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032-2028-95-125
-0 0 / 0 0 1 l cc 0 V A (1) ■ z 9 Z C, w 0 0 (A 0 0. S CO 3 'P 2 0 CD (D z 5t 0 ? - 4 A 0 C 0 CD 0 -N 0 0 CD > CL C , Er 0 • U) > m <D CL 0 :3 ca r . ca CD � o , § § i �; � ( CL a) z CD w ; § 0 CD CD 0 -4 -4 KJ rr tr 0 0 0 ia v U) w Oro 0 . 3 1 0 cr 3 0 w Zr m 0 m C) 2 Z z N 0 0 Z z§ a > 0 0 0 0 0 0) Er 3 = m TWA a 0 0 (n CA CD af t w (D 3 (D 57 1: c6 -q CA i z z o M W m m CL z 0 3 rr S* 0 > 0 E. CL CL (D Or — 0- m -4 C :3 U) M — Z CD po 00 6 CD 60 4 E -4 3 CD m CD Qb 0 m 0 69 0 CD 6 CL 00, /9 7vv / 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �•�otx l �A'TIO►'}�C. (J��T ADDRESS 1603 1 . ���I,�� 7 loo /� 13 s<3Y3 SUBDIVISION / CSM# T # SECTION T 30 N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i l30 711-7es '4 vu- og INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. J. BENCHMARK: �G�• �15d. sO C" �v►� �� Q �'�� i-F- � ALTERNATE BM • y S OD! 4 - 7 - N • 7 . 7/?. �' /ev, _ F7 � (� SEPTIC TANK-/ PUMP CHAMBER / Manufacturer: Liquid Capacity: Setback from: Well / Other Pump: Manufacturer &GV L,05' Model# _ Size � P. Float seperation l0 Gallons /cycle: 175 bi :4• Alarm Location 2NS /DE' Fy7 Z ,L IV `.K SOIL ABSORPTION SYSTEM Width: 3 Length 7 8 Number of trenches Distance & Direction to nearest prop. line: } - SOO Setback from: well: } S� House 50 f Other ELEVATIONS Building Sewer �Z•2O ST Inlet: 91.68 ST outlet: G d 79 r PC inlet 8a.77 PC bottom �5' 18 Pump Off 77. 70 o� Q #1' e� cc,. aP Header /Manifold / ? Bottom of system /ew ]re� A,� FF. fD • 13 o Existing Grade Final grade 7.07 -+z, Txe-.e _ /o) • GS • Z S. Z 5 . DATE OF INSTALLATION: PLUMBER ON JOB: VIP ('G LICENSE NUMBER: ,�s 3 3 0 / -7 INSPECTOR: / "/ J �� �r 3/93:jt 7. r Gd SS = o eor A oX - rAe l�oce�[d s S'�•v �t.�' SG,4 L L - rop 5kWs � 142,Z - - - - - Tor "P - 1 p� Fps p�eo TE c ri'On.) zl.�D� D�l'ivL' 7b/' 6�06f e4.e7 7, I /3•tsE �� H ,cc.v �o,vuSS�•o.v � �-Cv , .>t T N � m oo %Q,c: . PT yo ' /fov� 1 �S• 1 , 3 �v y, /of-7 SV Ulbricht & Associates Cants Private sewap 855 O'Neli Rd. Hudson, Wis. 54018 / "&Y • O PZ07 PZ 411J Submersible Effluent Pumps 3885 AVAILABLE CERTIFICATIONS L ISTED SUBMERSIBLE PUMP CL G CLASSS I A140 11 DIV 2 AND CLASS III DIV. 1 AND 2 ETL TESTING LABORATORIES, INC. CORTLAND, NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION $�1 POWORMANCE RATINGS (gallons per minute) MODELS YrEi51tH WE0511HH Series HP Volts Phase Max. Amp. RPM Solids Wt. (lbs.) Series WE0512H WE0712H WE1012H WE1512H WED51214H WE1512HH WE0311L 115 9.4 N0. WE0311L WE0311M WED532H WE0732H WE1032H WE1532H WE0532HH WE1532HH WE0312L 230 4.7 WED312L WE0312M WE0534H WE0734H WE1034H WE1534H WED534HN WE1534HH 1750 56 M P % %3 'A2 3 /4 1 1'/2 '/2 1'/2 WE0311 M 13 115 9.4 RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 1 4.7 5 100 70 80 90 106 — 60 — WE0511 H 115 13.0 I 10 80 65 76 87 102 112 56 84 WE0512H 230 6.5 1 5 60 57 72 84 100 108 53 82 WE0532H 208/230 3 3.4 20 36 45 65 79 WE0534H 95 105 48 77 %2 460 1.7 60 w 25 25 59 74 91 100 45 75 WE0511HH 115 1 13.0 'w 3 0 50 67 85 96 40 72 WE0512HH 230 6.5 it 3 5 40 61 79 92 35 70 WE0532HH 208/230 3.3 8 40 26 52 72 86 30 67 WE0534HH 460 3 1.65 - 4 5 10 43 64 80 25 64 WE0712H 230 1 10.0 w 50 30 54 73 18 60 WE0732H % 208/230 3 5.4 3500 2 _5 17 42 65 12 58 WE0734H 460 2.7 70 60 6 30 54 3 WE1012H 230 1 12.5 65 16 40 51 WE1032H 1 208/230 7.0 26 47 WE1034H 460 3 3.5 y� 75 5 14 43 WE1512H 230 1 15.0 - Ou 4 40 WE1532H 208/230 9.2 90 WE1534H _ 460 3 4.6 100 24 WE1512HH 1 �� 230 1 15.0 80 11 15 WE1532HH 208/230 9.2 120 5 WE1534HH 460 3 41 metal parts, BLINA -N elastomers. METERS FEET • Temperature: 160° F (71 ° C) 90 - maximum. MODEL 3885 ' • Fasteners: 300 series 25 ao; ? i SIZE 1 /4" Solids stainless steel, wEts►1 • Capable of running P 9 70; ' I without damage to 20 wEtoH components. 601. _.. :. —► 5GPM f Motor: _ weo 1 5Fr •Single phase: 1 /3 HP, 115 or Q 15 230 V, 60 Hz, 1750 RPM; o vrE '/2 HP, 115 V, 60 Hz, 40 3500 RPM, /2 HP through 10 WE03M _ 1'/2 HP,230 V, 60 Hz, Sod 3500 RPM. 20 Way Built -in overload with t i 5 1 � I I automatic reset, class B I insulation. 10 i ii3 • Three phase: 1 /2 HP through o o 1'/2 HP 208/230 V, 460 V, o 10 20 30 40 50 60 70 80 90 loo 110 120 GPM 60 Hz, 3500 RPM. I l 20 30 m /h Class B insulation, overload Protection must be provided CAPACITY in starter unit. a Wisconsin Departmentaf Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safe4y and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289349 Permit Holder's Name: Cit Villa a Town of: State Plan ID No.: JP GOLF MGMT /ST CROIX NAT' L GO A CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 2061 -60 -000 TANK INFORMATION ELEVATION DATA A9700165 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o ' Dosing Aeration Bldg. Sewer [ Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. ` tS Aeration NA Dist. Pipe Holding Bot. System C f PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft L oss Forcemain Length Dia. Ii Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _ r n I I )-- , DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of n c�3 CHAMBER mo Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 18.30.19.744A,NE,NW 1603 CTY RD V r t �J - �� � ; k . Plan revision required? ❑ Yes [:]No p( Use other side for additional information. SBD -6710 (R 05/91) " 100w Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Cq 4 y E i i =" Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ,p� I than 8 112 x 11 inches in size. q • See reverse side for instructions for completing this application' State Sanitay Permit The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION I C ' q 7 j S 3 Property Owner Name n P ��`� ,1w AlL1 4 IVW 1/4, S 1g T � , N, R rQ E (or) IGo3 Property Owner's Mailing Address l Lot Number Block Number V City, State Zip Code Phone Number Subdivision Name or CSM Number 150AJ&. t lt� /S 5 OZ.S 1 (1/ Xq7- N A II. TYPP OF BUILDING: (check one) ❑ State Owned 11 Cit Ne R 94 ublic 1 or 2 Family Dwelling - No. of bedrooms ❑ vll(i g of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) V32. - Cal 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1- ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5- ❑ Repair of an _____System____ ___ System____ _________TankOnly______________ ExistingSystem E sting System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V: TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 El Se age Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 12 E4-Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 3, b _2 ■ /� • ZS 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requir c�(sq. ft.) Propo ;d Csq. ft.) (Gals/d /sq. ft.) (Min. inch) q Elevation -370 (p )I- - r � d Al r/ ` e eo % /• �5 Feet VII Capacit TANK in gall Total # of Prefab. Site [ Ex er. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic A p p New Existing ,� /. strutted Tanks Tanks Y Septic Tank or Holding Tank 12 r 1eAPov ❑ ❑ F-1 1:1 Lift Pump Tank /Siphon Chamber 1 D y O f / ❑ E] El 1❑ 1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam fdFP /MPRSW N O.: Business Phone Number: i �►�' N W 330? 7�� 45 Plumber's Address (Street, Cit State, Zip Code): �� �SD�� � /► /� � s ,� ! IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (lndudesGroundwater D ate Issued Issuing Agent ps _�A pprovecl E] Owner Fee) Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD -6398 (R. 05/94) DISTRIBUTION:: Original to County, One copy To: Safety & Buildings Divi ion, owner, Plumber F - INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years_ 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair_ V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vei-tical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 corm; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 I\, Visconsin Madison, Wisconsin 53707 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary May 28, 1997 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN 597 -01537 FEE RECEIVED: 360.00 ST CROIX NATIONAL SENIC GOLF COURSE NE,NW,18,30,19W TOWN OF SUMMERSET COUNTY OF ST CROIX NON - PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above- referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. - The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and ch. ILHR 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. SBD5524 (R.07/96) SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 isconsin Madison, Wisconsin 53707 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary ULBRICHT & ASSOCIATES Page 2 May 28, 1997 PLAN 597 -01537 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sin rely, d `James Quinlan Plan Reviewer Section of Private Sewage (608) 266 -3937 3203R/ 2 SBD -5524 (R.07/96) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386 - Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S97 -01537 DATE May 28.1997 St. Croix National Golf Club OWNER J.P. Golf Management. Frank Posti PHONE _ _ ADDRESS 6016 Blue Circle Dr. Minnatnntra Mn 55342 410 LEGAL DESCRIPTION Site address: 1603 Co. Rd. "V ", Somerset, Wis.54025 Part of a 34 acre parcel. Tax# 032 - 2061 -60. NE 1/4, NW 1/4, Sec.18, T30N, R19W TOWN OF Somerset COUNTY St. Croi CSTM Robert Ulbrich C 2482 LOCAL AUTHORITY/ SUPERVISION St Croix Cnunnty Zon ing_De -pt. PROJECT DESCRIPTION: New construction, for a small 18 seasonal concession stand, with two restrooms; located within 500' of the main club house /restaurant. Please see attached concession building plans. One employee will serve the concession stand. There is no inside seating, or any inside access whatsoever for the public. No food is cooked or prepared in this building. Sandw fiches and snacks will be catered down to the stand from the club house kitchen. There is no stove or range or kitchen cooking appliances. No grease trap tank or grease trap building sewer is needed. The course owners and managers estimate that fewer than 50 people per day will use the restrooms, since the concession building is so close to the main clubhouse. A waterflow factor of 5 gal /day /per person is used (outdoor sports facilities). One floor drain is rovided for and this des is incor ortatin P g P g an ice machine /sink flow (exaggerated) of up to 50 gals. /day. Total estimated wasteflow is 370 gals. Very permiable sandy soils (.8GPD /ft ) were found in the soil test area. Rockles.s trenches (using "Infiltrators ") are proposed because of the steepness and sensitivity of the area (landscaped golf greens). Heavy trucks cannot negotiate the site. Likewise, manufactured steel treatment tanks are proposed (Door Cty. Fabrication Co. Pg . 1 PLOT PLAN VIEWS Sturgeon 4al" t, Pg.2 DETAILED TRENCH PLANS & SPECS ��o° 1SCO1VSj 4 Pg.3 CROSS SECTION OF TRENCHES Pg.4 INFILTRATGR SPECS ^�_ ` ROBERT1 ' Pg.5 PUMP CHAMBER CROSS SECTION & DETAILS 2 ULBPJCHT Pg . 6 PUMP SPECS : D"Joe HUDSON. WI " / ��� y ' uAtm�ii� n SYST �9 EM condit This design for installation is based entirely on measurements r.ei landscape conditions (slopes etc.) and soil suitability provid` I' lbe accuracy of his specs, as reported, shall remain the sole j, S NtlMAM IIEIATtG ii of the CSTT1. 0 T+ DIVISION OF SAFETY AND BUILDINGS Any use of this POWTS design ty any licensed plumber, or any r�'�� related unlicensed parties or persons (excavaters, laborers �p� GE' ... shall not be construed as an assumption of responsibility by SEE CORE =V ' IV E the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumt-er that any unspecified components MAY 2 7 1997 are state approved or proper, or the effects of poor judgement If working under adverse damaging weather conditions (wet /frozen SAFETY d► �$ G�IY soils) by any such parties or persons. Go �� 9� i ° 5 `� ^LN N cN it d i � X10 d o C � (1 C � � $ ► 100 1 I o � o tl w o •, � 41 � I ,�, o � ��'�• � � 1 1 1 1 1 1 ` p' M O I I 1 11� 1 oc, �► ti � (l 1 1 1 i 4 � �' LA � ra s 0 � o r ' Li eN I I I i I I o I I i i i 7p f7j 1 1l I I y I ICI I � I � I I I o I LN a I - n w c �o � o o G��A � �A� ti e � 65 ,o SO 5a<. Qo = /Ol , 45 Z ,� „ �pvc � s y s TAM �o3,a CRo S S c Tio� IA-) IN i G 7i r,,9- Tog's �9PPAOe > lo LV T U v �,vsp Ec T /ov t o lh-je Iff 49OUE Lb UeL P4rie-�D Sys TEA RECEIVED MAY 2 7 1997 SAFETY & f3LtDCS P� J � V N I Z ' m °z -n ' 0 RECEI %Icn MAY 2 7 1997 SAFETY & BIOGS DIV PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P ✓`oF VENT CAP 4 "C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER � 25' FROM DOOR, 12 "MIU. �/ ui^�N�Nf! /���l WINDOW OR FRESH AIR IAITAKt I r,,tT /oAl GRADE I I 4" MIN. IB " MIIJ. 9 COUDUIT — y �lEv4n oti 7?•� INLET PROVIDE I I - - - -- L._...�.. T / AIRTIGHT SEAL nnG I I APPROVED JOINT A y,I{V K I III APPROVED JOINTS PIPE IN "I �UF� I III W /C.I. PIPE `XTEMMUG 3' 0� , \ I II ALARM EXTENDING 3' ONTO SOLID SOIL ONTO SOLID SOIL I (�S i o N I I E LE V. �� Z FT. P __J PUM OFF D (� y 00A � p� 2 BLOCK i /e VA f 3 5A " �� ` RIStR EXIT PERMITTED GML-4 IF TANK MANUFACTURER HAS SLIC1.1 APPROVAL SEPTIC E SPECIFI'CATIOI�IS DOSE -DOOR 600,4 TY f j I o ,,3 4 TANKS MA NUFACTURER: Cr`, aPT wEC.DiaG -�j� IJUMBER OF DOSES: PER DAS TANK SIZE: �d 97 GALLONS DOSE VOL UME 36 ALARM MANUFACTURER: 4EUF/ 41�,A6 � , INCLUDING S ACI(FLOW: '(per GALLONS MODEL HUMBER: �� �"' CAPACITIES: A= 21 ' INCHES OR 370 GALLONS SWITCH TYPE: ' ER CyR F - I O AT" g = q INCHES OR r ` GALLOIJS PUMP MANUFACTURER* p C =.�! INCHES OR 1(v.a GALLONS MODEL NUMBER: /W / �P�4� �i �` D= 31 IAIC"ES OR 53 q GALLONS SWITCH TYPE: MER �IQAT_ NOTE: PUMP AMD ALARM ARE TO BE � . MINIMUM DISCHARGE RATE C� _ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 3 d* 8 . FEET -- "A A-)k SPEC - MINIMUM NETWORK SUPPLY PRESSUR / . . . . . . . . . . . _ •r FEET I t �I .Jt Pli ! * 19 0 FEET OF FORCE MA X ' •io F yo oFL FRICTION FACTOR.. • FEET t"go'AIC l�p. j ' 1 yd — TOTAL DYNAMIC. HEAD = FEET INTERNAL DIME."SIONS OF TANK: LENGTH _ ;WIDTH 72 ;LIQUID DEPTH i em Plec4s r .4oP.eov & TRb QOx o f TO So `/`. J O S . 0-/ T IE'FN�G S glAvl' T y Flo 21 fit 9 RECEIVW- MAY 2 7 1997 SAFETY & ®LOGS. tdiN 11s HEADI 2 Its- CAPACITY 32 joS CURV 3e ,� 95 2e - 26 es - I I EFFLUENT 24 so —T MODEL f] 75 MODEL - and DEWATERING = 22 70 165 — LJ 20 65 - - a ea — O 5 5 _ F 16 So MODEL _ 163 MODEL 0 14 4S te8 12 40. - 35 -- 10 MODEL MODEL 30 MODEL i8S SEWAGE and 25 DEWATERING 6 20 - - - — MODEL 15 MODEL _ \,- __ 161 4 Is R MODEL 2 LL ' 5 57.59 0 GALLONS 10 20 30 40 50 80 TO 80 90 100 110 24 80 -- - - — LITERS 0 80 160 240 320 400 22 - __.. FLOW PER MINUTE 70 - 20 18 60 - -- - - MODEL - C 295 Q 55 - — - — = 16 — v 50 _ �- -t - -- - -- -- — - Q 14 - �S MODEL -- -- 294 - - } - — - -- — - Z ECEIVED J MODEL 35 F 1 ° -- 293 - - - - ---- -i -- - --� -�- - -- - -- -- - - ' MODEL MAY 2 7 1997 30 264 -- — -- — -- 25 - -- - -- -- - - - - - SAFETY & BLD6S.'DIV• 6 20 - _ I .