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County:
Wisconsin Department of Commerce , PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
57
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village x Township Parcel Tax No:
Gessler, Raymond I Springfield Townshi 034 - 1041 -60 -100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
18.29.15.276A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Ina,, S 2 W E tS(-_4, LSD BI � �,D C 1 1•0o
Holding St/Ht Inlet AZ (tom r
` -ete �h • g D � .O
TANK SETBACK INFORMATION St/Ht outlet b C
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 1 9 , Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
del Number ($ Q oTT .jrOs!
�+ H Lift Frir�fi�n I nos System Head TDH r: I + I;
,'t S 20•
Forcemain Length Dia. Dist. to Well
bfl z
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L DG WELL LAKE /STREAM o
CHING Manu a turer:
INFORMATION Type Of Syste BER OR
DISTRIBUTION SYSTEM ,
Header /Manifold Distribution x Hole Size x Hole Spacing Ten to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges ITopsoil g ❑ Yes [j No Lps] Yes ] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 3 k
d 1 ZAD Inspection #2: I /
Location: 956 280th Street Woodville, WI 54028 (SE 114 NE��1/4``1__8 T29N R15W) NA Lot n!a P eel No: 18.29.15.276A10 1
1.) Alt BM Description = �j � cites' T� cco—" ' t��'�""
2.) Bldg sewer length =��._�� \ jVW (�
- amount of cover - b ` —:A � i t* � � S¢.w'aT
4
40
Plan revision Required? 4, Yes [ } No S I
Use other side for additional information. _ _ _ _ ___J i___�1_�_1_
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
1
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04/02101 )y TIN 12',38 FAX 715 386 4686 ST C,RA CO ZONING wool
County Sanitary Permit Application $T. CROIX COUNTY WISCONSIN
%10 In accord With 15.04 St Croix County Sanitary OrdlnanW ZONING OFFICIO
Personal Information you provide may be used for secvndBrY purposes ST. CROIx COUNTY 00VERNMENT CENTER
_& _ _ tPrtvaay Law. S. 15.Od(1 xm)) 1101 Carmichael Road
�", Hudson, WI 54016 -7710
(715)386-4680 Fax 1715)396-4686
Attach complete plans for the system on paper not lees than 8-V2 x 11 inches in size.
County Sanitary Permit # ❑ Check If re Ica previous application
1. Application Information - Please Print all Information Location:
Property Owner Name
4 SE 11 NE114, sec 1$ o�7f0 - U
RAYMOND GESSLER AP R j r 29 N. R 15 E (or
Property Owners Mailing Address r C Ro M Number Block Number
�g
z y , _
956 280TH STREET �- ��� a�' Nc ,,. N/A N/A
City, State Zip Code Phone Numer E Subdivision Name or CSM Number
WOODVILLE WI 54028 1 715/698-2014 N/A
11 Type Of Building: (oheak one) ✓ �� Q� A Lrity ❑ village ®Town of
LK 1 or 2 Family Dwelling - No. of Bedro ms: 3
El Pubtic/Commercial (describe use) 1l�ys�ih SPRINGFIELD
❑ State-owned Nearest Road
11. Type of Permit: (Check only one box on line A. Check boot on Oft 8 if applicable) 280TH MEET �
P� I �T / px Numbe �)
A) 1.❑ Repair [� tReconnecti 3.❑Non•plumbing 4. ❑Rejuvenation ; { r t (Y a
Sanitation �D
B)
Permit Number Date i
State Sanitary Permit was previously issued 240767 8 -18 -1995
IV. Type of POWT System: ( Check all that apply)
Q Non - pressurized In- ground =Y �Sb) ❑Sand Filter p Constructed Wetland
❑ Presaurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
r1 At-grade ❑ Aerobi Treatment Unit ❑ Reclrclilating ❑ Other
V. Dis rsel/TreatmentArco Information;
1, Design Flow (gpd) 2, Dispersal Area 3. Oisperaal Area 4. Sell Application Rate 5. Percolation Rats 8. System Elevation 7. Final Grad
Required Proposed (Gals.lday /sq.tt.) (Min.finch) Elevation
1050 875 876.75 .39 N/A 97.3 98.88
VC T ank h orw C4 paicty I n lall Total — 4 — of Manufa*VW Prefab Site Con- Steel Fite/ Plastic
New Existing
Gallons Tanks Concrete strutted glass
Tanks Tanks
Z a2� ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
VII. Respoli�lbllity Stitt! 76V / 4/J_U1da -_
I, the undersigned, a responsibility for repalrl reoonnenction /rejuvenationfinstellatlen of non-plumbing for the POWTS shown on the attached plans. A
license is not required for terralift re air or the installation of non - plumbing sanitation sy stem.
