D p O N (V CD T CD CD Cr -n 0 (D N°o C j o N N CL O I o I o b (D m r� O o 0 (D CD o a o° (D C) ° N visconsin Department of*.ommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 46 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: Sprague, Edward I Kinnickinnic Township 022 - 1026 -95 -300 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L BLDG 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) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [N No [] Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ! Inspection #2: Location: 437 V alley View Road River Falls, WI 54022 (NW 1/4 SE 1/4 9 T28N R18W) NA Lot 3 Parcel No: 28.18.18.142G 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [] Yes E No Li Use other side for additional information. � SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. REC EIVED AUG 2 2 200 87- CRQi� YC, NG� O FFICE Co iint; Samtar Permit App!tcation f ST (;PCiX COUNTY WISCONSIN to i CIA J el Friol ali intormanor. 6 Ao is,.4 r 'S pi Numbar 0 - ----- ue WX e k;i?li % 6 ly -7 sySb-" R es t � y. r d 7RAL!�c 6 T 151 la to- kXI-577 Af L i I A CD.J7)1 -) "RCIZ- er?'Z� TIG f �; T p,, A - F 4!, Af Pf EZ�1 Z �7.5x 7E - e - - 7 m V!5 MtV6 -j-Aovp- /,&j:5)P87t-T-6M � PUP ?15 iz 0 7Z) 96 P, 0 V/ 0 C:�-P UJI C P V c F 7 Ha 7 I - r if STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i ADDRESS Ida 11-d SUBDIVISION / CSMI LOT � SECTIO N ---�— T OP N -R�W Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 /'te/ � llellr s d �e Flea, d. G 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to cent -pr .-.r 1 t BENCHMARK: . Lo C � �� 49 L / may Q � ALTERNATE BM: SEPTIC / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: `�I&C S t brf (s� E f Liquid Capacity: 14:W Setback from: Well '1 ,4 G) + H > l H ouse Other Pump: Manufacturer Model Size Float seperation Gallons /cycle: Alarm Location I :SOIL ABSORPTION SYSTEM Width: f J Length ! Number of trenches Distance & Direction to nearest prop. line: 3 5 � a - Setback from: well: 'G 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 INSTALLATIO PLUMBER ON JOB:{ LICENSE NUMBER: INSPECTOR: 3/93:jt ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMAZION SYSTEM SPECIFICATIONS Owner � w .b sP Septic Tank Capacity /Coo a l ❑ NA Permit # 5 t/2410 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer amk Number of Bedrooms ❑ NA Effluent Filter Model A1,07 ��CSV /gip W-NA Number of Public Facility Units A Pump Tank Capacity a l Z NA Estimated flow (average) 360 al /day Pump Tank Manufacturer 93—NA Design flow (peak), (Estimated x 1.51 4ISD gal/day Pump Manufacturer "A Soil Application Rate Q. (0 gal/day/ft' Pump Model l A Standard Influent /Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & FOG) 530 mg /L ❑ 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 Dispee al Cell(s) ,2 — S / X '7 ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Q'fn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L 044A ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /1 OOmI ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other' ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ! 0' ean� )(s) (Maximum 3 years) ❑ A Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ th(s) (Maximum 3 years) NA Inspect dispersal cell(s) At least one every: 2 - ?j ear(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month ❑ yeaarr((s) s) ) ❑ NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the 9 round surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. ' r 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(s). If high concentrations are detected have the contents of the tank(s) 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. 0 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: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption stem. The replacement area should be protected from disturbance and compaction and should not be infringed upon by _ „p required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will q result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must I comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER 9 2 -7/ '�fTl� m A—S (�Cf /4"/c��,— o�� Name � a �' — 9s—O Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S-�' , �Ej/ Zd Ai//c� Phone Phone /L — 3 y K, `7"6 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. e System' yste Management Plan Pu uannt to Comm 83.54, Nis.Adm. Code Sectic Tank _ The septic tank shalfbe maintained by an individual certified to service septic tanks under S. 281.48, Slats. The contents of the septic tank shall be disposed of in acc6rdance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter snap be assessed at least once every 3 years by inspection. Tine outlet filter shat be deared 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 enc:csure. If the filter is equipped with an alacn, the filter shall be serviced if . the alarm is activated continuously. InteniUtient filter alarms may indicate su rge flows or an im en septic tank shop have its gnten y � P ding co ntinuous akrnr. The '- ts removed cued w - when the volume of sludge and s � udg _crm in the tank exceed 113 the liquid volume of the tank. If the contents of the tank are not re moved at the time of a Gfi ' the of when the next service needs to be performed to maintain less Man s maximum scan and Pe a cu shag advise the tank The addition of biological or chemical additives to enhance septic tank performance is 6n However, in However, N such products are used they shall be approved for septic tank use by the Departmentof Cort�un not cee and required. Building's D'niision. Punrt: Tank The Pump (dosing) tank shall be inspected at least once every 3 years. Ad s witch es. alarms, and pumps shad be tested to yedly Proper operation. ti an effluent filter is installed within the tank it shad be inspected and serviced as necessary. At- Lade Component and Pressure Distribution System No.trees.or s rubs shoo be plante or allowed to grow on the component. Plantings may be made around the perimeter and the component 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 