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026-1133-07-000
t..c cnsnzy ■ `EC IVE S ? Ir.r.Y nc~ Buildings 5 t7ivi " G ~••01 W. Wawhingtorr /1Yie. .(3_ 7 OCT anitar), Peanrit Nunltaer )culled in by Co,) ry15 Madison, Wl 537017-7962 rN 1 ,OM~,gHM t.~ c I'raJasact;irraa 'Nuntlaer In accordurace with SPS 383.21(2), Wis. Adnt• Codc, submission of this form t0 the'Rppropriat:c fovcnaaYatnt:al unit _ is required prior to obtaining a sanitary pernrit. Note: Application foatras for state are suCsrntal u the Department. of Safety, and Professional Servies. Personal irtf-owne0wndPC)~VT s to T~"4)jt;c;t.Address (i:f diffcreait than marlin! address; u apses in acc orrormnrdanne with the Privacy Law, s. I f.0 1)(rrt ,Slats.- ~oyon provide c may be us uondaay f~AP-Ej-icadaiern information -1'Re~YSe )!"a ink A RR .1;rYforYYiadataaa ~c Property Owner's Property Owncr's Mailing Property Location _ _A V R City, Slate Ti t Caclr CTOW, Lot Z n ~ i r Phone Nrtmber ~ S ~ -,...-i ! V Qw 1 Q \ LL 5_l6._ Section 11. '>r~rpe of 113YmildiYn vela- BN ~t~N AJ C. YV /.,{circle one) apply) 1 I Lot 1 N, R _,,..1-41.__. E or W or 2 Family Dwelling - Number of nedrooins Subdivision Nam - Qk GSd J Block # N r 1'uJ:rli.c/Cornxnercia] --1:>escxibe Lase I.~ C'it7, of State Owned - J:)cscribe IJse . 3 ViBage of Town of 1 T:tl• Typt £If.laerniit: (C liecEx orYRy EACOX Rine £aYriplete RiiYe k:w Sysi:em~ (7 Replacement System C Treat;meiat/1°IOldirig Tank Replacement OnR icat:i4aY to T-,xisdng SySrean (explain) n Permit Renewal . Pc.rratit:.Revision f~ CEYane of Plumber D Pcrzni£'T'zatasfer to T le.w !_,ist I'reviaus .PcrrtYit: Nu fiber ~r.?a, issued - 8efore h-xpiratioaa Owner e. Y>f nCAV✓'1 5 S stnzn/~:QYri • caareragJBDevRce, ~ lYeaRc. all tlYat a .rl _ S / V - ---1---1-.-1--.-.------- Pt Non-Pressu aced In-Ground rl Presst.uized .bt-Ground j_7 At. -Grade f~l MOUnd 24 in. of su itable soli ~ ~~M.oa,ind { 24 in. Of suitable soil I ~ Holding 7 ank Other i ispersal Component: a v~. ( pla,iYr)___._.____.__.__~.-- ❑ F'retreatntent.l7evice xaEain L 17Tis st~er:sa l/ i ~a:tY d: t~ rt a zaformwiti€ n- (t^ R T)esi n !Flow- (gpd) T>esign Soil. Application R' e ltd _ ~ t y„ - (gsf) 1)ispcrsal Arra [ve)r Ytir<x9 s1tj • - a r _ peaeaArea .R'ro isec a p sin Elevation o Tank .Infra Manufacturer - - - C)aiJOars _ Crallons T.inits - l:xistint; Tanks my ~ N r~ ~Z > ~ S:rPtzc, or J:•TnldinF Tank , ~ CJ c la ~ using Chamber VIL Responsibility stad:CYi@@YYt- 1, the undersigned aSSY Plzlmbcr's Name - Yzgc resl)clrlsiE)ilisy, for installation of the k'CP6tS sliawYa on t-tte attacEYCrd plans PIaY 1''5 Signata.t ~~MZ'/lvll']3S Nuniber~ 131.tsiness one N i r - Pllln ber'A Address (Street City St:ata• T' ® J ~y ' ap C'ocJc) _ _ 10'~ d 1 3 V.Rb ~YYn /f9e roartment- UsLQnly pprovecJ Permit Tee Date lssuc,d M S isstrtnrr ,era1: Signature; - - Crrven.Rcason for )enial y5 • do ~OIZ~j~~s IX Q ( r"d' easoiis for .lbis~r tsprn al 1. ` 5epti tank, of fluent fitter and dispersal cell must all be Services / maintained -3) tJl.~ as pertnanagement plan provided by plumber. 2 Ail k requi W wMWO -rr►ust 4e. rPairlteiri codi / or irian_M. fsr%'aC.il tfJ rrrrll--- r7rfgr,. pji £nr d1rl± cysrepry and suhmii to tine ~:ounty nnlY an a r. SBD-6398 (R.. 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Ta", insp-sm"Il nA muelt Frt6114t s, ulaial Inan'solimn at uhm tartla'(o) to NmaM-Y ant, rr WI'P 1; w kralrrarl hvowmr N ida'k' Ofly nr?XOM ar 1a00, msn wra Vra v0lurno ar, rrow.W)if4 simsp ;t?ct t9,prmm gnM tn. n:hetak fnr S'I41 NO um Gtr ~r'JnOnm •.0- a lvve art tht :Ol1d'OWft'wf aurrfsoc "I' o d1sr: v4C OV11s) 0' 11 he ramlly €17~P~ps'mit~t! ins ("IlAnk Tha raf-plugir, tairtala in,1th,~ osmo m tIYI Ala 8 W k lof Inv pa, m the of rAfTh-l'alt ants grrataqrl xurflas" The larstti'OnT V ~fINam nn rile grP1,117 l s,,rrPara A1a~y 4ndF~ p a f~9 oPjj +atr'PidPfarl Ind rea -RIVdss'xh" ittiarrrac(Faa PaaGP1:rGtitt17 a the Pr~a~ 9t.rlP.~rt latas,rarrklr, tinrlim tha ora~mv fn-ed rmzr,14 xtUS,r on 0 slud"vp ml 'sum 111 mm, zr7111Pb' gqu is r n-m-01M ) gr i :ra is uR4 vol as the d>'mrs aamonts of via m )k )k shoji rr;n~a,'atr,arl lav a mi w.tkga "r "pr"int Op arm-tar rd 0O'.p0,90 0 t'r . 1,rz!ra'rlamom iaft Ostper M.R 112, Wim annain . eMitn)A~,rmvNm C ocdr% All of-fter wtila , In N-Oin; SSW. rEtat PPa~l.~r1~ to 1w e soryloing q' affludant: filrom, r¢tu"M7149:117 r MORI r MN -rrsmponi 011%, prmtraemsm unEu, Ano srsrr'm0171 ; m, t-mvtta Vea vk ,12 manI.Ns, -hall Lid porfopm=4 A, ,mn404 meprtrl. shQ dry pr+amNad Im f& Emni rr m1 ,;Imlmr ,~nrrt r ~nrdta~tr~ 10 e1OV' R M, ~ )~Y4d~pI XW TOR, even4, PAM") 1*j O9} Mov-1 -mm 1D:4s AM St. Crnix Courj,. , Pi xn/3oninP 7i5 ;3 £S fa-xlCf3f START UP AND OP AMIOR sr rratrr a~rrrs~r Yarafam~ +trPnr raa F'&~ w h + a e~a~s t try/"P cFaaek er rztrm~rt~ *ar~ri~fay fop I" PPAIN MM of PaxrY~4n~; PYrt~a~w s s ca~trar ~afaYYrxrfcrala annap ►a rrha ~arlrrf1vsR Mfr dislp sear Crt3'1 If'fgla asltixai~arrs. i M" ua kNfa riHQr71vR df Yra tt7F~~ ? rarni urar~ ~ a rvPzsFn i rr~r+ay~re prfsaf^ to mr. n~ um. aaf~aFt not Ov4r4rvvhsn =4 40MMONt 1Rrra jraasrr yr rhrz surfamm, trvrmr ~tvrv Auring fararmar ww~~ so pr,~Ja 4arm~~p M,4y ;iifl a~a• nanrr're11 Nr4~ltnw~Yto~r tq:,re~l~., rn~,~ra r~auYrmr Pis rara~ ~~~afa ~ ~mr W711 bm dts r d rra + ~ drusaF 1fI } 71) Ong few d~~a„ r~Frgr'Itairl~try~y ~hra r aiJG~} ~rti~ mays n~ ~>f 1>r tC~e rfafA ~r AR em lt~~ ha1 far >bf afflxrsn" "Cuaa1Gi1 1u 'I1va4'6 a4G1r3rv8 a lyrsa PwA #arrit rervYrskad kayap1rti?itJt PnWer m lha afllwain7; pump or am'Mm s Fallamr 'sr or P'Omnq Nl-a* Zlmr to asal#'k In asv"1141141 ~ ~FFm ft , ~1!1iDfi rt ut rvkf' 1 ht~ irolto rsstom mormi.01a~ o vtw0l<rfrti T, rfs pm* unk, t r rtt lYtl 1F Do not, drlyra or Park vehgol:? Pamr um-lb and dS'a;prmot m.ep, mm not rfr'ktra or prank over, Or Othol 4se 61m, mya or namput, the Amin wlthtp Is fiin r+doum .91vPs of Qmyr mu'rra1 or V'-OP' H00 4011 aboorp fon area. R940411m or al4rr71rfuft of 1ha follawft flwe) Ilya t~rsg a• raaar s7 mom Mayr '1ml;rnvis the P!~t~!~rY~"1~11P/kas,~~~ .~t~~Y~a ~PYp ldfa 0 the llilVf"f+;rr~ilrlltP 1sb tvCPrpA° e1gtaa brads; aqndrrtrrs; ae7YUan gwht rar,immdI`1f PRoM leipw fn; armk➢rar7 orQn i krx~r p 1w 1 tN 15mr? urP qa7{ tra ,aGa ra r>a'e11#1t1' t f kTPCIiI~I 'r ~r r l' 1kai a try i a rYdr it t art ~ mfl7t<lm~ prmdwram pa~So1'~lasr adi't19~~'Y~ ttalal~lw+s; ~ar~pcrr7rs2 ~aracr YrrraPar ~~1~~1ia1" ~/1l~eo ADANO- Qr ANT' lAthr.an the F`Q'lJr T-$ 1114 ><igl/pr Is 1mr"It'V4Midt . ly uken Comj of- ssrvlras tbe. 1011o#tfing "t sh' N's wmk#r1 itaurm that fha sv*eh17 is PrrdlDerZy anal 9v Ebarr7:019ad 9rh rrurvrOang rnrrfa ah.~ptf irUla04rr .dS1Frl I1a All Pfkrln' fm' trrr~s +aci rra.shrarl be dias~nrrera'xael' e17~ .lye ~kfrrrrr~~neei ~P. T a or•.+rrtent c of all Unka acrd 1asus shall ba ram- wad sn f 'iao gx8'v ari P ro GI F F ~ a l r l~r~ M1f1 l q pYfar> t dr" 41 .ar p4Jr+ l 1Qq, z11 ~;mksa srr pft al all be a avradoo OM ramOv94 or 1,1701P raa+van 17m01INd knthe V1914f sgSlcs finso W- I% Boll, ga-vol cur s otmar lmffl t 801,111 +rrna%" ~11~i'A ' 'l Yaf PLAIN a a f'"rrilr1l7"%"1 'fall sail tarrrrtnr he tRYm4rAr The d +1lar+rrrln.P rnaaa~rtraa heUa ha~rr, ar rnsa (s M1al slAr dm MAO a aad# rS tRr iP rrf rpl arrarrran~ erm: ~a~ IN A strftri,bla taPrlramaarret i araro, fi04 been e$+iR11„rrarra-1 End may 1:Y15 W'T'lisad for trle lumfrelrl of A mmimm' On't' r y~rCrrr~r Vasa ra 1 r~rat rrr Gras at"ralw!fd b7z Jartar( t;ed from. s fs ttr~tarx♦ye ar7:i no M~t ar rmrt i 1d f1 1 fl N . S a t palarta ''sgLCfred a'o"ba Or`ty 4i } Pr t!rr 10 reswt'r fn uhra rea r frvr ri as ep ~nj sits svs u)a0m1 n for O"411 1M fY a arrd°abfs rag gUmmt Wft l r e rtXr lxd wa err by mPly WW,,, tN.4 rulap 1rr af'feta'a st that. -tfman Pl ~ rfb ~ari~ vrJ9rr ~►>1at ~ mum A ,$ur'Cab11'1 roglMent mvr.4'~ 1a nut; glr~llct~'l.~ G1r~YN 'fiGY so'hok AnalfGYP' k31191 19~iSft8j1v#7& As11n1'{g OtY"a'Itr2pr9s In POflI' 7etlar fooF v s l IP-1 Unik Mm'N ho insvm.100 OR ,a fl$s..r AMM WO r pigga MA fear( POwt, The srfs Iva nat la"m wsho~am I'm r~lala~l-:Yf a awttadsla r~r;r a ' lar:sf9ranr. ara~ar• 7rmmrl f~lrwr• rif a atarl OnM r~Yrs'tur Cann rfsr kYa Pvxrftarmts.raad to 1aa~rpra a ljwijatflR n~tael~~rrarr~ &rpr;~ 1f raw ralala~ai~r~sra7 fr~rw S~ ~t 11ia a 1s~+'l~trrI'm n7aor a 1>~ 1 1kr~f a 1a : 1*a ws ka najalaa , Y nr< 11ad lit tJ(J"1' n r wry 1" o~lsti a nk 11~lrararrd ararrl ~~~~~d~ ~~E .