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ortO' n�O n (nOI 3 0 d to eo m e r te } co co �_ •o a� • m 3 CD • 3 3 rf rr K M If r� O _L O O N (n T o o 0 v f�D O w O O CO I N 7 3 C O cw (n w n 7 ? m O O C 0 � Fwv p • CD m N °� a m s m y" c a m m `° y `�° o0 o p11 o m m v, m ►+s CD W W c O CD w m m e o a' (2 c o m m 5 C -4 w O ° co °° N CD m = G W r n y O ctDJC n CCD CD m m o A7 O m c o co o m m o 3 a o m l o a l 3 a a o o ey C A y C A e C Cj y O �j CD v G� (D m cn v D ¢ cn z D z D m° rn CD co a y o m cn D y a CD m D y a 0 ' o :3 Co _0 s D m W sl a W oo C) M N N CD =9 N N N O ::p ((���� O O L OZ W Cfl fD L m f� L CO tD (� lei CP O y O O N O co O y O A m y n 0 ti 5 3 1 o f o a T T c T = T T T 0 o z 0 0 0 a Z O O g O a z O O M o N N (O cr T G G A N y ' T G G 'A O O' T C A C1 O 0 O m ' Cp m O O 0 fD (-� ID f/! fD w Psi cn cn 5i cn o O b'i cn c v cn y CD N 3 •• C N N � � N N 3 d CL ° a Z Z Z _ _ N I I I � � _. z z _ z z z z D D o D m' O D m O 0 O c O 7 O o 7 7 o CD a o CC N D '( o . s s V !A1 • O O N W y (n y CD CD CD CD �. m m 7. w c' w CD a w m CD a CD CD CD z C6 Z (6 m I n c °. rn c C) n A Z O a CL O o o Z -1 0 W T W T W T ool m �o M fD n m 0 3 c c 3 B 9 Z v m C (D N N A CD CD 3 Er CL y a j y O. O �O c N N N d C m a a 0� o a o a n CD O a - CD m rn I o � I _ I c � c v, m 3 m �_ m CD a y CD a N 2 co ov o• a o CD =r a v a CD y a o o y a m a f CL CD CD CD <. f. I c s fD a y y 3 3 N 3 m a I 3 o i o 0 CD CD CD Dp A 0 0 0 0 0 ° a f o as 0 CL CL CD CL Wisconsin Departme , Commerce IVATE SEWAGE SYSTEM County. St. Croix Safety vnd BuildhIg I ..,Sion INSPECTION REPORT Sanitary Permit No: s 399513 GENERAL�INFORMATION (ATTACH TO PERMIT) State P 1 0 "' i34 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). a T_t* S /Q Permit Holder's Name: City Village X Township Parcel IU No: Schulte, Way I Pleasant Valley Township 024- 1013 -20 -000 CST BM Elev: Insp. BM Elev: BM Description:�� n cc{ S-�p' 3 = CST' 600 Z w TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV, Septic Benchma A-4- • K& S. 05 0 3 v Dosing Alt. BM ation V Bldg. Sewer St/Ht Inlet St1Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 84 dp Se SSD 1 jjov ,r + DtBottom lZ � Sy - o 3 Dosing > } Header /Man, f!D 3 Dist. Pipe Z W' Bot. System 1 pb " Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM �,g v , �w(t Model Number � 2 � 7�O " ' �� � •s • Li p Friction Loss o 2 y System Head rDH , O , f. Ft Forcemain Length f Dia. Dist. to Well / `C `i 3 SOIL ABSORPTION SYSTEM d v S= 3 a Width / Length / No. Of T,ren hes PIT DIMENSIONS Inside Dia. Liquid Depth ENSIGNS V 9 \) ` SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM bE CHING INFORMATION Type Of System: • / t CHA NIT odel Number: rk DISTRIBUTION SYSTEM Length Header/Manjfold 11 Distribution • Dia / '/ ' �� x Hole Size I' x Hole Spacing Vent to Air Intake *t 2 � 3 5' Dia Spacing • Z 7 / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges ` Topsoil ❑ Yes [W No [W Yes No I COMMENTS: (Include code discrepencies persons present, etc.) I Inspec . #1: / Q / Inspection • (< 1 Location: 1725 County Road C Hammond, WI 54015 (NW 1i4 NE 114 8 T28N R17W) NA Lot Parcel : 08.29.17.66 I � 40 1.) Alt BM Description = � `',,1"`�`4'�` Si � � �` ���� eO � '(�AAA+�� 2.) Bldg sewer length = �- 38 (! ( d1+t fir► - amount of cover = ' Z °• a w Conto 3. ur = /b *lo ! ;�� jla�QJ an revision 1 quired? [] Yes o 6), ?_ Use other side for additional information. �__� ! D Insepctor's Signa re Cert SBD -6710 (R.3l97) � �/ W � �� • ;,(A3� - , � 1 t i � t c ` I f` Q �� ,� ��r _. �.. • �„ - �- �. 9s• 40 Wes' 3•S' t�3•z. w�u�h 3 - �S )D 2. G 2 AMA4e 5 " 1111310 �., �. � _ .._ . , t ;of... ., .. , ., , , ,: . .. ,. •, n ; � w � , 1 \ '. ,..... ... _._. .. ... _, ..,. . � t ._ _ ' < G'i" > 1J .. .... `.M . {. is } r A ._ ;. S ,_ . . _ _ .�; x + +. �.. a�..° , .. .. .< , -. -^ <- i. c � ` .*a-. ''' ^•< " lid. f ` w I�_ _ - __ ._. ,,., . _... .. __. ._ _ ,, f y �� � ... _._ � i �,t , i _... S , �. a '. � � .,. __ _ � ,.. �.,.. - � _a._.. . w.,.. a' � . � �� v-. XXX .. 1 _ .�' � ` - i . ., i . ,, . � _._ �- ` �. ;� a `. �� �.! S 7r��1r- a . - . f ..fl...' `_ ..... .. ...... .. _. _ ..,..., l a .,. . _.. .... .... ._ . .... .. _... .. .. .� � } i.T+ � //{{ � .' Y y �.t .^ ..,.� .. ! .'� �, ,�.. a r .1 ti i __ n _ ....... __ _._._...._..._. � � -. I 34' Safety and Buildings Division Co'r' c Y 201 W. Washington Ave., P.O. Box 2152 if U� Vis�onsin Madison, WI 53707 - 7162 Site Address Address /a ' (` Dep artment of Commerce / Sanitary Permit Application Sanitary Permi Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revd 9S may be used for secondary purposes Privacy Law, s15.04(1 (m I. Application Information - Please Print All Information State Plan I. D 'Numbe FV f ^ I Number + Property Owner's Name '1 � �- .;� _ lA,l lv r3 - 20,-00 0 Property O is Mailing Address DrC` Location tV 1 c� E4; S T N, R E City, State Zip Code Nu VtW T 1 Lot r Block Number v on Name CSM Number H. Type of Building (check all that apply), 1 or 2 Family Dwelling - Number of Bedrooms L []village ❑ Public/Commercial - Describe Use ®Township ❑ State Owned Nearest Road�� III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 Replacement System 3 ❑ Replacement of 6 ❑ Addition to S stem I I Tank On ' S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) &. � 44 ❑ Non - Pressurized In- Ground 21yMound 47 ❑ Sand Filter 50 ❑ Constructed Wetland Z00L0 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic reatment Unit 49 ❑ Recirculating 30 ❑ Other ©! V. Dispers al/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./Inch) Elevation qt 916A 910 a /,0 --- M / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank eS CJ Dosing Chamber 4 I til e .S e r . VII. Responsibility Statement- I, the unde ed, 6 bility for installation of the POWTS shown on the attached plans. Pi be 's Name (Print) Plum S 's Signa _ MP/MPRS Number Business Phone Number ��e, ��a► � - Plumber's Address (Street, City, State, Zip e) low 06 VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Agent • ture (No Stamps) Surcharge Fee) El Owner Given Initial Adverse oa�� fO�yy d/ Determination o" 1B. Conditions of Approval/Reasons for 1 y ppr �looc(p lli i ►1 � 1�� 1e �r►t.e- t G 1 l,�., �`- � k A t� )�� 1 wsf . 1/+ Ntiw� w(k/KN f 5#e cdj �X�t� Po � tS 5(�«.G( to abr�ln+�l p�✓ - Co «.�I�y �3.3?j Attach com lete piwia (to th C only) for We "em on paper not less than 8112 x 11 inches to size r r�iyt Z f L'� ,�/ wt_ ova a k1 7,5 - (GG{ tc �wi n • SO H+ %11,'Cr nh y S�i'I°7'iy" SBD -6398 (R. OS /Ol) Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N* 6consin www.commerce.state.wi.us Department Of Co mmerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary ✓� i ...