component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at- grades stem ' e y may not exceed 220mg /L BODS thi l xa. for t in , I50 mg /L TSS and 30 m FOG. Influent fow may not exceed the mamum design flow specified in the permit in, low T he Pressure distribution system is provided Hn'th a fl po at the end of each Lateral, and lateral be flushed of act;rmulated solids at least once every 8mmonttrs. When a pressure test is is recommended that each compared to the infital test when the system was Installed to determine if orifice do 99th9 oc rued and is an d fi should be required to maintain equal distribution within the dispersal cell. ti o rifice weaning is Observation pipes within the dispersal cell shall be for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered' as an impending hydraulic failure requiring additional, more frequent monitoring in accordance vith•Comm 83.52 (2). General Th s_sy §Lem shall be operated i accordance with Comm '82-84 Wis.Adm'.Code and shall be maintained in accordance with it!s component manual SBD 10570 P•(8.6 /99) and 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 pose death. Septic and P ta nk cSc o abandonment shall be in accordance wr mponents. h Conan 83.33, Wis. Adm. Code when the tanks ace no k nger used as Septic or pum P tank manhole risers access risers and avers 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 be o st aef ective, or subjeG to failure must be replaced. Exposed access openings gre ater than 8- irmhes in diameter shall by an effective locking device to prevent accidental or unauthorized entry into a link or component. ConNnoon� ' ; � . • . _a_a_M•ln Pro o �Y of Paroling I s c c arrdrtion. components become defective the tank or component shad be repaired or M?Ucsd to keep the ' . _. .. . If the'dos4 tank. pomp, PurnP cons, alarm or related waing becomes defective the defective component shad be re Paired or replaced with a cpmponent of the same or equal perfomrance. Zf -the - . _.. - at -grade component fails to ac — _ - ' — cept wastewater or" begins - 'to disc arge wastewater the to giound surface, it may be necessary to install an aerobic pre - treatment unit or . .replace the component. Additional site and soil evaluations may need to be done. and additional plans may to be prepared and approved by the Department of Commerce, Safety and Buiidings Division. Questions.about operation or maintenance of this system should - be directed toc - The County / Zoning Office at --1 �S - Z -1•3.- 6 -7q-7 Q1t?RJCJ�F The system installer at - 11S— 2S- adS8 popoj a The tank manufacturer at V^IIQ'S1.TR The effluent filter' manufacturer at a`l�� - Z 2l- S}�Z. ZPC'C3kr y I.00 t NTT i I d CKINXIC 9.28.18.142G NW SE LOT3 � SKY LIN Labor and Human Relations PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: (SENEFMIL INFORMATION 175668 Permit Holder's Name: ❑ City ❑ Village EXTown of: State Plan ID No.: SPRAGUE EDWARD D & KATHERINE 4 KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: " ,3 022 - 1026 -95 -300 TANK INFORMATION EtEVATION DATA A9200327 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic' �� Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 7 TANK SETBACK INFORMATION St/ Ht Outlet ' 10 7-5/ TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic S _, , ? NA Dt Bottom �f. e> v �s . Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding ot. System 9 Y PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss H ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f DIMENSION SYSTEM TO P / L BLDG WELL LAKE/ STREAM LEACHING Manu acturer: SETBACK INFORMATION Type Of CHAMBER Mo Number: System: ,rr/, - 3 5 1 s r p N /� OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) 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/ Tr rich Center 3o Bed /Trench Edges Topsoil ❑ Yes ❑ No / ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) rLr rte` L r X; Al In'64 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 1 " SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION L�ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY � 0 • • STATE S L l - NPE RMIT # – Attach complete plans (to the county copy only) for the system, on paper not less than 8 X 11 inches In size. frevrs,on P, application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY QWNER PROPERTY LOCATION Y' G`t (i( L �J %a S� %, S 9 T�� , N, R IS E (or W PROP OWNER'FMAILING AD RE LOT # BLOCK # �,Ior tAlk k 7 gq ITY, STATE 3 K ZIP CODE PHONE NUMBER SUBDIVISION NAME CSM NUMB CITY NEAREST ROAD 11. TYPE OF BUILDING: (Check one) 11 State Owned `� 0 VILLAGE : j ia ZOWN OF: Ra I ❑ Public R 1 or 2 Fam. Dwelling -#of bedrooms J TXRCE TAXNUMBER(S), 111. BUILDING USE: (If building type is public, check all that apply) �) 2 /(! ,? !) 00 (/ 1 El Apt/Condo d 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 in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — D ate Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑. Seepage Bed ,, f 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ta $ sepage Trench �'X 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑. §eepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -in -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 1 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOE (9 q. ft.) (Gals /day /sq. ft.) (Min. /inch) 1D 6. d ELEVATION S� > �) Feet lO� I Feet VII. TANK CAPACITY Site INFORMATION in alions Total #of Prefa b. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdina Tank X Oo U 7 Lift Pump Tank/Siphon Cham VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu r' Signature: (Norps) Sw Business Phone Number: a a 3 a 9 lu is nddre 7 (Street, City, te, Zip Code): p (� IX. C UN /DEPARTMENT USE ONLY , ❑ Disapproved Sa 'tary Permit Fee (Includes Groundwater Date Issued Issuin Agent Sign ture (No m ) Approved ❑ Owner Given Initial - Surcharge Fee) 69m rse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: 98 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1:., A sanitary permit is valid for two (2) years. a 2. ` Yeur sarritary permit may be renewed before the expiration date, and at the 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 & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: 1. 