~11Ya~rrp'~fran: oy~f;~lx e v ra~~rrrs~xur2rl ~ ~danlr rnfll ra7'rura srJr r P r rp l rrr~ra l rrr~ of awrflt s i rears rneri ~rra uq ted inxr« PI .M. ftA flvw'a7" a ,M p~p/~(~~ryy}{4y'g h '17l•K'.I"1:~R e/tl if i{iV~,yi aF ~rn'rm P , ~F~i~'t•k at The ~(t,y~t1F~"'~~7'l~'Fy~°p y~y~~° ~~~fyC~~~.}.•"R" /.~~jy 'y~1~~~~~'~(y'~~P"~fp""'~T°.~f41Trr 1111~1~" ~~~1~~,~f1CI ~,~~'l~'>~~E. ~4''~'~.!! 1~~1~'t1~,1~1~'~' ; N1{7ry'7}yA ~MAN~,, .TWyryf7p~q'1~~AryLyii 4 MA.p"."rT"R ~t'(ripMyii•N ~~{Y"~'18Mi'nl"A~y+~yWy1i l~{ ~ q{y~w//{~~ppy ~q y~~7~,, ~;y '~'-Fi'M~M1~DI ~!'~'h'~~~HA tt ' 1~4M FiF~d'.~ ~A%L p*q R 4`4 1 F: W.~dA'F'd4w MpW '~IA "3'A +(+flMlV yy{f!~yV,, pyy►~p~~}ppy ~yy~piy~~ %7y~+yy'yA~p,pili~~4y7Ny+NJA Y'nD Mi.1~'~►ry~ 'RR'#n pNidiFF ~+Np ~~IAy.W.if rn A.,%~i~''Ye.WDPY'JF A r ^ rwmmm."°er'x""nY"wvrc-•-....--..•.nµ.++~wr.w,ew+rtn"w.ywW~v.+o-,~.w.r~rmn.,,.w- .~.+rr , i, ~'~'~""^TM'°-.r "."^"`.^^••-rte.,-,....,,T„r..,,._„~,,,"„ . 06 ,Rep. none "rhPtt ulna I S b ~ S ' ' 1~ ,,,V 9, ll au'm t vmmpg aPal~rr} ?n cinmoliptY m w,rrlh altiiggar'r.tserrrrr WIs, N .rpytnr:tv.lt~l~,trl atYrr wra.~,~taa.1;~,J. ' J ~ lta1~ trx~x~~tct ~~trrizrxt~ar~~rw~ ~~tar~e, uov tt 40^,0 10:45 AM St. Croix CaunLar Pl-an/Zoning 1i5-3SiG 4Cr3f TRART up Ago MpMAT'j= Pup of For rmtnr ~trrORrr.WI~A9lt:~Ym. krlWpr m* ~f ~Eti!"T, cFaksmzsrm~cn rain} fray ~b~m pts~r~ata as p~$~yE1ry: pna~tt>s rar rafset upkrigtP~rtf~u 4ha may llha"arearr ar hl+ tism e Eire 'lee 'r m+ rf@01. If 01 a J~a ll tte . d ed PAV14 fPts nt M is df tlta ' rtfG(t rsta a i My g aei)WQ servia}ria a~rarawr prfcr za s.Paa. Zymtamx mm up. Await not oar-ur W.hsn al osartrd:lftnfa err Im?sn ar, T,tm frzftmraIS 'Surpa s, During pwar rawt t s Ja P t p em a naz r iiil a ~a;vea raranrraIii f 'fatflwav mr tvals. an 1pa w+ar 9 r re r t i c u r ua~Ilt f rr dta krarg d u ttre 064 f fFt } IPr mme i >w d1oeg, overTv Mm.p Wo amtJt } IMd »p 5*0k fm a mr=eu ~a~ :d a m~ aff`I'uavt. "f"•a im tfPf dmwq '-aa '~Plj` s 'Efts wramiz-v a mf lho 243m; t-An G remrsvad lZY a G}t rvi Iltrr ftJ!1rPY Nri PTAW-err m tshts 011141 M., (aur3r(p er- m+urfi t; m F9I1nrfter or Pow.T$ IVhairt m?mmr tta aeelat In MIM4 ma tor- normol 14va w mn Twe pw G>3P~t'fK, r#010 ca Mawr rtt tUYJklGlta t» 00 rhal drlva a'r Taar•Is wah all pmr *9 and 0apermal rdtrftts Om rmt; drfva ar Park werq mr m'thomf a 4.1"tph rAr t-M. pp'mta the erect VvIthfm 95 flasm deanrr•, etzypa r4f'Art'y mammpl or imp-mdo a ll ebMarpdon wee. ReMmIrm or giRm9Pme' m of thm ftrtimOng from ilia womm tar argam may tm'tprows 'the infrImFhmor :mild :p tkra 'f•~a of the PGM/Tl; >~trnlfr.~lOV Of k*'bW 1pra'A„I e11arai,+ Bart, 4MTTde+rra; -morm molx~ 4f~~ a'i li 'trm fogpd'atYmn 9r4m 06 pum'fk} mar, Out silo 1100,g: luia pIIr'rp g otirre: 0rWARR; hoffin'694; r>R:r~'A* fa ma x~Pe rtm~0l~er ~ailA €patrrtfae pr^mdumm, A f 'd.eeP a trrf ry ilap€tilya; tarnpurr7rs2 mi?+( vnrater e0flarrer I riftao ADANON-T to/hen 'rh,es fa'114 Is per-~r'i~C+~t>tt(Yr '~k~an a,aY; of sarvime 'Stte •Pcaflca~tn~ ,Xri aIR•i I~~ ~ir~~- ~m t"tn~wtre ff~~at tl7e s~r>'atrpnn lm prmipark and uf'Rly Owlo-:-oIQ'ed 1Pn 4mmriyllartma vvf h a;hApur OPITIrp MM, W.''Nom 4 A tthf All piping4p '~ertrm aanig la'rta eholl be dPg ararrrteraparl and The ebarzftma~ pfAa ~~tarGfrs ~13~t+~tkt. The on+ntarits of ON mam and p ft ehafl be rem matt and piaperty^ cf immos'd of ~v a Uptap fealftp opn mmr~ Alftir'pi,iM.Tolpg, all tams and ASU ahd tsa exatRinpero end rearnavar( or ttraaip covers narmoPlltrd ea~i tNra w094i apama fi1iad tiutkf7 0011, gaarel ar erruT h'er ham of-To m r7g .If that l PWT°iR-falls anti tr im mx b-P rf-w1rar+i 111014MUMnrins M. Riagw an hmvm Psamn' ar tmaiat' (a0 'galtatar Im. prr;0144m a 0644 cwzPr MIlant; reptamsm,A Pt' aYISt&r.: A s rlsalufm i pfama rant areot ftMa bearr MraPaf l and may Ore w1lbs;d fttr thn Ijt=jt&,t cf ~ r latparrrer~ aaft aVsrrr tt stare Tfls~ ttap Ia~aiar rrr ~rdaaTaarrrir~ re r d frtsrri ~ifa rr art a 1214 wrtxip it P 494 al' TZ firvk ;f~ p mil raquim' d e~ on4 pmp>:ragd 0ruat'Wrrs, TOT 1111ma am4 Imolte; 0 tl - ~ urttm~ by ra&Wt fit tlto tn04 ' mr a M%w ar4f an$ sRs avsl almn to 000eNO a wftwblY V x% MY SM voffrme rntarsx I+rmPl,'y wfth ft Maw Th ef'fmx s: that tfine' A at fCatrltE Pt i l "173 t s 1a n ~i'P It> iii. RaiT& 'ftfia $ i0AR14 al /!DF' sail 9J;PJY1 t11t Ftt r #NTtt Ott ~'CJ Jt9 r b ' raof~mP~ta;~'' a Tnmftl 'g wlk Mt-mrr iaa In's".1104 ae a'sm memm rte replage *0 fago Fwfill, "tt Q T)w efts pw 44't k0 *1 euafrd&'Itad Im TOMM2161 a &JItat~t"ta ~a:P~riwm&mtmf~fi art xa,. t b etretta xmrl min's art aHP 7~ad r lur > a m ataG Gs tttmra re fwra of gh p+ W. I. v a aa91 ~d rJ m 1~ry` ~~ngq7a♦yt~r~lallrte ,Vryy;~IJ1 d eaa~ IMM~~~ww~ r*!a~'as~~ryP,}r~ ka rtna)tlaa~ya~ygt{!ly~ at ~`gf11 td 1; VM, ~•Vl l ~~yp~epm'yey'aryrJcre~,p If rim ra>ul etYr t Oros I t i] tYia a k~m1d' rr 'haPak l Ar~ R 1(S Fri H f~,y ~W'iY 'O'M1tf . a'Jl'~Ain/`"r ^.4r V~~j''IiN'(bfA m q M~ (G4PW 'kJ IN 44101(4~W ~!d ~,p!((CI• F?a!RW!If•W'f( Indiltraafere wf1s ararfm0a I sus? rrr~aetierr~ exf ~sumb av me mur. uam #pfy wuh the #q 1~ 0, t at that tfP~e. ¢p>dl y~~y~R~py 1~ rs~al it'P k~f~t at The M1* 4XXXA~311 Rh'~ 4~+'' .r' .w'IroR A 1~~~~r i ~~i*MM 'f".~lt~f~ xu,1+•!rH ~"'bl'~1~a'~~fAY •4C7W'r~. ~T~f+W ~1'7~t ~ b~' 7 . Gt Tr p Y FROM T Intl i OR F A a AMR MAY I if}~ -T- i IMAM M?' &Ya 1 ~e~", MOM w"N A, ~ ~II~ 1~Z~G&1u~ ZIlf~fp#~~ 9k ~n ~ ~f P~ATA T .amum l- W Rana _ _ X mm Norm a• Mam phone. C's- 0) rPrPre rJraraumt3rat nrw 4~rs1'C~a! in ran !?hTPP r~amiPar~e "~"~T«t)thJ:fY,Fir~l&t~} arart P;;~.~'Zt'ta, C~~ Sc 1~1,, t~tizna~iz•( ~k~f P(9f@911 4Ytve L"WWe+~ RECEIVED ' i 2416 Wisconsin De ~iner4t A 3 SOIL EVALUATION REP k 5 e5 3P>5 172630-)3. Page 1 of 3 I r f~djX CQUNTY in accordance with Gomm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ''WMcb~i~letegife pTan2P papei not less than 8'/ x 11 inches in size. Pla County include, but not limited to: vertical and horizontal reference Shawano point (BM), directio I.D. 026-1 3-07-000 percent slope, scale or dimemsions, north arrow, and location and distance tc Parcel Please print all information. Revi d By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. :nL /a Property Ownei Property Location James & Jennifer Franklin Govt. Lot SW 114 SW 4 S 6 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 912 172nd Ave. 7 Plat Of Pine Valley Addition City State Zip Code Phone Numbei J City Village t/j Town Nearest Road New Richmond WI 54017 Richmond 90Th St. ✓ New Constructior Use: y~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement -i Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comment; and recommendations: Soils suitable for conventional dispersal cell at 0 Recommended linfiltrative surface elevation to be 97.0'. Boring # Boring Pit Ground Surface elev 99.96 ft. Depth to limiting factor >11 1 ° in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 f#2 1 0-73 7.5r4/6 none Is Osg ml gs - 0.7 1.6 2 73-111 1Oyr5/4 none s Osg ml - - 0.6 1.2 1( .5z L -7 35~ Site has been cut to prepare for home construction. H#1 & 2 contain several bands of 1 Ory4/4 Ifs. Loading rates adjusted to reflect reduced permeability horizon associated with banding. 2 ] Boring # J Boring !L/J Pit Ground Surface elev 99.88 ft. Depth to limiting factor >108" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-12 1Oyr3/3 none ifs Osg ml gs 2fmc 0.5 1.0 2 12-27 7.5yr4/6 none sl 2fsbk mvfr cw 3fm1c 0.6 1.0 3 27-108 1Oyr5/4 none grls Osg ml - - 0.6 1.2 . Site has been cut to prepare for home constructio H#3 contains several bands of 1 Ory4/4 Ifs. Loading rate adjusted to reflect reduced permeability of horizon associated with banding. * Effluent #1 = BOD 5 30 < 220 mg/L a f TSS >30 150 mg * Effluent #2 = BOD5< 30 mg/L and TSS < 30 mg, CST Name (Please Print) Sign ure: CST Number James K. Thompson s_ _3@e2 321 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 10/7/2015 715-248-7767 " Property Owner James & Jennifer Franklin Parcel ID # 026-1133-07-000 Page 2 of 3 a Boring # Boring ✓j Pit Ground Surface elev 104.42 ft. Depth to limiting factor >92" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence I Boundar Roots GPD/* in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 Eff#2 1 0-80 1Oyr5/4 none Is Osg ml gs - 0.5 1.0 2 80-92 1Oyr5/4 none s Osg ml - - 0.6 1.2 Site has been cut to prepare for home construction. H#1 & 2 contain bands of I Ory4/4 Ifs. Loading rates adjusted to reflect reduced permeability of horiz associated with banding. ❑ Boring # Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 ❑ Boring # :J Boring _J Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ffi in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 * Effluent #1 = BOD 5 30 <220 mg/L and TSS >30 < 150 mg * Effluent #2 = BOD <_30 mg/L and TSS < 30 mg 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 (807700) A.C.E. Soil & Site Evaluations E1~i3 ut i~c~ ~/ude /e~Qct C ^Ta„es•f J"enrr,~rFra„C~/,:c 3CY) L-)( SYo/I ICJ 4c i~ 7lalk z~o~%"we (114 //ty ff o!a! i S w%y54-ZAy SCC, 4,, T3cn•l,~e- Trt . of c~mdna( 6. '4biX PG/. aZG -1133-0~ -a)O 81 7, -ve4. _ _ - - ` tfcc.