` , August 08, 2000 CUST ID No.267341 .'. TTN. POWTS INSPECTOR ARTHUR L WEGERER WEGERER SOIL TESTING & ��tIGN A0 � f, Otx F _ ` NING OFFICE 421 N MAIN ST ��.' SS C Nw T CROIX COUNTY SPIA PO BOX 74 �� N1ou pFp%CE %�" X1101 CARMICHAEL RD RIVER FALLS WI 54022 �, ' ,' >,, zo HUDSON WI 54016 RE: CONDITIONAL APPROVAL _ PLAN APPROVAL EXPIRES: 08/08/2002 ~ Ident Pica 4 rs Transaction ED .410334 Site ID No. 19624 SITE: Please refer to both identification numbers, Site ID: 196242, Wayne Schulte above, in all correspondence with the agency. St. Croix County, Town of Pleasant Valley NW1 /4, NE1/4, S8, T28N, R17W FOR: Description: Six Bedroom Mound - Shared System Object Type: POWT System Regulated Object ID No.: 753138 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. 0 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with P p g Y q g P the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Note: Maintenance information must be given to the owner of the tank explaining that periodic cleaning of a septic filter is required. Access to the filter of each tank for cleaning must be provided per Comm 84 product approval conditions. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. r I ARTHUR L WEGERER Page 2 8/8/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, L DATE RECEIVED 07/21/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 TITLE SHEET Page of �7 MOUND SYSTEM FOR A b BEDROOM RESIDENCE 1 m wa I LE E WIZ PMU This plan has been prepared in accordance with the Mound Component Manual SBD- 10572 -P and the Pressure Distribution Manual SBD- 10573 -P LOCATED IN THE 1yk1 1/4 OF THE NE 1/4 OF SECTION 8 , T N, R tl W, TOWN OF S (ZA - UIX COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR �J P�� 1.J Er S C ttU L1" �. - ✓ ��� IA-Ls 0_ uUN i "Cu �I� 2 �Z40 � PREPARED BY WECSEFZER St7I L .TESTING AND . DES Z Ca" !01= 2 CE P.O. Box 74 421 N.Main St. �tiq River Falls, WI 54022 Phone 715- 425 -0165 .� < Fax 715- 425 -6864 X� j ART1Hlw L P ® T aPy � OF v k! � 'OMM ERC A'S I G N " pEPAR� D ►,DINGS • V1510N FE 1/. �1 sQa �c� SEE G � JOB NO. 00 -t8) SYSTEM.MANAGENENT Page' Z of Management and maintenance of this system is critical to its proper operation and longevity. The system owner must be provided with a complete set of plans including the management section. GENERAL Proper functioning of any type of on -site waste disposal system is dependent on the amount of water entering the system and the quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting, the system will be. Typical system components include a septic tank settle out and break down solids, an effluent filter at the septic tank outlet to filter out small particles, a pump tank with an effluent pump and controls and an absorption cell to dispose of the water in a manner which will protect the groundwater and public health. RECOMMENDATIONS 1. Install water savin g devices when and where possible. 2. Repair any water leaks as soon as possible. 3. Do not pour greases, oils, chemicals such as paint or paint thinners into the system. 4. If you have a garbage disposal, use it sparingly., 5. Do not dispose of any paper products other than tissue into the system. 6. Try to avoid excessive flows of water in short periods of time. Spreading clothes washing throughout the week is recommended. MAINTENANCE 1. The septic tank should be inspected by a licensed pumper every three years or less and pumped if necessary to remove solids and scum. 2. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the septic at 6 month intervals or as per the manufacturer's recommendation. 3. Periodic inspections at the observation pipes should be made by the owner to determine if any ponding is taking place in the absorption cell. Also check for any seepage to the ground surface. If consistent ponding or seepage is noted, a licensed plumber should be contacted. 4. This sytem.contains an alarm which must be installed on a separate circuit from the pump. If the alarm activates, minimize water use and contact a licensed plumber immediately. CONTINGENCIES Monitoring of the volume and effluent quality may become necessary if problems develop. Monitoring must be done as per the requirements of COMM 83.54(2). Pumping and disposal of wastewater by a licensed pumper may be necessary while analysis and repairs are made. 1. Failed mound systems may require removal and disposal of the existing sand fill and replacing it new sand or installing an aerobic pre - treatment unit to reduce or eliminate any clogging mat that may be present. 2. In- ground soil absorption systems or at -grade systems may require the installation of an aerobic pre- treatment unit or replacement of the system. Additional site and soil evaluations may need to be done and additional plans may need to be ,prepared and approved by the Safety and Buildings Division of the Department of 'Commerce. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Pag 1 of 3 labor and Human Relations g — Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not lirnited to vertical and horizontal reference point (84, direction and % of slope, scale or PARCEL I.D. # - dimensioned north arrow, and location and distance to nearest road. ' 0, 24 - L013 - Z Z APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION - W PT_t)1�3 E. S CLcV LGT- NW 1/4 N E 1/4,S 8 T Z16 N,R l E ( W PROPERTY OWNER':S MAILING ADDRESS tr LOTS I BLOCK# SUBO. NAME OR CSM # �_j Z S eOv O " C — — CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN ' NEAREST ROAD 1 S o LS 01- 7q 6 ; S .5 i.3 Sfl -, _1T' ►°N..CSy Zb 5`4 sr, (] New Construction Use [A Residential / Number of bedrooms to [ j Addition to existing binding pQ Replacement { j Public or commercial describe Code derived daily flow °f �0 gpd Recommended design loading rate 0 bed, gpdJfl - trench, gpdfft Absorption area required °1 n bed, ft - trench, 11? - Maximum design loading rate - S bed, gpd/ft O • b trench, gpd/ft Recommended infiltration surface elevations) 1 b • S It (as referred to site plan benchmark) Additional design / site considerations Parent material ti-0i5's oV t!it PrP t {t(,, `T7 LL Flood plain elevation, I applicable M A ft S : Suitable for system CONVENTIONAL MOUND 1N•GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem 0S O U a s [] U I ❑ S o u I [i 13U [IS ®U I ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth I Dominant Color I Mottles Texture I Structure (Consistence & I Roots GPD /ft in. Munsell flu. & Cont Color I Gr. Sz. Sh. I Bed rrwch 0 .Lz -.2. -L _ - es z,�' S •b . Ground 3 -� 101cZ�t6 _ s 1 zynsb� M es ,s b elev. �o 46. 