Loading...
HomeMy WebLinkAbout024-1043-30-001 •2 M' aa m co31 � m N �3l �i �° ,�•y j W O i O� ID C CD n 3 f`GD C R� !�► to ul -� a e� fir -4 V 1 N W j lri aW w tnzD a0 •�'1� ai a n l m ca D N a ! o C CD ° 1 o F3 o 0 a CD 0 o p j y p c A A CT CA 3 "* cr ;o I �1 <N« w Al S � R I Z o o j l`l` G I =i CD cr CD 0 00 CD CD CJ d .. w w m •• a p j p N N I CD '� to N .. N Z N a CD 7 a CD 7 N M Z O O D D Q = D D o O O CD co CD a • I x I m N co a 0 A Z a I ca z 0 Z z o o CD 7 N CO -{w a CD a 0 m O w CL z o $ X CD_ b ? O CD Q a CD o. 1 1 I o �•y w c I v c (D, CL o a o a CD CD CD C CD I 3 o I a o m CD ti CD a rj) ' N � I I N K I q N a I � I a o o A DQ b CD N ! l0 0 Q C 0 v Z � �p Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: , 479295 0 GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SU — . !A. Permit Holder's Name: City Village X Township Parcel Tax No: Freeman, James I Pleasant Valley, Town of 024 - 1043 -30 -001 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Qfl . p ( I cr .p - �a►+ = CST ig ( 33.28.17.280B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ofl Benchmark �( Q. Ep aD .O Dosing ,�. __ 44 -- c I Alt. BM 1. Aeration Bldg. Sewer / 52) S, Holding St/Ht Inlet /Q 1 I 1 �� t ( J TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > (� I ' `� 33 «._ —.a. Dt Bottom 3 13•Wr Dosing Lr Header /Man. L Z8 Wa Aeration Dist. Pipe Z. 2 Z. zy h. r Z z 8 z . z8 OP Holding Bot. System 2.q2 p� �• OJ Final Grade q PUMP /SIPHON INFORMATION 1 I�- -t' 06 Manufacturer Demand S over�� �� C4 L1 GL GPM W`• t'► J Model Number / Z 3 p - a / , 1 TjD Lift Friction Loss t System Head . T Ft I 13.Io •5S .so 4. f W► 4. 0 Forcemain Length r Dia. (( Dist. to Well r �• �' q, �� �,a " Z2o 2 I tro 110 SOIL ABSORPTION SYSTEM H Width Length No. Of IreReHes PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI Ma urer: t INFORMATION rr� CHAMBER O Type Of Syste y � � � � ( � � 6 � �� UNIT I Number: DISTRIBUTION r z> I k IfUs v, � Distribution I /� u x Hole Size r � j x ole Spacing Vent to Air Intake Pipe(s) S_� Lengt Dia Length l Dial _ Spacing Z 0 2 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 l l COMMENTS: (Include code discrepencies, persons present, etc.) Ins�pection #11 Inspection #2: Location: 1736 County Road M River Falls, WI 54022 (SE 1/4 NW 1/4 33 T28NQ 7 fetes ( b unds of Pa I No: 33.28.17.280B KA 1.) Alt BM Description = bS �I p _ Ct jt � 2.) Bldg sewer length = 3 3 - amount of cover = Plan revision Required? i Yes No Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 shington Ave., P.O. Box 7162 ST. CROIX iS son, WI 53707 — 7162 Sanitary qPrmit Number (to be filled in by Co.) eo ent of Commerce (608)266 - 315 Sanitary Permit A at State Plan I.D. Number 150740 _ T2 ANS -- r�� � 1 • /A • ) In accord with Comm 83.21, Wis. Adm. Code, p al i formation you prbvS' may be used for secondary purposes Pri c sl5.04(lxm) Pro 77 Z ed�egs, (if di M fferent than mailing address) 11 l l 1 (.11'1 I. Application Information Please Print AllInforma' n RIVER FALLS, WI 54022 S7, (; Property Owner's Name ZONING OFF /CE Parcel # 1.0t*— \ BtM" JAMES FREEMAN 024- 1043 -30 -001 (.28D61 -- Property Owner's Mailing Address Property Location 83 170TH STREET SE '/4, N W 1 /4, Section 33 City, State Zip Code Phone Number RIVER FALLS, WI 54022 715/425 -9010 T28 N; R I 7 (circle one) II. Type of Building (check all that apply) / ✓ 3 Subdivision Name CSM Numb d 1 or 2 Family Dwelling - Number of Bedrooms NIA &.+ 1 �C,� �� ,� �YLS LJ Public /Commercial - Describe Use El State Owned - Describe Use QCity ❑VillageBrownshipof PLEASAN III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System El Replacement System ❑ Treatment/Holding Tank Replacement Only I] Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner �%. IV. Type of POWTS System: Check all that apply) , 2 = ❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable so Mound < 24 in. of suitable soil ❑ At Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized in-Ground [3 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) / V. Dis ersal/Treatment Area Information: _ !o .O Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation 450 1 450 450 97.83 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units _ onerete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Signature MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 7151772 -3278 Plumber's Address (Street, City, State, rp Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. County/Department Use Onl Approved ❑ Djsa ved Sanitary Permit Fee includes Groundwater Date Issued suing ent Signature (No Stamps) Surcharge Fee) ❑Own n Reason for nial � (S IX. Conditions pprov SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained � ° C as per management plan provided bw niunO. 2. All setback requirements must be n!:•:; . j o',:;t: as per applicable code /ordinance- SYSTEM OWNER: 1 Septic tank efflue � Attach complete plans (to the County only) for the systerdjyP�Mo t��l SF7fVll:� / rrlaIntsined as per management plan provided by plumber. 2. All setback requirements must be maintained SBD -6398 (R. 01/03) as per applicable code /ordinances. of A rx 1 % A vvx e s e c h1 Q h �- �� t�.li,•. e h �, e vt v� i � _� •e ova �;,)aCx'� �� 3000 6,L 'To ° s�' ;Ex's '� S r u� . _� JUea.) 100 Ga. R. 'I • �f �'• �( �C''ELL DE Seob` A&kA,,° 7c K k. f , � Q7� � �o�`' • - .. - -- - - -f� 330 g i ` 1 I i SC 4-/ l `I 1� 1734 C OP Y . »+ M . � M Safety and Buildings 4003 N KINNEY COULEE RD cot1 merce.Wi.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 It isconsin ww w ww.co e.w i. gov/s sin.go / yv.wiscosin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 30, 2005 CUST ID No.220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING bFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/30/2007 Transaction ID No. 1150740 Site ID No. 700841 SITE: Please refer to both identification numbers, James Freeman above, in all correspondence with the agency. 1736 CTH M Town of Pleasant Valley St Croix County SEI /4, NWl /4, S33, T28N, R17W FOR: Description: Four Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1026159 Maintenance required; Replacement system; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 publication SBD - 10572- P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD- 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication IISSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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 the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans s ecific ti his letter shall be on -site durin construction and open t o infection by authorized reiot6&ntfttwe§ -01 I the Departm which may include local inspectors. rw aim �, UlPARIMENT OF i:tIMMEFTE DIVISION OF SAFETY AND BUILDINGS . (_� -✓rte � h � V� V� � � ..2 o cti � �r� �� 1 F-x J 300o 6 i II��OIN �ahk - f'6 IIi? mow, f 5 e at + F, III To 3 ' Cll hicy v (7a! R.M. LoELL ct S� h / � 00 7�, k v f y u .1Jr1�e.u)a7 Ari J IL Lk 13 P roP L. �h•Q 3�7 k c c �p s it e cwc� /73L e r I kt wl 5 �r V" C M a Y1 p�gP Of 3 Synthetic Covering ��� � Distribution Pipes ;'�STN9 3 -3 11 et Medium Sand -- H F -�G 91.8 .Topsoil -" p 3 E l " I 01 u�r b E'leu. 96. o 7% Slope Plowed Ce:I,r4.Of 1 2 "— 2 i Force Main From Pump Layer Aggregate D /. 3 Ft. E j, 3 Ft. Cross Section Of A Mound FQ Ft. G t Sv Ft A Ft N I. Ft. Signed: 6 DS -Ft. K '73 Ft. License Number: L j Ft. Date: , Ft. T 1) Ft. W L Observation Pipe �K A 1. _- -- - - - -- _- - - - - -- I - T---------------------- - - - - -- _ -_ W _j — N— Distribution _ C `U_ Of '2 2'2 Pipe Aggregate !J � Observation Pipe Y 3., Plan View Of Mound P er(Orgleq ('I Qnloll End Vlaw .