►t alts! _ /W ck) v, Ex~:sfn9 T ze ~ ' ~ M V S o ~ -o tl~ ECEIVED County- attt j"'• l fe Ps Safety and Btailding rvisi Y * . A~u~5 2Q1 W - _ Madison, WI Washington 5Ave-, P.Q. _....---(,Y4 13 2 Y "Mar), Permit Number e fiI e in by Co ) ;3 162 °"~srotsa SST. GRQlA CgUNTY o7 ~m g 5_ 57 9 o 5 J J Sanitary Permit Application Siat:e'I7ansactiorNu tber In accordance with SPS 383-2](2). is required prior to obtaining a sanitary permit,Not : Applicaticnino( >rtns i~ n srtatee vnmd PgWTSi su milted to th:; Department: of Safely and Profess ional Se,rvies. Personal information you provideo ay be used for secondary p -reel Address if different than ailing; address) u uses in accordance with the Privacy Law, Is. 15Stats. lication---Information -Please Print All Bnitort►aation-- i roperty Owner's Name Ave, Parc~ef Property Owner's Mailing Address - - - os 0 ~ V V b Property 1:,ot;anon City, State - Zi Code - _ Govt. Lot P Phone Numbe_r 1 ~ - t r\.~~~lC S - W v",_SW -'/4, Section - V ! II. Type of Building (check all that a I (circle one) - T.3-0 N; R_~?Eorw PP J) I.,otZi- I or 2 Family Dwelling - Number of Bedrooms B1, oP ❑ Public/Commercial-Describe - Describe Use _ i ~ ~ C, ~ -1e nll~ Qa L) urn ❑ City of - ❑ State Owned - Describe Use CSM Number VInent Vill age of 1 klown of _ III. ype of Permit: one box on line A, ete fine B if applica~ ~~X ~klew System ❑ Replacement System Treat ent/HoI,ing n ly - El Other Modification to Existing System (explain)- i 1-1 Permit Renewal Permit. Revision « tge~l tber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before re Expiration j---- Owner ~ 'JPe of P(DWTS System/Com onent/ IJevice. Che all that apples- ~j~,, ,~-~-'A Non-Pressurized In-Ground ❑ Pressurized In-Ground C❑ At-Grade ❑ Mound> 24 in- of suitable soil 11 Mound <24 in. of suitable soil P/.)5 I Holding Tank ❑ Other Dispersal Component 0 (explain)~~ Pretreatment Device t,x, lain - V. DI'spersal/Treatment Area Information: d) i Design Flow (gp Design Soil ApplioaCion Rate d. • x_1, (gP Dispersal Area [required (st) -Dispersal Area Proposed ti - --sb v VI_ Tank into Capacity in Total # oP u~ Gallons Maml. acturer G allons Units as New Tanks _ a c~ Existing Tanks lo Flo i-, O I.. N -y QI Septic or Bolding N n 1. Y I e~ _ Dosing Chamber _ - VII- [responsibility Statement- Y, the undersigned, assume respu sibility for installation of the Pt)WTS shown on the attached plans. _ ~ - Plumber's Name (Print) jPlum er's ignatur ~ MP/M.RS Number Busi ness ddrss Street, City, State. zip ode) S $ / 40 L;~Approve t /JDe artm fifise d ❑ ~z . Perntit Fee Dai Issu° - Issuing nt Signature rven Reason Denial IX. Condi easons for Disapproval rl?, IiI~iF°lhE! 3) [~6 Jh r~.b 0., o piM cell mud a~ ntai , J P P~ P~. by plumber . / , G S b r►^ I~Z 1' i o. as s PK b6de / ardiritar~im. cDVJ, Attaeb to complete plans t'or the System and subrnit to tine bounty only nn paper not Yess tbau S ~iy x 77 inch7e, In sirs - S13I,-6398 (R It/11) Mee el S y b 1 r 1 ' I?u t r~ b pe F i 1 a^' ~ I F ~ ~ t>E Ya ~ [ f t t { ' i t • 1 i t ~ t • F „ v • ~..~s...-...,:..mow=...,,-mom.-+ _ em r e' `i ~-O o p y CONVENTIONAL COMPONENT I)ESIG Residential Applic9itic~n IN DE,--X APtY~l7 TITLE PAGE ProjertName: J~J S N}J) -E~(~flbAl l►AZ i Owner's Name: S 01" Owner's Address: 9 k~c Legal Oc4scription: W' Township /nMGNd Subdivision•Namo t. a _ _ d ~1 10~ Lot Number:_ _W ParcelIDMuMber_ OU0 page 1 Index at),d titit, Parge, 2 Plot Plan Fage 3 -:3 Lston) 126n Page ~ Ciross~ ~e-Se e 4 Flage 5 N i;n't~nanca 1*JlfOrmF-iioTl I pa, ge 5 __!VI_anaq:r rnent Plan ^ Page 7 St. Croix G ly Lptic-Sank Matriten.smc_o Form Warranty. C)e'ed Page 9 C M rar Flat 1esi drier/l"lurrrber: rYl bU~ 1 Q~ s a h Lict se 1` wmter Phone, Number Sign-afore )esrcJneN, i~urSu~nt to'ihe in-, ounci SOIi Absorption C;omponont 4htnua1 for Pow rs version 2.o m)m i 71,&p (N.n-jg)j). i Map A 4i Cpl W PSI t~~ca 15i { p l1 UVYh Ada nwv. S j3~ s. ~ ~ ~hbm~4tl ~ t.~ 3 so n F-D f';IVC Vann Pipe tAIM) Vent rap Chamber ---ter- k` System Elevation -r- 1 91,11 T Wo3 T= 3 4~4.~ o sm j At ktRO GS M FYa;R ~F I { - . _ L.l [VITM . - M.: I , E: , F__ k' D@a. ` Vent Or ?bs va aVon Pipe - - Tiff If _1 J. 1, EIM 1.1 t USA R€jtinq, sq fl taEKrharPltaer v Bois. Ap~aUca ion Rats 1 9Pd/F;q ft _ 0ort i7E`SI(~A0iov~t Soil Application r-Z., t~ S rnbe Pap, I ~f x le ~e ,n i Ira I'9 y aK k=I-Airflk"Id 14PvcP, WMlinff t'd, CT 0134St Q .11'1' I Fr4~ >~-e.trs ,at5ri PapAaa~dP: iyaRWPra1C,t etiYr a......1 ProO,won Detail- • ~ " I[ i n r ~y FILTER Rlf~' far ~I~~°~+~~~r+l fur I'Oir ~ qp ~~!yygg g,~ q g±~ a , I i4 i ilylok, Par. is }7teaseti 'ro acid its new corrtttterrirti filter t,cl its car„i ttinq Ifne rsf e{+aality ;tfli,rnr'+t i xtond i.,OVII fili:ors. The PL-SP5 is mterl forever 9Q, 000 GPO (GR114)ns PAr Dail) mr kIn(,1110 ne, of the largoat comrtt+§r+:.i~}i frltats in its r,4zs, it I'm 5~! knew ft:tet of Vh 01(raticn ,glat:s. f_flcn thr R194rs ~ Riser G very i Polylok I'I,••129, the nevv l'ohriolc PI fi 5 has Vi riutor%itic shwt aft hoU i~isY'r~W with every ljltar, IAft. 1) t1le filter i;. riMOV' 0 ! for toning, the ksali wlli float and tee -orully sluit off the oygf,Oll1 sp the a;flumnt urnrl''1 laavo the trunk, Nn nil^er iiITP.r on th I A ~ ~ tlpq rsltrkt,t r.an nla Ice that , Pumps, usins, Pomp rri riryg in Larrrratu7rr R gr,iest a (;ltlotc Bel teCl i $1141 SOP Syystarms mrrrrrM, „m r„ w,,.rra';' semis I Gmakatta 1~ ~•"M~'NP~A ~,Y.v i•-_._..._....p_.,MTIrRgx,f,l•.RI!,+w,r,,!.rvren„^NMMMwrs 1 %a'fias, i ►'nift ary Tam Rated fot"10,000 G'PO ((+alkma Par C)aN) - _ n.,rv US linasr feet of 9/ i~7" filiation ~ Robv spataors Enlarge for dmafis AOnept; " i',md 6" S:^HD, 40 pipe - mr rt me R mmn wnannm m Bu k, in Qe,$ Qaw1P~tc)r Fft rst i ~t rr')d Race! van m1` Autorrla.il(. shO?nili 'f.Q W11an flllrr iq rarYYC11/ocl m Alarm accessibility ' igna o Amapm PVC oxtinsirai'r handle Lando pe I Orairmae Thy. F11,975 Eflunnt Rter.,hoAri orlerntn r. !roi~srltl Y y t 4anr tr nr.+rl'tr li F'am"As, a clamps m. ricittionn tapfnre ce.quiring, cleaning. It is racnminand sel thm the ;iP¢eat f5a L;i~anat~ r vlrr'sf i.-. tune the tank is pumped or at [Past every throe ye y.. if thQ h13%lta61 filler Cta11iE(lt1S ~I1 m w.',", ~,w,„,„„rv ,~,,w m optfnnal afaritl, the 17imnr~r will be ncstiffed Nan ilArm urhe~n tha fllY~r Itc~eti r ~tnrVit;Ptg, I ~'PuP ~ ~+a~+ir~ldk~S Servlctng sfinuld he done by a ortrtlfiad 9endc flank pr rnpar or insatWlsr. ~'R h i w'"d P Gran Pressure Fth* 1. ;_ormtc, the Outlet of the septic tank. ~~~r ~t~Yta1P~+1 R~'p'1yr~i,t~ I-'•• "-rrwrmvnnrnmw,amr ,2, Re1rl'iOvi? tank cover rind pump tgnk if nice c(.;ssgry. . ~3. EJg r~c7C rd ~Q plran~laiwri ~Nftrwrt'IRile:r is rnnlt7vL~~{, t RORrnLO'k and CnViLJ! ,r, Ptiil !'I, 525 L)"i: of the llotasincj. ~k~a,Y l~ d"i 5. i-fase rsr filter aver the septic tank. Maicm ,Aurra nil snlicis fall a 17 jn; ,yl-,pfifi tank wtP gsf~tyy r~ lld 60 Op Insert tht~ liter rtlrtridg~: track into Ciln hrausinq mRklnta $rare x ii pl in ilG roY 1jalQtutify inA$110. he filter i4 pY l,7aarly - m, 7. Repiace anlatir tank envar, 1`4_,6255 PnsUllation; Ic•Ira~l foal` t csicierlRlaf nr;f r.,nn1151Prci~tP a ~ 1v utraste flows up to 70,000 0-111t) lls t~r7r C;tlf1?. ,m,~,M Mmvmxm~nrn.nm'^~n++~,TMm+,~+w„n~„n", 1. t.raca% thW l')ptrft of thl septi; tarslc. j Pomp AlMar wd Slim 2. Ramovar tank cr,vor an l pi,iInp t'tink if ne:cens&n1, 24" 9. Glue 'tile ~ffta:r ficimsIng to N4 fir" or fj' of QjAf- i ~I~L r h^ avare a ~rN,r r}irrg r.s a F,Iyrnk!^xta~nrj C~~'pciPc~ ~he5i~t ~r oj.,k no( f pipe ftnc mx r~fi ~Rr i ~rn~,YtFil~Crv~ M + nett onf p n.. Irm9Fri the Niter Into its housing. 