— 282 4 15 - -}- -- — - -- - -- . . - ! — MODEL 0 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 60 1 90 100 110 120 '130 140 450 160 110 100 140 P.O. Box 18347 Louisville, Kentucky 40218 LITERS 0 60 160 240 320 400 400 360 640 720 (502) 778 -2731 ' FLOW PER MINUTE cc !7 a It 1y tt +tff tt f! tt � � HIGH HEAL) 161 1G3 - 165 185 - 188 - 189 " Seri (%2 HP) (%2 HP) (1 HP) (1 HP) (1 %2 HP) (2 HP) • Automatic or Non - Automatic. staun "' "' "' • `h H.P., 115V, 23OV, 200- 208V,1 Ph. or 3 Ph., l 1" r..' un rx u•, a. u•. re tot ar a•. f r u.. SO �G 46OV, 3 Ph. ,,, sro , s,e ". m ". m tae sro so rx IM =i • 1 H.P., 1' /z H.P., 2 H.P., 23OV, 200 -208V, I Ph. s fsr + s .. .° rr+ ns . osl sas sst las ea+ m a ro ex s.o so fn m Ise sls 'ae ss° or 3 Ph., 46OV, 3 Ph. a ref f va v :'e s+ m xn fe. m sw • Passes 3 /." solids (sphere). n 21 e5 }ae ss x+s s" vm ' san Ial ase Izr ael m 'r'o ae va fe rry ss a'e rs SC 1225 fes +m xr na u' • 1'h" NPT discharge standard. '+N 7' so • Float operated, submersible (NEMA 6) 2 pole 4� Ill N S O 1 93 N 70 10 mechanical switch. "" "'" m n f: s e sr /ae • Automatic reset thermal overload M y OR e m protection, i Ph. only. 10 vvs v.�.• ss ee er ,. n ns • Durable cast iron construction. • 2" or 3" liange available. a Canad1an 51andalds • 20 1t. UL listed neoprene cord and plug. + UL listed O ^asoc ^oolo+ ava'lable N O" O - ^1 " WARNING: Model 185 should not be subjected to less than NOTE No UL listing for 200- 208V /1 Ph. PUMPS. Model Pichned 30 feet TDH. Mercury float switches are available for non- aulomalk models. 5�r'TE �F a9,tv�ss : ST" 601'X N'�4 rro' Z_ GoG� C G e '13 3 ` 16,03 Co . iP0 " t/ -5 6dls . SYoZS' ' Wisconsin Department of Industry SOIL AND SITE EVALUATION 2 y�_ zlzee o / Pa Labor and Human Relations Pa e of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and sT C�r�/ X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 03z -2 0Co /- CP o APPLICANT INFORMATION - Please print all Information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' Property Owner $T: CRO/ K A q71 oAJ f z_ o1 G'o a, Property Location �j d.1 • & O t- F l'I AtJ M &�T. - -t - N C Govt. Lot NE 1 /4 N 40 1/4,S /4 T ,N,R � E (o(D Property Owner's Mailing Address C/D 7 T/c Lot # Block# Subd. Name or CSM# 6D1� %3� �� ci,p� /� - D R • PART elc 3`51 g&e 1 444 6e� city State Zip Code Phone Number Nearest Road ti1iu�� To v�/f - �N 5 oy - (� 1 z) 935 - SoBo ❑city o 0 village �wn ❑'g Construction Use: ❑ Residential / Number of bedrooms Addition t ng building ❑ Replacement E3fu or commercial - Describe: Code derived daily flow 3 gpd 2 Recommended design loading rate bed, gpd/f? � 5 trench, gpdfft Absorption area required _ bed, ft .J trench, ft Maximum design loading rate bed, gpd/0 0d trench, 9Pd /ft Recommended infiltration surface elevatton(s) sX-e_ A4 • 3 ft (as referred to site plan benchmark) Addifional design/site considerations Ae4&�55 7A&AZ4I S OW SAO w / � ,�'D /� /3 0 X- Parent material _ _��i�l ;¢G OU7 5 4A- 1 P - Flood Flood plain elevation, if applicable N ft S = Suitable for system Conventional Mound �,/ _In- Grou / nd Pressure ;; GG System in Fill Holding Tank U = Unsuitable for system �❑ U ❑ s L 7 U s El U a❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o-g' /0# s� /fsd,� s� _5 I - s y 5 -1 /oY 3/e1 LS /.t►, ds C,$ ,� , 7 ' • 8 Ground ,3 ? / o Y P- s!� S 0 S elev. /o/• Depth to limiting factor Remarks: Boring # l /& /o yto V el L /fs/& GeLi 'x , �{ ; . s .3 �9r!v 7 5 YR Ground elev. Depth to limiting factor �ytn. Remarks: CST Name (Please Print) Signatur Telephone No. Ro 13 ERT 24 t-0 R i c47 7 ze4 4� 7/S 3 aG • 8/95 Address Date CST Number -s 169 - `?— CS 7—If 2 VP 2 — Ulb ri cht "dldtds Prhrate Sews" 06n*ulfa fn 855 O'Neill Rd. Hudtt4rny, Mtn. 54b`f � _. SO A�5T1oD-f 1 5 � G � �? J� �o ;r 3 SOIL DESCRIPTION REPORT PROPERTY OWNER Page of ' PARCEL I.D.# 03 2 Zoe 6 D Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench i 0-7 10,ye 3/f"" s w /oY,e Si 2 fs6.� cjr Ground 3 ? 5 - y6 lov 31je L S de C5 7 ,• g elev. //O • �o S d S �� _ — '7 • g Depth to limiting factor � in. Remarks: Boring # /f'Jdle �s� as y -� o ,e 3/ GS / GPs of , 7 Ground elev. Depth to limiting factor if —In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # / _8 /p � 3 .SG- /�Sd,� S �•S • S �f /f . ' /ofd Ground lo g, Depth to limiting // f '' acto. 7 1 n ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: S13DW -8330 (R. 08/95) I 6-o L P�tr 60' th �l �o � I t a I i II I I � Z U), • - NN - I ZO a N G p y a► 1� � I \ � 00 N / I ry �OV3 it N� 0 b � fi 7UP O O v► 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording -- - ) eao) - - C GU,vIS _ CG - S {. - - - - -- M�k)Ay+vq� Owner of property L Gtr Location of property�1 /4 /V W 1/4, Section = T 3 U N -R W Township Mailing address Address of site 44 Subdivision name ±Z Lot no. Other h= on property? Yes No Previous owner of property 14 AV (d e Total size of property P l OF Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 111 and Page Number L115 as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S J-71 ZO � and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co- Applicant �q q Date of Signature nat of STC -105 I SEPTIC TANK MAINTENANCE AGREEMENT ((` b St. Croix County • �• G � OWNERBUYER MAILING ADDRESS PROPERTY ADDRESS SJ (location of septic system) Please obtain from the Planning Dept. CITY /STATE ,� / PROPERTY LOCATION 1/4, I V � 1/4, Section / 0 T N -R TOWN OF A 7 , ST. CROIX COUNTY, WI SUBDIVISION ±.IZ4 , LOT NUMBER CERTIFIED SURVEY MAP, VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can .affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed d returned to the St. Croix County Zoning Officer within 30 days of the three year xperation d r SIGNED: J DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 Parcel #: 032 - 2061 -60 -000 02125/2010 03:11 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.19.744A 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - ST CROIX NATIONAL GOLF & EVENT CENTER LLC ST CROIX NATIONAL GOLF & EVENT CENTER LLC 607 WASHINGTON AVE S STE 207 MINNEAPOLIS MN 55415 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 34.000 Plat: N/A -NOT AVAILABLE SEC 18 T30N R1 9W 34A NE NW LESS 6A ASM'T Block/Condo Bldg: INC 032 - 2062 -90 & 95, 032 - 2029 -10 -110, 032 - 2029 -50 -100, 032 - 2061 -30, Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 032 - 2063 -10 -050, 032 - 2061 -60 & 70, 18- 30N -19W 032 - 2028 -95 -125 & 032 - 2029 -40 Notes: Parcel History: Date Doc # Vol /Page Type 05/02/2008 873943 EZ 05/02/2008 873942 EZ 05/02/2008 873939 EZ 05/02/2008 873938 WD more... 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 1490 2,072,400 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 219.940 874,400 865,000 1,739,400 NO Totals for 2009: General Property 219.940 874,400 865,000 1,739,400 Woodland 0.000 0 0 Totals for 2008: General Property 219.940 874,400 865,000 1,739,400 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 #: 032 - 2028 -95 -125 oz/25 /2Q AGE E I PM P 1 OF 1 Alt. Parcel M 07.30.19.577A -10 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/28/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ST CROIX NATIONAL GOLF & EVENT CENTER LLC ST CROIX NATIONAL GOLF & EVENT CENTER LLC 607 WASHINGTON AVE S STE 207 MINNEAPOLIS MN 55415 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1603 32ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 7 T30N R1 9W SE SW EXC 3.43 AC TO HWY Block/Condo Bldg: PROJ 1559 -08 -21 & EXC CSM 22 -5319 ASSESSED W/032- 2061 -60 744A Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 30N -19W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 05/02/2008 873938 WD 01/03/2002 667040 1805/630 WD 05/03/2000 622270 1507/261 DC 07/23/1997 450/32 more... 2009 SUMMARY Bill M Fair Market Value: Assessed with: 0 032 - 2061 -60 -000 Valuations: Last Changed: 11/30/2006 Description Class Acres Land Improve Total State Reason Totals for 2009: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 February 10, 2004 WP Golf Operations Attn: Steve Whillock 526 Inwood Avenue N. Oakdale, MN 55128 RE: Banquet hall addition Dear Mr. Whillock: This letter confirms zoning approval according to the plan drawings submitted to the Zoning Department on January 27, 2004 by Steve Norstad of Cannon Construction, Inc. Staff understands that St. Croix National Golf Course proposes to add a kitchen and restroom facilities to serve the banquet hall. After reviewing your request, the Zoning office does not deem this as a major change from the original approvals. Therefore, staff finds that the proposal meets the spirit and intent of the St. Croix County Zoning Ordinance for the following reasons: • Property is currently zoned Commercial • Town Board approved the expansion on October 1, 2003. • Special exception approval was granted by the St. Croix County Board of Adjustment to conduct a Golf Course Clubhouse with conditions on November 15, 1995. • No change is proposed in the operation plan. • The structure as shown on the site plan meets the state roadway setbacks. This document is to serve as approval to constrict a kitchen and restroom addition to serve the banquet hall facility as submitted subject to the following conditions: 1. All security lighting must be illuminated downward and is to be shielded away from neighboring properties. 2. All temporary erosion control practices shall be installed prior to commencing construction. 3. The property owner is responsible for the ongoing maintenance of the best management practices during the construction project and after the site is stabilized. 4. All driving surfaces must be paved within six (6) months of the completion of the building. 5. The applicant must continue to comply with the Board of Adjustment's conditions from 1995 6. You are responsible to obtain a building permit from the town. Please contact Brian Wert at 715- 760 -0027 regarding the procedure for obtaining a building permit. 7. Significant changes to the commercial use in the future may require the Board of Adjustment approval. 8. The structure must comply with all local, state and federal requirements. 9. This approval does not include the addition of employees, and /or signage. 10. All St. Croix County Zoning provisions must be met. 11. Please contact the Zoning Office upon completion of the project so Zoning staff can inspect the project for compliance with this approval. Future expansions may be required to address onsite storm water management issues. A copy of this request will remain on file in the Zoning Office. If you have questions relating to this matter, please do not hesitate to call. You can reach me at the number above, Monday — Friday, 8:00 a.m. — 5:00 p.m. Sincerely, Rod Eslinger Zoning Specialist Enc. 1995 Board of Adjustment Decision Cc: Jeri Koester, Town Clerk, Town of Somerset Brian Wert, Building Inspector Steve Norstad, Cannon Construction, Inc. file I. 0 N Q 0 (n Q 0 0 0 C m n rjA o d F l 0 w f l O m f c 11 O � 1 .. 3 1 3 `" 3 3 rr 3 rr -_ w Z to z O N L w S Z m z 0 N L Z= N z O w Cf ) Cn O O 'S O G � LU 1 ".eY 3 O C a - o N C 0 Ln =O 0 V N o �s -4 3 io ►.+ o a 0 rn G7 A Q m (D v O CD a m cn C:) No a rn(D 0 j (�D w w 0 A rn ry oa 3 m 0 0 p m U) N N O� N �• N 00 (0 a y0 d 5' CD n = o v j' O (° °° a t (D CO O 7 a Q a O n D N e•r a CD ' C O D d m ID ID CD I tea. a) w Co z D m .a. � I � U} Z D ID � C: •• Z D m . m IF D +� a @ D +� a o w a y co 0 co 0 Go N r I O O p) N Q L j W Q O 0 ' .'^^•, m f 0 w , {"'.`� W W cn v ' ((n Ul p y m o p O (D t (A ' Ali y 0 C a a C,) Cl) w 9 cn 0 v o 3 N N N 3 0 o I3 N N N 3 x 3 N N N N 3 Q T p p o N 0 v G G o 3 Q O n w 00 O" 7 R tD m N 00 O" 3 N CD y N w A_ (A p (D d _. O N Cl r. pf 0 O m N N = N (� W :. D1 N 3 m d l N 3 3 m m 3 0 CD m - cn m ° n N o .. zcoz 0 D a 0 D o m D a m cn v O v O O a 7 S 7 � N m ID m m CD CD CD m cn • CD y CD y <D c CD C CD Cl) @" a w �' a �" a 3 3 3 CD -1 N Z CD � Z CD � ca > > A O n c m c ±, a Q 1 N p p_ a A Z 0 0 0 m CD W V C (D m W m o CL c 3 03 A » - N y Z y Z CD CD A O O O p� CD O N Q p C CD O CD c CD a CD C p 0 - cc — a C fl- O F CJ CL C . 7 . . C m T C O? p C S TI O "n 07 0 C Q D) C y. N N fl) C C d z 7 S— N O S a CD O O Z 7 N- a o z a a c C CD m o _ •• c o •• m e a� a o .. cn m CD m CD a � o w m N N — N 0 - fD > 0 cu I y ? m O0- S O 2 m N (n m U w * 3 a 3 0 > j c N +� CD 0 3 Q� f p a o c N 3: m m v ?Saco �e N 3 Q CA O CD 0 3 tea, 0p C (.J Cr- J j O N A X O . O O I 0) �OaO) n p- 0 .. N m v m v o' - m ci a 0 0 m m (D < Qo o O o (O o O c CD 0 co 0 c - v0 r— o v E c o d `r1 m CD K C D 'v d m `° 3 xt m ` 1 0 M N O 0� O CO O w eC C) M m N y O Cl) 0 3 N O '- C X m O N C C 1 N Q w N 7 N Z O Q 7 V O O t3 N m 0 V Cn O C t C t7 O _ y V 3 7 D N T 7 N N O Q7 m m r o 3 co D d e n W c c o o CD "Now o o n r N CD N A A N° c rn O ir M M w rr �. z O O O I o N a O CD d N fn !V O to m y W CL - N z � I y 0 0 N 0 @ A !mil o m O � !n N N U1 ro p N C 0 m W A — a 3 0 :? Z m s C R �_ -I to N o Z c m i °^ y 3 c w m a +' Q. Ul .. Cl) W V W v m O m z c O " fn co m z O CD A d W Y CD a cjm w c - „ z a = 5--- i O N O C y m fi C c F a z m = N S �O CD N 0 O i � v A 0 00 � 0 ti EA O N O O * a O CL ti V Parcel #: 032 - 2028 -95 -125 03/20/2007 08:17 AM PAGE 1OF1 Alt. Parcel #: 07.30.19.577A -10 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/28/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ST CROIX NATIONAL LIMITED PARTNERSHIP ST CROIX NATIONAL LIMITED PARTNERSHIP 1603 32ND ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1603 32ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 7 T30N R19W SE SW EXC 3.43 AC TO HWY Block/Condo Bldg: PROJ 1559 -08 -21 & EXC CSM 22 -5319 ASSESSED W/032- 2061 -60 744A Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 30N -19W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 01/03/2002 667040 1805/630 WD 05/03/2000 622270 1507/261 DC 07/23/1997 1117/415 WD 07/23/1997 830/160 more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/30/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 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 #: 032 - 2028 -95 -100 03/20/2007 08:17 AM PAGE 1 OF 1 Alt. Parcel #: 7.30.19.577A 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/28/2006 00 6 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ST CROIX NATIONAL LIMITED PARTNERSHIP, RETIRED RETIRED ST CROIX NATIONAL LIMITED PARTNERSHIP Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 36.570 Plat: N/A -NOT AVAILABLE SEC 7 T30N R1 9W SE SW EXC 3.43 AC TO HWY Block/Condo Bldg: PROJ 1559 -08 -21 ASSESSED W/032- 2061 -60 744A (CSM 22 -5319 WAS CREATED) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 30N -19W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 01/03/2002 667040 1805/630 WD 05/03/2000 622270 1507/261 DC 07/23/1997 1117/415 WD 07/23/1997 830/160 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/30/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 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 #: 032 - 2061 -60 -000 03/20/2007 08:18 AM PAGE 1 OF 1 Alt. Parcel #: 18.30.19.744A 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s)' O = Current Owner, C = Current Co -Owner O - ST CROIX NATIONAL ST CROIX NATIONAL C - LIMITED PARTNERSHIP LIMITED PARTNERSHIP 1603 32ND ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 34.000 Plat: N/A -NOT AVAILABLE SEC 18 T30N R1 9W 34A NE NW LESS 6A ASM'T Block/Condo Bldg: INC 032 - 2062 -90 -95 032 - 2063 -10 -20 032 - 2029- 10- 100(CSM FOR 01) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 18- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 02/02/2005 786538 2742/324 EZ 01/03/2002 667040 1805/630 WD 07/23/1997 1117/415 WD 07/23/1997 830/160 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/19/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 219.940 874,400 865,000 1,739,400 NO Totals for 2007: General Property 219.940 874,400 865,000 1,739,400 Woodland 0.000 0 0 Totals for 2006: General Property 219.940 874,400 865,000 1,739,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q • 17s a A n w NOII dOI -4I1N3GI Law w ,� yO -4)ISH j JosePfi f/enne �� afj, F w •nol( aoj sgooq ayj A m F •� c, I 6uljnqujsyp uoijnziun6.10 6uuosuods ayj ao 'aul , $� ° a w N� o ��� At slays qnd dnW paojqao?