0 U-f �•S�� -31y sl ��Sb� wI�- ea :s Depth to 5 60 -6V - i-S 2 231 �� ,S ur � s� s� d �S ©,�-, s Y eS . 3 •� limiting Remarks: Boring # l n -°I 1p�tZ3lZ � . . Sid Z`Fsbk w�,`(� -• eS Z� �5 ;,b Z C� 1042 316 — stir Z Sbk wl'H eS �-� - • s -� Ground 3 2S SO S`� R- ��6 -j, elev. 3 t o3.5 R = Depth to kang factor 2S" Remarks: T Name: - Please Print Phone: Arthur L. We erer 715 - 4 25 - 0165 eg8rer Soil T sting & Design Service -P.O. Box 74 River.Palls,WI.54022 Sgnahue: 0 O L $ Oats: 6 _ Zg 0 Q CST Number.. - 220254 PROPERTY OWNER Se�J L� SOIL DESCRIPTION REPORT Page? j PARCEL I.D. Boring # Horizon D epth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Consistence ence Roots GPD /ft Gr. Sz. Sh. 8°u�rY hd:.t 0 -10 l p `f R 3/ 2 S I Z S Bed Trends � €� <•�::: €�':;•�� Z 1 q -Z� 1 O`t 2 31 ' s. I ITS bi-r ly fy- CS l� •5 . JL Ground 3 24 -v lr3` frz V/b C �•SLfR SA '31 C-1 �eSbk 1�`ft CS t y �lg_S3 �.S` -2 31y �� �, �S d Sg � cs ,lam Na Depth to S �. a� limiting C p rit `� j - ru1� factor Zg Remarks: , Boring # On: rv.w:vvh'•.? Ground elev. !t. Depth to limiting factor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 3oring # ;round 31ev. it. )epth to imiting actor Remarks: _ •h n•r •rnrt�..r ..... I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations g _ Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but• not limited to vertical and horizontal reference point ' and % of slope, scale or PARCEL I.D. I dimensioned north arrow, and location and d c e ,bst rod /� 0 Z4 - 10 \" - z o APPLICANT INFORMATION -PLEAS ALL IftORM I 1 E DATE cs PROPERTY OWNER: OPERTY LOCATION 1\)W 1 /4 N E 1/4,S b T ,NR 1`Z E( W PROPERTY OWNER':S MAILING ADDRESS. .- ' PO S BLOCK x SUBD. NAME OR CSM 1 Z S " C ST CRQIx — —" CITY, STATE ZIP CO - `ti, � PN CITY []VILLAGE �I ' NEAREST ROAD � [ j New Construction Use {xJ Residential - fo [ J AdditgQ to existing building Replacement (j Public or commercial describe Code derived daily flow °{ 00 gpd Recommended design loading rate a bed, gpolft - trench, gpddltt Absorption area required °LOS bed, 42 — trench, 11 - Mla)dmum design loading rate o • S bed, gpolft 0 • b trench, gpolft Recommended infiltration surface elevations} t 0 b • S ft (as referred to site plan benchmark) Additional design / site considerations Parent material `T LL Flood plain elevation, if applicable 'hJ A ft S = Suitable for system CONVENTIONAL MOUND "ROUND PRESSURE I AT-GRADE SYSTEM IN FILL WXDM TANK U= Unsuitable for stem 0 S OU I ' E S ❑ U ❑ S .®U 0S E 0 S ®U , E I SU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color ( Mottles Texture Structure Consistence &uxiery Roots GPD /ft in. Munseil Qu. Sz. Coat Color Gr. Sz. Sh. I Bed Tmnch 3 Z �Z � t opt cz-31 � — s i f Z�s�k ►��-- cQ s l � . s . b Ground 3 -fib l �� t6 _ s a 1 Zm sb�c wz�, es • s b elev. 1i1 G's ft. R31 sl ��s �� sb�z. Depth to S 6o -6y - 1 •S Ll 2 3L j wCl,_s- S�fZsl� s� �.� es — ,3 •� G m' rl iti n9 n factor „ (, 64 R Y l y ►, c 1 C)v+l 1�1`r i — lie b© Remarks: Boring # J o -°► 1p`,11Z31Z Std Z`� wl'� eS Z�' •5 =,b 1 3 1 Ground 3 is -s� z•S�Iz �l6 - �.s�t�.s1� sip, ow. �.� _ �� ,Z. slay . L S it Depth to limiting factor Remarks: T Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 ' egdrer Soil T sting & Design Service -P.O. Box 74 River.Falls,WI.54022 Sgnadue: ' Date: L O CST Number.. . 00 - C - -0 220254 PROPERTY OWNER S SOIL DESCRIPTION REPORT PARCEL I.D. ! Zy ( 01.1 - "Z,U Page ? of ' 3 Boring # Horizon De pth Dominant Color Mottles Structure in, Munsell qu. Sz. Cont. Color Consistence GPD /ft or Gr. Sz. Sh. Y Roots Bed Trench — aj It Sl Z S bk CS l�` •S c Ground 3 � 'SLI R SA St 'Ll 0- S bI elev. t 1v2 `�t LS Z l oS.o ft. �l� -S3 • S K2 3 �Y \ S9 w�rtti�y Depth to S S b —1 . `t -2 �/ �Y LC C limiting O vK`F i — NP 1UQ factor 9 Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: Boring # U {{ M} EEE Ground elev. ft. Depth to limiting factor Remarks: 3oring # around ;lev. ft. )epth to imiting actor Remarks: _ `h nO•vl�f+ r.r •. .. t Page Of 1 Approved Synthetic Covering ASTM C33 Distribution Pipe Medium Sand Eley Topsoil F .r1 E o 3 b Li. % Slope Distribution Cell of Force Main Plowed z" to 2-," Aggregate From Pump Layer D =1.0 Ft. E Ft. CROSS SECTION OF A MOUND SYSTEM F 0 -8 Ft. G o. S Ft. A ZD Ft. H 1•13 Ft. Linear Loading Rate =q.4 GPD /LN FT ° - -- F ` Design Loading Rate =O,.qS GPD /SQ FT j \1 Ft. - 7 Ft. K 9 Ft. i ti0� Ft. Z9 Ft. s L Observation Pipe - � 0 1-T --------------------- ----------- ----------- Ae— I----------------- - - - - -- --------------------- �,��� � --- - - - - -- ----------------- - - - -_� Force Main ftc cus Distribution i" . � of z to 2 Cell Pipe aggregate 1 Observation Pipe (Anchor securely) - PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page of - 1 Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45° fitting to a point within six inches of the final grade. Terminate the ends of the Iaterals with a valve,threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. T pvC FvC :Lateral c. ",-- Lateral Manifold - - L x x x x x!Z x!2 x x x I x lateral Lenoth — Lateral Length — Distribution Line P h Pr1l 1 F+� t-P c s 0-- _ G q �'�C 1=oACE tnA-tN P MI5 Ft. Hole Diameter 1/� Inch S 3 S Ft. Lateral Inches) X Y Inches Manifold Z Inches Force Main " Z Inches # of holes /pipe l Invert Elevation of Laterals Ft. � elf= 4• t1.3x b= 56. s8 s� PUMP CHAMBER CROSS SECTION AKID SPECIFICATIONS PAGE OF - 7 VENT CAP I" C.1- VENT PIPC WCATHEK P APPROVED LOCKING MANHOLE ? 10 FROM DOOR, JULICTIOLI BOX COVER WITH WARNING LABEL WIMI)OW oft FRESH IYMtIJ. AIR I)JTAKE f GRADE I COWOUIT PROVIDE I -- IMLET AIRTIGHT SEAL I I \f APPROVED JOI A Tank Construction shall comply f I�� A PPROVED JOINTS with COMM 83.15 and COMM 83.20 ALARM 8 �f 1 I f 1 f ou C LLEV. FT PUMP � OFF D CONCRETE CLOCK 3" APPRWFD - RISER EXIT PERMITTED OULy IF TAWK MAMUFACTURER HAS SUCH APPROVAL ggpp 5 PEC,IFICAT10AI5 ��LLLL 005E M "\JWEIMZ IJUMBER OF DOSES: PER D" P1�._�T�.9 � ' O � T_ANK,� MA►IUFACTURCR: TAWK bIZE: 1Za GALLOWS DOSE VOLUME 1 S Vic`[ RD �� INCI.UDI DACKFI.OW: �1.� GALLONS ALARM . _MMItIFALTURGR. _ MODEL AIUMBER: ) 0) W CAPACITIES: A_ ZD INCHE5 OR 6X3 GALLOQ3 3WITCH TSFC: Z 8= Z- INCHES OR G z 3 G;4LL0W5 PUMP MAMUFACTURER: G = INCHE OR GALLONS MODEL 1JUMaER: D- 1 C B IZ 3 � -1. _z Ll0AI5 INCHES OR 3WITCH TUPE: MOTE: PUMP AMD ALARM ARE TO DE MINIMUM DISCHARGE RA S b - SS GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE CETWEEN PUMP OFF AUD.,OISTRICUTION PIPE.. 8 FEET ' + MIA iAIJM NETWORK SUPPLU PRESSURE .... ... .. . . 