'a'( i I1f'1'rl'//~a;larta: ri d„l~r~41~F ~~17Ir,..F4: r~,,.rabl~ ;tic•I~r')Kyrnrln,,. 1'~~-:'~ IhINI I:0 A I n 7 yl an l)C i~, 20 10 9,12AM No, 2060 1'. 2 1 m o o-5 a h Ct'A C1 Cri ~ ~ rsa csa C'7 \ mK0 m -n 17 c~ ra a rrri in ~I (!h GF7 r;Y9 • R `T ~ • j I s en rM y~ ----•-r* .Cry • N N M !'^y ham-. l_r r„W? Gf1 n~ h ~ . 11121 El iii )010 0,12AM No. H66 ~ 3 c~as FTI rri 2 75 u t 6 l , I r NnV-11-;`_010 '10.45 Apt St.. Crntx Cnunt_y Pl nl~nni;u 715-3• tJ r;f~l?6 1~? Ayb c0,nrr~or w Sopt7o Tank o4lil Wsrrra~ x?!~ _ _i1u m ~PI! ?~►_`~,1 l . R 1...._Q NA a lr+ n'nlr lwtantlPaa>7~tra~ )es t►1 IQ NA I is V~ A~1Cr It ~ , ~ HM l imm, l`RRor 11u9u~rt t Qr p L~ NUMbor Of Ndroom'- P,fflryttm Flltar {ltl'o4ol CI NA hlum~ier caf k~utbllo l Rnlllhyr l Prrfta _ NA Pear p Took ope PEA RattmeW Vow (owora p) Pwmp Tank Miantafor"~ NA Design flow (P90), l~s'Glrrlatorl x '1,t~1 Pump fulimixtaltulr~r NA INA, Sall Applfootlart Raw p+urnp. ~l~> M S anraer~i Irafllaw~rit/ t?Plunrak ~7•~ssllty N1camhl~f Avoratlo* prPma'aalrrPom wait 1- NA paxo, Qil & Qr as tlF0121 Aso MOP, o na/mraval Hitter 0 Assn 1411tor F loaheln'io it 0,V.;iAn Domanll G ODr,) $220 r- R& o NA i Moolitiftal Aorelon I W-ol-pnd 'natal Zmgpended Solids ITS PI 1150 tn'rg/T, Cl 01#108040. t ~ ~r ~~~.._._...,..~,-,R-.,..--.___..~. -.,-~.T~,~,-._.-..r._..r•.,.,~ ..~.„_~..,~..~,,,,..~....,~..1„ Pratravod Effi arnt; Quality MoI1 1V Average ialaNharol Co1{N A NA iattxahlmlraal oxygan n and (.1OmA:l 09"0 rngrl., gln~Orouand (pr ,'ll y~ r ll molar utnd (praaaWri~aedl Toni $ulepertdad fslldn 1TSR) ~ 100 OVA, 0 NA 0 As14Zrada PM1 m4tarnd rIS*Oj t'raat ro 'io Man) ^~J:O' atwp'1'Q•Qm1 . n N.r1, t;Ya 1'B 0 IklA Maxlmu m lfiW lrt: pralclale lflxa Y# il1 Glla, f~ lsrl 0 INA 0 NA Gxllsra ~ NA °~\Pdltaa ~Clrlsfnat Nr ft=' oft wtkatewntor ant} 9~ptln "pink a~ilGreMI ~llarrraak Inspeatt arnrr 10on I' aai*(al At ioAn ma autsnl Von) M NA Pump olAT anntontla of talWexl iNhen aarrthinetl alelip arm aolarri: e "s al^wsht pt fit%) of tank uolulrras 0 CIA M0% V fripsat sparol r.,rsl.l(AD Af looliT ono aueryt (19 Vasty) n NA art + , ' 8_7 0 NA Mon r3lifiwent filfar At, Ingot ~rrlrra auraly't 1nRPpa;: 91tr1'a'1'[a, PWrri p S?Q4'1t~fGtl tINIA ! alarm M 19,flmt anc,+a wary Flush 18t'arrtfa Ono prs"urro sr~~rr, At; Imst orloo owerv, C1t15pc, At lses, aryls overy; ..+.••..,,+.~.__.-.....-.,,,,.•....•~..,•„~...__~,~,~.+.--mm-.,..,,.~--~-----......,.,-+.w.«rwn,+m,w,•~em.~.__._,..*,~,.r-•--n,MrM.ww~!-.~... t;1Cllet^ P WA MAINTRA02,02 INSTRUCTIONS lnspsolons of villo amd dispel' l MIN ahAli bD mar4o ~y ,an In'rilaidual parraplt.0 anIA of ft fmlt5wIn t:lognsm tx?- r rt111~rttU~artsa Motu > lvillt!ar; MAOT',elr Pluambor l aptrlptRd Sovoi;rl P0VV Ins, rl F13W A MWllt '1101 ` 11 ' 'SMOg Apomlor, Taft inspoolorm must halu o * r1l4taal infraeptian tit the xankfay -to Iftlitify any rnlsoing or hrl kop kl~gir?dvvxra„ idarr y° & ny rtrsl ks or taolasr Prtmolaro tho vo-I pia at' an, mlalnod saiwdpa arl$ vr,-. i ra and t,zx ohoak.,Pnr any h' as k top or poli On, .af l'bf rlt qn: tbti'e .gttraott pwr'Pace. 'fits d1spersel arolfls) ttzll ~e vrsn#IIy 1nnp'at;ed for rlfaank the a•Piriulafnt favale In tha OsvvAfor pi.pso -ft tea 4, Kwo1, lor Arty porrdtag of Wfusiv an she growl owrfaco; 'T'he paandlm; pf efPiwans; nn the growid stap-Pa'r,a may lnd-Iora~a o •°st:Ptnp ottrrdltjpn ,acrd roquIrap , a im'rlatd1*6 molf-hi,0Inn of %hs lraval mgzrlvtory surd p*v, Wlian to rammOned ocau>;a~ IAton 0 slud:so and srxwM. in slay vin'k gatala ~ln'antln'trd ~~4 or ttr :o1P tvtR trl;t)vma, tha aztth P.On'tont.s of the unk shelf bo remaved by a Saptap „"`+mIrlsG c;t'pam"rar and 'o1 o."v 0 In'tmGSy4enpa 4nrlth o1'1apf NR 111, Wlpaesnaln AAminlAtrmth-pa f:oAi%. Ali athsr onil w a, Irrnlwd ng Wt MM Ilrtlttesd to 08 aOMOU W +.at~lwenx flltara, rrrar h.orIUMI ar prooputtt'1oU lur~bap'~rt'~~~r prstram- mans units, aratl any aorvtr: nq mi, inttrolls of SRI rnrant", ahttfl laa pof0l"M'ed Nay a.40"Iflar S 't U1" . n frr aPlYer, A snrvlna report sl1oil txa pmvtoed to the Innat rslawlatory :3Vtilnrlry ,nft"I"In 10 ctysa,e Crf arm, .t l4+rfn of xmy 1 sa'Sv AMU ~4101) 'opoQ aA141r4slulwp'd ulsu©a MA +Ie1 V W %10918 PUB p~ ! R ~ p p !41 - t - su04d 'S ~ Q I - - S eu04d OLURN U OweN JcJlaoHll77 AQ.LSY7Pli3t[ 1roCJ`1 MAIN) k1C}1UU0 JNi01/1t1SS3QCf1ddS au0yd eu04d ew1~l U1~ W'1~ w eweN kI~NJ1t1,Ntt/W S.~Mt~d kt~'1'1~f1SN1 S.LNIQ+d LN~JWLV00 lViyol.L eav "S'IBI8oodWt v01'tn0ide4m as itrw XNVI b 40 U0.11131Nt 3H L wow idd iYosvild V:10 317100111if '1164 H AVW H.4V9Q -SHONV18141C101:110 ANV IdaQNn r'IN`G'L.LNj ujVjkIL kjgNj'o No (ima'Jtedas "d HjjNo ION 043 'NRVAXO INWO1ddASNI VOICNV 699SWO `ItIH.LM NIVIN00 AVW 5)I'NV.L INSIN.L'tISWI 1:13H.10 QNV dWSid '011clao < <ONINHYM> > 'RwA 4944 4e W049 ul satnJ 444 44!A^ Aldwoo zones swo4o4a 40ns;o suol;dnr ucaaad .aaa ens eAR9, 111u! 9448 4OLUOlq $41 10 11AQUJQJ Buinna11a; scald ul po40nr48ucoaJ aq Avw $WOWS udl;;daosge lice aPeJd•aa pus punON Q 4UR; BUIP104 a e140t1sA9 Of VON 4uewsaoldeJ CU ;I -Baia 1vow~ oldol olq ns4 a 80HOW 41050i z8 o us 040001004 yaw4o;JSd eq asn U014,tnE na 24Es PUB 1109 a S.LMOd 944 ;a smite; uadri "each luawsoslder olg14lns a A;iwapl oa pe4,enisne useq 30u say Olls $41 C] SIMOd ul soaUEA a BU uo -iiulp ice rot sld s mes sou Avw 401 P B sp11 /pus 4oaq~.a~s oz onp g( qa11 at So watu a gezlns V 'ewll iRg4 4s 4oogs ul ealnr 044 44IM Aldw©o wnw ownoAs juewsosidelg 'em, wowao ldaJ o1go4ins s 4Spge160 04 ualIgnISAO 0418 pus 1108 Mau $ J0; p80u 8y4 u14lns6J 111m Rare 4uoweaaldeJ 044, 4aozOJd o4. oanp '8119m puE vault 101 lwr4.o'nJ4a osadvl A uv n P d PUB 6u14s1it0 W04 s~109g4gs ea nbsJ q d podul,tlul eq gnu plnogs pue ucj4aedwoo Pull 60UagJn;R1 W01 81041W o p 1 uol;dlasge 110$ wow. sosideJ a ;v uo14B001 vqz Jy1. pazlign oq Aaw pus pa unjoAs ueeq seg enraur,usweaaidoi o1q 3 n8 b 4uel(dwoa apQy a eplnaJd a4 'uele4 eg 4asnur rO 'ue0cl ene4 seinsaew BuMa a :wa;sAs;uaulaoeldea I II ; 944 JOW10dar eq 40uued us 0110 4 4 9J.MOd e4} dt NVId ACINOV111111\11 0 44IM p01111 1901108 p10A 94; PUS PVAOwaJ B98nRa 41044, Jo pe/%OUIE [ pUV p940ABoxe eq 11ati4s s srtd p p pus sal 4s jual lie lie '6UldwLund 10ASA `Ilya q Il rally valpledp OulolnaaS ebviOaS s Aq;o pssodslp AlJadold Pus paAOUJ6r 6q 1184$ s41d pus quE4 Ile ;o s4.us4uoo 941 e 'poloss sBulusdo wild psuopuaga a44 pus pajosuuoosip eq 1194s Sold pus sjual 04 wuldld IId' • ;ep0O ani;eJ4Slu1urpd ulsuvcslM 'EE'gq t4 WOO J04 040 411m eouslldwvo ul paugpuegs Alops pus AlradOrd at wo;mAs e44 4044 olnsul of woNv i oq 11*4t sdow ISUIM0110; 944 anINSS ;O lno ue%aj Alluouewred al rte/true sllox SILMOd W4 U04M IN91AInIOONV8V 'aulrq rsualps 1e4aM put tsuvdwin.sul4dsu AJo4lues moplogsod :Slonpvrd Oupuled ,Ilo :Suopoolpaw'Sdw4aa Mow :seplsgJe4 Ieseor8 :oulloseD :aduliead alga;aSeA pus 4!n4 cro4eM (dwnd darnel u111p ual4apuno; :49; :s4uezovololp wedelp, !$$01; JR4uop :saaseardep I RUM$ u0440n :$UJOpuoo :s;gnq o:4aJe6lo ;socilm Agaq to#14ojgjjum :S"LMod 044;a Q;i1 0y4 au4lvJd puB a0u3ul101J9d 044 en0rdwl Asw U12446 IRMm ulm 04; wQ4 dulMOiloi 64410 uopulwll9 1v uol=npall sere uo14osg9 Jlos ope16.4e Jv punow Aua;o edais uMap 4961 S I Ul441M 1619 RW '4oedwoo J0 gJMNP VDIMA0410 J0 '.Nano )JJad JO en14p 4OU 013 12110011Sradslp PUB gUax 1OA0 8010140 qi od 10 GAUP 4OU OQ 03 $lo, UOa dlund 944 u14eJedO AllBnusw u1 4sl$$a v4 reu exu a ,nun dwnd 041 u1441M $10n0{ ISUJJOU 6JO4sa4 OZ $JOAU O4 OW 1o4eJed0 dulolnJ 08 de a A I I IN SIMOd JO JaquJnld a 4co4,uoy JO dwnd ;Uan111,e 844. o4 raMod ;o oda94o81p ooelans Jo dtqoa4 044 ut 41nsaJSAaw p l1 us {A s)11a0Na41 BU1pSn1aJa j 'osy p a e8Je1 eauo uI {111 t a(s loo lowdol pay 1041 8$184 Q q 4 p 4091P q iltnn JOWM0400M 6861WO 844 pwo;ow al ramod uagM 'SlaAsl JOWAA4014 lewrou oAogn III; Mw S~uax dwnd o0o4nc raMod kSulrnq -scams oA14ejM;ut a41 is UOZOJ1. OJO awalpuoa lice ue4M lncoo sou IiRys do ue4s ujazoAS •8an slusauaa 944 sAB4 pe4,a04ep eJ9 cuvlaeJruacuac 0l rvlyd r04eredO $uiyinJam 88o4d8o a Aq p8A0ut8J (s)alue4 841 10 4014 kJ '(s)11ac llawodslp 041 dowsp Jo/puo sesowd TU8w4R6J4: 944 spsdwl ARw 4$44 sloolwaya 1a44p ac S4onperd Sulruled ;d vouasaad 04 s©; 101Ue4 ZU=1204 400,40 SJMoj cox 4o Ben 0a JOird 'uoponrssuo~ Mau JQ, °;o - e61d 11 OLL'tl IdO QNV do IUV.LS Z/Z 9?91' 98 96L 5u ucZ/Ueld tluno.D x'OJJ q5 Wb' 9b:0I OIO2-L1-naN Nov-11-2010 10:45 AM St. Croix County Plan/Zoning 715-386-4686 2/2 START UP AND OPERATION