/ \ w } b l Swanbe A A % /Ph lscons /� fi. D O Jo anljnjuasaadaa apy m c a -nuoq n yJIAA 6ullnap aaa no�f jnyj juaWaSrWanpn I n arc ��'� �� •�.� �" Q V Jno/( mauai of paj-injuoD f �`� Cl) ti -) 9-in y awns a 8 n no/( ua • " ; c, z: n , A , 3 Durar g A �pQA ^ •h a: > q ' • o y � o PP a ��� ° � � � n� W�.Q . N� � rn ck (p X O o iazt rc.a P u de $ 0�� v C O a l • B° q° n AA • ��J �• o A� a 1" 51 \ O 1n A � S � • .o � e • w �� 2I �o.d �IISI IflI1d a � -Owe // 3141 NONA n � 39VSSIW ��o O Y. T• ja 4� a � 0 , A • 0, � Germorn � � g. } efe � \ 'hm Y h � 'H::::::.: o � � A O 79 � � � 3G ,son •' v ::::li;"::• r. -� �� /ro,5= '_'. amen' Tas, f A J 4 ° Nanc • c�a _ no .. :::::. :.•. rlaac,E ynder G.tia � n ::.� - cs. beck k: hated 7 p n d o R\ \Zl 9ZOb9 u!SUO3SIM'BIJIBJd IBIS 09L£ :3MOHd a ^N ° g " a j �,•� fb RIV ■ I P l l � B ui q wn id ■ k INYr'ths� s6 � 1. � �� p C pi w m v. j AAA � 1, C q O uemps (b �' A A m , 9 (` ] A') l� 0 A 't '� • � � �` w !I /fled. �i/ inrQi� N c � SE£ PAGE 43 Form Plb 67 Wisconsin State T APPL CATION FOR PERMIT Division of Health for PURCHASE OR INSTALLATION OF A SEPTIC TANK 6 1� (Sec. /W— �P�. 7 144. 03, is . S ats . ), A. OWNER OF PROPERT Type or use BLACK ink. Name Address Street, City, Zip Code / 7 B. LOCATION O PROPE WHERE SEPTIC TANK IS TO BE INSTALLED Check 17 City Mail address County one: 2. _ Village JV Give license number held: C. INSTALLER Wisconsin Restricted Licensed Sewer Plumber Services Name Address D. SPECIFICATIONS OF SEPTIC TANK NEW TANK REPLACEMENT Size in gallons: Check one 1. 500 gal. 4. 1,500 gal. 7• 4,000 gal. _ 2. _ 750 gal. 5. 2,000 gal. 8. — 5,000 gal 3. 1,000 gal. 6. _ 3,000 gal. 9. mover 5,000 gal. give capacity Oev Materials: 1. Prefab concrete 2. Poured concrete 3. Steel E. TYPE OF OCCUPANCY 1. Single family residence 3. ommercial establishment 5. Other 2. _ Multiple family residence 4. Industrial establishment F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY 15 G. PERCOLATION TEST MADE 1. C Yes 2. No Date �c �"� By whom (To be completed by County Cle k) Date application is filed 7zo paid Permit issued (date) // ,,7 Periftit Number- 9 7 S Count Clerk Note: The application cannot be conside for f ng until all of the above questions are answered and the fee p5id. Count Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. 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C •- m O t U •-- 4j 4) E C 4- m E > m u > N 4- E r- 4- 4) 7 m M 41 O L m C 4) •- O 3 c O c c O + .• 0 O L .0 m • c ++ O 4) m 3 u L 41 4) C.- ._ 41 • a >. 41 ^ L L s - ++ C • C 7 - .0 4 4) 'O c O m O •O C C m 4• d +1 E m >. 4J 0 0 O m 0 c m U 0> O C 4) •- m L c - 0 •- 3 X_ L m 3 0 0 • O u L. •- c 4- •- ++ 4 •- •• c O 3 W-- 4J m 3 •- m 0 L 0 t v► m .D L m m 3 " m 0 4J c E 4+ m •- m.0 ++ ro m x ar u a 0 0 s • m 4J m e 4- 0 m L u O c c m - m a L •- E U - m a+ F a v - 4- 0 m y c= m 4) U • - C 0 t x m 4- 4 0 C C— O 0 d •- O C to 0 E •- > m •- &- C m c O 4- 4) u L 3 m m W .- m m — U — L O m >. ++ 0 .0 m L. 4) 4) - 0 O ++ 4) ++ — C • t m m - O1 — 4) — (M m c— m L U 4) c m-0 •- m 4) O 0 0 4J m N m - L c m C— c %D m •- •- 3 C 7^ c L+ u L 4) a+ L 4) t C L -0 +j 0 d —= 4- -- .- 4) O m •- m t m C C 7 4J L m •- 4J ++ O O 0" m 4) d (a .. +-+ m 4- c to '0 (n m 3 s •- •- O O I- - 4- 4) u 4- m y O 41 m W W .- m - m- c 0 m >. 4) 4J :G c O - a— 0 m 4) O 0 E m 0 ++ m E m m - m m L •- >. a m E— v X u 4) 4) m L 0 s- C 4) a 0 3 (m Er m4 4) 3 - 0 m • - �L — LL > 41 • U.0 0 04- L 0 0 m m O C W 0 4J 4) •- C 4) m 4) • O L- 7— a m ++ m 0 4) 7'— C L L p C m L •- - s- a+ U m m 4J m ++ O m O a >— = C 4) — •- M O a 4- 4J O V — O m a+ 0 m m m C L. 4- L c. L 41 •- X •- - m •• .D c O O c 0— t s- m 0 a L. a L. > - • 4) 010 0 0 0 s- E •- 4- X 7 t _d 4) O C— m a.- 0 0 3 m c 0 m C +J O > C t C 4J 0 4- 4- W.- p m L.C c 41 1.- 4 -4J4J- - 4 1 0 c¢ O CL m 3 c 4 1 C L 1A O O ++ ++ O C 4) C 0 m m 0 m m m O c t 4) 0 • m 0 m in 0 t m •- rn s m O L• 0 3 4J = CO 3 •- 0 4J 4J >> d 3 4 J m 4- L ++ 7 41 m — .-. a+ p 4J � L a+ .-. 4- u O 4) 0 IJ .-. 0 ,-► 4-•- O 0 m 0 ++ m w c v m-- .0 m 0 m m O c c — m-0 E c U c O O 4J m u _ O o v s- W 4) O m ^ 41 vs 0-1- 4J 1 .. 0 m � •...- ._ .., ._ L O > C •- m > L L 4) L m- c m C m 3 O L L aJ 0 L L 4J 4- y L O 0 4+ m a O v > 41 L- .- u 4j 3 o u 4+ 0 c- 4) 4) U a s+ >. L m c CL a c 0 E 4) 4J m D d L O L 0.4 " 4J - 0 0 0 m 4) 4) +J >. 4) O L 0 L m L 0 0 3 7 L 4-4- 0 4) 0 0 0 C m m m .0 L- 0 a c c t c c H - v u a cc a+ vs M m t m •D a - 0.0 a L a •- 3 3 U 4.0`0 4j m m 0 3:.- N M ? Plb 60 OCT 2 0 1 199: NAME OF BUSINESS _lj LOCATION S f� ;... �_ -- := �/ d36 `" L - 1, street or highway city or township county _3 T -�,� LY . OWNER �;. _ ). �� << >�:� -� ` f.I:. J Mailing address ARCHITECT OR ENGINEER Address PLUMBER � L . / �,?,; l,f, _..._ Address ; f l /- C 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: �/ N building Existing building New u g Addition If addition to existing building attach detailed memo for each. O Restaurant or dining room . . . . Seating capacity (10 sq.ft. /person) O Motel O Hotel O Cottages Number of units: Ragular HousekeopinZ 2 persons /unit 4 persona /unit TOTAL NUMBER OF UNITS O Bar or cocktail lounge . . . . . Seating capacity (10 sq.ft. /person) () Nursing or retirement home . . . Number of beds O Mobile home park . . . . . . . . Number of units - dependent - nondependent O Service station . . . . Number of cars served (daily) O School Number of classrooms Meals served Yes_ No Showers provided Yes (} Factory or office building . . . Number of persons (total all shifts) O Residence . Number of bedrooms O other - specify 2. Indicate whether or not the following facilities are oonneoted: Food waste grinder . . . Yes No � Dishwasher . . . . . Yes No Automatic clothes washer Yes No 3. Fill in the appropriate information for the following as indicated: Septic tams capacity planned / 7; Normal septic tank capacity required 50 increase for VgG or AN - Total septic tank capacity required Percolation test re €alts - ATT.#ZH PBPLOLMON T3ST RrPORf SHEd, i" Seepage trench bottom area pinnnsd width ``` , linear feet , depth Seepage pit planned outside diameter , depth below inlet , depth Ssepage trench bottom area required "', width ' , linear feet Seepage pit required , outside diameter , depth below inlet Signature of person completing form: STATE BOARD OF HEALTH, PLUMBING DIVISION J P. 0. Box 309, Madison, Wisconsin 53701 Address: ! Approved ; Date Date ? 9 LU r 1 ACES t!OT t;;i �I r 1 C1T'(, VIL- GRiz- I t� i ------- --- - - -- - w➢ y I - - - -- - -- - -- I� I , I i III T� - -- - ------ - - - - -- I i ;I - -- - -- -- -- -- - - - - -- - - - - -- - -- - - - -- -' -- i j . - - I J ' Ali Parcel #: 032 - 2030 -30 -100 03/19/2007 05:05 PM PAGE 1 OF 1 Alt. Parcel #: 8.30.19.584A -10 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HANSEN, CHARLES J & GLADYS CHARLES J & GLADYS HANSEN 1670 50TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 19.400 Plat: N/A -NOT AVAILABLE SEC 8 T30N R19W 29.97A SW NE EXC CSM VOL Block/Condo Bldg: 3/897 AND EXC P584B & P584C EXC AS DESC 1592/253 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 30N -19W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 02/27/2001 639292 1592/253 WD 07/23/1997 706/599 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 19.400 1,800 0 1,800 NO Totals for 2007: General Property 19.400 1,800 0 1,800 Woodland 0.000 0 0 Totals for 2006: General Property 19.400 1,800 0 1,800 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 I Parcel #: 032- 2030 -50 -000 03/19/2007 05:04 PM P 1 O F 1 Alt. Parcel #: 8.30.19.585 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HANSEN, CHARLES J & GLADYS CHARLES J & GLADYS HANSEN 1670 50TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1670 50TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T30N R19W SE NE Block/Condo Bldg: 1 Tract(s): (Sec- Twn -Rng 40 1/4 60 1/4) 08- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations. Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.000 2,300 0 2,300 NO UNDEVELOPED G5 2.000 200 0 200 NO OTHER G7 3.000 45,000 64,200 109,200 NO Totals for 2007: General Property 40.000 47,500 64,200 111,700 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 47,500 64,200 111,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 139 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges 0. 0 0.00 Total 0 00 0 rosin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ty and Building Division INSPECTION REPORT Sanitary Permit No: 453076 0 ENERAL INFORMATI-ON (ATTACH TO PERMIT) tale Plan ID No \ ersonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J 8 3 'ermit Holder's Name: City Village X Township 'Parcel Tax No: S St. Croix National Limited Partnership Somerset Township 032 - 2028 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 60 .0 / �O.O / 0„ = CST 8 A7 t 07.30.19.577 TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION pw HI FS ELEV. Septic Benchr�tark p.z0 r 1 W l S E - 2 t s� )en Alt. BM Bldg. Sewer tub St/Ht Inlet Dls�-"t'fin� CJ E f SL 2_ TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z� I I SS f Dt Bottom �, Header /Man. �,, / z > 4 / ft 9z.Zo L , Dist. Pipe �a Z I � � � ��� �. � � a � 1 Bot. System , Final Grade UMP /SIPHON INFORMATION �JI �o • Manufacturer Demand St Cover GPM M odel Number jFYDH Lift Friction Loss System Head TDH Ft b'� 3 .3 -' Forcemain Length f ia. Z Dist. to well 44 � SOIL ABSORPTION SYSTEM 2 Z BE RENCH Width f Length 7f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN ONS 2 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR N F11 T( � Type Of System: f > 2oo Q ( 1 > /ma UNIT Mode�I�N ber:�� DISTRIBUTION SYSTEM I Header /Manifold Distributio x Hole Size x Hole Spacing nt to Air Intake P e �v Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �7 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1595 County Road V Somerset, WI 54025 (SE 1/4 SW 1/4 7 T30N R10W) 40 acres Lot Parcel No: 07.30.19.577 1.) Alt BM Description = 2.) Bldg sewer length = S S - amount of cover = K T s - '. Plan revisi Required? j . ' Yes V.o � -L -- Use other side for additional information. Date Insepctor's Si ature Cert. No. SBD -6710 (R.3/97) Maiden Rock. WI 1 -325 -8456 Portage, WI 1- 800 - 362 -7220 Fond du lac, WI i- 800 - 641 NIESEI IIIII t . Webs�te. www.v�neserconcre a co m i �. C_M Cy- il) A�n W &-L i � NCtt CCLL. C-L C- " N s l��l � steer -^ � • �� � � 2 . S`F t ) �TetNCtt ES �T FRS I.�w �sT `l-o k c, kV 5 i A-L-4 -J 4 6R" �S ( �� e s c tt+ s SrsrE Ec � v�+Tr oNs 1 I) I5.7 .L , 3.7-(. 2) 15.32 = 9 . �a .5 9) 10 .83 3-�' DDS& - r - nWK 0 )0,13 = qo. off-' ,� 4. i Project Name: Computations B j it Location: "" Daic Titic /Ilem: Sfcct:: Of: S Y Z� °t b° C0 j6 tq If) Al Me r ` ,1 t �.S LZ1 Je sie � Nyve Subject: Wang, St. Croix National Limited Partnership, 453076 (Mound) Location: Somerset Start: Thu 4/15/2004 9:00 AM End: Thu 4/15/2004 10:00 AM Recurrence: (none) 032 - 2028 -95 -000 07.30.19.577 1595 County Road V 1 f -- Safety and Buildings Divisi n County 5 T ` err m 201 W. Washington Ave., P.O. x C,/C d �s�On��� Madison, WI 53707 - 7 itety Permit Number (to be filled in by Co.) Dep artment of Commerce (� 261 -6546 S3 Sanitary Permit Application M �'t` °' In accord whin Comm $311, Wa. Adm. Code, personal information you vide qR 9 7 may be used for secondary pugwm Privacy Law, s15.04(I xm) 2 if diff than mailing address) I. AppUcatioa Information - Platse Print Ail Information Property Owner's Name CF 2E - 77� /T 'Al / �" Panel N Lot 4 B Property Owner• icing Property Location olf C Zip Code Phone Number �/ti 2� ' /a Section p. ��n 'ln• S� 06 6 T 3© q(c iele IL Type of Building ( all that apply) N; R E 7v ❑ 1 or 2 Family Dwelling - Number of B Q edwo ms Subdivision Name 1t-RubHclCornmerehd Describe the J P e taY'S e N ❑ Stste owned - Daubs Use ❑City_Dvivaila Township of erye III. Type of Permit: (Cluck only one box on Use A. Complete line B if applicable) - ,� ^ - - 00 - 0 A. D Replsrenxm System ❑ Tnamsmtmosdiog Tank Rq&c matt only D Other Modirwatian to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Chow of ❑ Permit Tmwfer to Now List Previous Permit Number and Date blued Before Plumber Owner IV. of Powrl; Chock an that r 1 is Y' x /57P YIM t ' C�W1'1. I g Non —Ptasutixed hn- Cuo und ❑ Mound >— 24 in. of suitable soil ❑ Mound <24 in. of suk*k soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Coustmeted Wetland ❑ Pressuized l&Qround ❑ Holding Tank ❑ Peat Fiher ❑ Aerobic Treatmdtt Unit ❑ Rcomlating Sand Filter ❑ Media Piker ❑ (member ODnpLjw 0Qnrv&lcVPqn r e � V. Dispersiallfrreatment Area Information: R Design Sot C.e a - U t Appiicatioa R.te(gpast) Dasul R�uirod (st) $'u 7 es: o Capacity a Total Number Maautiduer Pretib Site Stoat Fiber Plastic e 9 >vew call= Gallms of units cAncr le Consuuuad Ohm $"6, 5 Exid Teaks Teaks t1 H- w-S Test es f '` � t) 7. I Z OO. �7. 7 D"IMrhaaber pa I i S (°1^ ?� .3 VII. aslbitity Statement t, the a Huy for installer wTS shown an the attached plats. 0 .a Now (Print) Plo MPJMMI Business Phone Number Pkwkmeet Adders (saes, C. Zip ) 10 t tvU Approved ❑ Disapproved it Fee (includes Groundwater Date lssued I Isifiing Agent ) sm hang P Fee) ❑ owner Given Reeser for Denial Sanitary Perm IX. Conditions of Approval/Reasons for Diapproval SYSTEM OWNER. 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code /ordinances C 93 , q3 ,-1 u i An cappkte ptaas tta the Calatr 0*1 bar ere 2raes •a paper 1001 less dust 8112 x 11 122:res IS 2131 SBD 639 .