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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% x 11 inches must be submitted to the county. The � 0 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 cutve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by thq 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, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) 3 9 1 3 �� �� �ue� '�a � S4/d 3 . 7 -Y �' C� 1 u_ SCCL Qf D�c�s e x/s 6 14 E � �Q' Se�1'►� �Vl n 11 t n �� g9 • .� Cl�grn�1 Ir�o.D 1Xa "�:D�� S�kQ�L° sky �i�ne � STC -100 This application form is to be completed in full and signed by the ovnicr (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 . P I Z Location of property/vol /4 SE 1/4, Section T N -R2F W Township Mailing address ®U e Address of site Subdivision name Lot no. other homes on property? yes_r No Previous owner of property f Q � de r j 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 X No volume & Page Number as reco of Deeds. rded. with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 fice of the Count Deeds as Document No. and that I (we) Y R egister of own the proposed s i t e presently e 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 record t office of County Register of deeds as Document No. Signature of a lican Co- applicant Date Sig ature �—" Date of Signature tiKt. X PAGE OCUMENT NO, r �7 r 1 {STATE BAR OF WISCONSIN FORM 11 -1682 THIS 111r,u,a R[GLRVLO FOR RLCOROINO AT LAND CONTRACT lRdlvWaal sad Corporate i (TO D i26 00 E USED FOR ALL TRANSACTIONS WHERE OVER c II _ 0 1$ FINANA`� TRANSACTIONS! �° { NON CONSUMER T eR / S OFFICE Ii ST. CROIX co.,,wj Contract by and betwe - Woodrow M. _ � amd.Ax_Y�1,. M ..�ver_sQm_�alad M -an_••__._ • -••__ ReC for RAtclnd !I MAY 0 61991 ,I huskand ..b�..W.ifa..as..�.Qinz.. tenants,-- an ..und�x�.rla�i..�12{,Vendor ", whether one or more) and ..... E VAXA,A., - ,S s ,� 8:30 A, M � uw~.�aiad. th7.eea�..�1.... � C 'I S�xague.,•_ husban .d..and..�.f�.a.s..survivarshi ma kgpirty ............. R ri.tal_._.....----•- - --- -•••.• ( "Purchaser ", whether one or more). QogliferofDseds 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 j rents, profits, fixtures and other appurtenant interests (all called the "Property "), in ......... x...•�xp . .......- • .. .................... County, State of Wisconsin : Lou Ann B e k k u m RETURN TO Century 21 Bertels — River Falls, WI Cudd Tax Parcel No ................ LOT THREE (3) OF CERTIFIED SURVE MAPS, RECORDED IN VOL. 7, PAGE 1815; locatad'`ip' part of the NWh of : 1r Sec. 9, T28N� It18W. • This ....iS not homestead property. (is�t (is not) Purchaser agrees to purchase the Pro ert the sum of =_ 1.,_QQQ : .QQ - -- P y and to Pay to Vendor at .1;31�h..Rr3Cir..s1,S._x f rZ�S QDAb ly .... in the followin d1 v.9ted , g manner; (a) at the execution of this Contract; a '-••-••'--••• nd (b) the balance of ],2,. ,. "-' °"•-••••••• - hereof on the balance outstanding from time to time at the rate to t ogether with interest " " from -• date until paid in full, as follows: f 4.. ) ......•... per cent per annum Monthly payments of $200.00, commencing on the 1st day Of June, 1991, and on the first day of each month thereafter until paid in full. Provided, however, the entire outstanding balance shall be ....... Provided, however, 19..9.4.. ( the maturity date) paid in full or before the ............. lst•- day of Following any default in payment, interest shall accrue at the rate of - D.; Q % pe 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 ercused 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 a taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear nterest 'unless otherwise required by law. Payments shall be applied first to interest on t' a unpaid balance at the rate specified and then to principal. Any h3mount may be prepaid without premium or fee upon 'here may be no principal at any time After ............... 19........ (OR) 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 P a yment so long s the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated s.a unpaid principal) is less than the amount that said indebtedness would have been had the month] 'nade as rat specified above; provided that monthly payments shall be continued in the event of credit of an ents been d insure ice or condemnation, the condemned premises being thereafter excluded herefrom. y Proceeds Pur haler states that Purchaser Is satisfied with the title as shown by the title evidence submitted to Purchaser or exami ation except: Pur a seer agrees to pay the cost of future title evidence. If title evidence is In the form of an abstract, it shall retain by Vendor until the full purchase price is paid. Purchaser shall be entitle to take possession of the Property on .......... ,- Out o e. ....date of clo sin&..........., 19.91.... STATE. RAR O!` Wtr( ON9IN — __. SIN REAL ESTATE TRANSFER RETURN - CONFIDENTIAL v►reoone'Ut Revenue RfiN70R: L[oodrar K. Iverson, Oral I. Iverson -W PHYSICAL DESCRIPTION AND PRIMARY USE 1. Name and Alvina G Ivaraotn 15. rind of proper" 16. Primary use 7- Full Address - New address H property transferred was reiiderloe ®land on" x� Residential ❑ Land and buildngs single .. 108 Y. llf(aple St. ED other (e0min) hula ---- Robe rts, W1 54023 17. Estimated land area and "rpa ❑ line �' ' Parinarship , ❑ Corporation ❑ Other .ter 9. Grantor is �] frtdividual El a Lot size >< -0.❑ Comn►ercid IL GRANTEE: a{ 't` b. Total acres q❑ ��ft 4. Name turd 9 -prje to i t ' �y c. MFL / FC / WTL acres d.❑ Aprk Allaral E:] No 5. Ful Address `jSp rasm d. Ft of wafer frontage Adpnn9 held? . e.