Rage - of For new construction, prior to use of the PONSTS cheek treatment tank(s) for the presence of painting products er other chemicals that may impede the treatment process and/or damage the dispersal ,,ell(s). If high concentrations are detected have the contents of the tank(s) removed by a aept89e servicing operator prior to use. System start up shah not occur when soil conditions are frozen at the 1nsQtratlve surface. During power outages pump tanks may fill above normal highwat>ar levels. When power is restared tha excess wastewater will be discharged to the dispersal cell(s) in one large doss, overloading the call(s) and may result in the backWp or surface discharge Of effluent. To avoid this altuation 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 PONSTS Maintalner to assist in manually operating the pump controls to restore normal levels within The pump tank. Dc 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 env mound or at-grade colt absorption area. Reduction or eiiminatiori of the following from the wastewater stream may improve the performance and prolong the life of the PDWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dagreasers, dental floss; diapers, drelnfectonts; 'Fat; foundation drain {sump pump) water, fruit and vegetable pseiingg; gasoline; grease, herbicides; meet 2araps, medlcatlonw all,, painting products; pesticides; sanitary napkins, tampons; and water softener brine, ABANDONMENT When the PONSTS falls and/or is permanently taken out of service the following steps shall lie taken to insure that the system Is properly and safely abandoned In compliance with ohaptar Comm 83.33, Wisconsin Administrative Clads. a All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealer. e The contents of all tanks and pits shall be removed and properly disposed of by a Saptage ServlolnR Operator. r After pumping, all tanks and pits shall be excavated and removed or their oovera removed and the void spaoe filled with soil, gravel or another Inert wild material. CONTINGENCY PLAN If the POWTS 'Fella and cannot be repaired the following meaeures have been, or must be taken, to provide a code compliant replace ant system: A suitable replacement area has been evaluated and may be utilized for the location of a repleasmant soil absorption system. The replacement area should be protected from disturbance and t: mpactlon and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells, Failure to protect the replacement area wilt result in the need for a new soil and site evaluation to establish a suitable replarcement area, Replacement systems must comply with the rules In effect at that time. ❑ A suitable rep'lacernent area Is not available due to setback and/or soil lirnftations. Marring advances in PCIWTS technology a holding tank may be installed as a last resort to replace the failed POINTS. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the 12OWTS a sail and site evaluation must be performed to loosta a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resort to replace the failed PL WTS, 0 Mound and at-grade soil absorption systems may be reconstructed In place following removal of the blomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules In affect at that time. < < WARNING> > SEPTIC, PUMP AND OT14FR TREATMENT TANKS MAY CONTAIN LETHAL GAS698 ,AWia IOR INSUFFICIENT 'OXY0EN. DO NOT ENTER A SEPTIC, Pure OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANOR-0. DF-AT14 MAY RESULT. ROSCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POW TS INSTALLER FC3111r1'S UAiNTAiiIiE(d Name M t~V\Ai V1 Name Phone Phone -ma- SEPTA,i3E SE0{9 iCrftitC, GJ#al RATtJW (,PUMPER) LOCAL REt~7JLATORY AtriTWGI;Etl7'i' Name Name L t>d Z~wi w Phone ' S - (3~ 5' Phone t. This document was drafted in compliance with oheptar Comm es.22(g)(b)111(d)&(f) and 83,54(7), 12) & (a), Waaonsin Administrative Code, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S d- ~eN Nl'T enXl~Nk J Mailing Address 1 r Property Address )A~Kql. ~Q(Verification required from Planning & Zoning Departme t or new construction.) City/State yurl G Parcel Identification Numbe Qa~ ` l 33 614) o~ LEGAL DESCRIPTION Property Location SW 1/4 ,S W 1/4, Sec. ( , T 3_ON RtW, Town of 1 C. M e) t Subdivision Plat: K , 1 6 N , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # I Spec house 0 yes no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify tha tements on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described a ve, by v' e of a wary deed recorded in Register of Deeds Office. Numbe bed 'ooms A OF APPLICANT(S) DATE * * * ormation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) ' ~ • ~npS nt ~ 8t ' ~ ,troy; i N. ~t. I tN6509'05W 0►.?jNi 79 II°°tl j +I ' A in 6- 'A 104, t t I j 1p a l gj' ao l t ~•{n ►.y tt O1 \ ~ N ( O, ' W NU loin VI \ \ \t \ U sA f ~bz~ CD N tr W 4 $ , Ng f n GoN \ Ay f ~ \ 5187 79' 79 ` a n -6\, o00 l"' N * ` \ \ \ ono 44 Lri O J 00 N 1 \ J-s a 3 ; ,n 8 o,~sH~Yy $ \ 1 I OOo.< s ~nsa \ \ S -N 04 b , 1 r Z~S , Y r \ t 2 r _ - I&,- - 1!8 L96 o A 79' sxo Nov- a n ; b 1, _ ~3 \ t F oo / \ t b I A d Hot I b ~M< i ~Ia s ~ ' I :8L M su CINV-l a3J \ u stgV a wg :R8 uBi$-u IM'43 s~ar,a - u.a+g lno~ wwa ruo!mN ~ Y pp q dOasev/ue8 . .oaep,wa p1!n*08d [4 IWAMOdMI ...H.4.p A-a•a1•5 UM NPahM ulquejjsewer 3JHd i j ..aic'•OI au~ul ?a. W W gjQ^ I) OQa~W~Z~ ~ ~ QLLY ~1/ i S ~ ~ i ~ VVV dpm°a~~ a III 1 • h!1~ ► Ell i ' ®1 Mr] o X j f 1 W ~1 J W tz- ®®N7~ z CL lL y LL 1 III ~ I '1~ flif~ Q IJ I I / ~1 r 1111 W I I I fl 1 V i ~ lfll I 1 H ~ I I ~ 'C~ I Dga i ~ x 1 f i F ....e' uue4ltle~.4S ;fg u8lsep IM'~1!'J .w`wrw'..`i`«~.: a'~.zw •r~-•~+~°~-~~.~~': st<na an..ww~..u wnm.m shame. ~Y s~ a"~° .~Uaax3 Nwl'Wxetl Ieuc4aN r.. « ci wad~eewv ties a +o o «ro eauaPlB+il ~1aY11lUdWIw~ ~•'!•u -ps 'to-sE srs:aa urjue3.4 sawi•p :30Vd 5d's w39c~~o as ys'a i , Iwny~34 . ~$i~dnC YY Z I a 8 £ ~E N a f6~qa z N i i~ qtt uiz 7e d ? i t~6 ~ ~N 2 d+ ,o- 5a a o-a P6 .o-zc o- Q o I o c F ~ p G' 7--- U- Z I . 3 I I b, J p p $5j of Y~p~u ~ 3a ~ ~ I HI o o 3 z I` .tt I s~ Y .wr,a kx el 8 p I ` ul 9 piL• 6 ^I ,34 3 IT e 8I. n Y ro a S f T s iep~~ Y Oil FIN .O.CS r : .~.w:.. wewPY euwne4s :As Asap IM'A!J ~w~.«... uioa Pll~9atl~vwa4'~4a9 s~isp -..a ws 8puepisell pt~nu 78 AA 1MYALOdwi «.o ea,eH Nap :ma~s fr"L x mat-aa utlxur.tj sasuep :30Vd kk~ >u { e` ~ 9 p a o e ~r3na~ ~ a'F •4 ~ m. o Pn x3 =S ? R~ Ra-. p Z g I{ LLI g 9Y'e36~ ~ o ~ r.~. ~ a NZ a W - .P ca n r X 9 9 i 4 Z a ; ` LL w ~ ~ a F y a ~ ~ a V -x~~seFr'~.~ P Q I QS V M 4 : .o.a .o-.a 's Q j k 4 - d V ~ _ $ P •z~=c~+-.rte [ I t i p , al y i 7yy~~ r' yy a f~ f j ~ .41-.f .OL .MOi-.L f p ; f : . 8 ds ~ 3~= MA '4110 WA-M" As Am ~ IIIII~' I o Ilu~l w hI19P~IPII~~IIII ui C= ru LL Till! WIWN~~II i,41~ I~I'~'I~'llll~ll uj~ ls „ilk s ' Wisconsin Department of Commerce SOI L EVAWASION REPORT Page of Division of Safety and Buildings in accordance with,Comm 85, Wis. Adm. Cod r County S~.~D f Attach complete site plan on paper not less than 8 1/2 x ~1 - jhq es 1, in ' , a udst s, include, but not limited to: vertical and horizontal refereq( pAint (BM , n Parcel I.D. 133-o percent slope, scale or dimensions, north arrow, and looatioh and distance to nearest ro 4f Please print all information. hi~'1Y ~ a 2001 ; ~ Revi ed by Date Personal information you ovi may b used secondary purposes (Privacq Tairi~IX.04 (1) (m Prope y Owner ZONKVG L 1~1 1 Gov t 1 /4 S W 1 /4 S ~j T 3 N R f E( co W Property Owner's Mailing Address Co n+ac g L t lock # Subd. Name or C 0 . P'S 10 a s k c'y~ de~ sUn City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road wk(eor Lae YYiA Q\> s (651 )24-09`19 T;Cc won~ /7a C'ty'Q K New Construction Use: ;K Residential / Number of bedrooms 3 Code derived design flow rate y SO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Q, B~ r . C,k Y' v ` Flood Plain elevation if applicable ft. General comments Qe -75 r "T F:. he - VC. . • - and recommendations: ~1• 5+~'~ Ir. I C Iq 1~. ~.x- I ) -T 'S -',3 lgN,78') © Boring # 0 Boring ) Pit Ground surface elev. 1151-5 -1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 0-11 J0yk 3a SL afcs~5' R US ofr - a )I-3 -7, q SL 5 C Cw 1 r .p9 41 a r, 3o`~ff~ ~a~bf ® Boring # ❑ Boring Gt u Pit Ground surface elev. y 7 ft. Depth to limiting factor lo1a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 sL ar~R mFR aS aF .s .9 a icy- Li 6 -7,5 R ql - s L am Zk F Q W )F 's .9 3 -4,~,D-7,5Y y f sL 0-23 tnVC - .7 I. ay\ a,~ 31'd 30°U c'a~~l VIA * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number donna ~ ~~`ac' ~a 11yb Address Date Evaluation Conducted Telephone Number aOl~ aoo+' S+ S+Ckc PC6", ,e (Ail SgOD y-a7-01 15-aye-35S~ tV- r SBD-8330 (R07/00) ' R 11~, Property Owner A -LL OS i k5 Ylc Parcel ID # Page ~ of F3-1 Boring # ❑ Boring 19 Pit Ground surface elev. 9 1 ft. Depth to limiting factor t~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o-g ► Ala s C. rn pp, Q s a P .9 a ?