6 'S� FEET + 3IJS FEET OF FORC M AIN X 6 ' 3 � f% 23.03 100FtF RICTIOIU FACTOR. FEET TOTAL D JWAMIL HEAD = FEET As per .manufacturer gal /in. Liquid depth 3 $ t )zt` r- 7 HEAD CAPACITY CURVE HEAD CAPACrrYUNITS/MIN I De sign MODELS "185/4185.186!4186 - 188/4188 - 189/4189 - 191" 18514186-- Automatic 50 r I QA Lir Gal L10 Gal Ur GO Ur 5 1.52 58 220 I 145 549 145 549 45 170 +a a I 10 3.05 58 220 " 530 140 530 45 170 -' i ' 3!• 10 20 6.10 58 220 I 128 484 131 494 45 170 3e 120 30 9.14 85 322 58 220 116 439 120 454 45 170 a 40 12.19 70 265 58 220 104 392 109 413 45 170 I 32 I I I f I 50 15.24 51 193 58 220 90 341 97 367 45 170 y 10e I 60 18.29 32 121 58 220 71 269 85 322 45 170 re ye I j I 70 21.34 9 34 52 197 51 193 69 261 45 170 i 80 24.38 145 170 28 106 51 193 45 170 6 11/32 za es 90 27.43 31 115 I 2 8 34 129 45 170 100 30.48 16 60 t 17 64 40 151 110 32.00 4 15 30 114 1 1 /7 1 -i /z +/ ai ?) ? 120 36.58 20 76 S - a vvr �( 16 se I I 130 39.62 1 10 38 I i • idle. 73 1 f 4' 91' 110' 137 70 009903 ' 10 °t / "°` °° /" WARNING: Model 185 should not 1a 9 /16 �i -!,�� be subjected to heads less than i 1li II I U.S MIM +0 7c 3o a 56 ra 7o eo W lm 110 Ip ,p 140 150 160 30 feet TDH. U1Fn5 6 80 tb 2�0 d20 W0 .e0 %0 ea ROn PER MW11E i_ L ' IL..�� SKA374 a- .-F- -- a 3/s -.. 185 MODELS 4185 MODEL Standard all models • 20 h, card • 1 H.P. Control Selection I Listings � e . - "W", Single Seal Double Seal' Volts Ph Mode Amps I Simplex Duplex CSA UL 6 1/2 Weight 89 lbs. 0185 - 230 1 Auto 9.8 1 1 or 1& 9 I Y I Y E185 E4185 230 1 Non 9.8 1 2 or 2& 8 3 or 5& 6 Y "' i Y fl H185 - 200.208 1 Auto 11.5 1 1 or 1 & 9 N N - - - ' 1185 1 14185 200.208 1 Non 11.5 1 2&8 3 or 5& 6 N I N o F185 • F4185 230 3 Non 7.4 i 2 &4 3 &4or5 &6 I Y Y J185 ' J4185 200.208 3 Non 7.5 2&4 3 & 4 or 5 & 6 Y Y z-}- 1 1/2 -11 112 .NPT ' G 185 • G4185 460 3 Non 3.7 i 2&4 3& 4 or 5& 6 Y I Y I s- j? nr* icet BA185 - 575 3 Nan 3.3 I 2 &4 3 &4or5 &6 Y I N 186 MODELS 4186 MOD Standard all models • 20 tL cord • 11} H.P- Control Selection Listin s Single Sal Double Seal" Volts Mode Amps I Simplex Duplex CSA I UL 0186 - 230 1 Auto 13.7 1 1 or 1& 9 I N I N E186 E4186 230 1 Non f 13.7 1 2 or 2& 8 3 or 5& 6 N! N F186 F4186 230 31 Non 8.6 2 &4 3 &4or5 &6 I N; N G186 ' G4186 460 31 Non 4.6 I 2&4 3& 4 or 5& 6 F N 188 MODELS 4188 MODELS Standard all models - 20 ft. cord - 1% H.P. Control Selection Listings SKA1413 Single Seal i Double Seal Volts - Ph Mode Amps I Simplex Duplex CSA ! UL D188 - 230 1 Auto 13.3 11 or 1& 9 N I Yr" E188 E4188 230 1 Non I 13.3 2 or 2& 8 3 or 5& 6 I Y`r i Y"' SELECTION GUIDE 1-1188 - 200.2 1 Auto I 16.8 1 1 or l& 9 I N I N 1188 ' 14188 2OD -208 1 Non 16.8 I 2&7 3 or 5& 6 I N N F188 ' F4188 230 3 Non 8.9 i 2 & 4 3 & 4 or 5 & 6 Y I Y 1 • Integral float operated mechanical switch, no externa control ' ' 200 X® 3 Non 10.3 I 2 & 4 3 & 4 or 5 & 6 Y J188 J 4188 Y required. • 188 • 4188 460 3 Non 4.6 2&4 3 & 4 or 5 & s Y Y 2• Single piggyback wide angle variable level switch, or double piggyback variable level switch. Refer to FMO477• BA188 575 3 Non 3.5 i 2 & 4 3 & 4o 5 & 6 Y N 3. Mechanical aftemator M -Pak 10 -0072 or 10-0075 189 MODELS 4189 MODEL Standard all models • 20 tL cord -1% H.P. Control Selection Listings 4, Combination starter. Refer to FMO514. Single Seas Double Sal' Volts • Ph Mode Amps i Simplex Duplex CSA I UL 5. See FMO712 for correct model of Electrical Alternator » D189 - 1 230 1 Auto 16.6 { 1 or 1 & 9 N Y E -Pak. E189 " E4189 230 1 Non 16.6 1 2&7 3 or 5 & 6 Y 12) Y " 6. Variable level control switch 10-0225 used as control activator with XE189 7 j XE4189 230 1 Auto 16.6 2&8 Y Y E -Pak duplex (3) or (4) float system. H189 200.208 1 Auto 20.5 1&9 N N 7. See FMO486 for correct control panel model. ' 1189 ' 14189 200.208 1 Non 20.5 I 2 & 3 or 5 & 6 N I N 8. 4 hole J -Pak junction box, for watertight connection or wired - • F189 • F4189 230 3 Non 112 j 2&4 3 & 4 or 5 & 6 Y Y simplex or 2 pump operation. P/N 10-0002. J189 ' J4189 200.208 3 Nan 132 2&4 3 &4 or 5 &6 Y Y 9. 2 hole J -Pak, junction box, for watertight connection or spike. G189 ' G4189 460 3 Non U 2&4 3& 4 or 5& 6 Y Y P/N 10-0003. BA189 1 575 31 Non 5.8 2& 4 3& 4 or 5& 6 Y N CAUTION A0 instau a n of Controls, protection devices and wiring should be done by a qualified 191 MODEL Standard all models .20 flL cord - 2 H.P. Control Selection Listings- licensed electrician. AN electrical and safety codes should be Wowed incl the Sin Seal Volts - Ph Mode Am I Simplex most recent National Electric Code (NEC) and the Occupational Safety and Noah Act Ps P Duplex Pl CSA UL (OSHA). E191 - 230 1 Non 1 14.5 I 2or2 &8 3or5 &6 N I N No Molded PWg „ OW ASal pwtlps » ammble with oV� moisture sensor •Seal Fa d rdmta Fain 14;Pi g gyback dir iable evelSwitc Switches, ertocataloganCanbinationMO486, UL or CSA figs available n NEMA 1 a NFJ4A dx control panels. FM0514; Piggyback Variable Level SwBches, FM047T; ElecuicalABemata, FM0486; 1 UL lkle fi 2 Double Seal Pumps. (t) � listed � available ,,,� � plug� Mechanical Alternator, FM0495; Alarm Package, FM0513; St1mplSewage Basins, (2) CSA App- -W without plug cap. FMO487; and Simplex Control Box, FMO732. (3) 20 Amp Outlet, PM 10-0060 roust be used, RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. . ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer `� ` � rl e DC' ` I.t.' t Mailing Address Property Address (Verification required from Planning Department for new construction) City/State �6 Amwd -, vU Parcel Identification Number U 161.3 - V - 00 0 LEGAL DESCRIPTION rn� `/ �p r . T o S N -R —dW, Town of P'e v Property Location �. / %4, I� � ' /., Sec. Subdivision . Lot # Certified Survey Map # , Volume Page # Warranty Deed # 1 U 3 LE , Volume) S , Page # 3 Spec house ❑ yes no Lot lines identifiable ❑ yes ❑ no SYSTEM — MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, Journeyman plumber, restricted plumber or a li censed pumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic systemjias begemajqtaino must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year exp' on SIGMA OF PLICANT DATE OWNER CERTIFICATION 1(we) cer that all statements on this form are true to the best of my (our) knowledge. I (we) am are the owwr<ei{s) o tify f the pro rty described a , by e o arranty deed recorded in Register of Deeds Office. U /10Ja� SIGMA OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of tue certified survey map if reference is made in the warranty deed ( DOCUMENT NO ST ATE BAR OF WISCONSIN FORA 3 -1982 THIS SPACE R£SENV£O FOR RECVNOMO DATA QUIT CLAIM DEED • i w JL %.'V%F M r ' v :w�! I .