❑ Other ex 'n ._ 969 Greeavay, Ap t. 112 VI.TRANSFER Oakdale ![[~I 55128 18. Type of transfer. ® Sale ❑Gift ❑ Exchange ED O6ter(aKplain) n No © s s .1 1 and f�ntr�ct`__ 6. Is grantor related Io prances? ❑ Yes tl explain how related 19. Ownership interest transferred: ❑ Full Other explain) _ 7. Name and address to which tax bills should be sent ff different than grantee's address 20. Does the granror n ain any of to following rights? Life actal l amen 21. ❑ Deed in sacsfadw of original Iend contract? Dated 22. Points (prepaid interest) paid by 241W 4 •, L 23. Value of personal pioperV v4sierred but mmk+ded Bum (N 6 111. . !s ENERGY this progeny su - f the Rental Weaftwization Standards, L HR67? 24. Value of property exempt Bom local property tare included an t?9) bl� d ew -,t ❑ Yes 1C NO fxdusioncode �t� Vll. COMPUTATION OF FEE OR STATEMENT OF WAPUM�?g" IV. PROPERTY TRANSFERRED 1i. ED City [I Village C3 Town . ILivaic tlID is 25. ToW value of REAL ESTATE transferred = T< Cou 'St. Croix 26. Transfer fee due (line 25 tunas .003) 10. Street addr 27. TRANSFER EXEMPTION NUMBER, sea 7725 _. 11. Tax parcel number - 12. Lot no.(s) Blk no.(s) 28. Grantee's firtar , V obtained iron L Q Seller ' Plat name if box a or b is ehecl; d, b. ❑ Assumed axis*v > oxis . complete Pan Vill - c. ❑ Fi wx W institubon /Odtar 3rd party 13. Section Township flan, Financing Terms 14. Legal Description metes and bounds: d. El No financing irrvehred (attach 4 copies if necessary) ` LOOT THREE (3) 13y CERTIFI rD SMVET MAPS, RECORDED IN VOL. 7, ?AM 1815: locate[ in part of tt)pe 1[ii ; of M, S*c. 9, V aN, 816W. V11L FINA14CING TERMS (FOR SELL.ERIASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment S 30. Amount of mortgapelland 31. hinrest .32 Principal and interest 33. Frequency 34, length of 35. Date of arry lump sum 16. *wuividlump sure contract at purchase raw (stated) paid per payment of pymts contract (beltoon) payments. - a i 96 i - - l . l - - s � - • �-A,, - . 37. 9 the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the intarest rate), fill in the line letter from above Enter the date of rdtange - - J Y - J - _ and the amount It will change to $ [X. CERTIFICATION We dechare under p enshy of law, tail 1hic retu has been examined by us and to the best of our knowledge and belief it is true, correct and�eAtpll�li. /� Grantor or agent Date Grantor's t number- ►• . SI / ba� lip k F 715 HERE Grantee or agent b �s,`' n; q' Date Grantee's telephone n umber �. 612 _ 7 Pnnt name and address o grantors spent Agenrs telephone Document number Vol. Di recorded Ditto and kind of conveyance N. code LEAVE � 41 � , f 3 arcei number Fitt Sales number, TICS AREA srttt ear t9 _ ftoo .. Tai diet. REES DOOM WO Ar3R 13/IY FOR T Aasrnl. disc _ _ ❑ !Al ^_.)aD► -: ` 1 2 s 4 ___i� __________.__. .. N, ,., u01au14, w,Ln respect to pay so long as the unpaid balance of principal, and interest (and in such ease 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: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitle to take possession of the Property on ..............d ..... 18 91 *Cross Out One. FLGR1a1er STATF. ItAR OF WICCON9IN ... Purchaser shall keep use icu ruv�+• +• •• tended coverage perils and such other hazards as Vendor may ro or skull not re __ but YeitJquire coverage in an a olict� shall '° by in the suM of �._ l��• Contract. er sha ll ur Vr�.U� � the insurance premiums when due. The p olicies original than the' ball i favor nce owed under 4his Contract. Purchaser PaY the notice of loss to A contain the standard clause n fa� of shall ben interest 9 VendorysP Vendor rchasertnh otherwise n u ance s shall writing. proceed of all policies covering the Property oration or repair of the Property damaged, provided the Vendor deems the restoration or repair w be . insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, 'be applied to rest economically feasible•. ert to keep the Property Purchaser covenants not to commit waste nor allow waste to keep the Property tree from liens superior to the lien of this Contract, and to be committed on the Property. in good tenantable condition and repair, regu l a ti ons affecting the Property. aid and all conditions to comply w ith aU laws, ordinances and Vendor agrees that in case the purchase price with interest and ot Vendor will onldemar►d, execute and deliver to shall be fully p free and clear of all liens and encumbrances, excep performed at the times and in the manner above specifies, the Purchases, a Warranty Deed, in fee simple, of the Property, eagtnepC�_ the act or default of Purchaser, and except: • pd ................ any liens or encumbrances create) b Y .................. ................... .....___........•_._.••••••••.. ............ .... of••recor . . ............. ............. . .... . ........................... . .................. . ....................... . ............... .. .............. ........................._...._...._.................... ....._._..........___.......... ..... ............................... .. .. . I ..- ........ -.._ .. in file event of a default ii► Cite puy»►ent of any principal or - . . in the event of a default is Purchaser agrees that time is of the essence and (a) ecified due date or (b) or a period of .��••••• days following the sp balance performance of any other obligation of P m led by certified mail), then the entire n outsttat Purchaser ding under this contract wliich g rc aser written hereby thereof by Vendor (delivered personally or lion and with shall become immediately due and payable in full, at Vendor's op i a uity: (i) Vendor may, at his option, terminute this Contract and Purcu ty f o waives), and Vendor shall also ha . t he following rights and remedies (s ubject throu'h strictlforeclosurepw th any eg aw to rovided by addition to those provided by law q rights, title anJ interest in the Property and recover the Property bac b Vendor may in effect on such date and other amount d`ei er fulfill i thiswCmttract l and a us rent for the s full puyment of the ,'►tire uutstuiding balutce, with interest thereon r redemption to be conditioned upon Purchaser pre the duce of default at the rate aid by Purchaser shall be .forfeited as liquidated dumai,es for fa p p urchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contrast to comps the date of Property tY p shall be auctioned a t judicial sale and Purchaser default and