-ao ,s s s C_ aFSaK C W I F , 9 3 2"9 -761k q P, C IV F41 1W Boring # ❑ Boring 9s Pit Ground surface elev. ft. Depth to limiting factor I 'D d in. Soil Application Rate Horizon Depth Dominant Color Redox;Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f 0-19. ►0 R L d FU R YID F G! 5 a F , S d ~a-ai o`l~ q Fs ew 1 , S .8 3 ai- 39 iov 31y MS-eF C LAJ 1V F , 5 M 8 39.63 -7,5Yk 4 b SC aM 58 ' b3-fats -7,5V9 S L. 2 s FP, 9 - , a` u` OG ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor El pit in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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.07/00) Property Owner Parcel ID # Page of Boring # ❑ Boring ® Pit Ground surface elev. *49 ft. Depth to limiting factor P~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 S L c FGA ri~~ti~S . , q F-41 Boring # ❑ Boring q Pit Ground surface elev. 15 , a9 ft. Depth to limiting factor a in. Soil Application Rate Horizon Depth Dominant Color Redox;Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f o- la 10 Riot L a FG R 3 qw- 39 OR 319 It, amsak /r-R 1-1 vi v r , :1,5, Is y 39-83 -15U 4)6 ~ SC art 56 tnF OW 83-** `7SYF q q d~' a 59k F/ .9 47 S ~ oG ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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.07100) o e. Ao y 4 ant 4 I 3 J Y 111 ~ I zoo ,N. 30~ aNl Tv sr ! p S S. ~~.x._ ~ i 101.E a III.99. y~► a~ ` t3:M 1 160,ao' vemot,--1,a..,z.. g' r The soil test report for lot 3 was discovered to be inaccurate during the septic inspection on Nov 2, 2001. The soil horizon repo ted 71oamy in loamy sand was actually assivsn with occasional pockets of sandy loae ore the ,loading rate must be .5/.7 and not.7/1.2. If this error is discovered on any other lot, additional borings/soil investigations will need to be performed for the rest of the subdivision. The plumber should make note of the potential for error and prepare for the possibility of increasing the size of the drainfield. -0 C) v ~ p °En. I O c a ~ V Q N O CL, I I O (n Z c LL 0 I I a ~ 3 M I d ~ z y I (DF-c~nl, am c a 0 z c w w 7 y v avi Z v ° -o c aoi I to H c m C N 9 as x J ' CJ O CD N ~ N = C yN ICJ • O N 'O Ai a ~ O ca II O z z N 0 I *Its i a £ 12 3 Z Z H N c`> p a~ coca ~ h w c c v~ v~ m 3 d ~v ¢ 3 3 3 ooo •H ~caaa EL ~ O to cv ~ U) J U rn N Z = N - O co m o n z in O ci M c O N C O 0 04 U (3~ U M co _C 7 N iO O Cl) E N l0 q1 N .p 1.•.I (O M U (p .s+ 7 E o o Lo o z y d z O ee d V y..~o a as m a • ~e CL m a E c c °3 3 r A 0 0 a 0 o Wisconsin Department of Commerce t PRIVATE SEWAGE SYSTEM County: St. Croix Safety and euillog Division INSPECTPID,N REPORT Sanitary Permit No: 506153 0 GENERAL' INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Halle Builders Inc. Richmond, Town of 026-1133-07-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 06.30.18.920 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM I Aeration Bld .Sewer Holding S t Inlet St/ t Outlet TANK SETBACK INFORM ION TANK TO P/L W LL BLDG. ent to Air Intake ROAD Dt In t Septic Dt Bot m Dosing Header/ n. Aeration Dist. ipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer D mancl Cover G M Model Number TDH Lift Friction Loss S tern Head TFt Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution ix Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over -TT Depth of Teeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges psoil - 1 i Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 912 172nd Avenue New Richmond, WI 54017 (SW 1/4 SW 1/4 6 T30N R18W) Pine Valley Lot 7 Parcel No: 06.30.18.920 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No 1 Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) commerce.wl.gov Safety and Buildings Division County C !~T 201 W. Washington Ave., P.O. Box 7162 S T. Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) i sconsin Department artment of Commerce Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropri ve mal /~1 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-own are Proj ddress (f different than mailing addre s) submitted to the Department of Commerce. Personal information you provide may be for secon n~ purposes in accordance with the Privacy Law, s. 15.04 1 (m), Stats. ~ 1 2 / J 1. Application Information - Please Pr'nt All Infor tion Pr erty O er's Name 9p W2 VV,,,~A Par # - / / ?3 - 07-6OO P operty Owner's Mailing Address Property Location ///,3 4 -OUNTY Govt. Lot (,47-26) City, State Zip Co a Phone Number P fit/ y, ~>w Section /S OSyb 'coo13 Tao N, R/?' (clrclEone W~ S98 7 p H. Typ uilding (check all that apply) Lot # or 2 Family Dwelling - umber o Bedrooms / Subdivision Name Block# Ifl~ Gee~~►'i ❑ Public/Commercial - escribe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use Town of /CIA O H 10 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit B. El Permit Renewal El Permit Revision El Change of Plumber Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS S stemlCom onentlDevice: Check ali that a 1 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound >~2,4~ i~n.~of~suitable sot ❑ Moun < 24 in. of suitable s/oil y,, , ❑ Holding Tank ❑ Other Dispersal Component (explain) a~LZ7~ BSc=ICJ-P~ea~rren ce ex lam ~i'1 ~~TYGG~ V. Dis ersallTreatment Area Information: (/1't. Gt.~Q,~ 0(~YlL Design Flow (gpd) Desig oil~plt do (gpdsf) D' persal Area equired (sf) Dispersal Area Proposed (sf) S tem vation ysv //2s~ 7 r96,® 9y Y VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r n ; New Tanks Existing Tanks o S W cc a U in to rn Et C7 Cs Se ti r Holding Tank / pO0 t7 Q 6 Dosing Chamber L VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PO S shown on the attache lans. Plumber's Name (Print) Plumber's Signature R umber Business Phone Number b61,;,S ,ffc. zzlv7i 172 /X-.;?4 637 Plumber's Address (Stre&,t. City, State, Zip Code) 3S?- k c/o ST Ahi-c.,-V G~-~ ~'yao l VIII. oun /De artment Use Only pproved ❑ Disapproved Permit Fee Date I sued Iss g A ent gnature L ner Given Reason for Denial IX. Conditions of Appro UReasons for Di pprova S STEM OWNER 1 Septic tank, a filter and l -dL e i must all be serviced / maintained as per management plan provided by plumber. 2 e system and submit to the County only on paper not less than 8 1/2 x 11 inches in size as per applicable code/ordinances. SBD-6398 (R. 01/07) Valid thru 01/09 04/20/2007 16:30 7152467227 HALLE CUSTOM HOMES PAGE 05 I af~ ff , ' + I ! ~ i I i 1 1 i ~ l Imp- 1 7-r ' s , 1 } 'IS A ; fir L i H O C ti t~D ~ p ~ ~ _ I~ I 1 II CPO- CA ~ O CC, + CD CIO \ /D ylVy M , ~ \ ~ fir. L ~r \ y `C oy I t.........._...-............_... o ~Q II II it I I1 04/04/1001 10:! 7 VAX 7188376847 8A1 ON CO ZONING C OI SYSTEM SPECIFICATIONS In -ground SOiI Absorption Coiuponent SBD Af Project Narne w~~ Distribution Cell`h'ype Septic Tauk- AwT to Lein ing chambenig Min. Septic: TkA Voltaa ao Wastewater QUTAliq Seplac Taxsk Volume gal. Txesa.red [I Un meared ManUfractruex Numbef of Bedrooms ~ Effluent filter Design lAya ing Rate PLR) i (Nfaximuria S-il.Appli- im lUte) M3i7 fBCtt eS _ Combined'wastewaer; Model Nr&iber of be&ootiu Damp Tank gal./clay/bedtoo wily Wasrewater Flow (DWp) VOI Cleft and gtaywater orAy.. W=iber of bedrooms mvetter valve Eyes []no gal/day/bedroom Dally Wastmuter Flog (D'Wr~ Model Blac kwater Now : '1170 •ume of a &a •tiv valve shall be itAcared on the management pka W ixrlrg bow skid when the valve Number of bedtooins d=U be use& gal/clay/bedroarn Q 'C.Juily Wascevwater Flaw (DWI-) T]i8trib't7tiort Cell 5lZing (Aggregate) Distribution Cell Sizing (leaching chambers) Leaching Chamber manufacture Model 0 Adjusted Design Loading R. gpd/kt` C•hurnbeyr size. bottom area fe System d-Anag = D1Wlx / .ADT. fit. J t~t~aml~Zx tdzg (DWI)- (ARIA) (sq.