Plumber's Name (print) Plumber. mps gnature (no sta MP/MPRS No. Business Phone Number
BENNIE HELGESON 1 220292 1 715/772-3278
Plumber's Address (Street, City, State, Zip Code)
W1229 770TH AVENUE, SPRING VALLEY, WI 54767
r ounty Use Only
Disapproved Sanitary Permit Fee Date Issued I ng AQ t Signature stamps)
Approved Owner Given Initiasl Adverse
13 c Q v 7
otermination (
J 2 'S
of Approvel /Reasons for DiSa royals �� I. -le
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PU!'%P CHA •bER CKC).c AMU 'PECIFIi:!•Ilu�!`:
VC UT CAP
'I C.1 "E'JT PIPE WEATHERPROOF _APFROYED
MAIJHOL E COVE I:'.
JUIJCTIOJJ BOX
DOOR, 12 "MIU.
WIIJDOW OR FRESH I
AIR IrJTAKE
GRADE 1 y "MIM.
10 1 18••/11JJ.
COWDUIT
Ib"PtIAl. - - -- -- nlJpve-,--
PROVIDE I - - - --
IKILET AIRTIGHT SEAL I III -T I I
I
I I APPROVED JOIU
APPROVED JOINT A I II W /C•I• PIPE
w /C.I. PIPE I II ALARM EXTEUDIJJG 3'
EXTENDING 3' I II OWTO SOLID SOIL
CWTO SOLID SOIL D I I
1 I ow .
c I I
I
1 ELEV. FT. PUMP- OFF
D
CO UCRETE DLOCK
RISER EXIT PERMITTED OWLH IF T WK MAUUFA2TURER HAS SUCH APPROVAL
SPECIFItATIOAIS
SEPTIC E n f�
P. k 6cckfl�w �OIG'm�- /`/
TAJJKS MANUFACTURE
7 �U GALLOWS DOSE VOLUME
TA1JK SIZE: �• / ? /`��_ GALLONS
.S �� �,S _ _ S �'o`�'cJ � dose Va
ALARM MAUUFACTUKSIX: GY>,S ALLOU5
MODEL WUMBER: �% CAPACITIES: A- IIJCHES OR 4/6 S
- 6. OR _L=- ,kLLOF.J5
SWITCH TyPC: �-l�rCc- �v - - • � , -�
10CHES OR GALL0U5
PUMP MAMUFACTURER: p�
MODEL QUMDER: 87 'z � W C� � Dom - — INCHES O L GALLO►JS
SWITCH TYPE: �j�`t = � MOTE: PUMP AMID ALARM ARE TO bE
INSTALLED OW SEPARATE CIRCUITS
MIfJ 1 MUM DISCHARGE RATE � G PM
VERTICAL DIFFEFE DETWEEM PUMP OFF AAJO DISTRIBUTIOM PIPE.. FEET
+ .MI NETWORK SUPPLY PRESSURE . . . . . . . . . . - FEE
FEET OF FORCE MAIM X �— oorT.FRICTI° "J FACTOR. - * y 7 FEET
TOTAL DyWAMIC. HEAD — i 7 FEET
J
IJJTERFJAL DIMEIJSIONL OF TAJJK : _;WIDTH �O � ' ,LIQUID DEPT
� / L 4
Lt
SIGUED _ LICE.W�F ►.DUMBER: _ DATE:
�I
a
MODEL
Submersible Sewage Pump
E:
1 t
S
L
x z
METERS FEET
6
J+ +
MODEL: 3872
7
a 6
1+.1
= S 15
cv
6 4
T 10
FF 2
5
0 00 10 20 30 40 50 60 70 U.S. CAM
0 2 4 6 a 10 12 14 16
CAPACITY y
Pump Specifications Features and Benefits
V2 HP *Glass filled, thermoplastic vortex
Up to 75 GPM impeller with stainless steel
Maximum head to 18' insert and pump out vanes for
Discharge size 2" NPT mechanical seal protection.
Solids: 2" maximum *Rugged glass - filled thermoplastic I '
casing and base design provides
Mo motors feature ball superior strength and corrosion r
All
bearing construction. resistance.
Single phase: 115V *Cast iron motor housing for
Materials of Construction efficient heat transfer, strength
Cast iron and durability.
Thermoplastic *Corrosion resistant threaded
Stainless steel stainless steel shaft.
• Available in automatic and manual
models.
•CSA listed models available.