other amounts entire outstanding event Proper rest thereon at the rate in immediate and full payment of the en cf rice °' any portion due hereu ; or (iii) sue at law for the chore u shall be liable for any deficiency a t purchase p thereof; or (iv) Vendor declar h p s aser is insignificant, and (v) i Vl tSu�Ty tr may itsvdurunghtharl e of t udency► may decl of any action action if the equitable in of ointed to collect any rents, issues 1 tile Property and have a receiver uPP under (i), (ii) ,or ( e ies shall only iths riding upon V ndor f nw hen u sued i ion a ubated not) to t: the foregoing rem or in cluding reasonable attorneys fees of Vendor incurre ind to enforces y extent not prohibited by law and expenses f title evidence shall b° .dded to principal and paid by Purchaser, as m -- cursed, and shall be included in any judgment. Purchaser consen Upon the commencement or during the pendent of any uctiun of foreclosure of this Contract, cio, and such rtents� tissues, and tprofitslwhenhsorcollected shall be held and to the appointment of a receiver of the Property. the Property during the pendency of such applied as the court shall direct. without the prior writter Purchaser shall not transfer, sell or convey ally legal t�rtn the tnteres+ ` Tease f or t in e any ► other way) its (b assignment o any of Purchaser's rights under this Contract n by option long - , consent of Vendor unless either the outstanding balance payable under this Contract is first pail in full or sale or conveyance without Vendor's written c onsent 5� oh Liun notice conveyed is a Pledge or assignment of Purchaser's interest under this Contract soles as security for an indehtedness o� Purchaser. In the event of any such transfer, e outstanding ai;ainst '.he Property idedt Purchase balance p under t chase his Contract shalllbecometunder ►an yt ag in full, at ci Vendor shall make all pay purchaser) or under any note secured thereby, p this Contract (except for nny mortgage granted by makes timely payment of the amounts then due under thi so by P u r chaser It shall be considered payments ►made o'. the Mortgagee if Vendor fails to do so and all pay this Contract. other subsequent or prior default of Purchaser. Vendor may waive any default without waiving any All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representative: successors and assigns of Vendor and Purchaser ( no t an ect Propertyoandtiy�rees toujointin the o esecut� n of cc.nsideration joins herein to release hamestesd rights deed to be made in fulfllh.:,,. herf,1 � X I� ........ - - -- '� ......... 15.9.... . day of ..... ........... ........ ................ .......... Dated this ..........y ....... • ,G(f -,R.� /�... ;4��n, (SEAL) ... LWk^ r W odrow M. era n ..................... + E - ard.. .U�....P- xaStte........f....... . C ...............(SEAL] •.... + : ..........'- 4 ..j�!- .'....i... :yy_►+.. � g �.. .. S r a u e l I. Iverso • .. K> whelYin.. M.... P. .... & .......................... Orva ...................I.. Alvina G. Iverson gCBNOWLEDOIAN AL°THRN TIC AT ;ON _ -.., STATE OF WISCONSIN Signature(s) .......... ............................... ................. St. Cr .. oix County. ...... ......... •- .................... Per .. son all 18•••••• came before me this ... authenticated this •••.•••• day pl�,•• • .••.••••� 91.... the above na a April � ................ ..........................O 19 rval I. Iverson Woodrow_ M. Iverson Alvina G. Iverson - , D. :..Sp .......... TITLE: MEMBER STATE BAR OF WISCONSIN Katherine M. Sprague .............. (If not, ---------------------------------- ..._. N,- on .5.._...... wko execu c authorized by $ 706.06, Wis. Sta • e ts.) to me known to be1-peft' �, ledge the same. foregoing instrumc�� nd�c 4# .. THIS INSTRUMENT WAS DRAFTED 13Y ...� •;. at Law Steven B. Goff, Attorne e 'y * tu,,,',_ ..... - _ . Box 167 710 North Main Street, Notary Public :,..._...:.. C�Qx... :.....__.... C ount y, ` • W1_... Sl, �D?. �- ............................. .. ifnent.11f not, state expi kiuer-- Fal]s.,.• My Commission is p er l9._. (Signatures may be authenticated or acknowledged. Both date: - - - -•. . .4 � - e • - are not necessary should be typed or printed f t •Names of persons signlog in any caDscity '�►11�1� below their signatures. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER ROUTE /BOX NUMBER P 0 Pot 3 FIRE NO. y� CITY /STATE ZIP �lo 2 Il /14�Y ��`G�- PROPERTY LOCATION: f 1� 1/4 1/4, Section , TN, RW, Town of I( ►o , St. Croix County, Subdivision , Lot No._. 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 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification p form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED (} n DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address I ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS STRY„ DIVISION LABOR AND PER COLATION TESTS P.O. BOX 7969 HUMAN RELATIONS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHI UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NW SE A/ '/4 q T R ICE (or �IN1J IC. 1 k3 Q l 2 - P�iP�SLzD e, s E-I COUNTY: OWNER' YER' AME :E���rggke MAILINGADDRESS: S7 - CCz.OI W OO�R)J�l 1 V SON a -u��LT S kV I S llbz3 USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: PROF LE DESCRIPTIONS: LATION TESTS: Residence 3 � � A. XN.w ❑Replace I S Z`t3 - 86 RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN- GROUND-PRESSURE: SYSTEM- IN- FILLHOLDINGTANK: RECOMMENDED SYSTEM: (optional) �s au os ®u �SU [:]S ®u ❑sou z - ey�fc.N If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the under s.H63.09(5)(b), indicate: . {�. Floodplain, indicat Floodplain elevation: A • PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUN WATER -IP}O MS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH M. ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) IS.% q9.0' tw_ ��► 4.0' 1•a'v�r 1 TS;z•z'51 ) -S, \.a'12a>1 ��►.7s s I � - z S.S' 46.0' Z.S' >MO a z.S' \.S' • 1.0' ' r 4S -f ; 2, S' I, o.5'w� 3 b - O ' \Ot,O' w,TQ 4•Z' \,-4' I ; z.9' it ; I. - 1 I B- y - 1. 