�.rJ a -r 343 REGISTERS OFFICE Jean M. Schulte - - - - -- ST. CROIX CO., WIS. . ..... ....... _ . .......... ........ . - --- - - - - -- Rec'd. for Record Hiis lst quit- claims to Schulte Bros a co-partnership day of MY A.D. 19_ consisting of Donald H. Schulte and Playne A. 10:30 9 Sculte h ^1 ....... _. the followiinz described real estate in -..St • CroiX County, State of Wisconsin: Re -. ,Y TO NE1 /4 of Section 8 and the W1 /2 of the NW1 /4 of Section 9, all in T28N, R17W. - Tax Parcel No :................ .. ......... ... This deed is executed for the purpose of terminating Jean M. Schulte's interest in this property, and divesting the Grantor herein of all right, title, and interest to said property, pursuant to the stipulation entered into on May 29, 1985 by the parties and as per the Judgment of the Court os found in the Findings of Fact, Conclusions of Law and Judgment, Case No. 84 FA 168, signed by the Honorable Phillip P. Todryk, St. Croix County Circuit Court - Branch II. 1 . --� Y_ -_19 -- ;i,Nt� I This is homestead property. (is) (is not) Dated this j K _ day of June (SEAL) ',ly,Cr r y�1. SCIU Q _..(SEAL) _.. _ JEAN M. SCHULTE ._._ _(SEAL) _ - - _(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) _ - - - - -- STATE OF WISCONSIN ss. - -- -- -- -- County- authenticated this ._- .._.day of --------- .---- 19 ...... Personally came before me this -.. ..... day of ----------- � tZ E - -- -• -- .... 19. the above named --- ------- E- - -- -- - -- -- - _.._ - - - -- - - - -- E - �� j - TITLE: MEMBER STATE BAR OF W1S('ONSIN (If not. -.... -- authorized by ; 70R.06, Wis. Stats.) to me known to`jigjilPT4j ........ who executed the foregoin in f{f+ ent' aiirl" Arledge the ante. '-i:i !NSiHe: 4'=!.T �. .15 DH•1 E' "ED f?Y .•� j A. Mark J. Gherty - - -_- GNERTY AND DUVI AP, Hudson, WI f // x - tiota -v 1'nblre� ' 4 ;4)4 -- - County, Wis. Si ^r, ttu re "- nl:ly he a•A'_entieatcd or ark nowltd_,.1. Eoth � is Perm t.�If• nen not, state expiration re not re<eaary.) ,;` j - date ��it,. >' >, � S -... SU ',L DE SI'�l't. IMI fit "I1:0N -!\ 0.•«..,, f...c:,l P'nnk Cn Y, its 3. C t g� If- 8 ST. CROIX COUNTY WISCONSIN ZONING OFFICE K u r M�� ■! ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ''•• ' '= --- --°° Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 NOTICE OF VIOLATION October 07, 2001 WAYNE SCHULTE 471 165TH ST. HAMMOND, WI 54015 RE: Failing septic system at 471 165th St. Town of Pleasant Valley - St. Croix County, WI Computer # 024 - 1013 -20 -000 Parcel # 08.28.17.66 Dear Mr. Schulte: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(a) Wisconsin Statutes (Category 1). This violation was first noted on 10/30/2001. The violation noted is septic effluent discharging to surface waters. An on -site inspection on 10/07/01 did reveal the septic effluent discharging to surface waters. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 10/07/2001 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: By November 15, 2001, contract with a certified soil tester to have a soil evaluation conducted. The soil evaluation will determine the type of septic system needed and it's location. Then contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than July 1, 2002. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sincerely, A tJ- Ate.. evin Grabau Zoning Technician cc: file I PC4 wCz3 W ,;sconsin Department ofCommerce SOIL EVALUATION REPORT Page of Z Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ County -. S'I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must x include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location an 'stance• tonearest road. Please print all informat' .`3 .' ! Reviewed by Date rs Peonal information you provide may be used for secondary u o s (Pr cy S.15. r' , 11( Property Owner fit perty ' on �C>>J Iti� SC4��1 i. - fsovt -teE 1/4 N�.1/4 S T N R E (or W Property Owner's Mailing Address ®' # Subd. Name or CSM# ( L - 1 1 6 S `fit S'1-• ST C — -- city State Zip Code Phone r ZID(VfNo Ci cb Village 0 Town Nearest Road r�w�owv� w 5 01 s ( - i tis r , �� �>��� 16S `Ttf sT ❑ New Construction Use: Residential / Number of bedroom Code derived design flow rate GPD Q Replacement ❑ Public or commercial - Describe: Parent material - r\ u - Flood Plain elevation if applicable r11j P� ft, General comments '3) v4,,j G 5 v � Al �2 � CO>\1L� l rjUA1S P& and recommendations: - 1-'�.� � tS�t q PD12 h 1 L 3 ccw Sim © Boring # ❑ Boring - ® Pit Ground surface elev. ft. Depth to limiting factor �_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. S z. Sh. 'Eff#1 I 'Eff#2 0 - 10`21 -31Z S1 1 Z h K G - • S •8 Z -7 -I - r.S`�1 R3 L — 61^91 Z sb Ytt �S •S . 9 4 -- - I SCI) -V/y e Z P - 7sgRs /8 el c�v�, rn�� _ .o , p F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ature CST Number Arthur L. tdegerer 220254 ../—. Address N e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, HI 54022 lt_VZ -bl 715 -425 -0165 i PLOT PLAN Page Z.. of � ' Scale P = L4(3 s � a -D oLITr�rLL 11 12 -()I 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. Q c a o ' a�i ° o • o�i o i M t� r .. w E O a 0 y ry N E 0 A m OE °: a) '0 co c m m I' o j t o a •0 '= m o 2 0 E y ? o Z U) M c z a 3 -R m o LL C LL C E LL c O_ N O N C ^$ I Q Q a u d w E d w n c c v 1 p M O M m 0 Q) a a) w re in C� 6 " z 0 0 :: ° o cr v ° ° L z a m a m a m m I Z Q o 0 Z ? c cv c c E a c O E - a E N a � N R 0 C ! CY *1r N N c c c v •��wl m= s a v� � 0 � Z o CL �1r c o d O v o m d w o d d p O Z H Z Z Z h Z Z z Z p N m E CD a) ZZ a) N m E m N R E N to to m C L ❑ m m to a m ❑ c (0 !� a 'Y '' O c LO U') 1 O N N d N C O Q l p to N 0! O to d i1 ° O O I @ 'V' ❑ ❑ a • 0 N d' ❑ ❑ a S y � N d' ❑ ❑ a CD N N E (n LO h O n c!) uJ to ° F F ! 0 C3 1 � - F 1�- Co o a �i 000 d Z - 000 n z -6000 a a z 1 •►,a aan.a c CLCL. C: n.aa. 0 0 0 o rn rn o m rn rn o M o o a cn J V = rn rn z = rn s z Z oN Q O N N N — 0 U N N N .-. a) N N E .-. z 7::� 0 0 0 Q N N M O O� d m L O O� d L O m co C d N a0 1] c c U') � {11I m v 0) d cn m m m y a as tO QI Z Ul ca II d Q Z co ca 'a — Q A fn i6 N m Q 3 w a 7 r ❑ I I 'D c C O E V �' c0 U O a) � p 7, U v) � N O O O rr O (p M m N O G U C- p) CO a) (n U �- Q . 0 �"' O O O 'O e" ❑ (!) m ? N to Y m m _ N N v M C N " O 7 N _N O 7 N M_ C - io L" ° m m a m v a c a) 0 t0 a m t- a) 0 m �) o to' s L O 7 N 6 E* N 4) U O in O O U U M 0 E O U U O N • N �' O o Q. ! fn N O Z w z Z W U) e- O Z N Z CA U1 M O z N Y to � E d Q) '- a a d n ' • a m m M= = m c c °�) 0. m m `�1 A Uv ° oinc� 0U)0 Wisconsin Department of Industry. PRIVATE SEWAGE SYSTEM County: Labor and Muman Relations INSPECTION REPORT ST. CROIX Safetyanti Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State P an o.: SCHULTE /DONALD & WAYNE 1 123 aarant- Val CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosi ng NA Header / Man. Aeration NA Dist. Pipe Holding Bat. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No, Of Pits Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Pleasant Valley.8.28.27W, NE, NE, 165th Street Plan revision required? ❑ Yes ❑ No Use other side for additional information_ I I I I [ I FT SBD -6710 (R 05191) Date Inspector's Signature Cert. No- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s ®IL' HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COU NTY r 57A cIp,X STATE SANITARY PERMIT # – Attach complete plans (to the county copy only) for the system, on paper not less than a ? 9is� 8 x 11 inches in size. 1:1 Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION -? a 5 c4t4 1 fG NF Y A1,C s, S TzB, N, R 17 J (or W PROPERTY OWNER'S MAILING ADD ESS LOT # BLOCK # CITY, STATE / ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) ❑ State Owned CITY NCR �t �• /Ca ❑ Public ICI 1 or 2 Fam. Dwelling –# of bedrooms — PARCEI Ax Nu R( ) Dad- col+ 3 -10 -0 III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. IX Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — 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 42 ❑ Pit Privy 13 E] Seepage Pit Pressure 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 - – 330 Clai' S / �14 Feet WX Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exp INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 0 1 900 (,d, Lift Pump Tank/Siphon Chamber :f� I I J _ El 1 1:1 . El 1_0 1 1-1 F Vlll. 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: (No Stamps) MP /MPRSW No.: Business Phone Number: �a le �. �/� �� -��:- �� z 9 71 �5/-337g Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY Disapproved nitary Permit Fee (includes Groundwater [ Date Issued Issuing Agent Signature (No Stamps) ,4 Approved El owner Given Initial Surcharge Fee) _C' ! 7 s A dverse terminate X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (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. 2. Your sanitary 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 i State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name n mailing r a and a address. Provide the legal description P Y 9 ga 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 fine 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'n 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, ground- water contamination investigations and establishment of standards. sBD -6398 (8.11/86) Wisconsin Department of Health and Social Services Plb. #67 10/69 Division of Health PERMIT APPLICATION' for PRIVATE DOMESTIC SEWAGE SYSTEMS A. 041NER OF PROPERTY TYPE OR USE BLACK INK Nam - Addres City, Zip Code � County B. LOCATION OF PROPERTY WH .RE SYSTEM WI LL BE CONSTRUCTED, ALTERED OR EXTENDED Check One: ' CITY VILLAGE LEGAL DESCRIPTI Ns '►i TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WO t? ," S NO �G � PERMIT NUMBER D. SEPTIC 7 CAPACITY J C t ;!' Gallons NEW INSTALLATION I REPLACEMENT ADDITION MATERIALS: Prefab Concrete / Poured in Place Steel Other NUMER OF TANKS TO BE IVSTALLED: E. TYPE OF OCCUPANCY -- � Check One: One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC& Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other ( Speci fy ) P G. EFFLUENT DISPOSAL SYSTEM NEW X EXTENSION ADDITION -�,-- REPLACEMENT Tile Size c No.Lin.Feet C Tre h nch Widt Depth G� Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines Seepage Pitt Inside diameter �? Liquid Depth . y/ " P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inc Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to I Next to 'Last To Fall 1st Wetted Overni ht in Minutes Last Periodf Last Period Period . :ne I nch Example P- 0 36" To p Soil 10" Cla 26" 25 Xes or no 30 1/2 1/2 1/2 60 RECORD DATA FROM MINIMUM OF 3 TEST HOLES i ompute size of absorption area in accord with H 62.20 Wis. Adninistrr Code. S O I L B O R I N G S- Minimum 36 Below Prop osod Absorption System _ oring Total Depth Depth to Ground Water Depth to Bedrock umber Inehas Observed Estimated Observed Estimated Character of Soil with Thickness in Inches xample - 0 7211 721' Black To2 Soil 12 "• Cla 18 18 Gravel 24" RECORD DATA FROM MINIMUM OF 3 BORE HOLES r' COMPLETE OTHER SIDE I, she undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. a NAME ��Z TITLE , c_ Type or Print) REGISTRATION NO. 771 �r or MASTER PLUMBER LICENSE No. ADDRESS i ✓�� , �4 I S _ DATE � / �' / b _ SIGNATURE MASTER PLUM3.4'R MAKING, APPLICATION f I signatures �� Ott ✓�• alt t� License Numbers MP MP RSW 2 13 (To be Completed by Issuing Agent) Date of Application - J� I c 7C` Fee Paid $ `11. Permit Issued (date) /C .7 Permit Number T �` Agent (name) ` / /��.. c 7 j�� �-"l� For: Town, Village, City, County, *to. (Specify) Notes The application oannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below FOR DEPARTMENT USE ONLY DATE RECEIVED / jU� ACCEPTED BY RETURNED _ (Initials) (Date) (See Corres. FEE RECEIVED VALID. N0. U PERMIT N0. (Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMENTS: .�cha Sec. /Ol -v. &),Oync Sc�ict C 8 '�i�Q r�1YIO yj�� �i . � � S• c o, 7� N R L No. i a l Z udlSOj^' csT 3y�� P Z r � cal si Soo = —B., Set BL n: —, cl�' — _ — e Nouse s f 9G A lp 4.6Z,? CST SIV1 S7`. D": ' US T TR . ( OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INU US� { DIVISION LABOR APED PERCOLATION TESTS ( 115 P. BOX HUMAN 707 MAN RELATIONS ` ) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: S E TION: a OWNSHIP /MUNICIPALI Y LOT NO,:BLK. NO.: SUBDIVISION NAME: A4 - 1- /a '/a q /TZY N/R 17 9 (or �� �snr�f l� /f COUNTY: OWNERS BUYER'S NAME: MAILING ADDRESS: / 574 Cro,ar o.