\ 13 Pik i �' f� `Vi 2U1 W. Washington Ave., P.O. Box 7162 1 4coissin Madim, V1 53707-7162 Sib Adthew Sukaz . • De artment of Commerce . Sanitary Permit Application_ -' Permit Number In accord with Comm 83.21, Wis. Adm. Code6 personal iaformation yon provw 0 Check if Revision may be used for acoodw yamoses Primy Lw, SWOKI L AppUcatlon 1(nforanatba - Fuse Print All Information State Phn I.D. Number Property owner's Name Pueel Number ProM Owner's Mailing Address Property Locadou u 4:S T N R E City, State Zip Code Phone Number Lot Number Block Number Subdivision Name ' CSM Number IL Type of Building (check all that apply) OCity 0 1 or 2 Family Dwelling — Number of Bedrooms Dvfflagc 0 Public/Commercial — Describe Use 11 TO wnship 0 State Owned Nearest Road III. Type of Permit: (Check only one box on line A (n eying scheme for internal use). Complete line B if applicable) A. 10 New 2 0 RepWxzrieat System '3 0 Replacement f 1 6 0 'Addition to For County use.. Tank Onl B. 0 Check if Sanitary Permit Previously Issued Permit Number ate Issued IV. Type of Permit: (Check all that apply)(numbering scheme is In Internal use) 44 0 Non — Pressurized In- Ground 210 Mound 47 0 Filter 50 0 Constructed Wetland 22 0 Pressurized In- Ground 410 Holding Tank 48 0 S 510 Drip Lira 45 0 At4rade 46 0 Aerobic Treatment Unit 490 30 0 Other V. Dispermsa 1/'Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Appl' tio Final n Percolation Rate System Elevation Grade Required Proposed Rate( / Days /Sq.Ft) (Min.Mch) Elevation VI. Tank Info Capacity h1 Total N Manufacturer Prefab Site Steel - Fiber Plastic Gallons Gallons of T Concrete Constructed Glass New Hx4tlns Tanta fadrs Septic or Holft Tank _ Daft Chmiber VII, Responsibift Statement I, the aestmie responsibility for wu shows mt the attached plans. Phmtber'a Naam (Print) Phnab Sigmture� � • B us in ess � P l Phmtbees Address (Sftet. City. Foarij Zip VE L �e �e �/ 6); d pig 0 Approved 0 Disapproved sanitary Permit Fee (icludes Groundwater Dues issued luting Amt Sig MM (No Stamps) Surcharge Pee) 0 Owner Given Initial Adverse . Determimdon EL Conditions of App mnilatessons for Disapproval Attaeh eomplete plans 0011116 Coaaq 014) far the Wftm m paper not 1w than 81/1 z lI inches In she SBD -6398 (R. 051011�� :_ =:�, Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 \ V isconsin TDD #: (608) 264 -8777 www comm WWW W 5cons g erce state wi goo Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary December 12, 2003 CUST ID No.267341 ATTN: Plumbing Inspector ARTHUR L WEGERER MUNICIPAL CLERK WEGERER SOIL TESTING & DESIGN SERVICE TOWN OF SOMERSET PO BOX 74 PO BOX 248 RIVER FALLS WI 54022 SOMERSET WI 54025 -0248 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/12/2005 Identification Numbers Transaction ID No. 949836 SITE: Site ID No. 669216 St Croix National Banquet Hall Please refer to both identification numbers, 1595 County V above, in all correspondence with the agency. Town of Somerset, 55082 St Croix County FOR: Object Type: Plumbing System Regulated Object ID No.: 935043 Plan Type: New 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • All notes and spec's listed on the plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of constructi on /install ati on /operat ion. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should _ conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. s . Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required S 70.00 i t Fee Received S 70.00 ��a•- s'j G�� -�-- Balance Due S 0.00 Herman J Delfosse Plumbing Plan Reviewer 2 , Integrated Services WiSMART code: 7657 (608)789 -5535 , Mon -thur 6:45 - 4:30 Fri 6:45 -10:45 hdelfosse @commerce. state.wi. us cc: James E Wehinger Sr, Plumbing Consultant, (608) 339 -7430, St Croix National Limited Partnership RECEIVEI) IEC - 8 2003 TITLE SHEET AFETY & L Page of for D GS DIV. A grease interceptor serving a banquet hall kitchen. Located in the SE4 of the SW4 of Section 7,T30N,R19W, Town of Somerset, St.Croix County, Wisconsin. INDEX Page 1 of 4 TITLE SHEET Page 2 of 4 PLOT PLAN Page 3 of 4 PROJECT DATA AND INTERCEPTOR SIZING Page 4 of 4 GREASE INTERCEPTOR SPECIFICATIONS PREPARED FOR St.Croix National Limited Partnership 409 Golf Links Drive Red Wing, MN 55066 PREPARED BY WEGEF:ZEF:Z SQ S L . TEST S NG AM . DES S GN SEFRW I CE P.O. Box 74 421 N . Main St. �% WE River Falls, WI 54022' Phone 715 -425 -0165 Fax 715- 425 -6864 r, o-tis r 1 d y$t t �..� � r. M~ Job No. 03 -217 GI YLr• Scale 1 " =':0 p age Z of X6 0 a i / (A S) TE LQ) C UM SkqT"Z. �4 Z / v\�QW T ` / i C Z _�s, q t+-1 t - $ q.5 f* �.Z -h�• 1 - a i a of COhi.Q- Pr t3i�I OJJ - N? OF V 1 Z,1 vT__ I PIE - NOTES: - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( ZG required). 3. Septic tank to be - 7Z0 0 gallon capacity manufactured b wi \A-q �o .w y cc)svcc�- _ ` Lf�3�vo t►vSevzt� w p��o - 1 ZX3D Ze , E -FIZZ IKv 30ooGP� 4. Bench mark: S )O�sov 5. Divert surface water around system,to prevent ponding at the uphill side. PROJECT DATA Page of ?i This grease interceptor will serve a banquet hall kitchen which will prepare a maximum of 300 meals for wedding receptions. GREASE INTERCEPTOR SIZING C= MXGXH = 300X3X6 2XP 2X1 = 5400 = 2700 gal minimum size required. A 3000 gallon Wieser Concrete Grease Interceptor will be installed. �)F y a 46" c 102" O ch m I 51 4 n I vi rm -_ Do a 5 I I I s 1 j � rn rn 3" 20 "' 1 I I I 1 i 48' C C N O > •� D N O r Z Z p V, 0 --q m D O O DZ O D LnnZ D aZ LIL"Opgzlm>00 >N ZN � '0 V1 ,CD SSCOiG� = =r<i �ir-i Z O m N 0 �QO- +�_�' -� !n c Z rn ��rn o4,AWiC D � Q 0 rri Z c) rn N - 0 0 rn X A - L r� p VJ D VJ M C � E �� � R 0 D r-o oN n _ Pli Dw y M Z o� ca aZ - O O W Do m � x F M z N s N o f N Z t� A 1 19 0 N 0 -, mho A r ' or rn rn D .w o 0 r M m C' o °z n O o C A O m CD n Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 &Co'nsin www.wi www.commerce.st Department of Commerce sconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary December 11, 2003 CUST ID No.267341 ATTN.• POPVT.S Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1 101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/11/2005 Identification Numbers Transaction ID No. 949840 SITE: Site ID No. 669216 St Croix National Banquet Hall Please refer to both identification slumbers, 1595 County Road V above in all correspondence with the agenc Town of Somerset, 55082 St Croix County FOR: Description: Commercial (Banquet Hall) Non - pressurized In- ground System �7 Object Type: POWTS Component Manual Re Object ID No .. 934854 Maintenance required; Replacement system; 3,303 GPD Flow rate; 1 18 in Soil ininimwn depth to limitin, factor f original g rade; System(s): Conventional POWTS Component Manual, SBD- 10567 -P (R.6/99); Biotilter I The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Condit 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. APPR The following conditions shall be met during construction or installation and prior to occupancy or use: ENT General Approval Requirements: SEE C ORREI • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Conventional Soil Absorption Component Madizal for Private Onsite Wastewater Treatment Systems SBD — 10567 -P (R.6/99). • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812e • 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. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site dtirin4 construction and open to inspection by authorized representatives of the Department. which may include local inspectors. ARTHUR L WEGERER Page 2 12/11/03 Effluent Testing Requirements suggestions: • Within 45 days after system start-up, the influent being discharged to the In- ground dispersal component shall be sampled and tested per Comm 83.54(2)(e)2, Wis. Adm. Code. The testing is needed to verify that the water quality entering the mound is within the limits of the code as established by Comm 83.44(2)(a), Wis. Adm. Code. The influent contaminant levels shall not exceed the following: a) A monthly average of 30 mg /L fats, oil and grease. b) A monthly average of 220 mg /L BOD c) A monthly average of 150 mg/L TSS. • The initial 45 day test may be a grab sample of the influent. If this sample indicates higher levels of contaminants than those listed above, a minimum of 6 tests on 6 separate days over the next 30 days is required per Comm 83.44(2)(b). The results must be submitted to the county for review. • If it is determined that the influent contaminants exceed the values above, the owner shall take immediate corrective action as established in the approved management plan. A pre- treatment device or other method to lower the contaminant levels discharging to the In- ground system shall be put into action. • Upon implementation of corrective measures, another grab sample of the influent shall be tested within 30 days. If this sample is within the limits of the code, influent testing intervals shall be reduced to one full set of tests conducted according to Comm 83.44(2)(b) on a yearly basis. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 275.00 ,� Fee Received $ 275.00 � Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 TITLE SHEET Page of for A dosed conventional in- ground system for AA ff1� a golf course.banquet hall. c �` This plan has been prepared in accordance with the Conventiq$a.l 6 �� Soil Absorption Component Manual SBD- 10567 -P (R.6/99) Located in the SE- of the SW4 of Section 7,T30N,R19W,Town of � A Somerset, St.Croix County, Wisconsin. vO,� s INDEX Page 1 of 11 TITLE SHEET Page 2 of 11 SYSTEM MANAGEMENT PLAN Page 3 of 11 PROJECT DATA Page 4 of 11 PROJECT DATA Page 5 of 11 PLOT PLAN Page 6 of 11 LEACH CHAMBER DETAIL Page 7 of 11 SEPTIC TANK SPECIFICATIONS (4200 gal) Page 8 of 11 SEPTIC TANK SPECIFICATIONS (3000 gal) Page 9 of 11 GREASE INTERCEPTOR SPECIFICATIONS ✓ Page 10 of 11 PUMP CHAMBER CROSS SECTION Page 11 of 11 PUMP PERFORMANCE CURVE PREPARED FOR ST.CROIX NATIONAL LIMITED PARTNERSHIP 409 GOLF LINKS DRIVE RED WING, MN 55066 PREPARED B �WED C OMMERCE OY DING3 LaIE CBS EF:Z FEE FR tOC3 I L . TEST S iV G ;PONOE E :DES I CS" SEFZV S CE P.O. Box 74 421 N . Ma in St. River Falls, WI 54022 °�� S C "")N � Phone 715- 425 -0165 ••., Fax 715 -425 -6864" :'�•• `fi 0.91.5 P El1SWORTH. ' 7� ' 61 !: + SIG.:.+ Job No. 03 -217 SYSTEM MANAGE14ENT � 0 Page Z of Management and maintenance of this system is critical to it's proper operation and longevity. The system owner must be provided with a complete set of plans including this management section. GENERAL Proper functioning of any type of on -site waste disposal system is dependent on the amount of water entering the system and the.' quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting the system will be. System components include a grease interceptor for kitchen waste, two septic tanks in series to 'settle out and break down solids; an effluent filter to filter out any small particles, a pump chamber with duplex pumps and controls to dose the system and soil absorption cells to dispose of the wastewater in a manner which will protect the groundwater and public health. RECOMMENDATIONS Install water saving devices when and where possible. Repair any water leaks as soon as possible. Do not dispose of any paper products other than toilet tissue into the system. MAINTENANCE The grease interceptor and septic tanks must be inspected every 3 years or less and pumped if necessary to remove solids or scum. This is to be done by a licensed pumper. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the':tank:at 6 month intervals or as per the manufacturer's recommendation. Periodic inspections at the observation pipes shoulr)be made by the owner to determine if any ponding is taking place in the absorption cells. If consistent ponding is taking place, a licensed plumber shoA be contacted. CONTINGENCIES If the soil absorption cells fail to accept wastewater. replacement cells should be installed below the initial cel ls. Additonal plans may need to be prepa e prove b an apy the Safety and Buildings Division of the Department of Commerce. Questions about the operation or maintenance of this system should be directed to The County Zoning Office at %wISC The system installer The tank manufacturer at w1L �M The pump manufacturer at _;S ZIJ - LIB LL t V Gc)VC6? § The effluent filter manufacturer at S ev -ZZI_ - 7 , ,j - Z Z The leach chamber manufacturer at 0 - -LZ.l PROJECT DATA Page __ of This system will serve a Banquet Hall with bathroom and kitchen facilities, 2 floor drains and 4 employees. When used for meetings, (assembly hall) anticipated gpd is 54X90 - 10X1.3X1.5= 947.7 gpd. When used for wedding receptions, a maximum of 300 people is anticipated with food being prepared on -site. Meetings and wedding receptions will not take place on the same day. THIS SYSTEM DESIGN IS BASED ON THE MAXIMUM FLOW. (wedding receptions) ANTICIPATED WASTEWATER Dining hall with toilet and kitchen waste with automatic dishwasher. 300 meals served X 7gpd X 1.5 = ----- - - - - -- -3150 gpd 4 employees X 13 X 1.5 = ------------- - - - - -- 78 gpd 2 floor drains X 25 X 1.5 = 75 gpd. TOTAL =3303 gpd SEPTIC TANK 3303 + (CXPEX3) + (DXPE) 3303 + (11.61X44.04X3) + (46.77X44.04) 3303 + 1533.9 + 2059.75 = 6896.65 minimum capacity required. A 4200 gal Wieser Concrete tank with a 3000 gal in series will be installed with an A100 -12X30 Zabel filter in the 3000 gal tank providing a total capacity of 7200 gal. SOIL ABSORPTION AREA 3303 - .7 - 5 = 943.7 lineal feet of Infiltrator leach chambers are required. 13 cells, each 3' X 75' long with 12 chambers per cell will be installed providing 975 lineal feet of chambers. PUMP CHAMBER A 1000 gal Wieser Concrete tank will be installed with Goulds EPO4 duplex pumps and duplex alternating controls. USee_page 10 of 11- Pump chamber cross section.) GREASE INTERCEPTOR Page of �) C- MXGXH = 30OX3X6 2YP 2X1 = 5400 2 = 2700 gal minimum size required. A 3000 gallon Wieser Concrete Grease Interceptor will be installed. WASTEWATER QUALITY After effluent from the grease interceptor enters the septic tanks and the septic tank effluent enters the pump chamber a sample must be taken from the pump chamber and tested for water quality by a certified testing laboratory such as: Commercial Testing Laboratory, Inc. 514 Main Street Colfax, WI 54730 Phone 715 - 962 -3121 The effluent quality of this system must be less than 220 mg /L of BOD5, less than 150 mg /L of TSS and less than 30 mg /L of fats, oils and grease. A copy of the testing report must be sent to the State plan reviewer, the system designer and to the owner of the system. - 12/11/2003 12:32 17154256864 WEGERER SOIL TESTING PAGE 02 . PLOW PLAN ll Scale I "= a 0 Page of 1 'Q S: i . $ u X N ON O 4 ' • -!'" LSD � r• h..- - g.1�_ �„ /� /" o Ir Zu0 J JN VI rol d / �- 53 O't"[i� ` ►•'� OF• C � � !:1 t PC"r"1 U A/ � Ex.1srIKi J�, L 6 t+ Q1 _ X5.3 g - i , aia,a r—�l - e g.s ►• ►- z -ho., STANDARD CHAMBER FQuicklil Standard Chambers — (EFFECTIVE LENGTH) l�2" ► i {� 8" i - - -- 34' -- - - - --- — SECTION VIEW SIDE VIEW ' MuitiPort End Cap -}— - T— A — "j SIDE VIEW TOP VIEW FRONT VIEW I s ,•. , + r ; % r{� ! +'� a��[ ���1 � � � / t �^-..., �'r'r1,�.