3' \4Z.S' `I > 7.3` Z.O 'I.V'BnS)'2.7'Y8o sw /-s es. 5 S•S' 'VO4.0' a mtt yo 4.Z.' \, p' a I.3'8n 1�S 'I B- 6 S.O' 1.05. - 1 ' �t `�`F ►v-T�' � ' 1.O' `r ' 2.'7' Bn L ' 1. wlntTe 7 S.8' 1oZ.7' UzICN-4 Z.S' �.► It 1- WBI%1'�S;2.9'R$kL-ID.y' B- c,3 b.o' 10"Z.. z' SZ10vE > 6.0 S'll TS Z. 6'Bn Si) - 2. - Z 13 S I "o. Z' I I 9 G -7' 1oZ.0 \•%I' �Z.9' a� B " 10 •9' ti0g. ,� > 6, ' \.o' lt�a-, 1 i • �.4'$�•4' 1 \.1' 11 S.S' vz' S' S' ,\ 5 S. S' 1.6'ROS;0.9'18h s>vh iS . B" > S. b' \. � Z.3'an�Sil• .Q'' 1'O.)' r1 dl\' pp SulTt 3 BoTLtiv6S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D2 PE RIOD PER INCH P_ z No 3C� N11 1 -lit 1 - 7 /8 !b P_ Z -2 t/ 1/ I / �) ZY IDs.9' P. 3 Z� fJo 317 \ t \ ` `�! 16 1083 P__ P_ E - a ' I t) SEP P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. LIJ I ft 1.- C2Q_P C.0 -- -Ie^ s T Q S Nle. -.►►J © \06.0 \OZ. (' I SYSTEM ELEVATION © r - ---- -- -� - JL d11 � S - _._ _ Ro o ? S IA C*ro0Ai jv I 6' S I a3 I LZ %6 g �1 Aj � I r j 14 4 1 na SC,K\ -E \ 60 64CeSuT A W>\1 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedur and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. IF �11 7 NAME (print) TESTS WERE COMPLETED ON: ADDRESS: 12tu1C. `Z,Z,( t RTIFICATION NUMBER: PHONE NUMBE R(optional): li S V 01 T SIGNAT o 0 `N: Original and one copy to Local Authority, Property -6395 (R. 02/82) INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - 6395 To be a complete and accurate soil test, your report must include. 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systern; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT EASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for �nvriting protile descriptions and completing the plot plan; 7. MAKE A LEG=IBLE diagram accurately locating Your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point. are clearly shown, and are permaneirt; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 14. I° the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and Your Certificdt;ion number; 12. Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS S Soil Separates and Textures Other Symbols 5 st - Stone (over 10 ") BR - Bedrock cots Cobble (3 - 10 ") SS Sandstone gr. Gravel (under 3 ") LS - Limestone s - Sand HGk�V High Groundwater cs Coarse Sand Perc; Percolation Rate razed s - Medium Sand W - Well I's Fine Sand t'ldg - Building is - Loamy Sand `j - Gioiter Th,']n y *sl Sandy Loam Lass Than f �l Loarn Bn - R;ou , n �. sil -_ Silt Loam EI - B,r,<;k Silt G - Gray * c l - Clay Loam y YeMwv sci Sandy Clay Loarn R - Red sicl - Silty Clay Loam rnot Mottles Se Sc =ifdy Clay tyrtl - sic - Silt=y Clay rf i -- rt v., fine f,I�:rat °C _. C1,1y cc __ coinnion { € [ISE tit _. Peat IrlITI -- lNjI:my, nved um rn - Muck r.1 -_ distinct P - l3rot�s;raerit I" VV -- Nigh U at€ r level, Six general soil textures sorface water foi liquid vvastf. disposal hM - -- B eI-c1) f:1za!k VRP Veiticai Ref € =rence Pc:aint TO THE OWNER: TI "iIs, scniI t €Isi reporP is the iii stF)p Ira Sf;ec it ntt a sanitaty nerm it, The (,only or The D('pa me n ;:' "ncay re ouest v�,r;'icalic-) of ihis, so 'l t"st ire the fi.""ld pr"; r to A €;ornpl tt. set <at plans (£sr the pi at.a fs >re system and a perm"t ap(lica "km must be 'A apploprmte local aurhorily ir order to ut)iain 6 oer €mt 1 s anital v 4?r` mit rnus': r7c.' , lh1' ;. lined s ;_; 2£ iv d pi ier 'o °.°li DEPARTMENT OF � , REPORT ON SOIL BORINGS AND S AFE I Y & kiUILUIfv DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115 MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWN SHI UNICIPALITY: r T NO.: BLK. NO.: SUBDIVISION NAME: OC _sE 1 /4 1/4 q for ,— Prz�pos>� csM COUNTY: OWNER' UY R'S NAME: MAILIN ADDRESS: Ne-N, -E ST_ C'LOIX WOpUR1Jvv 1\3 E -SON X% - u'BF1ZTS (N 1 5ifOZ3 DATES OBSERVATIONS MADE USE PRO _ DE P ONS: PERCOLATION TESTS: NO. BEDRMS : COMMER AL DESCRIPTION: Residence '3 , A • [gNeW ❑Replace S - (•- 8 6 S - �,� - 8 (� RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN -I- ILLit DING TANK: RECOMMENDED SYSTEM: (optional) �]S ❑U DS ®U ZS DU DS ®U DS QU z` ej +A _ �c>� s xis' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: N I k. I I Floodplain, ind icate F l oodp lain elevatio N • A PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER -IWL CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT}iIC, ELEVATION OBSERVED ES . HIGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 5.�' 99•p' t�o+ve I«i7` y •o' 1•S' 'Dhr_Gy 's` TS; - Z - Z l ;s, %•8`1Zt3� �etvse s I B _Z S•S` 96.0 Z.S' VW T4 2.S' \.S' �.p' �� 2.S' I, •e.S 'w11 •�s "3 ►xe? Ca B- U `1. 3' \O�•S' tt > )•3' \ -Z' tt 3Z.0'BhSj) '1,Y'13mS '2.7'YBn sw L.S t 9.Z �, o' ; 1.3'8n B - (� S.o' 105. - 1 �� rioT:t 3 6' l 'r 'Z•�' Bn L ' 1.3' I•v 'FS 1JOQE > 6.0' \. '`o`RG T '2.6'8n s11 • Z.Z'3nsl •0 -2' 'I r coq -3' t. > 6.9 ' \•o' flk3n 1 i \.y'8„ 1 �.�' r s' 1 ).c' nls •�.y'Bn�'j : \•o' `tikGy8nsi1TS;2.O'Bnsl; 1.6'Br11S;o•9'f B 12 S. 6' tioS•3' 'r > S• b' \• 3' +p_)�pl Cfi`i�S Sut�°MaL� So1u�J�S PERCOLATION TESTS TEST ; D.EPTH . WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RA TE PER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. P RI D1 P R_ D2 R --- 7 1, — , P- Z Zy If`\O 3� 1 / 1! \N) Z 1oS P_ 3 z.q No 317 1 i ` /16 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. L1Jl'T1ftu r cs'►E►vT 7" Q ^ IS NlehtnJ SYSTEM ELEVATION Q ��y•3' \o� 9' I f t rx Z DTfl i lr A _ _ 1 1 i I f , I SEA/ /y i t � - I 810 1S ', 12__ • , _ I DC Ac - XY�1 S i 1 -T O 9 l5 N I I tN - __ d j sr 4 Z Li AJ;E- — r � - g c+� LE \`' = 60' sx��PT ,a s sry wN 1•iRP � Z S F;,C , q 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedur and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: J ZTU �jJ)( Z. Z.(� CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNA ;oti DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ' DILHR -SBD -6395 (R. 02l8r2) - OVER - SANITARY PERMIT '• COUNTY D1 Lk TRANSFER /RENEWAL UNIF M PERMIT (PLB 67•T) PERT$ NE ATE: PERMIT TRANSFER DATE: ORIGIN PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PROPERTY LOCH ION: C TY: r 1 S ,T d� N,R E (or W TOWN OF: LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAR EROAD, LAKE OR _LF�NDMARK: 1 N4 /`e !