?ration and feature stainless steel hardware.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
the ,6 1)g0A � residence located at: SE %, j,
Sec . , T 2 N R S W, Town of , St. Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced
2 koynes Loth/ eZTj�D V A- sEpA- e-A- - rte S - nC i 4#,Je-C Tb OA1E� 76 r2. /VWAU1
Did flow back occur from absorption system? Yes No (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity: 10(90 V /C � 00 1 6� � /
Construction: Prefab Concrete (/ Steel Other
Manufacturer (if known) : /did
Age o f Tanks (i f known)
(Signature) ( am ) Please Print
220 Z_q 2
(Title) (License Number)
(Dat )
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over
outlet baffle) .
Name Signature
MP /MPRS
HELGES N
EXCAVATI 0 N, Inc.
SEWER AND WATER SPECIALISTS
Plumber /CST Cert. #220292
BEN HELGESON Office (715) 772 -3278
W. 1229 770th Ave. Home (715) 772 -3127
Spring Valley, WI 54767 Fax (715) 772 -3387
April 8, 2003
St. Croix County Zoning Office
1101 Carmichael Road
Hudson, WI 54016
Dear Sirs:
I inspected the existing mound system and it is in proper working order.
Sincerely,
J
Bennie Helgeson
President
BH:cb
Enc. 3
+ • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa / of 2—
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner �� Septic Tank Capacity Z Gb0 f al E3 NA
Perm # Z O DD 7 Septic Tank Manufacturer 1LV&1 1 ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms � ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units NA Pump Tank Capacity/V S70 a l ❑ NA
Estimated flow (average) g al/day Pump Tank Manufacturer �61e5-e/- ❑ NA
Design flow (peak), (Estimated x 1.5) psQ g al/day Pump Manufacturer ULDS ❑ NA
Soil Application Rate • 3 gal/day/it' Pump Model KJwb ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit I j "-4 �p NA
Fats, Oil G) 530 mg /L [3 Sand /Gravel Filter ❑ Peatilter r
Biochemical Oxygen Demand (BODJ 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODJ :530 mg /L ❑ In- Ground (gravity) In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade Mound /K1
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: [3 NA
I i
*Values typical for domestic wastewater and septic tank effluent. I air' ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: Z.3 13 months) (Maximum 3 years! ❑ NA
y ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank vol e ❑ NA
Inspect dispersal cell(s) At least once every: Z _ 3 ❑ yea�lsl(s) (Maximum 3 years) NA
❑ month(s) NA
Clean effluent filter At least once every: ❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month s ❑ NA
Flush laterals and pressure test At least once every: '�O month(s) ❑ NA
❑ year(s)
Other: At least once eve ❑ month(s) [I NA
every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ T he s ite has not b Pn P al��a * - - *^ �+ •" " " "` "~'^ '�;' "- - -- - - -- - -- `' �" ^f the Pnw_ TS a soil and site
ev_luar,nn .+�.. • -- ^-j- _� _ :��e nnla^nrrfant anxa If nn rcnl 1 hl a 1' id ,a t ank
r
Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name _ Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name —, r
Phone Phone `S — A FO
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
f
Y . 1
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Pei r� C141t- C c sy /'��-
ADDRESS
Cu
SUBDIVISION / CSM # � LOT
1
SECTION V T 0,1 N -R W, Town of Cl/�T��
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: no
ALTERNATE BM: Y'v1
SEPTIC TANKS /: pUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:
Setback from: Well gTi'o��nC '�Liquid Capacity;
f' /pus -� ouse ��, � ,,
Oehe
Pump: Manufacturer 2-0.0 ��t/
Model # /3 7 Size
Float seperation /,5 Gallons /cycle:
�L 3-2!
Alarm Location
SOIL ABSORPTION SYSTEM
Width: g Length
Number of trenches�i
Distance & Direction to nearest prop, line:
Setback from: well:
_ House / Other
E ELEVATIONS
Building Sewe q i A� -757.)
_ ST Inlet. s= 5P</,0. ST outlet _
d = 93
PC inlet �. PC bottom�y_
Pump Off
Header /Manifold ,�,� Bottom of system
r
Existing Grade L�
Final grade
_3
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR :�
3/93:jt
1
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' Wiscg4sin Department of Industry, :
Co nt
4aborand Human Relations PRIVATE SEWAGE SYSTEM y
Safety and Buildings Division INSPECTION REPORT ST . CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: C] City El Village p Town of: State PI o..
GESSLER, RAYMOND & SUSAN X
CST BM Elev.: Insp. BM v.: r B� scription: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic d a Benchmark ;rpa.o� 00.
Dosing y`U�e ✓r: i- �i� / ✓��b��>:�C.