�u lc� r�� rJe S�J� c� /7`� / <5 -Z� USE DATES OBSERV TIONS MADE NO. BEDRMS.]MOMWERCIAL DES RIPTlON: I PR NS; A N TESTS: Residence 1� i h ee I RATING: S- Site suitable for system U= Site unsuitable for system �p, k r CONVENTIONAL: MOUND: IN- GROUND•PRESSURE STEMIN- FILLHOLDINGTANK: RECOMMENDED SYSTEM:(optional) ®S ❑U ®S ❑U � ❑U ❑S ®U I EIS MU 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: / /vI LFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO R UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH -W ELEVATION OBSERVED EST. HIGHE§T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) i B-1 l •30 Alo ne -3n / -3� ls, �• 3�t3ns,'1' •2'o Bn s rr , B -Z_ 5'R / or). C x'%80 ,Z, , s." /� / 9/7 -5-. ,Z � n Cs v' ✓, B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L- INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PER IOD 1 P RI R PER INCH P. P. P- P P- 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. SYSTEM ELEVATION xl� 41 tN i 1 I 1 i I I I I I i l 1 I I I � ff f { t 1 j 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures 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: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02182) — OVER — STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS X f f c� ►�- �.o/�, f�c% � J PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE PROPERTY LOCATION /` ✓2 1/4, A/✓ 1/4, Section Aff T _2_2_ N -R TOWN OF }��t�CtSQ �. L/ / (' �i' ST. CROIX COUNTY, WI SUBDIVISION AM LOT NUMBER *4 CERTIFIEDSURVEY MAP , VOLUME 5 ,PAGE -Y/9 ,LOT NUMBE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the, on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed retu ed tot . Croix County Zoning Officer within 30 days of the three y expiration date. SIGNED: DATE: -- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 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 Location of property _ l 1/4 NF 1/4, Section g ,T Z,? N -R_Z7 _W Township �IjPa Sar,�" � ' / ) f�� Mailingaddress Address of site e, ��. Subdivision name /VX r � // Lot no. /l/X Other homes on property? _ Yes No Previous owner of property 1�or.� f /3� �c� U f!e- Total size of property Total size of parcel Date parcel was created // ISO 1 7 Are all corners and lot lines id ratifiable? X _Yes No Is this property being developed for (spec house) ? Yes _,V No Volume �� 5" and Page Number 418 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. -3# , 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. 1�� -�� ji""Z sigplfure &C Applicant Co- Applicant — -1 Date of Signature Date of Signature "Federal Land .Bank Y � River Fa,116,4: I �� LW nA *t� '�"�, �4`�# '�` �,, - , �. -' - . Tex ty • - - :,W - t This is ►anttdtaad pro* j �� °`• j _ Bsa#,�� "8; ,aAd th8 W� nf the NWT of Section 9 , 4 restrictions cfi',rscf : ' !!!!!! Ow s .�. y� a Wd r " r5 _". r Jean M. Schulte R r.Y ro - r n.2 v 11 ate 8nd JB • ig • "' + �� T t�.ytlstiaatd tl!!a �9 ,tW at !9 ` . t- A g Michael Rajek Title: 1Mebw Stste gar of Aldewsln STATL O/ WOCOMM ` P al►r eaafe tw(am ar, Oki$ y day w bs The vetsm --- "be executed the 1 iagrwent sad ac k no wledged the 1181110- 1i Wt 4WAm eru dratted by Michael Ra ek Attorn Netter PUNIC -- ' .. my coamiaslas (tGspleea) (16) ; 1iN of wlatetifaes is optiarAl. � . r .vX �,��i a Wit{ is +qr Pr*" DNoa tMir slatatarea. . x r QEPARTM1vNT OF INDUSTRY INSPECTION REPORT FOR SAFETY &BUILDING LABOR &HUMAN RELATIONS DIVISION P.Q. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION � ADISQ� T 5 07 State Plan I.D. Number: 2, q, ec. 8,T2$ -Rl7 (If assigned) Town of Pleasant V�ley ❑ CONVENTIONAL ALTERATIVE 6 5th St. Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Don & Wa ne Schulte I 165th St. , Hammond WI 54015 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Dale Hudson 6629 St. Croix 135541 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: I TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO VENT MATL.: ❑ YES F_ NO NEAREST - -� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: I PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCK COVER PROVIDED: PROVDED: 1 DY6 S ❑ NO ❑ YES D NO I ❑ YES O NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ) ❑ YES ❑ NO NEAREST —100- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL AND MARKING: or excavation. (if soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: TRENCHES: DISTR. PIPE SPACING: MATERIAL: INSIDE DIA.: # PITS: LIQUID PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END PIPES: FEET FROM LINE: AIR INLET: NEAREST 40- SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. ERVATION WELLS; SOIL COVER TEXTURE: PERMANENT MARKERS: OBS ❑ YES ❑ NO ❑ YES [__1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES DNO , __j ❑ YES ❑ NO ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES: OLATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &MARKING: ELEV: ELEV: DIA.: ELEV.: PIPES: DIA.. ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO 1. 1 ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ---A- Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: SBD -6710 (R. 06/88). SANITARY PERMIT APPLICATION "71LHR COUN � In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY I # –Attach complete plans (to the county copy only) for the system, on paper not less than / / J J pp ; ; ll ( ( I 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION /7 _1 :),:::, Id -)' �(�CI /?C`' �G�G1� C %a J 'la, S Y T Zf, N, R e E (o W PROPERTY OWNER'S MAILIIyG ADDRESS LOT # BLOCK # CITY, STATE / ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER BUILDING: (Check one) CITY Pty osa�1 NEAREST ROAD II. TYPE OF ��--pN� State Owned VILLAGE ❑ Public ,01 or 2 Fam. Dwelling -# of bedrooms 4- PARCEL TAX M R( ) Ill. BUILDING USE: (If building type is public, check all that apply) Cos' 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) ' A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4.,0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 El Mound 30 ❑ Specify Type 41'M Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: Clary 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14.LOADINGRATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /da /sq. ft.) (Mi ELEVATION 3.3 X V / / /�� Feet /V Feet VII. TANK CAPACITY Site j in allons Total ## of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete stCon-d Steel , glass Plastic App Tanks Tanks Septic Tank or Holdin Tank Oks COQ f Lift Pump Tank/Siphon Chamber Vlll. 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:: No Stamps) MP /MPRSW No.: Business Phone Number: 7 1 S Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Date Ise u ISSUIn Agent Signature (No Stamps) IK Approved ❑ owner Given Initial / — Surcharge Fee) � Adverse i i / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SSD -6398 (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. 