� PVC P'P< O r s �11 Holes Located on Bottom are Equally Spaced I e I'E + C� G`Cl� �'� oitlrlbullon.. PID. U1S'Cr1DUC_ 1011 1� 1j�C y r t, R S 3 X Y 1 Hole Diameter _._ Inch Signed: Lateral " Inch (es) License Number: Manifold � inches Daee: Force Main " Inches 91, 33 Hcic Pee �qf -*A S e f �Li n er ; Scam e s - I v�lcin Page -„Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" PLX -VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E WARNING LABEL 4" MIN. ty° 18" LIN. ' �, 18 MAN• INLET /4r-o. WATER TIGHT SEALS GAS- TIGHT , VAPPROVED ,. FILTER — A SEAL JOINTS WITH ZA $Irk I w i -ALM APPROVED PIPE APPROVED ja „ x ��,, B i ON 3' ONTO PIPE 3' _ SOLID SOIL ONTO SOLID C ' SOIL PUMP OFF ELEV . �•�FT. -f-- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS L t SEPTIC / DOSE 37 TANK MANUFACTURER: f !) Lc- TANK SIZES: SEPTIC 1 GAL. DOSE VOLUME INCLUDING GAL. DOSE Q_ GAL. ;3 1 • G&I'FLOWBACK: --- ALARM MANUFACTURER: ��e��it° S A = g INCHES = . AL. / u.s GAL . - MODEL NUMBER: � B _ _ 2 INCHES 3 S.? SWITCH TYPE: r C = INCHES = .5'E-GAL. PUMP MANUFACTURER: Z c MODEL NUMBER : D = L"` INCHES = , GAL. SWITCH TYPE: r wr �bcA� REQUIRED DISCHARGE RATE 35 7, GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC PUMP OFF AND DISTRIBUTION PIPE / ,S3- FEET BETWEEN - VERTICAL DIFFERENCE B �� FEE T + MINIMUM NETWORK SUPPLY PRESSUR FT /100 FT. FRICTION FACTOR FEET + FEET FORCEMAIN X � ,� FEET 1- TOTAL DYNAMIC HEAD INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH f LIQUID DIAMETER � SIGNED: LICENSE NUMBER: DATE: 1/88 a `-L Z a F Ci wa Q�cp N a @R Lo w Z Z F � ui Ua N Om Z I oCUn. 10 CL o ��Lo 0a� O vv Q o Q I- o m �� zz d i pQUW cr O - 1 J= JJ a �( � � ~ 0 F= V) CL � wow < -< ? l=1CJ 00 V o 6 O Nip V) < w�N 00n O w Qw 8 , W r Q O -* M Lo fD V) N� CY) CA N'D w�d� w*U W Z r ow oz� 09 o w vS . �x_� " mY AZ m o r U13m0 <m w Z. 0 Q�� U U H � Z j J O O O Z Z J J w „Zb J Z e - M -__ -- - ---__ 1 . I I I 1. I I _ � I Ld iu 1 5 w + i 1 i CL U N cn 1 I i 1 I: I Z I I r 1 I • I I o „6£ y tr,1° YK 6- i j i of (c G�'T i ii At) j CAPACITY HEAD CAPACITY CURVE t 11rIUrF DFWlJEkING V) MODLL 1'12 153 W MUDL; 153 - - -- 50 t tutu f : vat. i Liters Gal. Liters 153 _ r J 261 77 291 40 J X31 70 265 12 152 - -- �-� 201 61 231 o -- - - -t - - - - - i - - - - -- 44 167 52 197 v 30 ,, b 34 �1?9 42 159 _ z 8 J6 J. 13 I 57 33 125 _ IU -/ i 1 a 20 -- - -- 1- - -- —± ..�_i 11 42 1 o 40 I 12.2 4 roc V(Ilv(� L580 ft 'I 1.6m) 44.0 Ft. (I3.4rn)i� 10 -- - -- - 014508 0 20 40 60 80 100 GALLONS _ J LITERS ~ -- 6 1/4 — 1 0 80 160 240 320 .1 z;/ - - — —r— /a —j FLOW PER MINUTE �� } 3 27/32 CONSUL FACTORY FOR SPECIAL APPLICATIONS /'4 � -�— • Timed dosing panels available. \ " I 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. - -- Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik•Box available for outdoor installations. See FM1420. Over 130 °F. 54T. special quotation required. i 1521153 Series 1S2h53 MODELS Control Selection I p Mode Vob-Ph Mode Am s Simplex Duplex 5 1/8 N152 115 1 Non 8.5 1 2 or 3 - - --- - -° SN152 115 1 Auto 8.5 Included 2or3 _1 SK2004 E162 230 1 Non 4.3 1 2 or 3 1_. -- SE1521 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 _ BN153 115 1 Auto 10.5 Induded 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float SE153 230 1 Auto 5.3 1 Included 2 or 3 1 switch. Refer to FM0477. o CAU71oN 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed includiny the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - — MAIL TO: P.O. BOX 16347 Z Louisville, KY 40256 -0347 Manufacfu+els of . . D t SHIP TO: 3649 Cane Run Road �7p ® Louisville, KY 40211 -1961 QUa[ /TYPUMP9 S NCE �9�!✓ ® (502) 778 -2731 • 1 (800) 928 -PUMP httpalwww.zoelfer.com PUMP !O. FAX (502) 774_3624 © Copyright 2001 Zoeller Co. All rights reserved. • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner JAMES FREEMAN' Septic Tank Capacity 1000 al A NA Permit #9Z9S Septic Tank Manufacturer WIESER CONCRETE O NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL O NA Number of Bedrooms 3 ❑ NA Effluent Filter Model AIOO 12 x 20" ❑ NA Number of Public Facility Units [A NA Pump Tank Capacity 600 gal O NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETE O NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer ZOELLER PUMP CO O NA Soil Application Rate 0. 5 gal/day/ft' Pump Model 152 O NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L W NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L M NA ❑ At -Grade It Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: O NA Other: ❑ NA Other: O NA "Values typical for domestic wastewater and septic tank affluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 O month(s) (Maximum 3 years) ❑ NA earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 2 Q year(s) Q month(s) O NA Clean effluent filter At least once every: 13 ❑ year(s) Q month(s) O NA Inspect pump, pump controls & alarm At least once every: 13 ❑ ear(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 3 Q years) ❑ month(s) O NA Other: At least once every: ❑ year(s) Other: O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. GMW (4/01) GWN4: JAMES FREEPIAN Page 8 of 8 ` - STARTUP AND OPERATION For new construction, prior io 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 tanks may fill above normal highwater levels. When power is restored the excess g pump P 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. water stream may improve the e following from the waste y performance and prolong the life p P Reduction or elimination of th g 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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code Compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a yy holding tank may be installed as a last resort to replace the failed POWTS t9 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. <<W ARN ING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER ASEPTIC, 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 MAINTAINER POWTS INSTALLER , Name HELGESON EXCAVATION INC Name ' I Phone 715/772 -3278 -Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Namsj JOHNSON SANITATION /agency ST. CRO Phone 1 715/273 -5811 Phone 1 715/386 -4680 This document was drafted by the staffs o/ the Green Lake, Marquette and wausharo County Zoning and SanbLion agtutdp M dOcumantaVeb the minimum requirements of aft. Comm 83.22(2)(b)(1)(d)3(9 and 83.54(1). ( 6 ( 3 ). Wlsconsln AdmkdsV&0w Coda. We 0(1116 doafmattdW IM guarantee the pedotmance of the POWTS, 0110040 I - _ ORIGINAL Lr Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings `7 (0 in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County -57- include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I. r [� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ew Date Personal information you provide may be used f secondary purpo aw, s. 1 .04 (1) (m)). D Property Owner " °' '"` `' p Min erty Location -� -T CL( ex Lot A) - 1/4 114 S33 T a N R j E ( W Property Owner's Mailing Address Lo Block # Subd. Name or CSM# g3 '70 k r� �-� � ` City State Zip Code Pho e.Numr City ❑ Village own Nearest Road Z k) OFFICE a 11-e C. T. /-1 ❑ New Construction Use: esidential /Number of bedrooms -- Code derived design flow rate $;�rO GPD E�Oeplacement ❑ Public or commercial - Describe: — Parent materi CS 4 1 r1- Z!]& Flood Plain elevation if applicable AM= ft. General comments S �, C e- ( ( r �ti a� S ( ��d p � and recommend s: tion C 6 r 4 u r, NI o u�t d �o-�`' �5 e � � S Y Boring # ❑ Boring 2 Pit Ground surface elev. 7 y� 0 ft. Depth to limiting factor J 7 in. Soil Application Rate 1 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' rr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -�10 Yt � o 6- L tn,a a .S + 9 r — d 0 Boring # E] ]Boring F- 9 Pit Ground surface elev. 7 (o •J ft. Depth to limiting factor in. ff*Eff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' L in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#2 Y1 � - z C k tm _ a * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/- CST N e (Please Print) Si ature CST Number ✓� 1 P 2 eSo �4 d Address at valuation Conducted Telephone Number ^ s ITT tw�I TI^,,In 7.� 7 II r Property Owner TQ✓t I eS e Wt a ^ Parcel I D # Page of 3 FS71 Boring # o Boring v pit Ground surface elev. � ft. Depth to limiting factor a � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 k - f,� 10' R 3 L N 5 ' !Z ` 3 p vjL Mof 4 O F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Kplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 100) f 1 V^ a �. B e V% , e ' j'A. 100.00 ° Ho�c�i41To -" 14 U #' op o f 3 8,2X Perm( q B.M. 9g•q N • 1)r to - Te Y� 9a4 0 ,,i Cx e e As S,i o,vw 4 o o1 { c > > ° 3 r , ° m C) V CD m m z Z 0 O 7� W N c 1 • O N O A fD N N? m n ° to 3 w Co J N O ? ^ V W L N ONO f.J d 3 CD Q O m O o O c° D CD W CD d .. O OJ C O a j A tai o CD N .o - CO) (n ca dq :3 �-3 O O O y CD tj N 9 D] 3 O r Q Z 3 d c D D a O O a �+ cc !