&) # of chumbera 'Niu aber of chambers to be used of L14/20/2007 16:30 7152467227 HALLE CUSTOM HOMES i - } I ~ ! ~ PAGE 05 i f r >r i ' ~ ~11i 1'r I i i ~ s _ I I I ~ I I ~ I I t ~ I i i , i i , Ovse I I I , i l i I I ( I ~ I I I I { 7 ~ a 1 it ,r . i r .I . T t ' ~ I I l i l I 3 I ~ I 4i j i I• ll j ,fio I I ; 1 r 1 ,wr.n 111 ~ ' ~ ~ ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with,Comm 85, Wis. Adm. Code, County ro f K Attach complete site plan on paper not less than 8 1/2 x a't ngties in 1 a ust''4 , include, but not limited to: vertical and horizontal referer ce_ppint (BM jnd Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road..... ! ! 3 3j l O Please print all information. (~i ^ fir' la 7 Z01 Revi ed by Date Personal information you p ovi may used secondary purposes (Privacq~LTai,1~.04 (1) (m Prope Owner .ZONIN Warty L 11 Gov t 1/4SW1/4 S 6 T3V N R E( )w Property Owner's Mailing Address (Co n t ckc 9 L t lock # Subd. Name or C P•o P,OX )0aD \Ricl,ofA Son city State Zip Code Phone Number ❑ City ❑ village Town Nearest Road Wk,4 (eon Lake MAJ 5116 (bSI ) 74-0 WH T;awo-c /~a "a otv~ New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate SQ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments T esrt- 3 - .5 `rl . 75 -r Q,S !\C.M and recommendations: Boring # ❑ Boring M pit Ground surface elev. .5-. ft. Depth to limiting factor ) a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-11 /0yk 3/,;Z S a ),_3 y s, 3 30 -1;it 5YR uio 5 ~ The soil test report for lot 3 was discovered to be a 3©a/0 CA inaccurate during the septic inspection one Novn2, 2001. The soil horizon repo loamy sand was actually assive loamy san with ❑ Boring occasional pockets of sandy loam. ere ore the F51 Boring # Pit Ground surface elev. 99. y y ft. Modft rate must be .5/3 and not .7/1.2. If this error is discovered on any other lot, additional Horizon Depth Dominant Color Redox Description Text borings/soil investigations will need to be performed in. Munsell Qu. Sz. Cont. Color for the rest of the subdivision. The plumber shout o -10 /a YR 3/a SL make note of the potential for error and prepare for o~ /0- y b 7,5 p y ` L the possibility of increasing the size of the drainfield. -N 7' y SL 3 y /V I an C+ 3 co~~1 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L CST Name (Please Print) Signature Donn a ~ Spa ~ Address a7~ aoo4` S S+oc l~r ~r;e wi Syoa Property Owner LA IseS + 'i i5, N►G Parcel ID # Page C~ of 3 F3-1 Boring # E] Boring 19 pit Ground surface elev. a9 ft. Depth to limiting factor r a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 a-8 1 Ala S his rn R as a r .9 a g~av ,s s s~ aFs6K FR Cw 1 -5 ,q 3 9 -7,s`IRy 'sL yFi2 CW 1V ,9 ' 3. off' Fq-1 Boring # ❑ Boring p Q pit Ground surface elev. 15 9L9 ft. Depth to limiting factor 'D Q in. Soil Application Rate Horizon Depth Dominant Color Redox; Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f o- a ►0 R 3 a 1-- a FG R m F CA 5 a F , 5 , 8 a ~a-ai pyg y L FS CW ) F S ►8 3 ai- 39 joig 319 yeCy M-Sak MAR C V F ► 5 'S 39- 83 -1,51R 4)6 SC am 5$ F y I o~ ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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.07/00) R ~ N c s-r vY► aa~~ ytA Sca 1 t : 1 = 9o, o ;)L acv, e.~ x Z E t 1. t' 1 o 30 Obml 1 S``` r`Pe° v► ra ~ac,khoG P;-}s 4= • 101.5;a m l 1DO,oo' vex-t,-t-hnr.Z, g9, yy' Irt f Cc IL IL V- UI/Ud/U1 MUN 1f JU YA.X 715 J-bti 4UMS ST CRX CO ZONING IA002 ST CROIX COUNTY ' SEPTIC TANK MA114TENANCE AGREEMENT AND OW,NMISHIP CERTIFICATION FORM Owner/Buyer &2e~e Mailing Address el w Property Address- a (VerifiigAtion required from Planning Department for now coastzuctiaq) city/state`/ Parcel Identification Dumber. 0 2 6- 3 -6 7 G~) LEGAL D CRXPT>ON Property L,oostionSW %,Sw Sec. T30N RH „W, Town of Subdivision a~ Lot # 7 Cet ti ied, Survey Map # ~ Volume ..Page # Warranty Deed # 7 1 S Y Volume y P it Spec house yes ❑ no Eat lines identifiabie yes C3 no sx - NONCE 38 ~ 4Improper use and maintenaneeof your septic a zcouksa6z~tsp tune wore to bud(~aassW. ~ consists of P=Ping out the 0000 tank every three years or sooner, if peeded by a licensed pumper. Whitt you put into the system can affect the function of the septic t m k as a treatment stage in, the wastes disposal system, The propoiry owner agrees to submit to St. Croix Zotung DepaMout a ccrtitabon form, sighed, by the ow= and by a mssWplumber, joatueyn= plumber, rostricted plumber or a licensed pumper venifying that (1) the an-site wastewaterdisposal "CM is itt proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than. 113 Ault of sludge. Itwc, the undersigned have read the above requiraments and agree to maintain the private sewage disposal system with ft sumdards set forth, herein, as set by the Department of Commerce and the Department ofNatural Resources, State of'WWisoonsitL CertMeation stating that your septic s has been maintained must be completed and returned to the St. Croix C.omty Zoning Office within 3o da f the theta lion date. f?y /o7 SIONATURE OIL APPLICANT DATE OWNER GD+RIUMATTON I (we) certify that all statements on this form are true to the bast of my (our) knowledge. I (we) um (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 0I2 APPLICANT DATE 00s0s« My information that is mis-represcatad may result in the sanitary permit being revoked by the Zoning Department, Iaetude with this application: a stsmped warranty deed from the Register of Deeds of lice a copy of the certified survey map if ref wee is made ih the warranty deed htl.~ t~t1rC? '~1i,711t b` R7 ~ 1. /4~J't 1118 U W:ntgl' 8e0tia Tank agityy 0 NA Sepeta7 Tar k 11llanufauturer ~ CJ N~►. VASI 1, . ..~.a. _._u...__._.. A1tAlVI i't lei &fluskit 1911-ftir AAanufauturar L'I CIA urnber thf Bedrooms - - .W es C77 0 l1 NA l~ffltyant PlIter Model NA Niltntcaar of p'ubll ~-~-~--W-...... - - ~ W.. t, Facility Units &NA Pump lank Come* U NA Eattrnated flow isversog) lump Tank Allanufmoturer l:?tats!d ra t .w._,.._._.~.... iuvv (Puk), {wris lat+sd x 1.51 41so pyrrip Mmrudtttrar 0 NA. Still Application Ratio ~ )y111Yi Modal W W .w. _ w_~..r IqA . _ t3 t a~lfds3 _ _ tarldacrd irrplUcastY/!`ffluflttt C2urallty M nthly average lara3ti'r~arors+ant i!n]t W - W W L I NA_. Pate, Oil & Grasse (14001) aO mg/L 13 Sasrid/citravaal Filter 0 !'out Pikkar 81arrharrnloal Oxygoit Dom and t60DJ 4,j2D mg/L. U NA Moohonloal Atara flora rJ Watland _ "rota] buupe ded Sotida (TS81 9190 frig/L_ Dishf'aution 0 00th er: Pratreacedl lrffluorrt Quality monthty average Dimpaarmal Collis) .4~..__0.N.A_ Hicatihaemloasl Oxygen Dernand ifs 0D? aO M211.. U to -mburrd {gravity) 0 lri-&oUnd {presasurtzed) Tu'tfil sut3rjartdtarl Solids f7 ga) 1920 mg/l. 0 NA 0 At-0rade 0 Mound Idso l Callform {gmuiriotela mmen) sti'IO'► ofu/9012rstl 0 Drip-l..lria ri Other: 11tlsadmmn i:-fflumnt Pardole Shea Ys nw din. ARIA Lj. i~ A s~ cSrL 014A... ~ f~'*Valurta tylyaiedal for rlamwtto Wastiouftter and saptia tmhk atflW,1'tt. O~vsrr t j NA l1f1A1111`1°l~l1lA11itwr~s ~'Oll w l3ervltlra ttvrarrt GMT" Fraciumay 1111 11111111 Ifni!aeo't tltindhllon of tanks mt1t1 thhil ftltlwttt'rttltll yasalts) C! NA {as} At ttsbtai'l: uncsrs isvasryt: ~ r{ tsf truck vrslult LJ 1VA Pump out contents of 'tank(s) When a wnbli-ind Sludge mid spurn equrd'e ontl ltlyd W inspect dleparalril tgell{s) At least ones every: I'yerlrla) (lYlslaxirtluin years) . i NA Clean iaffluent'111ttar At tenet Once every rman lVA s L"1 NA lrnapeat arrussp, taunip 0611trals & Sirat'trc At least MCI& Svery9 Yatlr{s _ _ _ µ _ . w .W. ST- ! 