2. Your sanitary 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: 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 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 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, ground- , water contamination investigations and establishment of standards. SBD -63M (R.11/88) �✓Qmmoy�� ��; .. � s. c H o, �8N Rl tZ 800 " ' c• A b© U .D�ain trC�O Aern A! p 46Z9 cs 3�l,3' Sf I D'.4F"USTR;'ENTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INU USTR %�, DIVISION LABOR AND P.O. BOX 76 RE LATIONS PERCOLATION TESTS (115) MADISON WI 53707 HUMA N RELATIONS (H63.090) & ter 145.045) C � - p LOCATION: SE TIO • TOWNSHIP /MUNICIPALI Y OT NO.: BLK. NO.: SUBDIVISION NAME: 1 / /TZ8 N/R 17 R (or W t� ensnrr� l� Aq N COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDR SS: sf Cro,x oJ�ulc� ��c� rre S�J ��f� /�5 St arn�lnr�a, ll� USE DATES OBSERVJ<TIONS MADE NO. BEDR OMMEACIAL DESCRIPTION: PROFILE P ONS; A N ESTS: LO Residence ! I 3 O _ ,f` JI � eec— o/I JL'C. 7 J"41 /V /J RATING: S= Site suitable for system U= Site unsuitable for system �q, �p_ ,r CONVENTIONAL: MOUND: IN- GROUND-PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) Pq S ❑U ®S DU [2 S ❑U CJ S ®U ❑ S MU co,�1l Gf'o�'I 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: I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH4#+, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK;) r J J B- /la > /3 /° 'e "o �n s +r r• B -� ��� Jv� pyl ��0 ,Z, J' • e / 9.17 5 n CS B- B- B- B- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PE RIOD 1 P RI D2 PERIOD 3 PER INCH P- P P- P-- P P _ PLOT { P AN: howlocations f L S o 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. SYSTEM ELEVATION I 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures 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: -:,T>a le s0�^ W ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 021$2) — OVER — 1 ,i INSTRUCTIONS FOR COMPLETING FORM 115 SBD 6395 i 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; 1 , 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile g I c descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification 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 Soil Separates and Textures Other Symbols st — Stone: (over 10 ") BR Bedrock rob -- Cobble (3 - 10 ") SS - Sandstone gr — Gravel (under 3 ") LS Limestone * s — Sand HGW — High Groundwater cs Coarse Sand Perc Percolation Rate med s - Medium Sand W — Well fs - Fine Sand Bldg Building Is — Loamy Sand > -- Greater Than '`sl - Sandy Loarn < .. - -- Less Than *1 — Loam Bn - Brovvn * sil — Silt Loam BI — Black si — Silt Gy _- Gray *cl — Clay Loam Y ...- Yellow scl Sandy Clay Loam R — Red sicl Silty Clay Loam mot -- Mottles se .- Sandy Clay w/ - with sic — Silty Clay fl! - -. fee -v, fine, faint �c -- Clay ce -- common, coarse pi: -- Peat inrn — Many, medium m Muck d — distinct p — prominent * HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A cor- r set of plans for the private sewage system and a permit application must be subrlritte(J to tl)(� -pi ;iate local authority in order to obtain a permit. The sanitary permit must be obtained and posted pi iv the start of any construction. 1 H z V) H ' a S T C 105 r r . :v H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d _I I a OWNER /BUYER �ny1 ��i� �� yJ , �C,/�11,! e_ r ROUTE /BOX NUMBER J � sf Fire Number CITY/ STATE /26 12 1 j r _ZIP S,/,9 ff ? l PROPERTY LOCATION: iz, �, Section � �J , T ! J N, R 0 W, Town of V , St. Croix County, Subdivision Lot numbe Improper use and maintenance of your septic system could result in ` its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, , if needed, by a licensed septic tank pumper. What you put into y the system can affect the function of the septic tank as a treat - ment 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 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 veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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. H C I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart - v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoni g Off' e within 30 days of the three year expiration date. SIGNED 1) ATE St. Croix County Zoning Office P.O. Box_ 98- Hammond, WI 54015 715 - 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. i APPLICATION FOR SANITARY PERMIT STC -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 -D ✓� 1 l�� y�f' �C��f�? 17 Location of property ALL 1 1/9, Section , T N -RW Township Mailing address Address of site Subdivision name N e l l I Lot number Previous owner of property Total size of parcel Date parcel was created `� �© 7 7 Are all corners and lot lines identifiable? -, — Yes No Is this property being developed for resale (spec house)? Yes �_ N0 Volume ��� and Page Number �/ f 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 rec r ed in the Office of the County Register of Deeds as Document No. 3-V � ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office o e C ty ister of Deeds, as Document No. ), Signature of Owner Signature of Co -Owner (If Applicable) Date of Signature Date of Signature J 6 .�....��.,... :,._t.- ;'Donald H. Schulte and Warranty Deed. Jean M. Schulte, his wife, Con. $1.00, OVC. Dated Nov. 22, 1977. -to- Auth. Nov. 22, 1977. Rec. Nov. 30, 1977. ' Schulte Bros., a co- partnership 9A !!565 „ r*X5&A03WWft consisting of Donald H. Schulte and Wayne A. Schulte. ti ak. :: or ., a66ft and W of NW u of Section 9, all in 28 -17. Recites: Exception to warranties: All easements, reservations and restrictions of record. This is homestead property. 7 ........ V Schulte Bros., a co- partnership Mortgage. consisting of Donald H. Schulte Con. $133,000. and Wayne A. Schulte, by Dated Oct. 19, 1977. co- partners, Aek. Oct. 28 1977. Rec. Nov. 30, 1977 @ 11 :15 AM. -to- In 1156511 page 419, #345119. I i The Federal Land Bank of Saint NE- , Section 8; W2 NW, Section Paul, a corporation. 9; NWu NWu, Section 29; EZ E2 NE- NE, , Section 30; All in 28 -17. Recites: Subject to existing highways, easements and rights of way of record. The above described premises contain 290 acres, more or less. Mortgagor hereby further grants to Mortgagee a security interest, as security for the payment of all indebtedness of the Mortgagor to Mortgagee in certain property generally described as: all cattle handling systems, manure handling systems, feed storage and handling systems, ' milking systems, milk storing and handling systems, cleaning systems, and water systems, together with replacements, additions and similar equipment hereafter acquired, including 20 x 70 Harvestore Silo with j unloader and 25 x 80 Harvestore Silo with unloader, located on NWr NE- Section 8- 28 -17. This security interest is being given pursuant to the Wisconsin Uniform Commercial Code to secure the above described items. In case of default, the Mortgagee shall have all remedies as provided under said code and under the other terms and conditions of this mortgage, and may proceed upon any security liened to it, either concurrently or separately, in any manner it may elect. (Released, see No. 15). 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