�1 • M y CD :3 X C I CD N c cn w A z o m N W W 0 m a CD Z 3 A � o 3 fA � CD ? O Oj C N) N Q N C o7 n .O. ° M, w N C Z d — o m �o� o S c d �a CL 0 0 I � ° m m 3 a m N N O N O N A O N CD O O A EA O p CD �Ry7 O L ti y Parcel #: •024- 1043 -30 -001 06/20/2005 02:05 PM PAGE 1 OF 2 Alt. Parcel #: 33.28.17.280B 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * FREEMAN, JAMES S JAMES S FREEMAN 83 170TH ST RIVER FALLS WI 54022 Districts: SC = School SP = Special roperty Address * = Primary Type Dist # Description * 1736 CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 21.000 Plat: N/A -NOT AVAILABLE SEC 33 T28N R1 7W SE NW THE E 21 A OF SE Block/Condo Bldg: tIAPLEASANT VALLEY TOWNSHIP Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 10/23/2003 744559 2441/541 QC 02/22/2002 671862 1841/389 QC 07/23/1997 962/341 07/23/1997 834/615 more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/03/2005 Description Class Acres Land t71,000 e Total State Reason RESIDENTIAL G1 1.000 12,000 83,000 NO AGRICULTURAL G4 14.470 1,700 0 1,700 NO UNDEVELOPED G5 0.530 100 100 NO AGRICULTURAL FOREST G5M 5.000 3,000 0 3,000 NO Totals for 2005: General Property 21.000 16,800 71,000 87,800 Woodland 0.000 0 0 Totals for 2004: General Property 21.000 19,900 71,000 90,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 314 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 05 02:16 PM Parcel #: 024- 1043 -30 -000 06/20/20 1 OF 1 Alt. Parcel #: 33.28.17.280A 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner JAMES S FREEMAN FREEMAN, JAMES S 83 170TH ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es) ' = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 19.000 Plat: N/A -NOT AVAILABLE SEC 33 T28N R17W 19A SE NW EXC THE E 21 Block/Condo Bldg: A TOWNSHIP PLEASANT VALLEY Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 10/23/2003 744559 2441/541 QC 02/22/2002 671862 1841/389 QC 12/02/1998 592838 1382/456 WD 07/23/1997 9621342 more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 17.520 2,100 0 2,100 NO UNDEVELOPED G5 1.480 200 0 200 NO Totals for 2005: General Property 19.000 2,300 0 2,300 Woodland 0.000 0 0 Totals for 2004: General Property 19.000 2,400 0 2,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 024- 1042 -95 -000 06/20/2005 01:59 PM PAGE 1 OF 1 Alt. Parcel #: 33.28.17.279A 024 - TOWN OF PLEASANT VALLEY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JAMES S FREEMAN ' FREEMAN, JAMES S 83 170TH ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1736 CTY RD M SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC I Legal Description: Acres: 25.000 Plat: N/A -NOT AVAILABLE SEC 33 T 28N R17W WNW EXC P 279B Block/Condo Bldg: TOWNSHIP PLEASAN LEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 10/23/2003 744559 24411541 QC 02/22/2002 671862 1841/389 QC 12/02/1998 592838 1382/456 WD 07/23/1997 962/342 more 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: ? _ Last Changed: 06/03/2005 Description Class Acres Land mprove Total State Reason RESIDENTIAL G1 1.000 3,000 0 3,000 NO AGRICULTURAL G4 21.320 2,500 0 2,500 NO UNDEVELOPED G5 2.680 500 0 500 NO Totals for 2005: General Property 25.000 6,000 0 6,000 Woodland 0.000 0 0 Totals for 2004: General Property 25.000 6,200 0 6,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 127 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: • 024 - 1042 -90 -000 06/20/2005 01:57 PM PAGE 1 OF 1 Alt. Parcel #: 33.28.17.278 024 - TOWN OF PLEASANT VALLEY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JAMES S FREEMAN * FREEMAN, JAMES S 83 170TH ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 83 170TH ST SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 33 T28N R1 7W NW NW TOWN- SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 33- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 10/23/2003 744559 2441/541 QC 02/22/2002 671862 1841/389 QC 12/02/1998 592838 1382/456 WD 07/23/1997 962/342 more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 12,000 118,700 130,700 NO AGRICULTURAL G4 35.320 4,200 0 4,200 NO UNDEVELOPED G5 1.680 300 0 300 NO AGRICULTURAL FOREST G5M 2.000 1,200 0 1,200 NO Totals for 2005: General Property 40.000 17,700 118,700 136,400 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 19,200 118,700 137,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount I I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PLEASANT VALLEY /RUSH RIVER PLAT T -28 -N • R -17 -W (Landowners) See Page 112 For Additional Names, FIAMMOND PAGE 36 1500 � 160o 17oo PLEASANT VALLEY 1800 RUSH RIVER 19W 60th AVE 2000 2100 n Donald Jesse & ¢ CN Steven & o Rally. a June Greegg Charlene Allen Charles §§@ ri Heinbuch 79 tr Hanson I '6 ell+ p g'iJ, 8 WBco39 I Loock M � 27 °- A &M Hansen Wahlttist i 'sS f Trust , Hoe n a wy . p T h o mps I J t s Trust R LL B Cat$ 144 ellx 7S M143 °+P4 2 138 MeritteBOl�v~i34 Trust 119 5 h V1E & earson fr l G 1 Jeffrey , Sun Sun ueck 129 4 N Ridge m,F,mM 3s 110 Thompson � N 94 m F` 37bt 102 4 4- Farms 3 A. d a = Farms R �b Id s o Lorin a on Inc Peabody 78 250 �1> F_ R rickwn $ gl 0 o' a Smeester M arms 7 S & K N 79 x S di v,' 40 7o J 122 r� ° ' Jr 122 s"' Inc it 8 ram zo ' 2 2 s> R3 Goren& Retry J 504 AVE i Herman & f M xt t +o sme QtJ Fui a Mary & Cynthia L illy e Delores s Donald & Chrlstlan h 11 40 28 Huenink Symes 75 63 1k Heinbuch v� Wayne Hanson ilm W. saw 39 .ie ,�, Tb Omis a idy & 3 Mkhael o John& Trust ` Schulte , salvo Bonnie A Kea � E tdra w David ' Robert Mssaaem canes Moe ab 3 9 6 °� 77 157 & M 160 ' 78 149 3 +s L O A w J See 1 at1' Gwd. .l Zwald shares. Daryl & I N G P I ' 1 1 a w I s rmt Lurene a n y D a R 13 157 Je All� riri I B 11 Bomar Luren n Fairmont a ° � 4p ° r $ L r6 yq.q Mark Barg a ` Owens , 4U Inc �-. 115 Inc I Mohr, A In a0 tzol 224 I! "o-, 3 :1 35 Carolyn I Tubman 80 35 7 T37 '—' - Zr9 4o s N is Fredric Al ^ I 1 i Dawn Darl f Owens ° FAY qqqqq 56aron °I Wm & e S m I Glen & q W 7 40 I Ra.n Trust $ AMA KrUt is $ Az een +a �� wwmne arms E I I ¢ Stoppel f +$+ Mohn a Newton's Irg 150 J 35th AVE so 119 160 4 Q aim., 2gp so eo 160 y4 an- J & ... wcck zo Mary i� & mo s M ;� a E�le Richard Leslie & w star- Bomaz ; «e Farms Aabp aww�� Weber & oan on Karen B ft a Jayne � 40 Ilnc sraa[om 115 39 Tr04t Inc 40 40 36 a a , 120 Walton � a John I Afdahl 46 V ictor :a °,`, r tl c Larson Ices �` Famtty 60 Mira John & U �Afdahl8c 60' J°Rn 5 � 199 w e m Y n E Q ns_t25 o Zp i< 80 Nemnam § taut °�„ -h' :6 a - 2 38 "'°°`. &K 80' a 35 159 134 y �y cYi aM J o " 30th A E 1&y a [ 6 a $ Richard & N� = 7 3a N Go 0D Gwy. S 15 ew u D a 3 Dalry b Dorothy l y Donald & Pedaio � 5 t Fairmont 40 39 s 40 to 3a 81 ,Jacobson W � - Sch to .o g Dav[d a H it._ Farms 5 N e M es a AGeO�, ei d 000 a g u Juen Lan Farm � Thomas Eararatl„s N 25th AVE 240 11 u 40 33 xClx P 155 1, ��"� 40 152 K 145 40 Inc -�-. 40 A'by 40 in` E Clarence & (7 Joel a Rld,ard a �a t a3 Helen I A o 80 Cind R err& N Jacobson 8 40 38 Talbo P wai"kon 15,E 0 1 Neison �m 80 22nd WE Schultz 120 L Res 40 i• o n & Ce Kim & Luella H ° m J 64 SR A 63 b Maule Y Raell e 71 c D..N e?1 40 - a z 120 40 Torae 80 T - 160 _ — 1 - — - eo,� - — 200 ry Ki JJ �'— - m r - - -- a - Fosseos N' roe Betty� - Bee tttty e y @@ a erimoot Y 120 tl cob acobson 80 9 79 40� 18th AVE ,a 78 20 so �cbulte40 80 40 J son 40 40 JiCO 40 39 1 8 E Pie � J 20 p o Charles S n W 4 e.as 2 Dean .g °� Langer i Eric a Wanda Co1by oo m ^ mith p �� - �+ a s + rr o3'p 0 Swenson ( 40 C a 2 40 " - t0 - R am« 0, 40 L ones n 136' 80 2 eske 60 o m 20 sera zs Maas saw 5 i_ S W E v I o 80 - so- oero Ericrsen Clarence 164 Gordon Kral F - .'SU.., iv° q s tC 4 ens ss s<bwo ,s S31 Swenson DQ . &Roar to h & Ft49 t H & nth t+�•�9 o ae �+> )ake RictYa Jam« Dryo Gs6ert ry Nol Thomas a Robert a redwa eaoo Crow- Coal 8: Mary ' M..• Ann Koenig 80 _ g_p 1 111 f D_ lZQ Rushfeldt 80 Sharon ,,,,, w m tA�n �I 2 uY 40 train • sane«4O 150. 