0 NA Pluatt•t laterals, witd pressure teest At least onrsta a~vaa►'y. 0 ntont . , S Mark At least owe every' L'l yasasl'{s) 15i isr. - 0 NA l11tA1111`19NANCLI iNsTrxU9TIONS cte►iti9uzakletr►eat Inspeotlons of tmiks and dispersal wallas ajaai) be made by an lndlv]duai t;srrytrtg 0110 tit tt'd tsaliow1ttO lima n sas or lVlamler Isluntbmr; I, MMaster Plumber Ftutatricited t3+rvver; PUW`rS luslterYt,:ir; k atllhT; rill&h7telnlas; eoptagsa Bervloing Opsi'ilii3r.. "I'ank In%petilons imust W~iaiud0 ra visual Inepaotion of the tank(s) to Identify any YASSing Or broken hardy""' idas►rtify ttu~y crooks or tdaulds, rnealsure the Volum a of ooszlbirted sludga w1d artmun's raetd to shook for any b8ok Up or pandir►iy of effluent on dire grriund euyfma The Xsrxarsal ooll(m) shell be visually Iraspooted to ohmak 'dtg offltient tevaalta hl the ribeffivetlort plptss grad to nhatsk for any laurad]eaL1 of tslfluent nn 'than ground surface. The p()ndfng of efrlurant rtrc the graiihd rsurfaaea may Itidlaaft w t'aatling uatiaadli an and reaUlreay th a Initnedluka notification cif the Im al regulatory authority. tllftiisri the nuttibirtasd aloa3urnultaiion of sluda* and scum in say 'tank. equaW one.,third (lg) or nteuwe of tits tarsk volurnta, 'thus erff'rat lslyr►'Cerl'tas of titss lank atl'u,), be fooloved by a gept&B6 tiervloing Operator and Mapnsed of in ail0 rdettcae wins isltep'ter C~llt 't'(:s, Wimear►elki AdmirilstnAlvaa Cads. Ail oilier servioom, Including but not 111111ted to th's armrvitiing of strA ak MOM, mat0mrAce, or pi~aseaaluixaaad Crsrrepynagn'ks, pratree'trrieial unites. and array servicing at Ultervatlu Of 102 rritsrrtho, shalt baa performed by m cser'tifted POW TS N1aIr tSinar. A s at'i lee report $hall ba provided to this local raygutattory euthxarlty W1t1'tlr1 '10 days of 00rrlpletibn at 60Y "rvtoe rsveiak. OMY1f {4101} Page v of START UP AND OPERATION Por new construction, prior to use of the POWTS check tr&atniant tank(s) for the presence of painting products or other ahamTcals that may impede the treatment process and/or dainage the dispersal e611181. If high connGritratlons are detected have the contents of the tank(s) rmrnoved by a eaptage servicing operator prior to use. System start ups shall not occur when soll canditlone are frozen at they Infiltrative surface. During Power will be outages pu tip tanks may fill above normal 1'rlghvsrater JevaLs. When power is restored the excess wastewater discharged to the dispersal call(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. 'I'o 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 Malnta(ner 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 calls. Do not drive or perk over, or otherwise disturb or compact, the area within 15 feat down slope of any mound or at-grade soli absorption area. Rvduation or erirreinatlon of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antiblotlcs; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dielnfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; greaser; herbicides; meat serape; medloatlons; oil; Painting products; pesticides; sanitary napkins; trarnpons; and water softener brine. ABANDONMENT When the POWTS falls rand/or Is permanently taken out of service the following steps shall be taken to Insure that the system k; properly and safely abandoned h compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pike oper►ings sealed. • The contents of all -tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After purnping, all tanks and pith shall be excavated and rernoved or their covers removed and the void space filled with soil, gravel or another inert solid material. COINTI NGE14CY P It the PdWT ails and cannot be repaired the following measures have been, or must he taken, to provide a code compliant roplacoms system: A suitable replacement area has been evaluated and may be utilized for the location of a relplacernent soil absorption sys°te m. The replacement area should be protected from d1sturbance and compaction and should not be infringed upon by required setbaoks 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 astabilsh a suitable rerplacarnent area. Replacement systems roust comply with the rules in effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Marring advances in I OWTS technology a holding tank may be installed as a last resort to replace the tailed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and she evaluation must be performed to locate a suitable replaoerrient area. if no replacement area Is available a holding tank may be Iristallad as a last resort to replace the failed POWYS. Ll (Mound and at grade soil absorption systems may be reconstructed in place following removal of the biornat at the infiitratlve surface. Reconstructions of such systems roust comply with the rules In effect at that time. < <WARNING> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CWCUllltti`fANCLS. I)W,H MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INST 'R POWTIS MAINTAINER. Maine "Tie :E] 'hone a (o 6 3 7 L one SEPTAGE SERVICING OPERATOR. (PUMPER) LfSCAL REGULATORY AUTHORITY Name (Name S, lei10[IB Phone gs- 97- This doeurnerd was drafted hi eomplisnoe with chapter Comm 83.220(b)(1)(d)&(f) and 83.5x40), 12) & (3), Wisconsin Administrative Code. 04/20/2007 16:30 7152467227 HALLE CUSTOM HOMES PAGE 02 w 4 • STATE BAR OF WISCONSIN FORM 11 -1982 LAND CONTRACT Individual and Corporate 1'0 BE USED FOR ALI, TRANSACTIONS WHERE OVER '11,000 IS FINANCED AND IN OTHER NON-CONSUMER Deeumcnt Number ACT TRANSACTIONS CONTRACT, by and between Hlilvale Develo went Limited, a Minnesota Limited Liability Partnershlp, ("Vendor", whether one or snore) ar,d Halle Builders, Inc. - Recording Area ("Purchaser', whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this contract by Purchaser, Name and Return Address the following property, together with the rents, profits, fixtures and other appurtenant interests (all railed the "Property"), in. St Croix County, State of Wisconsin: R 026.1022-20-0_00 _ (Parcel Identification Nlin char) Lots 2, 4, 13, 14 and 15, Piny. Valley Addition, St. Croix County, Wisconsin. This is not homestead pn perty. (19 nOt) Purchaser agrees to purchase the Property and to pay to Vendor at place vendor directs the sum of $ 172,175.00 in the following manner: (a) $ 5,500-00 at the execution of this Contract; and (b) the balance of $ 167,175.00 togcthcr with interest from date hereof on the balance outstanding frirm time to time at the rate of to % percent per annum until paid in full, as follows! No interest shall be charged on this Contract for six months from the execution of the same. Commencing on the 30th day of January, 2002, and on the 30th day of each and every month thereafter, equal monthly iastallmenta of principal and interest in the amount of $1.A00.00. Purchaser agrees to purchase Lot 2 for 526,675.00. Lot 4 for $26,190.00, Lot 13 for $42,680.00, Lot 14 for 542,680.00 and Lot 15 for $33,950,00. Provided, however. the entire outstanding balance shall be paid in full on of before the 30th day of July 1002 (the maturity date). Following any default in payment, interest shall accrue at the rate of 10 % per annual on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the cntir: principal balance). Purchaser, unless excused "y Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessraclits, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply pay ments w these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to prt~n~c~~rpal. Any amount maybe prepaid without premium of fee upon principal at anytime after day of elesing XXXX (OR) there maybe no prepaymeni of prir 'ipal without permission of Vendor.* In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is le:is than the armor that said indebtedness would have been had the rhonthly payments; been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the t:ondemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Mrst morttage to Builders Mortgage Company, LLC Purchaser agrees to pay the cost of future title evidence. if title evidence is in the forth of an abstract, it shall be rctaincd by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on day of closing. XXXXX " Cross out one. LAND CONTRACT- Individual end State Der of wlacoosin Corporate Form No. 11 -1982 IMennMion Prvfeesbnala Ceropeny, Fa"E du i-ac, w1 a0a•555-2021 jmrv tp h i 1 -3 10. N U~' M I INOS'09'05`W O~ gt IIN = 88 - ao I I k~ p 79' I I I I ' `pN ot -tl N05'13`11"W ' 104.77 ~ o~2 ' \ LO N m ~ V J\ `yam N \ tt1' 2 . I n O r \ Y~ SZS N N z"' LL. a) rni I w, w $~~j\ \~•s I OII .0 LLJ \ n F ` \d d W 'CA ;9 99 196 w ! .QS , ~ N I 0 ()too V') b QON$ CKO I. o. a C14 a U I ~y \ Q v \ \ \6~. N z l % t .S\NoNQ g v 000 04 00 I I \ -,100 \ 33 \ I \ \ 16.25'38"E v 17~2,p ~ v +I P, N ~v\ \ \ It < 00U) N ~m \ O w \ \ acv 00 LLJ W o\ S► \ 8g y \ /E 5 ' ~ I N2 3 p.'L2 \ ~ 522.ry9 ~~n M I \ \ \C2s -H 41.00 poo AL OP. R -00- • Q N \ 0) 10 3.W .00'0£ ` V \ 00 00 -AP O 0_ O `O ~q ~ 4 .53 \ ~v 0 I rnc' £j+ N1 c g'o ~o V t \ 04 L96 o II 79' N ( E ~PSEM k7"W `m PI) ; P\NPG ppg \t\w ~rn \ x ~ I ~ R Nei , ~ 4 Q I / 3 iZU\I M \ V F- N o 200 I c .1 1 V) V) i I o Q W I W 7V OD ob ch 81. to 99t°pi M - 50• 56 aNVI a3J