� l j ` � C „ l ) PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRESS: I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this I pr Y. I P R SIGNAT PREVIOUS PLUMBER'S NAME (IF CHANGED): PfX0 D R S: yr� PREVIOUS PLUMBER'S ADDRESS: �� 1 kl� RSW BER: PHONE NUMBE MP /MPRSW NUMBER: PHONE NUMBER: D3 ► S ( 1 SIGNATURE OF T: DATE APPROVED DISTRIBUTION: Original - County „ / Copy - Bureau of Plumbing Copy - Owner DILHR -SBD -6399 (R. 51821 Copy - Plumber D - p r r z O Cn O C z zt m p z coo m o m O m Jo X m m C=) 0 � � 1 C0002 m x < m U) � C7 r m � co 0 0 r" —� C O0 O z = 1 � - 7 D r O m o C7 C7 N U) z O O m C 7[7 D ° c mo 0 C � O C � z � < C� O m o � zz n O p z C/) � C Z O rn �• s� �Q�oH z U = _ _ -� z D _ („ I „ I fD N d 7 0' N 7 CD � m ` m m e d D CD aa) a m °� 0 'mom � oa ms3? ma y = m �� p n o< m c < y d m 3 m 3 o m o v m c. N _ o a 70 m �3 nid � '�am3 m � - m �saH "_ � H o- Co _. w <? G p 7 C p _ N cn O � c� c `� ; ?� o SN a � o �� 3 3 3.� ` m C ti ��o v a n r9m m 3 O m �m obi- s o�N 3 �'y Z to m C :! . < _< - y D '� H _. �_ CL m � am H o Z 1 m i � D �a o m3 Cb o < .o �°� ° 3 ' C >> m mh 3 me m 3 c y CA o 30 .0 n d o o h Go CL 3 0 _ s m This file contains information on how to use and maintain your septic system. h also pro- vides a convenient place for you to record vital ma folder with other important documents about Mainta your infor home tion and about propertyour ysystem. Keep this Your Septic System You would certainly never think of connecting functioning septic systems can add pollutants the plumbing that carries wastewater from to lakes and streams increasing weed and your house to the plumbing that carries fresh algae growth and, in extreme cases, killing water to your drinking water tap. That's ex- fish. actly what you might be doing. An improperly sited, overloaded, or poorly maintained septic These problems can be avoided if your septic system can add nutrients, bacteria, viruses, system is: and hazardous chemicals to groundwater. • correctly sited Those pollutants can then be drawn into your • properly designed well and come out the tap in your drinking, • carefully installed cooking and bathing water. • correctly used • regularly maintained. Even if you don't pollute your own or your neighbor's drinking water, improperly Regular maintenance costs much less than repair or replacement of a failed system. How Your Septic System Works Whatever you put into your toilets and sinks last line of defense to prevent polluted water flows into the septic tank. In the tank, most from entering lakes, streams, and ground - solids settle to the bottom and are partially water. The wastewater is partially purified by decomposed by bacteria to form sludge. the filtering action of the soil and the ability of Some materials float and form a scum on top microorganisms in the soil to decompose of the water (see illustration). many of the remaining contaminants. How - ever, the soil cannot remove dissolved sol- The liquid in the tank - -carrying bacteria, vi- vents, drain cleaners, and other household ruses, compounds of nitrogen and other po- chemicals that can easily percolate into the tentialy harmful substances --is discharged groundwater. into a soil absorption field. The soil is your access cover observation inlet pipe from house baffle baffle outlet water4 .scum. water , level level SOIL ABSORPTION FIELD (laid on gravel bed) sludge SEPTIC TANK Septic System Maintenance The most critical part of septic system man- 3. Find a pole or thin board long enough to agement is the decisions you make about reach the bottom of the tank (• --a'). Wrap what to put into the system as noted later the bottom five feet with white rags. under •Household Hints.' 4. Lower the wrapped part of the pole. Note The Septic Tank the thickness of the scum as the pole penetrates the floating layer. Then lower The tank is the part of the system that re- to the bottom of the tank (see illustration). quires regular maintenance. You must have 5. Hold the pole there for several minutes so the tank cleaned out regularly so that sludge and scum don't build up. If you do not clean that the sludge layer will get the rags your tank when needed, sludge or scum will fifthly black. clog the outlet pipe or move out into the soil 6. Remove the po le and note the sludge line absorption field. This will clog the field and 9 lead to early and costly failure of the system. and the liquid line. The sludge line will be darker than the coloration caused by How do you know when your septic tank the liquid waste. needs to be pumped? You can have a com mercial septic tank pumper give you an idea 7• If the total depth of sludge plus the scum of how often you should have the tank is more than one -third of the total wetted It depends on the size of your fami- length of your pole, it's time to have the pumped. tank cleaned. For example, if the total ly, the volume of water you use, whether you use a garbage disposal, and the capacity of length of your stick that is wet is 48 in - the tank. Generally, for a family of four using ches, the tank should be pumped if the a modem septic system, it's a good idea to dark sludge portion plus the scum portion have the tank pumped every two to three is over 16 inches. Pump the tank immedi- years. Pump annually if you use a garbage ately if the scum is more than 4 inches thick or appears to be escaping below the disposal. If you don't want to pay to have the tank pumped this often, you can make your baffle. own determination about the need for pump- If you have trouble measuring the sludge or ing by measuring the sludge and scum depth scum or have trouble with the stem, call a in the tank. Here's how you do it: pumper or plumber. The gases generated in 1. Find the tank. Sometimes this is tricky. a septic tank are dangerous, and can kill. The tank's cover will usually be within a Never enter a septic tank. Only a trained couple of feet below the ground surface, person with life support equipment and a but the depth can vary depending on how trained assistant should ever enter a septic