40 d° — - — Robert & a , I s "20 Beth I i�nn�Bhn & ma s h e d Carole n . Clarence lot Kathleen 2 r+ N am s r� axe a3 C1atre Foede 30 N Th I +e M " - et ( Hat & Dana W Kerry' 'Swenson ' ZO.,m Licht F 77 v, re an e,nA A. N g4 on eeta 40 ew 4o Sw«3son ilmmers Francis a auR 28 tram th u.." 9 And— o ° Eleanor 60 J d: M a °`wM,ae @`3"`0 '10 Karl VE , a p R d 31 Im 120 f1 108 �`R 80 224 SchRtgen 80 20 Fells zo 8 ,� r " 20 50 Karl 21 iA 4o a� 30' K �� 3ib: C Tom & �Ff f5 sat g ado John '3t m 4n rueoa 4 B to �� Barbara esa r� Ton�yy Cannon r- ark& Nang a Mon- Jeanne 4o i 5 w 4o w- 120 Dallman ( an 40 Ory i„ '� ieken M Ranches s oell er To s roo 2 0 Peterson 3 < 80 NE 97en1 tr t l�antr�Y , H11 Au15 a F 3 38 120 LLC 160 L — IZO eo `-W Main; 120 VILLEE Y — 70 ° . x ' 40 40 4 36 'A c — -- — — — — - -- — PIERCE/STCROIXRD PLEASANT VALLEY IRUSH RIVER PIERCE CO. XIM ST. CROIX COUNTY FARM BUREAU /NSUi9.4NCE "The Voice of Agriculture" ti COMPANIES A Faml Bureau Service Agent We believe in the future of agriculture and our area 'you 1 , Ken Singerhouse sponsoring 4 - H and FFA members to leadership tr aining, (715)- 796 -2207 and workshops. We also support numerous agricu promotion events, including Farm -City Day, hvesto 4 960 Davis Street w Box 129 at the County Fair and legislative workslit ='' Hammond, Wisconsin 54015 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address S ) 7 4 Tk �, r u 11—P r Property Address _17 (Verification required from Planning Department for new construction) L Parcel Identification Number C)o /� `� 3 -= —'::5C> / City/State ��eX �S 2 g LEGAL DE SCRIPTION . , N -R W, Town of o s � f /i ll Property Location /., LV/ /4, Sec. , T A� — Subdivision ��g �(� t °' Woy- Lot # . Certified Survey Map # g , Volume Page # � -- Warranty Deed # _ 5 qp 3 3 , Volume 5 , Page # Spec house O yes JZ no Lot lines identifiable 09 yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result ature failure to handle wastes. Proper maintenance in its prem 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and ptunping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CeTd&Ation ' tamed must be com leted and returned to the St. Croix County Zoning office within 30 stating that your septic system has been maintained P days of the three year expiration date. _ SIGN4URE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / SIG ATURE OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •i * *� ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed � _ � . �� �=, � � � '� ;' ' 4; � U4y D.1`AYL Hl.t NfYitl •Mf MLrNN nh1� D.►« N ccx..omtr4r No: WARnANTY 0 -0 :1 STATH DAR OF WISCU\ StN FORM : 39233 vaL fiS5 PAGE 314 't T. g 604 iTMS OFFICE 1` ......................: by, MI Co WM E' Oona d W, Freeman L ... Rec'd. for Raoond ft 9th ...._ .. day of April A.D.14A4 • i .._ .......................... e conveys and warrants to ................... it pif llti. 1: Raney- A...:, Ind % aJh ..as.j.QJ t...ten.AA.t.s....... ............. .... ............ ................................................................ '. . .. .._ .._ .... ........................... .... . . . ,. •• R Lt4RN fD. 4 .a . `. . ............... . .... ..... � James FN amen , _ ... ...... .......................................... ....................._........: ........... Mi Route S, Box 19 . _.River Faris KC 94Q22 the following described real estate -in ....St...CrOIX ............. .........County, State of Wisconsin. a section 33 Tax Parcel Ne............................... The east 24 acres of the SE of the NW ofd N R 17 W. i l [ Tl%6 .... iS_.nO.t ..... ....... homestead property. 1 t (isa (is not) Exception to warranties: 1 { A r i t 19 ' t Dated this ._ 5th .. ............................... day at ........... P.............. ........................:... ... , ... (934 1111 / �c¢'r'`r ...:.......(SEAL), 4� (SEAL) ....... .. f.�. James ,S.- raeman ........ ( . Donald W. Freeman .............................. t (SEAL) ............................................... (SEAL) ....,.. • Lindseth 1 AUTHENTICATION A CXN OW LEDG1SENiT STATE OF WISCONSIN _ i - - -- v. � St. Croix County Map Output Page Page 1 of 1 St. Croix County Mappin 1 27 � <BFN "VEN'UE eft s a LOTI L012 / P l e 11 I ( / 32 / UN "TIGUfl V4E1GrF11 Ad` "Rr LORI i l m m i 1 MatrYCtpal Boaa�d,arks St. Croix County Planning Department aa.d'vlstor,: 1101 Carmichael Road cer■ted Oxrvey Maps Hudson, WI 54016 n A Phone: (715) 386 -4674 R `" ° " R.C�naed Arai wage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was DAM prepared. It is not intended as a substitute for an accurate field survey. Nerrenlal Okean hletrnl Ilenl Y+e a'rf AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http: //72.21. 230. 178 / servlet /com.esri.esrimap. Esrimap? ServiceName= StCroixOV &ClientV... 7/8/2005 St. Croix County Map Output Page Page 1 of 1 St. Croix County Maggin I �p I g i u 114 -N S1N 114. = -4. sw :"sue„ :'�►a I MS 5' rah a � µ i t.. �P L *PS• a 7 -'UN TRUM H:I H I I 1, Lend M�aVGtPaI @au++dat les St. Croix County Planning Department antllylslas 1101 Carmichael Road rI Oef "` a OLZ"e" maps Hudson, WI 54016 "�s Phone: (715) 386 -4674 r � ^ °'e° .. ICJ Na�noaA ❑rai rrage DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Dmm prepared. It is not intended as a substitute for an accurate field survey. Ferrenlal 3rean n*rml Ilenl vtean AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist' presently in the County may not be present in the photos. http: //72.21. 230.178 /servlet/com.esri.esrimap. Esrimap? ServiceName= StCroixOV &CIientV... 7/8/2005 Jessie Nye Subject: Helgeson / Freeman, metes &bonds, 479295 (plow) Location: Pleasant Valley Start: Thu 9/1/2005 10:30 AM End: Thu 9/1/2005 11:30 AM Recurrence: (none) Meeting Status: Meeting organizer Final @ 2:00 024- 1043 -30 -001 33.28.17.2808 1736 County Road M 1 I � / 1 � � s` ~� ST. CROI X COUNTY W I S C O N S I N a� ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) a� HAMMOND, WI 54015 QUARTERLY P U M P I N G R E P O R T ST. CROIX COUNTY NAME: 5 6zf—f m ffii RETURN COMPLETED FORM TO: ADDRESS �r B OX 113 ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 I t/6-e— FALL5, (A 5 HAMMOND, WI 54015 ./ 715 - 796 - 2239 or 715 - 425 - 8363 TOWNSHIP: �L#��c,�N7 V�L�Ey PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: I pt-1k4Lp Ff (Z/ LOCATION OF DISPOSAL SITE: f £kN S NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND X SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED 3000 THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 198 OWNERS SIGNATURE mj :12 -83 VIII i Z e K ST. CROIX COUNTY leer y 3 zfi� � 6 8 W I S C 0 N S I N ZONING OFFICE 96 -2239 (HAMMOND) 0 25 -8363 (RIVER FALLS) HAMMOND, WI 54015 Q UARTERLY PUMPING REPORT ST. CROIX COUNTY NAME �1 /+�M� �� ✓y! /3"N RETURN COMPLETED FORM TO: ADDRESS T ST. CROIX COUNTY ZONING OFFICE � P.O. BOX 98 I'. HAMMOND, WI 54015 Q 715 -796 -2239 on 715 - 425 -8363 TOWNSHIP U L �/i-N � .¢ ��� '7 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: Dot, `j LOCATION OF DISPOSAL SITE: k NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND )C SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED �a 3oo 0 THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985 x OWNERS SIGNATURE�� I � pD .. ; 0 < O O A 0 O r C. Z �a T H� m -4 on � r ru aM r ro o� Nom° Z mwoAfN X =N m 03 z z y o N ru i 0 Ln 3 O , D $ W Cc Ln co i r r ST. CROI X COUNTY WI SC NSI N ZONING OFFICE JU 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLYPUMPINGREP0RT ST. CR01X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS kT g o, (( ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 ( J,6 c5 HAMMOND, WI 54015 715 -796 -2239 o& 715- 425 -8363 TOWNSHIP P� f�/� �,�N 1` ,ft- tE y PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: bo 6A A ) LOCATION OF DISPOSAL SITE: rr 5 NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND �_ SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED HATE VOL. PUMPED 30 ©o THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE l y ? $, ST. CROI X COUNTY �,Nd y 11 WI SC0 NS1 N ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLV PUMPING REPORT ST. CR01X C0UNTV NAME f - C;� k,� M A - � RETURN COMPLETED FORM TO: ADDRESS 0 k ( 3 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 i V �dZ F��Ls HAMMOND, w 1 54015 n q �/ 715 -796 -2239 on 715 - 425 -8363 TOWNSHI P 1" L �� S ,TIU - ( r V �¢ L C - PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED 1 BV RECEIPTS FROM YOUR PUMPER NAME OF PUMPER: bON f N LOCATION OF DISPOSAL SITE: I /L Af S NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND /\/\ SEASONAL (CHECK ONE) JANUARY FEBRUAR MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED 3�1 700 THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15, 1985 OWNERS SIGNATURE M �r ST. CROIX COUNTY WI SC0 NSI N F .. ZONING OFFICE 4 " t - � 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 UARTERLV PUMPING REPORT ST. CR01X COUNTY NAME ��� 4 � RETURN COMPLETED FORM TO: ADDRESS T J g cx (13 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 / 115- 796 -2239 on 715 - 425 -8363 TOWNSHIP �_ tr /Ic PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: Do rJ F� ,2 v LOCATION OF DISPOSAL SITE: f r ,2 w' NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND X- SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED I THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1984. OWNERS SIGNATURE ,v r ST. CROI X COUNTY WISCONSI N ZONING OFFICE 10 6 If - 796-2239 (HAMMOND) ."� 425 -8363 (RIVER FALLS) HAMM ND WI 54015 O Q U A R T E R L Y P U M P I N G R E P 0 R T ST. CR01X COUNTY NAME RETURN COMPLETED FORM TO: ADDRES ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715 -796 -2239 an 715 -425 -8363 TOWNSHIP 4� LEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: .