��"`aAy<'t } � - � 1��";xfMt � F(� { ?aYl�+...: y; , #s r .: r �. ' Qui ck 4 Standard Chambcr'Nominal Specifications � , ���„ ; MuitiPort - End Cap`Nominai Specifications �` y4 ��� _ e(WxLxH 34 "xi6'xt2" • ective Len th � 48" invert Height 8' or 1.25" lrvert Height a ll IN FILTR ATQ R XM - STANDARD LIMMA&RR t n e i t Ka< r aFt'il el edCh r- hTMJer w-U DWO. wedge arsf nnt+r a..ceauxy , ngrVdnC;..,rsy� - br kW* 0l,r r•:ltPr M. h F"XI NM1:?krR. 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O� O'O •I V/ D Q t � p z c� i 0 0 -n A N D 0 p O ril < O �� n D �0 v^' rn-u o�� z Z m� mw a z p D W Q �� v D 00 VI U (n 0 ^' > N Z n rn � 0 m rn M W m r O• J T ry m C� Z n 0 o O M m �u r� PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE I O OF I VE1JT CAP `t "C.Z VENT PIPE • WE:ATNER PROOF 10 � FROM Door, JUAICT1o1J Box APPROVED LOCKING MANHOLE '— � COVER WITH WARNING LABEL WINDOW OR FRESH 12�MILI. AIR INTAKE I GRADE I oif I e MI IJ. COIJDUIT �. r 11� INLET • PROVIDE 7 AIRTIGHT SEAL I V APPROVED JOIIJ A , I I APPROYED JOINTS Install duplex alternating controls with the alarm ( II I system being incorporated into the duplex controls I II ALARJ+1 Which will be activated in the event of pump failure, - I II 0 simultaneously switching the remaining pump to dosing on each cycle. C i I oN _ CLEA = __ %J 1 � PUMP --� OFF S IS CONCRETE CLOCK Y RISER EXIT PEF -mrwED OWLy IF TANK MAIJUFACTURi~R HAS SUCH APPROVAL � 3"ADPRWIE: SEDD I NK 5PEC.IFICATIOILIS oos E 'rALJKS MALIUFACTURER. w1��R e D�1C'i�t'7� IJUMEER OF DOSES' S ' PER DA-4 TANK SIZE : LQOc) GALLOWS DOSE VOLUME Z ALARM __M 4 FACTURGR: S - 1 S`-I5T j INCLUDING 6ACK /LOW: MODEL NUMBER: `O I CAPACITIES: A= - WCHCS OR ' - WLLOys -- swITGH TyPC: B = Z IMCMES OR S G{ LLOLJS PUMP MANUFACTURCR: a C= Z� IIJCHES OR ' GALLOWS MODEL D IN CHES OK 22 '_- SWITCH TYPE: QYLCO`Z' IJOTE: PUMP AM A ARE TO bC \" � MINIMUM DISCHARGE RATE — L—A INSTALLED ON SEPARATE CIRCUITS �nx VERTICAL DIFFEKENICE OETWEEW PUMP OFF A „ FEET t MIAIIAUM NETWORK SUPPLY PRESSURE ... ..... .A " -FEET + S FEET OF FORCE MAIN X y '�� fXp rEFRICTIOIJ FACTOR. \ FEET TOTAL 0!JU 1MIC. HEAD - fi A - FEET As per:manufacturer Z - �3 gal /in. Liquid depth 36 I • Gouldsc Submersible Effluent Pump 6 3871 _ EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: and float switch attachment • EPO4 • Heavy duty sump Single phase: 0.4 HP, manual operation. Automatic models include Mechanical Points. • Water transfer 115 230 15 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, , built in ovv erloto ad with automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES -Heavy duty ball bearing Pump: EPO4 built in overload with construction. • Solids handling capability: automatic reset. ■ EPO4 Impeller: Thermo - 3 /a maximum. • Power cord: 10 foot Plastic Semi -open design AGENCY LISTING •Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for ° Total heads: u to 24 feet. with three ron mechanical seal protection. SP Canadian Standards Association s f p p g grounding • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic- stationary, three prong grounding plug improved performance. end in "F" or "AC ".) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 •Capable of running dry without damage to s components. j � Pump: EP05 FT • Solids handling capability: c 25 3 /' maximum. a 7 • Capacities: up to 60 GPM. _ I I • Total heads: up to 31 feet. 6 20 • Discharge size: 1 NPT. z 5 • Mechanical seal: carbon- 0 15 ! ! rotary/ceramic - stationary, 4 + c. `w BUNA -N elastomers. ° - - - -I —EPOS' - • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 I 5 I 1 i i I I - OL 00 I 10 20 30 40 50 GPM L I 0 2 4 6 8 10 12 ml/h CAPACITY qD 1995 Goulds Pumps, Inc. �(� Wisconsin Departmen of CO 2 Te ppq SOIL EVALUATION REPORT Page of Division of Safety and uildin CROIXC &Nwdan with Comm 85, Wis. Adm. Code _ t ST_ I County j �� J c Attach complete site Ian on �p@ttd(dt 11 inches in size. Plan must ` include, but not limite n onzontal reference point (BM), direction and Parcel I.D. 1 2 S -Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ' wed Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope p rty Owner Property Location ST 'X20 �?C ►U P"1"l !j't Ll i�1 ; s;. met = va S W 11 s T N R � E (or - Z . 3 O 1 B Lot # W Property Owners Mailing Address L Block ock # Subd. Name or CSM# F L_t � v� - - City State Zip Code Phone Number City ❑ Village © Town Nearest Road TZCa7 �vt G h-) N S SU 6 ( ) J r� `'��. S �- � 1 V (� New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD [ Replacement Public or commercial - Describe: �' -? k4 ST ) L^rCLI ; r 17 1 �r4^7?}� V , , 5 Parent material G tl Prt O y`(ti./P�SH Flood Plain elevation if applicable ft General comments and recommendations: \ CFl 14 G f �Z vYV 1T a P )d�j �=j tZ Boring # ❑ Boring ® Pit Ground surface elev. QU�� ft. Depth to limiting factor. 7. actor 1 \ in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 - ' Z :S -q y _ j L Ig Wi CLJ F Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor y l Z 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 g -33 ! o-i }z s1r, S1_IZ lD 'i (Z l — 5� � C� 3 0-0 W Iv S x ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Signature CST Number Arthur L. Wegerer _ 0 3 -� 11 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11, 1lain St. River Falls, NI 54022 715 -425 -0165 1 Property 0 Ll r l � 7 P►�'RTA�Ls2 SH 1 17 Parcel � Z -D6 /- 6 -000 Page of 3 Boring # ❑Boring �Ya ® Pit Ground surface elev. o `► C � ft. Depth to limiting factor Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Ts c s m •S •9 3 C*P-UV(- OS9 YA es Y Boring # ❑ Boring ® Pit Ground surface elev. q 3—S ft. Depth to limiting factor > ZZ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 J 0 - 10`1 I2 Z 1 =tS I — 6 1 csbk my cw L 3 1S -6v l 0''l. V � � — F`r 7 �b -kl r IZ yl _ S �Lu 1 Q (� fY� 1 , , <Z F-1 Boring # ❑ Boring Ground surface elev. ❑ Pit . ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 y gm iv 1 L' L • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L Tlie 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.6100) ` PLOT PLAid Pace of 3 Scale 1' ' 0 3 . q6 b �0 -.,5 Al, B, D z Lo UM Sk c u A c L`X1ST - 1rvG 81 1+-1 - g 4.5 tZ -I) o. t t!7L , 1 a s o ' a , cnVw z o f cav c- P" C Curb 7�Ty t f 715- 425 - 0165 220254 0 z 1 CST Signature Date Telephone Into. CST No. Job No. Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of in accordance with Comm 85, Wis. Adm. Code County } Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. D. v- 000 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location `�� • �l�fJ `?� 111 l�ll�NP't �!i�l; ''f. r 1/4 CV) 1/4 S ? . T 3 0 N R )� E ( Property Owners Mailing Address Lot # Block # I Subd. Name or CSM# y C q Gc� L F L1 �2S .� � (J� _ _ City State Zip Code Phone Number City Village 2 Town Nearest Road Q New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate E] Replacement Public or commercial - Describe: B R "1'J Qj tT t!-� Lt %v r ` GPD Parent material G1 j'rt p`.r�� Flood Plain elevation if applicable 1�j A ft. General comments and recommendations: 3 CF1_ >~ mi �7L'TlZt1'1U 1- ,p..,.._, TLGV) 1 ! 0i✓S a Boring # ❑ Boring © Pit Ground surface elev. Q�,� ft. Depth to limiting factor 7 1 - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-S 1pM (Z _3 Z S - y0 3 L4 ,3 Sri -1 L� - 1 , 3 1 -1 31V i i i 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 231 s i t Z hr m c . S g -33 totvL -S _ �S ems, • �1 , b 3 33 Cy — 6� CJ S9 wt �S �L � G � � s9 r'l I . Z 1 • Z ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS < 30 mWL CST Name (Please Print) A . _ Signature CST Number Arthur L: Wegerer 0 3 —'Z 11 220254 Address We g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11, Main St. River Falls, UI 54022 11 - -03 715 -425 -0165 S. • �°—Ru tK rv� -1-, U ry p� Property Owne P'- T �-� Parcel ID # C�3� - Z�6t / - 6U Q Page of 3 E Boring # ❑ Boring ® Pit Ground surface elev. S ft. Depth to limiting factor in. p*Eff# pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 T� h E S A.syR3iv c� �ru� OS9 r� 1 -- 2 Z G O M Boring # ❑ Boring ® Pit Ground surface elev. S •• S ft. Depth to limiting factor > zZ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n 'Eff#1 'Eff#2 O -� I0` 3 3 � — SI - � l Z`S� M'j 1•- C S .S to ,l rZSk 6V t esbh mv'k cw • 4 .6 1 S -6v l 0''1 R y 1 c we r- C Iti Z - 3 y bo -�i r��►� y1� _ Sit d Sg Z F-1 Boring # ❑ Boring El 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 t 1 Th C 33 lh/ G o kv 1 L 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.6/00) PLOT PLA`3 Page = of Scale 1' =30' t ^� 0 \0 � 8- \ n7 C n - ;4-t S 1`� / 0\ vEw- r _ �3 � �'TU 1.•il DF= C L Z C - F'Z: �V PCj'l U n� s _ - L� 1 S T1 r.,, G B L 6l: `� "?f j'�' 1. - _t'Z:.1 Q_0- t1 `.0►� CU�'ctiL2 of C01v :C_- 1�1'�P -� : B Z = Est _SSA '_ 0),) N? OE -V �5 vT_- P l 3 715- 425 -- 2 2 0 25 4 �3_ Signature � !-7 CST Si g Date Telephone I-To. CST No. Job No. ST CROIX COUNTY SEPTIC TANK MAINTENANCL' AGRB13MENT AND OWNBUHIP CBRInigCATION DORM Own uyer X01 e r � Ma ift Address Property Address C�2 led U (Vuificatioa re"aW Ir m Play wg I)Vactaaeat for new coastcuetioa) CSttylStatc _ _S6�N -Pr p � lNI �s'ab' a�W IdcafiicWon N �� Q/ umber �A,"j L�WAL DES pN 6 Property Location �(� Nett 9 W �' (° . Town of _ � 1�SL' Subdivision Lot# CotMed Smvey MV # Volume Page # Wacraaty Deed # Volume , I . .�., page # spcQhouw 0 yes ® no Lot lines id isalbic ,® yts O. no Lnpeapa+mcmd� s9d= oadadnits t consists of aac,6c bindle ada. y t�ea�a cmis ffoct�,, e.+ �,+ �oncfma�a� ;amc�elaQrc.�ad�o¢,;{ - ��"�epat.iaa°Qiesy�a` . sada wfa sc Cbixzkk D * faaoa, sognod byBreaWarxaadby aWwWf : is m�Op'°e O ' s, gc adW=sQdla(2) fie• «'s timt(�Qicou cirasae�oerd xis�bCdt � � kss>ban It3�aII of�dgo. .�`'� �b�aarddresbaue �,1�i4vsoet6yt5e +�axtom�cnabapdriteae�sy��jye . •�� amtaEClomeooeooesu,, d�„ �De�cma�etafN�eaat &soao�oe�st�6e�'FIrsooasin.. Qre bane �' r0 °�°�tbeeom�d�oda�rc�uoo�ad[to t5e stet, �+uoc�7oummtyZooiggOlhOerri�na 30 i SLG�iATURB APPucurr DATE OWl'W( TON all oa this fans arc hire to &c best of nW tc Pi%wdy abo�rr, of a Wu dwd wow*d is ofDods� I (wee ant (are) tlar owner(:) of �tA1UlI$ OFlIpPC[ � 3 P�i�/ CANT DATE ssssss � � tLtt is mis -tdumy tit in Qa" ��� Wag Irittoi M by 60 ZoaiQg Dqm* ant. s��s� • " Cadado Mth tLLt &U-- a UM4W Wwatt dwd fioaa &a RA&w of DW& 00kc a Dopy of d w c atiW su vey map if tdm,= is M& in the wanady daod LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2028 -95 -000 Parcel Number 7.30.19.577 OWNER NAME: First Last J P GOLF MANAGEMENT INC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 7 TOWN 30N RANGE 19W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 40.000 PLAT LOT BLK 01 SEC 7 T30N R19W 40A SE SW 15 02 ASS'D W/032- 2061 -60 (744A) 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, 175 -Next Parcel, F7- Valuations, F8- History, F10 -Exit P DOCUMENT NUMBER WARRANTY DEED 6 6 7 0+4 O KATHLEEN H. WALSH' REGISTER OF DEEDS S'(• CROIX CO., WI RECEIVED FOR RECDRD 01 -03 -2002 9:30 AM WARRANTY DEED .EXEMPT I CERT COPY FEE: COPY FEE: TRANSFER FEE: 6000.00 RECORDING FEE: 23.00 PAGES: 7 NAME AND RETURN ADDRESS ^0r.r,. +nrl a-Tmu rnrID TITLE 400 SIBLEY ST.; SUITE 255 ST. PAUL, MN 55101 SEE BELOW: Parcel Ident Ilcat on Number 3 32202895000, Q a'rl � / 02 10000 , S2n0 _ - 32202950000- 32206130000, 32206170000, 32206290000, 32206295000, 32206310000, 32206320000 & 32206160000. ST. CROIX NATIONAL GOLF COURSE FINAL DESCRIPTION (12/12/0I) That part of the Northeast Quarter of the Southeast Quarter, the Southeast Quarter of the Southeast Quarter, the Southwest Quarter of the Southeast Quarter, the Southeast Quarter of the Southwest Quarter of Section 7, Township 30 North, Range 19 West and also part of the Northwest Quarter of the Northeast Quarter, the Northeast Quarter of the Northwest Quarter, the Southeast Quarter of the Northwest Quarter, the Northeast Quarter of the Southwest Quarter of Section 18, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing at the East Quarter Corner of said Section 7 (found P.K. nail); Thence North 89 degrees 00 minutes 09 seconds West along the north line of the Northeast Quarter of the Southeast Quarter of said Section 7, bearings referenced to grid north St. Croix County coordinate system, 33.01 feet to a point on the westerly right of way line of 40` Street; Thence South 00 degrees 42 minutes 00 seconds East, along said right of way line, 74.83 feet to the POINT OF BEGINNING; Continue thence South 00 degrees 42 minutes 00 seconds East, along said right of way line, 306.63 feet to the northeast corner of Lot 1 of the plat of St. Croix National Estates North on record at the St. Croix County Register of Deeds' Office; Continue thence South 89 degrees 18 minutes 00 seconds West, along the north line of said Lot 1 to the northwest comer of said Lot 1, a distance of 106.19 feet; Thence South 24 degrees 14 minutes 24 seconds West, along the westerly boundary line of the plat of St. Croix National Estates North, 64.07 feet; Continue thence South 39 degrees 36 minutes 16 seconds West, along the westerly boundary tine of said plat, 182.91 feet; Continue thence South 49 degrees 05 minutes 28 seconds West, along the westerly boundary line of said plat, 276.38 feet; Continue thence South 15 degrees 19 minutes 27 seconds West, along the westerly boundary line of said plat, 334.82 feet; Continue thence South 10 de of said plat, 248.41 feet; rees 29 minutes 20 seconds East, along the westerly boundary line Continue thence South 00 degrees 19 minutes 39 seconds West, along the westerly boundary line of said plat, 253.74 feet; Continue thence South 13 degrees 08 minutes 18 seconds East, along the westerly boundary of said plat, 469.06 feet; Continue thence North 44 degrees 35 minutes 47 seconds East, along the westerly boundary line of said plat, 188.41 feet; Continue thence South 22 degrees 17 minutes 18 seconds East, along the westerly boundary line of said plat, 134.53 feet; Continue thence South 20 degrees 35 minutes 30 seconds West, along the westerly boundary line of said plat, 240.18 feet; Continue thence South 44 degrees 26 minutes 15 seconds West, along the westerly boundary line of said plat, 206.21 feet; Continue thence South 35 degrees 27 minutes 28 seconds East, along the westerly boundary line of said plat, 97.10 feet; 1 I VOL 1 80s)PV t Ul WARRANTY DEED Deed tax due: Date: December 2001 For Valuable Consideration, JP Golf Management, LLC, a Minnesota limite n Grantor s }, hereby conveys and warrants to St. Croix a I na rns ip, a Minnesota limited partnership, Grantee(s), real property In ST. CROIX County, Wisconsin, described as follows: See Exhibit A attached hereto. together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: JP Goff M g ment, LLC By: Its: State of County of T mst m,�nt as a knowledged before me on t is � of December, 2001 by M � n the �t of JP ( Management, LLC a Minnesota limited liability compa be alf of s � NOTARIAL STAMP OR SEAL ature of N r) (OR OTHER TITLE OR RANK) CHRISTOPHER J. PIERSON Check here if part or all of the land Is Registered (Torrens) ❑ NOTARY PUBLIC- !'U(::[S0rA Warranty Deed Page 1 of 7 MN.30.22.0 (12100) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS - ��" af SUBDIVISION / CSM # LOT SECTION ', _ T - M N -R .Lq W, Town of ST. CROIX COUNTY, WISCONSIN ` PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF � � G G , 30 ' 3y , yo 5"Je so' q J0 I INDICATE NORTH ARROW Provide setback and elevation inf nation on reverse of this form. Provide 2 dimensions to cen�er of septic tank manhole cover. r�oti66, - BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: - Setback from: Wel House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location ;SOIL ABSORPTION SYSTEM Width: 3( r Length Number of trenches Distance & Direction to nearest prop, line: y Setback from: well House t /,ate Other I ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet 1 t PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisco6 in ' Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI .. JP GOLF MANAGEMENT, INC. X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: de S 6-�v A95903641 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi3O &76 C -x �f' .UU Benchmark rC.QSe f Aeration Bldg. Sewer �� � 97, 90 1 St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD 9t- mlet ir InCt Septic NA Dt Bottom eat' rah NA Header. Jb Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ><, °-/'S'' Model N�ru rh PM TDH Friction em- -_, H t P cemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION �� 7 / DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O ` n e,_, CHAMBER Model Number: System: - OR UNIT DISTRIBUTION SYSTEM Header/Manifold �� Distribution Pipe(s) x Hole Size I x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacin6O SOIL COVER x Pressure Systems Only xx Mound Or At -Gra ystems Only i Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed / Trench Edges — �� Topsoil ❑ Yes ❑ No ❑ Yes ❑ No aetAl COMMENTS: (Include code discrepancies, persons present, etc.) Y . LOCATION: Somerset.7.30.19W, SE, SW, County Road V T' z6a - � 4 C4 mss, Plan revision required? []Yes O No Use other side for additional information. 1 17-16 lit I ?f::2 SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ����i19■'�i SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E_ Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. '5� L �, 4X • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)].. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION - Prope y O er me Property Location 114 1/4, S T , N, R ,I?e(or)& Property Owner's allin Ad ss Lot Number Block Number e;4,1j Al City, at Zip Code Phone Number Subdivision Name or C M Number 11. T PE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road ❑ village CA JZ Public 1 or 2 Family Dwelling - No of bedrooms Town of 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 _a ©� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station./ Car Wqsh / 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify - IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ® New 2. ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System - _ _ - -, -- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 R Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. inch) Elevation Feet 9 F Feet TANK Ca aut VII. INFORMATION Manufacturer's in gallons Total # of Manu Name Prefab. Con steel Fiber- Plastic Exper- New Existin Gallons Tanks concrete strutted glass App. T Tanks Septic Tank or Holding Tank _ r — ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for I stallation of the o5site sewage system shown on the attached plans. P Na e: (Print Plum is g . N t mps MP /MPRSW No.: Business Phone Number: d Plumbers Address t et, Ci ate, Z Code iA / IX. COUNTY/ DEPARTMENT USE ONLY E] K Ap p roved Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (N - � Surcharge Fee) ❑Owner Given Initial � Adverse Determination / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRO -6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the'itate of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank re, lacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fi l in the capacity of every new /or existing tank, list the total .gallons, number of ta!iks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic; pump /siphon and holding tanks for this system. Check experimental approval only if tanks receive experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number w h appropriate prefix .e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be s,j L iitted to the county. The plans must include th e following: A) plot plan, drawn to scale or with complete dirnens,.. +r ;ocatron holding .ank(s), septic or ether treatment tanks; budding sewers; wells; wafer maii7siwa",- - .:-,d lakes ; pump or siphon distr >u.Jon boxes, svii absorption systems; replacement system are. the iota _��r of the t wilding served; and verll( ek °v, =tlon reference polnl�; C; cc)r,)p!e'e Speclfj,,, l! .r lincl contr(.lI .; dose volume; elev,-o.inn 'fif °,2 ences; friction loss, pump perforr, <,nc_: curve; pump mod-! r_i _curer; I, cross section of the sJi! absorption system if required by thy: cu i:,v, oii test data - m; n l sizinc inforr - nation. I GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of re( .elated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwa!e contamination investigations and establishment of stardards. ^ .� . ' SAFETY & BUILDINGS DIVISION 20/o. Washington Avenue P.0. Box ?969 Madison, Wisconsin mo?or State of Wisconsin Department of Industry, Labor and Human Relations October 20, 1995 1840 Ea5t Green Bay Street SUITE 300 W1 54166 K 0 CONSTRUCT ION KIM 0 CT}NMLL 308 MIDPINE CT STAR PRAIRIE WI 54026 RE. PLAN S95-31458 FEE RECEIVED: 120'00 JP GOLF MMANAGEMENT SE,6W,7,38,19W TOWN OF S0MMEASET COUNTY OF ST [ROI% NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal' Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHA 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans' This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHA 50-64, Wisconsin Administrative Code' This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can 6emade. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown a6c,*s' Sincerely, Keith Wilkinson Plan Reviewer � Section of Private Sewage _ � (715) 524-3827 euu^-6*2S vR.10x94, Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labb(a * d Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 La Crosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785 -9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548 -8606 Phone(715)634 -4804 Fax(608)785 -9330 Phone(608)267 -5119 Phone(715)524 -3626 Fax(414)S48 -8614 Fax(715)634 -5150 Fax(608)267 -0592 Fax(71 -3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans /inform *n. Your submittal must be received at least one working day prior to ;he appointment at the office where your review was scheduled. Pleaselrall any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. As ampl of a co mpleted4orm is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number 2. PROJECT INFORMATION If this review is a revisioh or extension to your existing plan identification number, provide that number here: Proje Na ❑ City El Village ® Town Of: County r zcff Project Location GOVT. LOT 1/4 1/4 T N R 0o r 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type t (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 ........ A ❑ At -Grade 1,501 - 2,500 gallon septic tank ........ $120.00 — H ❑ Holding Tank 2,501 - 5,000 gallon septic tank ......... $160.00 ........ M ❑ Mound 5,001 - 9,000 gallon septic tank .................. $200.00 ........ N Non - Pressurized In- Ground (Conventional) 9,001 - 15,000 gallon septic tank .................. $ 300.00 ........ P ❑ Pressurized In- Ground Over 15,000 gallon septic tank .................. $ 500.00 ........ O ❑ Other: Up To 1,000 gallon dose chamber ............... $ 70.00 ........ 1,001 - 2,000 gallon dose chamber ............... $ 80.00 ........ Building Type (check one): 2,001 - 4,000 gallon dose chamber ............... $100.00 ........ 4,001 - 8,000 gallon dose chamber ............... $120.00 ........ D ❑ Dwelling, 1 or 2 Family 8,001 - 12,000 gallon dose chamber ............... $140.00 ....... . P ® Public Budding Over 12,000 gallon dose chamber $160.00 ....... . S ❑ State -Owned Building Up To 5,000 gallon holding tank ................ $ 60.00 5,001 - 10,000 gallon holding tank ................ $100.00 ........ Code Derived Daily Flow gPd Over 10,000 gallon holding tank ................ $150.00 ❑ Check If Replacing Existing System Experimental System (additional one time fee) .... $ 300.00 ....... . Revisions To Approved Plan 2 $ 60.00 ......... Petition For Variance: Setback .................. $100.00 ........ Site Evaluation ............ $225.00 ........ ❑ Petition For Variance Plumbing ................. $ 225.00 ........ Revision .................. $ 75.00 ❑ Groundwater Monitoring Groundwater Monitoring - Per Site ............... $ 60.00 ........ (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 ........ Subtotal: ......... Priority Review: Enter same amount as Subtotal: ........ 4--.21 MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ...... .� 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Comp ny ame Contoet Per on No. & Street Address Or P. . Box City, Tow or Villa State, Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chamber 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. 9 .- i� 4 Q NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually. v The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)). (� SBDW -6748 (R. 09/94) OVER �iii0- I I ! I I �u�ie7.c ,•s�f t',�C /� /�s ; ' ..5�it/' � d•��i� j- �'�ok��� S'�.r q i t AIO bcs t�tvuS l �, c �sp�s��, ,e r' GE SYSTEM / EPAM NT til I ,, ! DUfi �s? ,LOGO AN6 Fiuyl RELATIONS` , �I of SAFETY A G BUILDING$ ZEE ORFE PONDENPE I I � i i I ThAS 41 ava� due: nol linciu � rsview of i i I Ad min. /e' ' .€'� E �t::a 'n�c : -1.. c' tc� }e� I t °' r . � I •',agar ittal and t a{f�Jyj S 9' 5--31 IWAI 30 :12)4W , re!2 E Lot Thip approval dead rvot is cludd r V11 w i01 j % I ► 1 upetraam 61 tho � clhb Id! h ank. Sc r�Vi' � 1I a; ' I C0eta �r� �'� r� �*� 3�� a �� >� �+ �� S'��s�al� &�� S�u� S/,�E,O I I i j s l : I � I i i � � � � � i I � � � ( i ✓ � I I AlAe SITE SEWA;'GESYSTEM ED i DEP RTMl =�,i i �GU TRY, LABOR AND HUMAN RELATIONS! , D1�, "IU iF Sf�FE i �' AN BUILDINGS s I i SEA CL�Rkk7t$ OND{ =NCE 3 1 r j 0 1 / I ! i WgGE SY i I x� ONSITr S P I f i I j i I 1 i I s7 F v+ I ► 1, A, D HUMAN R ���ON ' ,l• 1V1VL1 ti ' f j (S iP SP E G i I I i of ON EN Ac f- Bl f �9.Y't S ✓ I LD I , — .� lV I I I i I I I I I I j I i I , yo t I j I 8 a i 3 1 1 f 8 INDUSTRY, LABOR & HUMAN RELATIONS I65 / I � LHR � 8 + 2 Appeadi: A -82.34 (5) (b) EXTEQ -Ivt 4MASE INTER C.6PT0IZ- TeLM I N ATS AT o fR ABove (a ZADE FINISHC 4enDE� 24� rovlew of 4M �,a 1lactt�de This aRPse' '° qg�� Sapticlhoicling tr t �,� *1 � I�. AdmW- G�• s e e .yam ��.A �rvr ij . > +� � tih y�Etllt► SKk M e �R p 1.�+ yln �1'6•' /, ic�IF�1, �\.� ti• a '� , ` .,Ig4flU 1��JS i4�" • -- s oo INLET b — r + O�ITLE7 1 /3 of LIQUID DE>''fN l7 33 i, Z�3 OF LIQu1D 7 -13 OF LipWIlD DE ?TN V3 of LIQUID De PTH S95 Reuter. February. IM. No. 458 Wisgonsin Departrnent of Industry SOIL AND SITE EVALUATION REPORT Page L of Labor and Human Relations Division of Safe &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELL .. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE"R: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S 7T ,N,R E (or)® PROPERTY OWNER':S MAILINO AD RE LOT # BL # SUBD AME OR CSM # CI , STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE 0 N NEAREST R s btJ New Construction Use [ J Residential ! Number of bedrooms [ J Addition W existing building L J Replacement yq Public or oo mmeraal describe �?J,..4 �...�p - " Code derived daily flow Z::K� gpd Recommended design loading rate __,I _ bed, gVW _ trench, gpd/tt Absorption area requir �; � bed,.ft ZgqX_ trench, ft Maximum design loading rate _.� bed, gpd/ft gpd1t Recommended infiltration surface elevation(s) 322 7 it (as referred to site plan benchmark) Additional design / site nsiderations Parent material _ Flood plain elevation, if applicable 41 ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem 10 S U I ®S ❑ U 1 21 S❑ U I ms ❑ U [IS O L ❑ S ,O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bw Roots in. Munsell Qu. Sz. Cqnt Color Gr. Sz. Sh. Bed Trench � Ground 3 elev. 9.9- ft. f Depth to 1 jai _ limiting factor Remarks: Boring # _ t Ground 4 elev. = ft. Depth to limiting factor _1s2L Remarks: T Name: — Please Print Phone: e�� ide, 1Z 7/ 2 W." - - L F/ Add ress: Signature: Date: CST Number• Structure lormar. M.. lon. mm�JAVI&ml Qu.Sz.OontGolor I = Gr.Sz.Sh.-.=MIM I ml M" M,- _N m N,, m m m n, M. mo- R4111,11= m mm- -, �-- � , MM, M sYs/ e i Doze 4,r i l / I j I / Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor,and Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785 -9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548 -8606 Phone (715) 634 -4804 Fax (608) 785 -9330 Phone (608) 267 -5119 Phone (715) 524 -3626 Fax (414) 548 -8614 Fax(715)634 -5150 Fax(608)267 -0592 Fax(715)524 -3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans /information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION - if you have scheduled an appointment, fill in the information requested below to save time: Appointments Date Reviewer Name Plan Identification Number 2. PROJECT INFORMATION If this review is a revisioh or extension to your existing pl i number, provide that number here: Proje Na Z�a� O City n Village ® Town Of: County '/ Project Location / GOVT. LOT 1/4 1/4,S T '�' N,R or T 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type 1 (include new and existing tanks) Up To 1,500 gallon septic tank .................. $110.00 ........ A n At -Grade 1,501 -2,500 gallon septic tank .................. $120.00 ........ H E] Holding Tank 2,501 - 5,000 gallon septic tank ...... . ........... $160.00 M [] Mound 5,001 - 9,000 gallon septic tank ........... . ...... $200.00 ........ N Non - Pressurized In- Ground (conventional) 9,001 - 15,000 gallon septic tank .................. $ 300.00 ....... . P Pressurized In- Ground Over 15,000 gallon septic tank .................. $ 500.00 ........ O Other: Up To 1,000 gallon dose chamber .......... .... $ 70.00 1,001 -2,000 gallon dose chamber ............... $ 80.00 ........ Building Type (check one): 2,001 - 4,000 gallon dose chamber ............... $100.00 ....... . 4,001 - 8,000 gallon dose chamber ............... $120.00 ....... . D [:] Dwelling, 1 or 2 Family 8,001 - 12,000 gallon dose chamber ............... $140.00 P ® Public Building Over 12,000 gallon dose chamber ............... $160.00 ....... . S State -Owned Building Up To 5,000 gallon holding tank ................ $ 60.00 5,001 - 10,000 gallon holding tank ................ $100.00 ....... . Code Derived Daily Flow _ gpd Over 10,000 gallon holding tank ................ $150.00 Check If Replacing Existing System Experimental System (additional one time fee) .... $ 300.00 ........ Revisions To Approved Plan z .......... .... .... $ 60.00 ... .... Petition For Variance: Setback .................. $100.00 ........ Petition For Variance Site Evaluation ............ $225.00 ........ Plumbing ................. $225.00 ........ Revision .................. $ 75.00 ........ Groundwater Monitoring Groundwater Monitoring - Per Site ............... $ 60.00 ........ (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 ........ Subtotal: ......... 4a2 — Priority Review: Enter same amount as Subtotal: ........ 44;:27 MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ...... 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Comp ny ame C Per on No. & Street Address Or P.O. Box City, Town or Villa State, Zip Code s _ Ti 1 Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually The information you provide maybe used by other government agency programs [Privacy Law, s 15 04 (1) (m)J. SBDW -6748 (R. 09/94) OVER ------- D Z "' oZOV( C 0 c O v Z 3 S D ,�I W GI v N O S m o z p OaD �. _. N O O O v' m < Ge c LA m a m D< m n o D y A.m c �o >C 3 3 2� ^ n o' ^ O W ❑❑ ❑ ❑❑E ❑❑M❑❑❑ J m f G x b b O O y � O n O `< m e•c b N n � c v n <` v c r_ O o3 d ._ 3 p 'z _d :mfmff a� m Z T c0 v 09Z ;2D v. 3 m m f.� b o n d Q W ° °° ' In n z N my d N o m o m a m s m 2 x x > > o O '� m y> j S < O m m S '. °' + a c» O 3 v °w N U1 ,J, 2 m o. d n J �. °-' O m z _. 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T�eN1 l N AT6 A� O 1Z A Bove la e.Ac>a FjNISHC - -f> 4eADE� Z4 4N Z vi INLET b Z� OUTLET 1 /3 of LIQu1D DEP'i' A l7 3 � ii Z f3 of L I Qu 1 A DEATH 3�G� �� ZA OF LIPWD bEPTH �y3s� i �3 of L IQUID pepTN Register, February, 1994, No. 458 1. ^ bL n Q i 4Q ,9n `)t ' XI: - - _ 'r7S8 „ nol fr:, T9�,�114n) y2 l 9dmbrl)secib 0( 'o r, 19- 16 5 .5 , 20b - 011 P c: ") : "(1416iii . lloli, ( r) ] f 1"'() 1 muj p.;., ,, ., Z bGL gn:1 , U�) rT Lc � .l';f9lz 1' Ir 5 : u ,y Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Pagel of Labor and Human Relations T Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELL .. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OW R: PROPERTY LOCATION �/ GOVT. LOT 1/4 1/4,S T N,R f[(or&l PROPERTY OWNER':S MAILING AD RE LOT # BLOC # SUBD NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE PFOyVN NEAREST R S — f— b(J New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement Q Public or commercial describe Code derived daily flow gpd Recommended design loading rate _ bed, gpd/ft _ trench, gpd/ft Absorption area requir ;J - � bed, ft trench, ft Maximum design loading rate _ bed, gpd /ft _ trench, gpd/ft Recommended infiltration surface elevation(s) Z 7 ft (as referred to site plan benchmark) Additional design / site nsiderations Parent material _ Flood plain elevation, if applicable —� ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I Los ❑U ®S ❑U I 0S ❑U I 91S ❑U ❑S ®U OS ' OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cqnt Color Gr. Sz. Sh. Bed Trench _2 s Ground elev. SS,9— ft. Depth to limiting factor L I Remarks: Boring # 1 - ,62 ely "ZZ Ground r elev. Depth to limiting factor /dl Remarks: CST Name Please Print f Phone: Address: Signature: T Date: CST Number c r PROPERTY OWNER �1 SOIL DESCRIPTION REPORT Page, s� PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench \•.: Ground ele . ft. Depth to limiting factor r`�iGb Remarks: Boring # 'M1ti:: vL; AIZ Ground 3 s elev. er 9' ft Depth to limiting factor ?Lc2L Remarks: Boring # 1 ;v`' • Y: . k........... Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) o� .fi.U,4�,i�is,Eaa /ve /.9GE o \ j� � to ya , Sly � Y ro " ,.,n Go` c / xy so - 16 ew I-w Clubhouse STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O�VNERlBUYER T P Golf Management Inc MAILING ADDRESS 6016 Blue Circle Drive, Minnetonka, MN. 55343 PROPERTY ADDRESS 1603 County Road V (location of septic system) Please obtain from the Planning Dept. CITY /STATE Somerset, Wisconsin 54025 PROPERTY LOCATION _ 1/4, -sue 1/4, Secrion _� , T _ N_R g W Township VNMWOF, Somerset ST. CROIX COUNTY, WI SUBDIVISION St. Croix National Golf Club LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatulient stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60 of the cost of replacement of a failing system, which was in operation r10r to July I, 1978. St. Croix County accepted this program in august of 1980, with the requiremt!nt that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wnstewnter disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year SIGNED: For J.P. Golf Management, Inc. DATE: St. Croix County Zoning Office Government Center 1 101 Carmichael Road Hudson, WI 54016 11/93 S T C - ?.00 Clubhouse 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 delayer of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------- - - - - -- - - - - -- Owner of property - J.P.• Golf Management, Inc. Location of property 1/4 _Sk) 1/ , Section _ _ , T - _aN -R C _ W Township Somerset Mailing address 6016 Blue Circ Drive Minnetonka,.MN. 55343 Address of site 1603 Cou nty Road V, Somerset, WI. 54025 Subdivision name St. Croix National Golf Club Lot no. Other homes on property? Yc; XX X No Previous owner of property M. V Total size of property 243 A Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes xxx_ `Jolumc IL 1.7 and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITIi THIS APPLICATION TIIE FOLLOWING: A WARRANTY DEED which includes a DOCUME14T NUMBER, VOLUME AND PAGE NUMBER AND THE' SEAL OF TIIE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the decd description references to a Certified Survey Map, the Certified Survey Map shall also be roquired. PROPERTY OWNER CERTIFICATION I XX�go certifv that all statement:, on this form are true to the best of my XXK= knowledge that I am JQDM the owner)M of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S and that I 'N presently own the proposed site for ' the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co- Applicant: J For J.P. Golf Management, Inc. Dat(, of Signature Dato of Signature v; r � DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - -1982 THIS SPACE RESERVED FOR RECORDING DATA WAHRA TY DEED VOL 1 1 l.�f F ai.E415 - srs�R o c� _�..., ST. CROI CO. X F �,,, Thi Deed. made between .. R9NdforR�cc .... Manue .......... A. Vi lafana and Elizabeth E. husband . ....-- - - - - -• -- -- • - - - -- - ...................................................... PR 4 3 r,, and wife ...... .. ............... Grantor, at 9.30 A. • 1 and .. J.......... olf : N(ai ;.... -. .' ............. ' I . i ........................... &O&&- ........................ Regbter cf Decd ... ............................... ................................ ............................... Grantee, Witnesseth That the said Grantor, for a valuable consideration...... tiaras 10. .................................... --...-•-----•----...---........----------... ..............------ ......... -- RETURN CCJVAON%VMTH LAND TffU conveys to Grantee the following described real estate in 400 County, State of Wisconsin: St. Paul, inassa So 101 See - Zxhibit A attached hereto for Tax Pa:,:et No : ...... ............................. legal description of real estate. l�oolc� This .._ i3 riot ........... homestead property. (is) (is not) Together with 1 and air? lar the hereditament& and appurtenances t ereunto belonging; a� C z And .....- Manuel. -A. Vl�a ...41sl�...�11..tl.hc�...F:..li �.11g.... �' ..................... ......... .................... .. warrants that the title is good. indefeasible in fee simple and free and clear of encumbrances except the easeient referenced on Exhibit A; roads and highways; applicable laws, regulations and ordinances; and any levied and pending assessments, and will warrant and defend the same. Dated ................................... day of ...... ....................................... 1x95.... .......---.. ..................... ............................... .....(SEAL) ............. . ..... ....................... .................. (SEAL) ............. .Manuel ' lafam ...-•-- --- --••---•-••. •• ... ..... .......... .. .............. ..........(SEAL) --------------- (SEAL) r a ................................... ............................... ............... th E. Villaf AUTHENTICATION ACKNOWLEDGMENT Minnesota Signature(s) ............................. ............................... STATE OF WISGONS! i ss. .............................................. -................................. Hennepin ......................... County. �S ~- authenticated this ........day of .................•......... 19 ------ P came before me this . ............. day of i .........1 � � (e ....... .......... 19. a above named -• .............................•--•----------... ......•---- •-- ......__......... Manuel A. Villafana '------------------••----........---------•-••--- ..........- ••••- .....-- -•• - -- t .hst�!ia4.l.. v - !-�' � .• TITLE: MEMBER STATE BAR OF WISCONSIN (If not. ............................................................ .................-----••- ••- -- --- ••................_.._. authorized by 3 706.06, Wis. Stats.) to we known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY John B. Winston, 4420 IDS Center s -u- t -- -- - -- 0 a LFA .._..I ................ .................••. l t�JQ•(�iri Minneapolis, M 55402 -- •---------- ............. - ..0AKWA4XXA V ---•----...-•-----••----°--•-•----- ------ °--- _.......•- -•......... Notary Public - --- ......••-- ( AM Signatures may be authenticated or acknowledged. Both My Commission is permanen . are not necessary.) date: ...................................................... 19 ......... •Namep of persoas signing in arty capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co, Ine. FORM No. 1 - 1981 Milwaukee. Wis. • • y�� �11.7�a.F416 EXHIBIT A LEGAL DESCRIPTION Parcel I: Southeast Quarter of the Southwest Quarter (SE 1/4 SW 1/4) and Southwest Quarter of the Southeast Quarter (SW 1/4 SE 1/4) of Section 7, Township 30, Range 19. North 395 feet of West 370 feet of Northwest Quarter of Northeast Quarter (NW 1/4 NE 1/4) and part ti of Northeast Quarter of Northwest Quarter (NE 1/4 NW 1/4) described as follows: Commencing at the Northeast corner of said Northeast Quarter of the Northwest Quarter (NE 1/4 NW 1/4); thence South 1 degree 10 West on East line thereof 289.9 feet; thence West parallel with North line of said Northeast Quarter of the Northwest Quarter (NE 1/4 NW 1/4) 695.0 feet; thence North 2 degrees 00' West 290.0 feet to said North line; thence East on said North line 711.0 feet to the place of beginning, all in Section 18, Township 30, Range 19. Parcel II• The Northwest Quarter of the Southeast Quarter (NW 1/4 SE 1/4) of Section 18, Township 30, Range 19. Also a parcel of land described as follows: Commencing at the Northeast corner of the NE 1/4 of SW 1/4 of Section 18, Township 30, Range 19; thence West along North line of said NE 1/4 of SW 1/4 154 feet; thence Southeasterly at an angle of 45 degrees 217.8 feet to East line of said NE 1/4 of SW 1/4; thence North on said East line 154 feet to the point of beginning. Also the E 1/2 of the NW 1/4 of Section 18, Township 30, Range 19, except the parcel described as follows: Commencing at a point on the South line of SE 1/4 of NW 1/4 of Section 18, Township 30, Range 19, which point is 154 feet West of Southeast corner of said SE 1/4 of NW 1/4; thence North 2 feet; thence West parallel with South line of said SE 1/4 of NW 1/4, 1166 feet; more or less, to West line of said SE 1/4 of NW 1/4; thence South 2 feet; thence East along. the South line of said SE 1/4 of NW 1/4 to the place of beginning. Also excepting the following described tract sold to SKI -MAC, Incorporated: Beginning at NE corner of NE 1/4 of NW 1/4 of Section 18; thence South 1 degree 10' West 289.9 feet along the East line of said NE 1/4 of NW 1/4 to an iron stake; thence West parallel to the North line of said NE 1/4 of NW 1/4 695 feet to an iron stake; thence North 2 degrees 00' West 290 feet to an iron pipe stake on the North line of said NE 1/4 of NW 1/4; thence East along the North line of said NE 1/4 of NW 1/4 711.0 feet to point of beginning, St. Croix County, Wisconsin. Parcel III: The E 1/2 of the SE 1/4 of Section 7, Township 30 North, Range 19 West. Parcels I, II, and III are subject to a utility easement in favor of St. Croix County Electric Cooperative recorded in Volume 256 at pages 547 and 578. r , a 10 STC 104 4 1995 AS BUILT SANITARY SYSTEM REPORT CC*NTY OWNER �- ,�- ''ONlNG �?flFfCE ti ADDRESS //0.�� / SUBDIVISION / CSM# LOT # SECTION >: _T- N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3767 -- .� INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK• _ /'�, n� _.s „7z.0 = ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ��� >� Liquid Capacity: Setback from: Well ? House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width Length �/ ' Number of trenches Distance & Direction to nearest prop. line: -7 Setback from: well : House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold ,g,2 7(� Bottom of system 9�� Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: e o n 3/93:jt i 1, � ��- Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village O - Town of: State Plan I .: o J.P. GOLF MANAGEMENT, INC. A CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1 TANK INFORMATION t✓' ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / /vex . Dosing Aeration Bldg. Sewer Holding St /Ht Inlet 1/1, 1? 7.8gS TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >a i >io o' J r q ,. NA Dt Bottom Dosing NA Header/ Man. 13_5Sf 9�,7�. ' Aeration NA Dist. Pipe 13.6 71 Holding Bot. System , 9 � PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Fr' Ion System TDH Ft Forcemain ength Dia. Ff Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a '96 1 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of `tece.a CHAMBER Mo Number: System: Z�e ^. t, �dDO / �� "� as OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched i Bed /Trench Center 3 " Bed /Trench Edges �y - (� r Topsoil C] Yes [] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.7.30.19W, SE, SW, Cty. Road V Plan revision required? ❑ Yes E�No Use other side for additional information. SBD -6710 (R 05/91) Date 1 spector's Signature Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i Safety and Buildings Division �� =�■�r. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, Wl 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County S than 81/2 x 11 inches in size. f • See reverse side for instructions for completing this application State San�taty er'gt Ny ber The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION — Prop rty wnei Na a Property Location 1 /4 1/4,S T , N, R/ E (or& Property Owner's Mailing dress Lot Number Block Number ity, ate zip Code Phone Number Subdivision Name or CSM Number i ( ) 11. PE OF B ILDING: (check one) ❑ State Owned o it�r Nearest R ad E] VII age Public 1 or 2 Family Dwelling - No. of bedrooms kTown of 111. BUILDING USE (If building type is public, check all that apply) Parce 9 Tax C Num b ber(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station /,Ci4 r W sh 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. D New 2_ ❑ Replacement 3 ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an _____ System ___ - ___ System____ ________ _TankOnly___________ - __ Existing System _________Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation f Feet Feet VII. TANK Capacity in gallo g Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist strutted Tanks Tanks it Septic Tank or Holding Tank — ® ❑ ❑ Cl ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ 1 ❑ 1 Eli ❑ I ❑ I ❑ Vill. RESPONSIBILITY STATEMENT I, thq undersigned, assume responsibility for i stallation f the onsite sewage system shown on the attached plans. Plumber' Na : (P ) Plum is nadir { S mps) MP /MPRSW No_: Business Phone Number: y , - P lufnberS ddress S eet, Ci Sta I ip Cod Ae r � /.O IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San tary Permit Fee (includes Groundwater ate Issue sluing Ag t Si nature ( St ps) Approved ❑ Owner Given Initial j �6f2- Surcharge Fee) t/ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO -6398 (R. W94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I t INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If build ng type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank rc— Aacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of to - iks and manufacturer's name, indicate prefab or site constructed and tank material. Coy iplete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks receive experimental product approval from DILHR. VIII. Responsibility staterrent. Installing plumber is to fill in name, license number w h appropriate prefix :e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X_ County/ Department Use Only. Complete plans and specifications not smaller than 8 11:2 x 11 inches must be s,!! fitted - ,o the ;ounty. The plans must include followinij: A) plot plan, drawn to scale or with complete dimensr r , vocation o' holding :ank(s), septic tanks) or �tF:e ralrnent tanks, building sewers, r�ell)l water s :f ce; streay. i, :-rd lake,; pump or siphon tank;, u,stribu.i:.;; ) boxes; soil absorption systems; replacement sysi , o_c. �� ,the loci of the kuilding served; 3) i,vrizor,i L vertical elevation reference powts; Q (ornplet :, Pt�� :1 r f -)r rid contra GIs; dose volume; elevation difference); friction loss, pump performance curve; pump merK_I ;i , yip marl �cturer; D) cross section of the soil absorption system if required by the county, c) soil test data on < ,.-m grid F) a!I sizinc, information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of rec .jlated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwate contamination investigations and establishment of standards. �. �`• �o / i' �i9W.,�Ce.7.�,�T, X�c1C. S,� � sc� �/�.sEa 7, T v r � IN4 Alonzo � Lx, lz d /. SIL M iy f i J�t,�Cti TC `l F ; SYSTEM SEW A Pa IONS N Z OF S�- rr PAGE OF i cro S ecrlon Or ri �Jen SyS�e0-1 i Fresh Air Inlele And OOcervallon Pipe C�- Approved Vent Cap Ntnlmum 12' Above Final Grade 20 42" Above Pipe __ _ 4" Cost Ircn alp ONSITE SEWAGE SYSTEM Pipe ] / To Final trod. ten Hoy Or Synthetic Covering v yin 2 Aggregal• O +u P APPROV, E_n 1pe Illon F —Tae 0 0 0 0 0 6' A Perforated Pipe aslov DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELWYNe"' U (-� _ Coi0ina Terminating At J IVISION OF SAFETY AND BUILDINGS Bollom Of s r t SEE CORRESPO ENCE �.�cJ•- r t on . �\ \��\ SOIL FILL DISTRIBUTIOVI PIPE J RPR.OV1<O SjNT11£TtC COVER fliATERK OR q" OF 5`A4/ M.L. Co OF 12 - 2 1 / AGGRCGATE � /� �EV QF� FEEY DISTRIgUTIOU PIPE TO BE AT LEAST c iIJC1aE5 BELOu/ ORiCjUAL. GRADE AMU AT LEASTZO WCHE5 BUT, AiD MORE -1-14A, IAICHES t)E�OW FINA G MAXIMUM Deprvi OF EXE/WATI FKOM ORI &YJAL &KAK WILL e c if.l(_ r1 1NjmVM OF EYCAVAT110N FROM CA IGIN,�L (RAP WILL e�. _ IrICFaEs sees � SIG►JED: ` LIG E►J SE ►.SUMBE R: �� ��1 � � a DATE: -:S � � Wisconsin pepartment of Industry SOIL AND SITE EVALUATION REPORT Page - L of \ Labor and -Human Relations Q.rvisicn of Safety & Buildings in accord with ILHR 8 e �y COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches' . Plan m rude, not limited to vertical and horizontal reference point (BM), directio kn % ot&pe or '� �,;�I PARCEL .D. # dimensioned, north arrow, and location and distance to nearest r 0. G T APPLICANT INFORMATION- PLEASE PRINT ALL INFO e„ I REVIEWED BY DATE ON �; ` ,� I' ?�--. PROPER OWN TY LOCATI �: r G LOT 1 /4,S T AR (or� _ PROPERTY OWNER - :S MAI G A D 1GT_# _ _ # UBD. NAME OR CSM # 4 CITY, STATE ZIP CODE PHONE NUMBER ❑CRY' I LAGE EjOTOWN NEAREST ROA K New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) 9Z19 ft (as referred to site plan benchmark) Additional design /sit considerations Parent material F plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem as ❑ U ®S ❑ U I ®S ❑ U RI S ❑ U ❑ S laU ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cpnt. Color Gr. Sz. Sh. Bed Trenctn Ground - elev. ft. Depth to limiting factor Remarks: Boring # Ground Vev. ft. Depth to s - limiting factor > ,- Remarks: CST Name: - Please Print Phone: Address: Signature: Date: CST Number: i PROPERTY OWNER C DESCRIPTION REPORT P.w�of 3, PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Co9t. Color Gr. Sz. Sh. Bed jTrench ?\ Ground — — elev. 3ZLI, ft. Depth to limiting factor 9,9 Remarks: Boring # a /,�F en� • •.•........ �..4~ _ J Ground 3 — OF elev. _ I Depth to limiting faclQr Remarks: Boring # 1 � XZ �T 1 1,7 1 Ground 3 elev ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) � dA),e , ` / g� ' b i 0 Maintenance Building STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER J. P. Golf Management, Inc. MAILING ADDRESS 6016 Blue Circle Drive Minnetonka, M 55343 PROPERTY ADDRESS 1603 County Road V (location of septic system) Please obtain from the Planning Dept. CITY /STATE Somerset, Wisconsin 54025 PROPERTY LOCATION 1/4, S� 1/4, Section �_ , T n N -R _L �_ W W TownshF Som prset ST. CROIX COUNTY, WI SUBDIVISION St. Croix National Golf Club LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July I, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be compl ted and returned to the St. Croix County Zoning Officer within 30 days of the three year atio d e. SIGNED: For J.P. Golf Management, Inc. DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 r S T c loo ' Maintenance This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property J. Golf Manage Inc. Location of property1 5i 1/4, Section _� , T -R Township Somerset Mail ing address 6 016 Blue Circle Drive Minnetonka, MN. 55343 Address of site 1603 County Road V, Somerset, WI. 54025 Subdivision name St. Croix National Golf Club Lot no. Other homes on property? Ye x_No Previous owner of property M. Villa fana _ ^^ Total size of property 243 A Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ,Yes No Is this property being developed for ( spec house) ? Yes X_ No Volume 4Z I. and Page Number __ a!� recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICA`1'ION TIIE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE' SEAL OF TIIE REGISTEI: OF DEEDS. In addition, a certified survey, if available, would be Helpful so as to avoid delays of the reviewing process. If the decd description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (Vgj certify that all statement: -, on this form are true to the best of my )00= knowledge that I am JQUM the owner W of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. � -z��� and that I presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. S.ig tur- of App cant Co- Applicant. For J.P. Golf Management, Inc. _ /Z) - /d Datc of Signature ature Date of Signature 9 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - -1982 THIS arAcc RESERVED FOR RECORDING DATA WAHRA TY AEED VOL 11l.�15 '�R CE Z 3 D @@ made between ._ ROddforRocc -I Z l h e 1 .- -------- -•-•- ---•...._..... Manuel A. V lafana and Elizabeth E. Villafana, husband APR i 3 X995 i --- I ................ . - - - -- and_. wife -•-•• .............. ....... .................. .• - - -- -• -•--•---- •-- •------------ •.- •- . - - - -. t ...................................... . Grantor, &t 9.30 and A. J li' GoYf Nlanageirient; Yilc. , --.-_... . - ------ -- --•.- ---•-- --- ••----- --•- •--•-- -_ -- a- Minnesota. Corporatio . n ----- ----------- • ......... .........•-- ..._............._. RegL -- ter c J Deeds - - .......................... Grantee, Witnesseth That the said Grantor, for a valuable consideration...... ............................................................. .............................. RLTURN ITLE TH LATE T conveys to Grantee the following described real estate in ... ............................... 400 SWq Str"k 801 255 County, State of Wisconsin: SL Pout, `ink So 801 See 3r;zibit A attached hereto for Tax Pazeel No: legal description of real estate. 150 This ... is . not ......._ - -.. homestead property. (is) (is not) Together with a l l and sh) lar the hereditaments and appurtenances thereunto belonging; Manuel A. V1.�afana ( warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except the easemnt referenced on Exhibit A; roads and highways; applicable laws, regulations and ordinances; and any levied and perusing assessments, and will warrant and defend the same. Dated this 3 1 -- •-- •- ---- -... day of ... �:- •--••. -- -• . .......................... . . 19.9r�.... (SEAL) . ..................... (SEAL) .... _ s .Manuel . lafana ---•-•-•----------••-------------•--- •- •---- •-- .....•- •-- •- • - - - - -- .................. .............................. °---•._ (SEAL) •-- -- -----•-- (SEAL) c th E. Villaf AUTHENTICATION ACHNOWLBDQMBNT Minnesota Signature(s) ------------------------------------------------------------ STATE OF WISGONS! ss. ----------------------------------------------------- ------------------- •- . - - -•- Hennepin --- -- - -- --- ----- •- -... .... County. authenticated this -------- day of --------------------------- 19. - - - -- Personally came before me this ... - . - - - - -- -day of _4 .... 19. _ e above named - s ....................................•---•---- .........------ •------- •- - - - - -- Manuel A. Villafana• Ck, 12abft'►�_... - � - ----- ... - - -•- ...... _:. . _ _�9 tAv�,G2r Sa 1 r 1 G�� (_.. r�.'_^__'!�'S - - - - -- TITLE: MEMBER STATE BAR OF WISCONSIN .... .......... (If not, -- --••• ... .. ........ ------------------------ ---- -••- •- -- •-•-- ---- ---- -- --•- --- ------ ------ authorized by $ 706.06, Wis. Stats.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same - THIS INSTRUMENT WAS DRAFTED BY ;- John B. Winston, 4420 IDS Center �ca�a tce S QIALEA Minneapolis, M 55402 - AOOtA�TY ..-- - - --_. .---•----• ........................ •-•---•--__....---- - °- ------- Notary Public ............... (Signatures may be authenticated or acknowledged. Both My Commission is permanen W . I not, 510 Caw are not necessary.) date: --- ----------------------------------- • 19 ) eNamer of persona signing in any Capacity should be typed or printed below their signatures. WARRANTY DRED 8TATE BAR OF WISCONSIN Wise�nsin Leval Blank Ce. Ia. FORM No. 1 •— 1982 Milwaukee. Wis. p pppp. VOL 1117FAsEM EXHIBIT A LEGAL DESCRIPTION Parcel It Southeast Quarter of the Southwest Quarter (SE 1/4 SW 1/4) and Southwest Quarter of the Southeast Quarter (SW 1/4 SE 1/4) of Section 7, Township 30, Range 19. North 395 feet of West 370 feet of Northwest Quarter of Northeast Quarter (NW 1/4 NE 1/4) and part of Northeast Quarter of Northwest Quarter (NE 1/4 NW 1/4) described as follows: Commencing at the Northeast corner of said Northeast Quarter of the Northwest Quarter (NE 1/4 NW 1/4); thence South 1 degree 10' West on East line thereof 289.9 feet; thence West parallel with North line of said Northeast Quarter of the Northwest Quarter (NE 1/4 NW 1/4) 695.0 feet; thence North 2 degrees 00' West 290.0 feet to said North line; thence East on said North line 711.0 feet to the place of beginning, all in Section 18, Township 30, Range 19. Parcel IIz The Northwest Quarter of the Southeast Quarter (NW 1/4 SE 1/4) of Section 18, Township 30, Range 19. Also a parcel of land described as follows: Commencing at the Ncrtheast corner of the NE 1/4 of SW 1/4 of Section 18, Township 30, Range 19; thence West along North line of said NE 1/4 of SW 1/4 154 feet; thence Southeasterly at an angle of 45 degrees 217.8 feet to East line of said NE 1/4 of SW 1/4; thence North on said East line 154 feet to the point of beginning. Also the E 1/2 of the NW 1/4 of Section 18, Township 30, Range 19, except the parcel described as follows: Commencing at a point on the South line of SE 1/4 of NW 1/4 of Section 18, Township 30, Range 19, which point is 154 feet West of Southeast corner of said SE 1/4 of NW 1/4; thence North 2 feet; thence West parallel with South line of said SE 1/4 of NW 1/4, 1166 feet; more or less, to West line of said SE 1/4 of NW 1/4; thence South 2 feet; thence East along. the South line of said SE 1/4 of NW 1/4 to the place of beginning. Also excepting the following described tract sold to SKI -MAC, Incorporated: Beginning at NE corner of NE 1/4 of NW 1/4 of Section 18; thence South 1 degree 10 West 289.9 feet along the East line of said NE 1/4 of NW 1/4 to an iron stake; thence West parallel to the North line of said NE 1/4 of NW 1/4 695 feet to an iron stake; thence North 2 degrees 00' West 290 feet to an iron pipe stake on the North line of said NE 1/4 of NW 1/4; thence East along the North line of said NB 1/4 of NW 1/4 711.0 feet to point of beginning, St. Croix County, Wisconsin. Parcel IIIs The E 1/2 of the SE 1/4 of Section 7, Township 30 North, Range 19 West. Parcels I, II, and III are subject to a utility easement in favor of St. Croix County Electric Cooperative recorded in Volume 256 at pages 547 and 578.