your land slopes. If you don't know tank. where the tank is, you can probably find it by gently tapping a steel rod into the ground starting about ten feet from where the sewer drain leaves your house. If sludge your tank has an observation pipe, the measuring observation r_� device cover should be at the other end of the pipe tank -a few feet toward the house. After you find the cover, you might want to mark its location so you can find it again inlet < - - - baffles — — — > outlet the next time. water water level scum. level ' 2. Remove sod and soil until you can lift the cover. Loose soil should be kept clear of wastewater the opening. sludge { { 1 i l l 'r The Soil Filter from the tank. Other systems include a lift station. Make sure that all pumps or siphons are operating properly. Your The area where the septic liquid soaks into plumber can give you advice on how to the ground is called the soil absorption field, check your system. drain field, seepage bed, or dry well. It is a filter. If it is properly installed and used, it will 4. Avoid compacting the soil that acts as a accept septic tank discharge for many years. filter for effluent leaving the tank. Keep The soil absorption field should require no buildings, cars, and other heavy equip - maintenance if a few simple precautions are ment off the absorption field. followed. 5. Avoid overloading the absorption field with 1. Minimize your water use so that you do rainfall and snowmen. Slope the land not overload the finer. above the field so surface water is not directed toward it and slope the land be- 2. Be absolutely sure your septic tank is low it so water does not pond on it. working properly. Never allow sludge or Make sure that downspouts from your scum to escape from the tank. house or other buildings carry water away from the field. Never pile winter snow on 3. Some systems are equipped with a pump the field. or dosing chamber that floods the absorp- tion field in controlled doses rather than 6. Mark the boundaries of your drainage field letting effluent continuously trickle as a reminder. There may be one or more observation pipes to serve as guides. Household Hints that Help I To minimize maintenance costs - To protect your lake and the groundwater ■ To prolong the life of your system: DO DON'T • limit the water entering your tank. Use • Do not connect the basement sump pump water saving fixtures. Fox toilet float or other 'clean water• discharges to the valves, leaks, and dripping faucets. septic tank. Spread clothes washing over the entire week. • Do not put materials down drains that will j clog the septic tank (fats, grease, coffee • Pump the tank when necessary. This grounds, paper towels, sanitary napkins, means every two to three years (more disposable diapers, etc.). often if you use a garbage disposal) or as indicated by your annual inspection. Do not put toxic substances in drains that might end up in the groundwater (clean- Divert surface water drainage away from ing fluids, oils, paints, disinfectants, pes- the absorption field. ticides, etc.). • If you are buying a house with a septic Do not use chemicals to clean or system, ask the owner for the name of •sweeten" your system. They may inter- ' their pumper and their maintenance rec- fere with the biological action in the tank, ords. Have the system evaluated. You clog the drain field by flushing sludge and may want to have the soil tested for com- scum into the field, or add toxic chemicals pliance with the state uniform plumbing to groundwater. 'Starters' are not neces- code. Such a test will be required before sary for new tanks or after pumping exist - a replacement drain field can be con- ing tanks. structed. 1 Septic System Layout If you do not have a sketch of your septic •........... system to place in this file, draw one in the space provided. Show the location of your septic system components in relation to your .; .................::..................>..................:..... .............:................. house. Use the sketch to locate the tank for testing and cleaning, and to avoid the tank and drainfield when routing driveways, plant- .. ing trees, or directing heavy trucks or trailers. Maintenance Record Keeping a record of your septic system main- tenance activities will help you anticipate when the next cleaning is needed. Date Pumper Address Telephone # Cost Information Directory Inside Plumber DILHR District Office DNR Lake Management Name Name Coordinator Address Address Name Phone Phone Address Phone Septic System Installer County Sanitarian (or Code (Outside Plumber) Administrator) Extension Resource Agent Name Name Name Address Address Address Phone Phone Phone For more general information on rural living obtain a copy of Country Acres: A Guide to Buying and Manaoing Rural Property G3309 available from your County Extension office. Lakeshore homeowners have a special responsibility to ensure that their septic systems are not polluting the lake. More general information on lake management can be obtained from the DNR and Extension staff shown above. , t PUBL -WR -165 90FEV MW/ 19W Wbwr M Deparhnent of NaUnW Resourow U.W. EK%wW n D *whn" d Musty, Labor, and Hw= ReW ne IS THE GRASS GREENER VERY UR SEPTIC S YS TEM 19 --- - --------- ....... ....... �DJLHR ,rmT � ln0U5TRY,LRBop6"u DIVISION OF SAFETY 8t BUILDINGS OFFICE OF DIVISION CODES& APPLICATION WE ACKNOWLEDGE THE SSWMP FOR USE OF MATERIALS REPRINTED r e f If you want more information about your pri- vate sewage system, there are several other easy - to -read publications available. The publications can be obtained from: The Small Scale Water Management Project University of Wisconsin - Madison Room 1, Agriculture Hall Madison, Wisconsin 53706 Telephone (608) 262 -6969 For more copies: Office of Division Codes & Application 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 �� wrsmnsrn . '��DILHR OEPHFTTTEf1T OF - 1n0USTRV, "13nR & HUM"nRELRTloflS Office of Division Codes & Application 201 E. Washington Avenue P.O. Box 7969 Maidson, Wisconsin 53707 SBD- 7009- P(R.04 /90)