(- USE: YEAR ROUND )(- SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED 0 D THIS REPORT MUST BE RETURNED NO LATER THAN JULY 15, 1984 OWNERS SIGNATURE S T. C It 0 1 X 1; 0 1) N G Y 7 8 rf r r W I SC O N S I N ZONING OFFICI ,, Il ff 796 -2239 (HAMMON' `�'-y ---- 425-8363 (RIVER FA L HAMMOND, W) 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME 5 �� �; .M.-�J RETURN COMPLETED FORM TO: ADDRESS �( vx(C 3 ST. CROIX COUNTY ZONING OFFICE LjEA ­ P.U. BOX 98 + kj ( ( 7 _ - HAMMOND, GPI 54015 715-796-22' v %, 715 - 425 -8363 TOWNSHIP P � ��SfFN T V��t�� PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) JANUARY FEBRUAR MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN APRIL 151, 1984 OWNERS SIGNATURE , ST. CROI X COUNTY W I S C O N S I N ZONING OFFICE :r. -2239 (HAMMOND) 9 796 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 g U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME: t; �jw RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE P. 0. BOX 98 i tj ( - /�t� �� HAMMOND, WI 54015 715- 796 -2239 or 715 - 425 -8363 TOWNSHIP: 1"t i�r�a�j��t� `� PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION QXI,..DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 15, 1984 6J OWNERS SIGNATURE - 1, �n mj :12 -83 368156 ST. CR01 X COUNTY 2 0 N I N G O F F I C E 796 Poat 0666 ice Box 227 t Hammond, WI 54015 REGISTERS Office ST. aOIX CO., Wei Rec'd. for Rsmo d INS 8th 0 W N E R day o f Dec. XD. 19 80 P U M P E R at 830 A Aft A G R E E M E N T 2 of Dumb PLEASE BE ADVISED, That unt.iZ you ate again not.i6.ie I w.izz contract with h0pJdL& �Ete� 0 f774fMMVr , T W.i.Aeona.in, (Pumper), Son the putpoa e o n emov.ing at wa4t 6-t om the ean.i.taty ayatem to be toeated on the ptopetty and Suture home -6 ite .located in St. Cto.ix County, Wi.6 con.e.in, Town.ah.ip of being in the �( J_ 4 os the jVU) % os Sec. 33 T. N. -R. /7 W. (On mo 6 uZt y d e.6 e)t.ib ed a.e 6 otZowa : ) Vated t 1 � T � day o6 Qe-To &CP-- 19 (OWNER) St ate o6 W.i.6 eo n.s.in ) 4,6 County o6 St. Cto.ix) Pen.6onnatt yappeated be6ote me th.ia 12th day o6 Taovemb J. 19 so . the above named Donald nern to me known to - be .the peteon who execute t e otegoing .cndttument and aek.nowtedged the .tame. LIRrD M Rt�r >" F TO Notary P ablia - St C, { County 0 . ims at y u ti , t o i x o u nt y WT My Commission E-p Nov. 22. 19 �1 y C OMM. Cm (Ex - c.Jcee) 11 -22 -81 I, �o�iR�p (i �i , hene.inbe6ote te6etted to as Pumper, loin in th above agreement tot the extent that I have a eonttaet with Ownet as above htated. �� V-Q _(PUMPER ) 1 • VOL . 622 PASS 26 - HOLDING TANK AGREEMENT This Agreement, made a d en d into/ this day of Ae 13 A.D., 19 by and between thee ��„ herei called " _ " .an hereinafter called the Owner WHEREAS, application has been made for a building permit on the following described property, to wit: or that said property is not located in such a manner as to be serviced by a municipal sewer system or on site soil absorption system for domes- tic sewage, and continued use of the premises requires that a holding tank be installed on the property for the purpose oft proper disposal of domestic sewage. NOW, TH FORE, in consideration and as'an inducement to the Town of ,�zod l-� to issue a holding tank permit for the above de rem' es t e Owners hereby agree and bind ourselves as follows: P � Y g 1. Owners agree that they will conform to all the rules and regu- lations of the Plumbing Code in the building of their septic syst in- cluding the holding tank. They agree that any time the Town of * 'k—^.,ryh rhp rnitnty Pliimhina T"o / „�„��r �r 'r'.�w.. '.'. 1�,; -, Officer deems it necessary to pump out said holding tank, the Owners shall have same pumped out in twenty -four (24) hours, or will have said work done and charge same back to Owners an place same on their tax 'll as a spec char e. The Owners further agree that the Town of - &'1 and County of St. Croix granted the right, icense an auth ity to enter upon their property above described, at any reasonable time, to inspect pump and haul, if necessary, from the said holding tank. 2. That all charges and costs incurred by the Town of for inspection, pumping, hauling or otherwise servicing and maintaini.ng�� ✓/ said holding tank in such a manner as to prevent or. any nuisance or health hazarA Mh holding tank shall be paid by the Owners The Town of shall notify the Owners of any such cost which shaIJ be paid b Ow & f ers within thirty (30) days from date of notice and in the event that Owners shall not pay said cost within thirty (30) days, Owners hereby specifically agree that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as pro - vided by Statute of the State of Wisconsin. • .Ay y . VOL 622 F'Aa206 i 3. That a quarterly pumping report shall be submitted by the Owner or his agent to the local government and the county which shall state the Owner's name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous.year shall be submitted to the Department by the governmental unit responsible, per s. 145.01 (15), Stats. 4. Owners further agree that in the event that municipal sewers shall be installed so as to make the premises available to such municipal sewer service they will pay all special assessments levied against the premises as the property share of costs of the installation of such san- itary sewer and shall not assert any claim as to lack of benefit or reasonableness as to the installation of municipal sewers by reason of the fact that the Owners have been permitted to install a holding tank, and that upon municipal sewer service becoming available, Owners will abandon use of the said holding tank and connect the premises to the municipal sewer. 5. This agreement shall be binding'upon the Owner, their heirs and assignees and run with the deed. WITNESS our hands and seals this day of az/ ( , 1(y 19 d !2 . TOWN OF OWNERS b "lCeic Y by ,- STATE OF W t SCOt�kN Personally came before me this 12tti of November 19 8o , the above named Ferman kfd ahl Chairman and Beverly Jaco%ners , to me known to be the persons who executed the oregoing instrument and acknowledged the same. THIS INSTRUMENT NOTARY PUBLIC DRAFTED BY: / r I ° t M commiss ion ex ire c��..'..•��T� Notary Public - St. Croix C y ` Wts. { . t o My Commission Expires N 38. 1W. `�'. 1 U , NOTE: As specified in H63.18 (4 A) Wisconsin Administrate Code' document is to be recorded with the deed, located at th6,�'940' t• i� •fster of Deeds. At the time of Sanitary Permit Application, a espy o r „ his agreement, with the recording dates and number should be submitted - this office. G AS BUILT SANITARY SYSTEM REPORT �_ W OWNER TOWNSHIP SEC T R /" ADDRESS _ v^ ST. CROIX COUNTY� , WI NSIN. _ _ SUBDIVISION _ LOT _ LOT SIZE 90 -- SI PLAN VIEW Distances and dimensions to meet requirements of H63 p SH OW.- EVERYTHING WITHIN 100 FEET O SYSTE u?, � I 71n AM R y I 1 _ I di a e o th Arrow SC L�- . BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: _ Liquid Capacity: Number of rings on cover : - - Tanc manhole cover elevation: T ank Inl Ele vatio n: Tank Outlet Elevat PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set — for a cycle gallons; tota capacity of distribution lines gallon: sire o pump head; - - -- - - -- - — gallon per minute horsepower____ name of pump and model number Type of warning device HOLDING TANK: Manufacturer _ Number of gallons 1000 Elevation of manhole cove Type of warning device_ _ SEEPAGE PIT SIZE: _ um.er pits meet Eameter feet liquid depth - -LL seepage pi_t inert pipe- elevation bot =tom of seepage pit e. e vatJon feet . SEEPAGE BED SIZE: number of lines __ width _ Ietsgth_ _tile depth_ SEEPAGE TRENCH: width__ length__ _— PERCOLATION RATE , — SEA REQUIRED_ AS BUILT INSPECTOR DATED �` PLUMBER ON J B - �' LICENSE NUMBER F R I I I Form - STC- 104 AS BUILT SANI SYSTEM REPOR OWNER TOWNSHIP SEC.�� TN -RW Cj �& ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIO LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O�q.d W INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: �lQ44A. Liquid Capacity: 0 Number of rings used: �, Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side 0 Rear, O feet From nearest property line Front,0 Side,0 Rear, O feet Number of feet from: well R3 0 ! building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) i _ 1 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: ``` Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: LengIth: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: I Number of feet from �nearest road: Alarm Manufacturer: S'� 1J • �QJGMi�� 1 J Inspector: Dated: Plumber on job: W License Number: d /� 3/84:mj VOr�� L REPORT OF INSPECTION - INDI`iI AL SEWAGE Sy' San.i..tany Penm4..t 64 State Septic . TAME_ .6 A s Townehi.p . St. Cnot x County ocutiun N �./ Section a Lot M Sub di,vi.6:kon 1 PTIC TANK S.i z e ,�''�c�'' C1 gat a Nu en u 6 cumpan.tmente e Lance Anum: Weee Buy edi ny 12% e Yupe _ Hig aten '11 MPING CHAMBER .Size � �aeeon4 . ump Manu.6a tune4- Mudet Numbe 0LDING TANK Si z e gaeeon Numb en u� Compan n.te — 2 --- Pum n pe AYanm S,yetem f lie.tanee 6 40m: wee ' Bu i,edi. ng 12% 6t ope__ d H ' hwateh f' 8 SOR P TYON SITE Bed Tne.nch (,6 tanee 64 W e ee Bui.edi.ng r 2$ eeope Hi,ghwa.ten /iSO S ITE DIMENSIONS W.id.th u6 .tneneh 6t.- Re x ed anea_ - Ax Eerng,th u6 each eirCe 6-t ep th : oA tuck b et ow .tkte <ri N.umbe u6 t�nee uA Hoch oven -tale to TutaT teng.th. "u6 "tin a 6"t ep"th 0 .tite betuw gnade in Dte.tance b I twe.,en t nee 6-t Seupe 06 •tnench _<.n. pen 100 6.t Z u 4 L4 aLo nN ti urt a eu 6 Type o 6 Cu ve�e: Papers un a "t4aw ' lT DIMFNS'la4s Numb 4 u6� pi;tb Gnavet ahound p•i.te yee nu Ou di.ame-ten 6t Depth beeow inee"t 6.t To tae abe onpti.on anea A &a a k e q Ui.! ,e-d ..w 6t NSPEC -8 y N. _.._... ....._.. - -.-. ITLE VPROVED �� �'�6�' DATE d 198 '1. JECTED DATE 148 'IASON FOR REJECTION I DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL MA LTERNATIVE I State Plan I.D. Number: III assigned) XX Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: James Fneeman R. R. 2, Box 113, Riven F", W1 BENCH MARK (Permanent reference point) DESCRIBE IF bIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SE NW, Section 33, T2 8N -R17W, Town I Pteasant Va tey Name of Plumber: MP /MPRSW No.. County: Sanitary Permit Number: Tam Wang 3231 St. Croix 54949 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ❑NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER ROAD: j PF1`N OPERTY WELL: BUILDING: VENT TO FRESH ALARM E: AIR INLET. FEET FROM DYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER. [ 71 LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: 1:1 NO I ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. IIIIU E OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FRfIM LINE AIR INLET PUMP ON AND OFF) OYES ❑ NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing F ®RCS LENGTH J DIAVFTER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until IFO the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH: I N 0.OF HES: DISTR_ PIPE SPACING. COVER .INSIDE CIA.. #PITS. LIQUID PI �f TRENC MATER J 7 (AL: T DEPTH. e sE1tI�I�1.�1N�, GRAVEL DEPTH FILL DEPTH IDISTR . PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER PROPERTY WELL: BUILDING: VENTTO FRESH BELOW PIPES. ABOVE COVER: ELEV. INLET ELEV. END. PIPES. FEET LINE: AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED = TOPSOIL. SODDED. SEEDED MULCHED: CENTER. EDGES. OYES ONO ❑YES 0 N OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: �,etl WIDTH: LENGTH: NO.OF LATERAL SPACING- GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: TRENCHES: •':'. MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: CIA. ELEV. PIPES: DIA.: UVT , ■t�s, #�Mq HOLE SIZE HOLE SPACING. DRILLED CORRECTLY_ COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ONO DY ES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: N,1IER LINE:ERTY WELL: BUILDING: FFISTF ❑YES E:1 NO ❑YES 1:1 No I I AEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION S AFETY & BUILDINGS INDUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'h x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: lo Y-113 Property Location: City, Village n i County: S F '/a ]�j' /aS j �T� NCR E (or W Q Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or ndmark: State Plan I.D. Number: (If ssigned) TYPE OF BUILDING Nu r of ❑ Public* El ❑ Other (specify) Bedrooms: Nt 1 or 2 Family * State Approval Required. R ` 3 TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY x LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: Lizes e EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New DR Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit V e 5d Alternative (specify) % o - wk ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private El ❑Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of PI ber: Signatur MP /MPRSW No.: Phone Number: T a s �a 3 ( (his ►sus rs� Plumber's Add s: Name of Designer: COUNTY /DEPARTMENT USE ONLY Sig t re of Issuing Age : ee: / Date: 1y/ El APPROVED Sanitary Permit Number: 9 f �/ ❑ DISAPPROVED 77 y Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod- Plumber DILHR -SBD -6398 (R.07/81) 67 State and County State Permit # Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OW NER OF PROPERTY Mailing Address: `�"i, es Fre ewo e eivo �� S Ll B. LOCATION: W 1A ' / 4 ' /4, Section Y.5 , T F N, R E (orl__V-..)Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family A Duplex No. of Bedrooms f No. of Persons 4 D. SEPTIC TANK CAPACITY 4& Total gallons No. of tanks 1 HOLDING TANK CAPACITY X Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private 9 Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other t p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Teslr, / / NAME ,t e fr e z► �((� C.S.T. # J and other information obtained from A�7' (owner /builder). p Plumber's Signature MP /MPRSW# F-01 Phone # —L6�: Plumber's Address O PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. , E s I , , E mm .. m�..,.T ..... e , E [ t 1 7 � e f-� a S r # f � F 4 { _ �.. .� v �. . �..,........ z t , , . _ _ ..._. .�. a E r , Do Not Write in Space B ow - FOR COUNTY AND STATE USE ON Y Date of Application ,2 ees aid: State County Date `Z_ Permit Issued /Rejected (dateK (date Issuing Agent Name Inspection Ye No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVI ION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/11/78 Rev. 9/78 ` REPORT ON SOIL BORINGS AND PERCOLATION TESTS } WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES \� 81.. P.O. BOX 309, MADISON, WISCONSIN 53701 1 I� of V LOCATION " /4, ' /a, Section 43 ,T�N,R r 1# (or) W. Township or Municipality (� �9 Lot No. , Block No. County v Subdivision Name Owner's /Buyers Name: I" G 5 4 Mailing Address: TYPE OF OCCUPANCY: Residence X No. of Bedrooms d NC COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS s' g Yd PERCOLATIO TESTS SOIL MAP SHEET ! 3 NAME OF SOIL MAP UNIT Af�.2 q ��— PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- -1 P- P- . P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK g OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B /.Z. l 50 It CLAIJ d A U B- 3 / n 1 / 4 q B- 44 2 0. Q;Q t1 x s B PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ,Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 7 4 71 Q � r _ t t r F � , E i A5..� N € I r I ' I ' I F � I -- A ._.._.1. f 1, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (print) 4�V aR L' T & '+ Certification No. f Address L S t Name of installer if known Copy A —Local Authority CST Signatur i i� Department of Industry, Labor and Human Relations mnvw �u mft O/swl _ Division of Safety & Buildings Bureau of Plumbing D ILHR P .O. Box 7969 �W=UsTRY.LRS0Rswurt REuarions Madison, WI 53707 Tel. (608) 266 -3815 ,T ft M Es ERezmatr� tj Nc.V Ll ND - N IN ALL CORRESPONDENCE REFER TO PLAN ROU.T0, Z _ S o x t t - _; IDENTIFICATION NO. 4/, NAME OF PROJECT S r°t M £g R e.� 4 N O-rlc. MGENE RIVATE SEWAGE ONLY - PLUMBING PLANS k,�- Fee Received: LO AT ON Priority Plan Review Only N V 33 z_g l� ITY 0 TOWN COUN P Sf� i4L,L SN T Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. apprnval w i l l he Wn;� any D o w pl ap co; l -Mall be obtained before work ma beg4*. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is'based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For Private Sewage Systems Only: . Tt" approval is valid for two years or it will be valid until James Sarg t the expiration date of the initial Bureau Dire or sanitary permit ; PL ANS REVIEWED B a DATE: 2_ g cc: DPS - Owner H & R & Rec. San. Section LojLal PI Plumber Bur. of Health Fac. & Services ount Other DILHR SBD -6099 (R. 05/82) I I I �• -�- � I I I J � � j I i r I I ^ r 7 : �I I i cam/ 1 j M 0 I i •%j'T, �. I 71 NS AV H "MA Q I I A TTAMNI DEPAR D�VlSi N : F 5. FET'r` At D E iL I � S Xi I I I I I l i I I I I I I i I J � I II I I - A J 'CA' J qj L L - I � I f _r : �v L W V r 1 ' OLL O= W O W h O L W 0 0 v O A 7 J 41 OC 7 T J J` � W � Q WCf) ul OC W W f H Q Q d Li O j 2 w 0. W M OC 7 H O Y C H UJ w? ►,� O h v O O Q 0 t H Ij IL O LY d O71 Z o� 4 = h�OC 4 y�j 0 J W CO �_ 6 2 N 4 Q N p F O J a O_ W O H U d W 4 O W y > i+l Q K W 2 X Y 0- > oc O 2 0 O LL � Q W 0 0 Q m a H `V q O p W ly S 4 v W r � Z > W ►' OC \P3 W w cY > �+1 7 c cn .r v= d — o _Z � N O ` 0 Z :2 tic" �0 D� Z Z C , z Li O � i d Si J = O 7 � d 2 tD W V� 0 Ul J J J cc = 4 J a j =1 do = a C( v o z O to F 2 c7 � .o v a � L Q W . W 0 ? o Z � �, 4T 8404 T ®4 V Q Q Q 0 cc 2 L `.. JUN 2 9 1984 IJ J W DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY & BUILDINGS INDUSTRY, 1 1 G DIVISION LABORS AJIM PERCOLATION TESTS (115) MADISON W BOX 76 I 537 9 53707 HWMAN RELATIONS 09(1) & Chapter 145.045) LS�I 'jNtY4 SE 3TPJ'NjR�9E (o I U NICIPA Y. � LOT NO.:BLK. NO.: SUBDIVISION NAME: r'rp 7, f r� COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRES ster.01"x 'TM raceAvi x /Y le"t)(op USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF DESCRIPTIONS: PER LATION TESTS: F Residence ' New ❑Replace RATING: S= Site suitable for system U Sit unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOM EN 0 SYSTEM:(optio all ❑ S ®U El S [RU El ©U CJ S 2U 12 S Ell .I If Percolation Tests are NOT required DESIGN RATE: 4 _ I If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate F l oodp lain elevation: 7e e0 IL6 DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- fft8++fiS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER QC12fI441V• ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B- 3.00 95.6 0 0 5 . .a B S; '. 58 Y 4 4 fi me B 3 3.00 W, 7 7 s J. a s' 81, c / til so 1 9 1 9 s. B- y 3,60 97 17 �o 0S c) v ; d Itilra s 7 4mil 6 r1 s- 3, 98',60 q0 81 0.33 6o t 6 S7 44 S 97 la S / l� y� s_ .60B ^ f ,y PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 P RI D 3 PER INCH P- P- P- P A P" 674re L 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,.(�Lc� ; the surface elevation at all borings and the direction and percent SANITARY PERMIT I County CW GROUNDWATER SURCHARGE Sanitary Permit No. 9y On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- ' water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground ignature of Issuing Agent: (ir�yndwater Fea: Date: Wisco �` es-d o2S - buriedf'>>tt _HR SSO -7289 (N. 05/04) e f Dep stry, Labor and Human Relations ""s"°"S'" ivsion of Safety & Buildings DIL.HR V Bureau of Plumbing l , ; P.O. Box 7969 � oEVRRTTrIEnr ov I LABOR 6 .«.mRn, RELRTIOf15 ® o FG Madison, WI 53707 Tel. (608) 266 -3815 ,TA R e �, AN ArJ I NJ D'S. IN ALL CORRESPONDENCE REFER TO PLAN Uu T sc Z o x t 1 I IDENTIFICATION NO. r u z z . a` NAME OF PROJECT (\ NA v i'). i! .. t & - A ts, WRIV ATE SEWAGE NLY - 0 GENERAL PLUMBING PLANS Z Fee Received: LOCATION Priority Plan Review On Ty N w! 33 z ( - 7 W ITY 0 TOWN p ::> A r 'r V tj L L AY T. C R v x Examination of plumbing plans and cifications f" this project has been completed. In accord with Chapter 145, isconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. Y In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in whit stall tion is to be made. Failure to obtain local permits will aut vo this approval. Sincerely , For Private Sewage Systems Only: cu' This approval is valid for two years or it will be valid until James Sarg t, 4 the expiration date of the initial Bureau Dire or X- sanitary permit. PL ANS REVIEWED BY t DATE: cc: DPS -CM) Owner H & R & Rec. San. Section LoLAI Plumber Bur. of Health Fac. & Services ount Other DILHR SBD -6099 (R. 05/82) ST. CROI X COUNTY W I S C O N S I N >•t 7s: oi7Ck ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 E RIV R FALLS ) HAMMOND, W1 54015 May 11, 1984 To Whom It May Concern: An on site inspection was conducted on May 3, 1984 with the aid of Leroy Jansky, State On Site Waste Specialist on the Tim Freeman property located in the SWJ4 of the NWk of Section 33, T28N -R17W, Town of Pleasant Valley, St. Croix County. Soils profile revealed a seasonable high ground water level at a depth of 10 - 12 inches, allowing for only the use of a holding tank on this property. Should you have any questions on this subject, please feel free to contact this office. Sincerely, J� Thomas C. Nelson Assistant Zoning Administrator TCN:mj I tj UL SECTION, ECTION �. i t i t /v • k' > r j t ,{ a A • Gc-�r IL tv f fr L P � `F�hM.M 'w*«wr.✓w*.Sir�rb.rJ f"�"•i!�`#�Mi•n..µe.wy.w . � �����' y�. � r , x • � y y " < 4 ,Y •� . i .y+. '. � T � yy . V ' L i .ai �' it= '' I I `'t o �- ���,:. a s � ,�.� ,. � ��� e L t� y � � , s .. s a. �.�� ' n e � • ,x ` r 4 .. I , «�� wil yNMa: F�efa ?. r . 4 gold in to 17 k 3,vve) l ad Yo k ;41 a5' Fro(° 14afne Wet Jeeq C f iv WA ( Jvs 1po Y1 Qe I d 1 a U)e m41 .50' 3 r TV ` s1iS''F{t til "1 ` r k A ND a Return C orr esndece �� ►�, _ AD DATE: Augus 14, 1980 PR James Freean - �_ Holding fiatfik.; M14 Sec. 3 Mil Mr. Everett Bol dt Town of P1 e8fi►eiat *­ k 8oi.dt's Plumbing & Heating St. Croix Colir°' s N ' Baldwin, WI 54002 u PLAN ID. # 80 -02956 ..,. DETACH HERE b . #4 - -- r James Freema - Reside 80- 07956 � �i PRQJECT.P/A ME PLAN, ID. y • fih is to ackrrovvl r 1€ of ter - and cifications for the above4ndioated pr" z yo pl `nM�' y ' r •Preliminary; review indicates the plan review fee requ•red is $ Plan accepted for review. Fee received is $ Fee is being teturned�k3ecause of U Overpayment, . .;,- Underpayment. Providing one of the two catagories.above is checked remit . oprr. t fee in ope,paymerit. No fee has been remitted. Plans submitted with no fees will be held in abeyance. i I Plans being returned:.. Additional information'requieed. SEE BELOW. j, Ran Submission 0 Additional information shall be- submitted in triplicate unless specifically noted. 3 ❑ Plans not clear, legible or permanent. (' tR . ❑ All information submitted shall he signed, seated or stamped in accord with Section H 62.2642)(a):w4scollift ❑Affidavit encl osed. l % v ' z Y IK 11, ,Alternate sewage Disposal Systems (Mound Systems) �� ? ❑ PLB 108 (Application for use of an alternate system). Q County onsite requ #red #:] copy). ❑ Design calculations for pressurized distribution' 13 Cross section of mound. ] Pipe lateral layout.. ❑ Plan view of alternate. s III, Private Sewage Disposal Systems t ❑Ground slope with 2' contours in entire area of soil absorption system extending 25' on a sides. rK O Eievatilo' of permanenrrefierence point (benchmark) { ^i F1 Location of area suitable for replacement syst m - provide soil test data. W ❑ Plot. plan showing lot size and ail lateral distan s from sewage disposal system or holding tank to bldgs, text Intl ¢ ., C].Conslrxtion detail of septic, holding or lift pu p tankiflsite constructed or tank mapufact0ter CoriStruc #ion detail ,and crosrrsec�iort of toil :abs rption system. s ;; ❑Soil boring and percolation test on EH 115 completed by certtfietfsoiE4est'er 1 l copy)" © Complete data retative to anticipa�d use of bldg. ❑ 3.copies of PL B 60 enclosed. t�F ', i �s r M Deed restriction required ( # copy): lN Holding Tanks. Profile of holding tank. w tr :A+ ' ©Motding tank agreement signed by owner and local unit of government (sample enclosed) El Reason for installing holding tank snit test or statement from Bounty 0 cap_y }: .j a FAD Lift Pumps alrtatations fexr';tota #lift pomp disihatge, head and aPons pumped per. cycle. Size, tenjth & depth of force main. F Detail & model of pump Qr automatic-siphons instuding size, pump curves, draw0own „ artd • ave,rage ftglk ra t � �.Crct s sactton of.lift pump tank showix pump( or soft s!. +~ ° wxias'trx Fitt (Filtiri&t.:' �3ri�ro$lan'sctblltliori)' l ” x�} �' � ��'#a#``a! �►Ued- #�ilt, ct`#r Iaey±� ;�#`• t�p�l amore Ride: slex�s I�gtn,,� , >� � :� �, � � tvvii -of fill. tb.t±nty di+ amp yy : { t Y 1 . va 7�5 i4b RIM Ro n R��tttt F� tw { K •.Y a YSK'S S3 ors � � s f 'k y3..•GR^E �v � ^y�fro 'T„_ �t R s y s� l a � ` of y 5 . k ter, iz ✓ _fit;: e�g�,+� F;'e •e .� ;?P £� M �3 •�r rT t "SIC t z ask tt ' Y. �''�` '*` ? sue,,. Fd`4'Y' � `� �s 'a $• 4� ;ij } r 5 w'; e�° �*a. ° ,gym €; N� Y j ' + Y 4r V7 � ALY 2L 1"0 y f 4 PROJECT: .✓lade$ Preece "w ? Holding Tank Y W1/4 Sec. 33, t, , Town of Ploatint, `f p t � Heating St. G"Cdlf �. 7F. 5400 z i 1 . w PLAN 1 D. # $4.02956 t ! • d + k t r DETACH HERE 3 2' f1+ !^dM�fi"tF'ese+�Rab#. .. .r►.«w......- w�+w «.e.r.�nww...�n.+a..... Jomew Freema Residence $429% d, � QCT N�4P11E " 4-0 PLAN ID. 3 tc�www of your plare and, spaafications for the above4ndicrted a"tury review indicates the plan review fee - required is $ .._. Q . Plan accepted,for review. Fee received Is $ Fee is being returned because of Q Overpayment LJ ' Underpayment , :. Pr "vidi one of the two categories above is checked, correct fee in one payment. a ng agor , I -No fee has been remitted. Plans submitted.with no fees will be held in abeyance. `#'fans being eturned. s !➢' :# g i' ` : :Additional information required. SEE BELOW. N Submission ti ' $ Q Additional information shall be submitted in triplicate unless specifically noted, � z b Piisns not clear, legible or permanent., information submitted shall be signed, sealed"or stamped in accord with Section H 62.2512)a}` 1 QAffidavit enclosed, Alternate sewage Disposal, Systems (Mound Systems) ` p , ©Pl B 10$ (Application for use of an alternate system). Q County onsite required $1 copy!. ❑ Design calculations for pressurized distribution f d, $ QErass section of mound. Q Pipe; lateral layout. ❑Plan view of alternate.£ x ' p a xi. f: frivate Sewage Disposal Systems El Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. z* ❑ Elevation of permanent reference point (benchmark): © Location of area suitable for. replacement system provide soil test data. . ®:Plot plan "showing lot size and .all lateral distances front sewage disposal system or holding tank to bldgs, u i Q CctnsCruction detail of septic, holding or lift pump tank if site constructed or tank manufact€lrer Q Construction detail and cross - section of soil absorption system. boring Violation teston EH 115 co leted by, certifiedsoil- tester (1 "coPY? _. >._ lte data relative to anticipated use of bldg. Q3 copies of PLl3 60 enclosed.: restriction required (1 copy). lJ. tiding Tank3 t �� �•� ��` � Profile of holding tank. ' - 4oldirlg tank signed'by bwner and local unit. of government (s ample enclosed! ,R+ Q�fori all haidutgtank' soil'testortstatementfromcountg (t�copir }. �.; d iii, P41 A wN , rrap ' d iat dhs =for t+ ti t pu+r 'c�C#� tt ,head and gallons pumped per cycle. f i Size 1etf+ force main. °fi#� er autartrietic s4�irlc#udirl�a�ixe, purrtp curves, tlrawdown ead> auerage flow, ra i l p � t �' >y boon of ��ttank'�show'rng pun9r�fs)" or sipht�n(s ?. � . ,�� d i r� ' � prcckr' te 'planSUbm ission) eifii 2l�' ,+onif ed of trench° before side'slsae beginf. = y s days �� � : - €'• � d — — e..- .e- — . —r ..-- _ — r , — — — — n- +— — '3!Y+:.� -.si f�•� Vw, �l w'�Y"?'f 1 ' a, j6.'t£ r ma ys P M Y } " '. �•'�,' ' .,rte ''f qis ,. , - ' 10s�nraclns Wfquj� j Department of Industry, Labor & Human Relations Division of Safety & Bldgs. S tate of Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608- 266 -3815 IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL STREET AND NO CITY OR TOWN COUNTY STATE ZIP CC OWNER *16'980 w Fj Gentlemen: l ` Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed,. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, it� James Sargent- Bureau Director PLANS REVIEWED BY: DATE:. cc: DPS-O S- Owner DILHR Lo I Plumber H & R (2) C my Mfg. Rep. Bur. of Health Fac. & Services DILHR 9D -6099 (N, 06/80) Rec. & Env. Services i I it H • y S T C - 105 r y H SEP'T'IC TANK MAINTENANCE AGREEMENT r' 0 St. Croix County d owNER /BUYER �j 1 Yh re � _ q `V �Ir3 i t} ROUTE /BOX NUMBER R .60 t 3 Fire Number CI'T'Y /STATE f-K �,4 L (5 'LIP S PROPERTY LOCATION: �� 4, W _1:, Section - - 3 T_ ; N, R Town of - - L j _i l_�`� St. Croix County, Subdivision , Lot number 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 li censed s eL)ic tank What you put into 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 maxi 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 stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zonin - g 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. 0 I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- rd' ment of Natural Resources. Certification form must be completed and returned to the St. Croix CountyLoni.ng Office within 30 days of the three year expiration date. S I C N ET)�1k 4iy_j_.j A -. **I-- - DATE - - =t St. Croix County Zoning Office P . 0 . Box 98 Hammond, WT 54015 715 - 796 -229 or 715 - 425 -8363 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 S - me 5 r� L W b 114 4 Location of Property j � _�W 'k, Section _ 3 T At N - ;R / W Township Mailing Address kT go 113 Subdivision Name ` Lot Number ` Previous Owner of Property bo,L),f � f���/j� J Total Size of Parcel CBEs t q �J l / Date Parcel was Created L t Are all corners and lot lines identifiable? X_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 3d as recorded with the Register of Deeds IN CLUDE WITH THIS APPLICATION ONE OF THE FO LLOWING : 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti.6 that aU statementz on this 6onm are true to the b of my (ouA) , knowledge; that I (we) am (are) the owner (h) of the paopehty de c&ibed in thi.6 in4o4mation Jp m, by vi tue ob a wwtAanty deed neeoaded in the Oj6iee ob the County RegisteA o6 Deeds as Document No. 3q a �c and that I (we) pamentty own' the proposed site ion the sewage poba.- s y.6tem (oA I (we) have obtained an easement, to nun with the above de�scAibed pupenty, bon the constnucti.on ob said system, and the same hays been duty neconded in the 0jjice o4 the County Registet o� Deeds, ab Document No. `: ) ti IGNATURE F� (WNER SIGNA1 OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIG ED 'I x �*^ 58(# 47i3 )9/87) (Plb 1 Oft .. eE3C1 A#tu " p' ` x i►ltSt+t3(M3F' A �� 1001 Of TMs Form With �, � �. ���� � pr~� 201,E 1NAS141 , 1l Al lr .o: l3tX y ourrt Cc�rres ndenc DATE 06J29J84 PRO Freeman James &Na�Li, F° € SE,NW,33,28,11W Tn Pleasant Valley jame s. rreemWkanc y LindsLth St, Croix WI ' Route 2 , Sax 113 R ver. falls, Wit 54022 PLAN ID. 84 -04104 DETACH HERE �WS.. ., .,F �►YY _ , q. ..��' .�wM� q .. �T ax Freeman +lames 6 -Nancy Lindseth y - 84 PROJJECT NAME ' PLAN ID. * This: is.W :&* recei o our erowledge �t y plans' and specifications for the above - indicated p�ujec�. Prat inoy re nr- indicates the rewired fee is $ n Fee. Received is Q * R ' 5 IJa�cierpayment : f8ease subtactit the additional fee. Overpayment Refund fort# "qeptad.for,roya Plans being retutnW. =tWo�: has been titd ,l"18tas subrrjittert 1� +t1�[ Ito # mil' bYe Ac#c#i rit►n &I infot+nat':T �{ field :in.abeySince, 1 Vu f, ' "ler�r�m►ssion Cl Complete data retety fo' kht�ojr l mfpr�n shall be subtr►itted in duplicate un- Cl 2 copies of PL8 enNo # E ='��'v x less. ificatly � , ° Dead restriction retlwtad (4 4 . Pl ktss riot c#ear. legibtex r.perri�anent. Condominium declaration Alt . rr submitted shall bs signed, dated- and,sealed or stomped:, in accord faith Sect ton H 63.08(2)1%) Wisconsin Code, MOM nistil #ive ©Affidavit: enclosed, IV. Holding Tanks x 0 Profile of holding .t sh ish,. a marKdactarer if r it "lurle D�lioFi �uY dor•fn Griauund Pr+essur8)� site" constructed lxiatu> Fie tsf gn alts eystern sighed by ovmer Q Holding #ar►k agrtrtelrt sighted is V O copy Ul-90-UM -9 f1 ct�p�/). ❑ 69sign' cal -culationS a , t Reason for installing lxilding pressuri €fistr+atc►n Sort boring & percolateon fr om'+coUnty (1 cx►py Wq x -, iOattxrrr.tsf#t� # :ectitt oI!` sVtem . CI Pipe lateral layout- ances: to any building, vue( n) C31'ct year of ystem Plot plan. cout'" lot limes, swimming° ( lerit�o f Excepttoct Status Form by County, (1 ,copY) Etc. Provide benchrn9* with e � i e Ili V. L(ft Punt e t 1 * w^ tl rn entire area of soli absorb n Calculations for total, Lift pcnrt dares syste f # fir• <ur ell s%des. w . pumRad'par cycle. x ' ' ¢• Oil I t t r8ference . point fbenrh ngrk }. .' Size, length & depth of fdr, arse 4l lot rap ement m - "pro�nde ; , Q Detail & model of:epumpR sc3ta size, pump curves, -sir w sfir � w arxd all lateral +ilsta cpa� frgm salp �. � Crosssectiono Ilft' peamr# tat�c . lot', ones, .vv l#, iaaiter siphon(s). fAc i4E1 00 SCR 11 9 11F ;a1114, ff c PP �f1. to IZ R (Fell must bye a� ea #itHei P tc� ., WE before side slope begin) : r t moo ll� t9Qr tYt+ " on$ � i 3 4 �5 �'s s Wig i a ;PA y , k v ' �- �"',�'•! r te' On- me �.� �, a} '�' ,: � r tj,.t i a ',� �.�• a °i tp +,' � ��" ,+ ����F a. :• yr get _ G � #,G. "� w, � t � '' . ..' �• is g_ 't`''k z _ Y� t'"` 6 •,,•, F F + ctf nib .s`r.°1 k. ¢•'� x.:r 3` �i .�-i+'"•:�t<„�`+r i , -�-� y . R e ��"` °% "fit r <a` �.�i.r� s �y p 3` � '"� t '^ �' t• C Jo ,� `� ��` `� ��;�tgLi '��•< 3 � "�.�� 50'3 � �6�' �, E z :1 OR � 4 ty 9p 3 : 4 n • �At T / " } i tjAi s�- 4 g 00ow#A� 4m a° �y Ti F c r s } yy r , PANII � t- i - `` r F s kL# • �k. l �v.g q t