Aeration Bldg. Sewer q�
/ 9y,
Holding St /Ht Inlet q
TANK "S`ETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Air to
i ROAD Dt Inlet
Air ntake O �l
Septic �� �p1j' 76 NA Dt Bottom
Dosing }�C� r ti 6 r NA Her / Man. (
Aeration Dist. Pipe j3
Holding -, Bot. Systen,O 97 9d f
PUMP /I INFORMATION Final Grade - --
Manufacturer �.,. 7Demand `, 1 �; Sal G ,3
Model Number 43 C�P�A
TDH Lif 3 5 i Lr 03' mead �qJr TDH )P,�SFt
Forcemain Length 23' Dia.3 '' Dist. To Well > 160,
D`�' a ABSORPTION SYSTEM
BED/TRENCH Width r Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Dept
DIMENSIONS �y I DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHIN u acturer:
SETBACK A
INFORMATION Type O CH R Mo a Num er.
System: rn�,( ? j, / .`'! OR UNIT
DISTRIBUTION SYSTEM
+tamer /Manifold „ Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
Length t03 r Dia. 3 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
ed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SP INGFIELD.18.29.15W, SE, NE, 280TH STREET
1 -30 - ?�5 Q�b -� �.., ;r�.z2,CX k��C / o,__ j ,; r n�Q / �' /,�..� „� -_
Plan revision required? Yes 0 /
Use other side for additional information. 1 9 1 0/ 1
SBD -6710 (R 05/91) Date Inspector's Signatur6 Cert. No.
� 1
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
�.�,�cx�� � Vii; ¢�• dam„ � -� P � � � �-
I
'I
r,
Safety and Buildings Division
V�.LiI� i SANITARY PERMIT APPLICATION Bureau of Buildin 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 8112 x. 11 inches in size. ST CROIX
• See reverse side for instructions for completing this application State Sa2ita�y Pernt Number
The information you provide may be used by other government agency programs E] Check itt to pr . i.us application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S95 -40812
Property Owner Name Property Location
RAYMOND & SUSAN GESSLER SE 1 /4 NE 14,S18 T 2 , N, R 1 E (or) W
Propert Owner's Mailin Address Lot Number Block Number
959 U00 28TH STREET N/A N/A
City, State Zip Code Phone Number Subdivision Name or CSM Number
WOODVILLE WI 54028 ( 715)698 -2014 N/A
H. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road
E] Public 1 or 2 Family Dwelling - No. of bedrooms 7 ° Town of SPRINGFIELD 280TH STREET
411. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 034 - 1041 -60
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 online B, if applicable)
A) 1 ❑ New 2_ [1 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 ❑ 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
-S7 0 1 R 7S 7 S . 39 97.3 Feet 98.88 Feet
Capacity
VII. TANK in Ca allo s
g Total # of Prefab. Site Fiber Exper
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank 22001 1 2200 2 MIDWESTERN PRECAS [ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 14001 1 1400 1 1 MIDWESTERN PRECAST [3 1 ❑ I ❑ I ❑ 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 Sta ps) MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON MPRS 3215 715/772 -3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE, SPRING VALLEY WI 54767
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved San ary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No St mps)
A pp roved F1 Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
XV7�
yam`
SHO -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Dive ion, Owner, PlurnWr
INSTRUCTIONS '
Y ,
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.
11. 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 {placement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
Vl. Absorption system information. Provide all information requested for numbers ' through 7.
V11. Tank information. Fill in the capacity of every new /or existing tank, list the total jallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Coy. plete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks receive:; experimental product approval from
D!LHR
lI11, Responsibility statement InstaIhing piurr,ber is to fill in name license number w ih appropriate prefix (e g. MP, etc.),
address and phone number. Plurnoer must sign application form
IX. County / Department Use Only
X. County / Department Use Only.
1C1 SO It1C.S 0'.s 00 smu ?I1 1%2 x ' 1 nches'T Jst `bi 4 ,. It`ed to [he :_ounty. The plans must
u; Yt' ,...,li.�c'`.., u loccjlior of Holding tank(s), septic
:y,_ ,I e; _ ;rcu ns .:nd +afces, pimp or siphon
of building served,
�rnf.s A! _; controls; dose volume,
iilG. c'. r ur:'r: D) ._ - oss section
L) ui;... .II s izing
Inforl"TlatlOn_
GROUNDWATER SURCHARGE
0 inr!uded the creation of surcharges (fees) for a number of % slated practices which can
e'fect - rou:idwater
��e i�lo ie7 .oiiected through these surcharges are used for monitoring groundwate ontarrtination investigations
,nd establisIm ent of standards
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 4, 1995 2226 Rose Street
La Crosse WI 5 9�
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74 y�
RIVER FALLS WI 54022
RE: PLAN S95 -40812 FEE RECEIVED: * Z
GESSLER, RAYMOND
SE,NE,18,29,15W
TOWN OF SPRINGFIELD COUNTY OF ST CROIX
MOUND 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 ILHR 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 ILHR 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 be made.
All permits required by the city, village, township or county shall be
1wior to installation.
Jr,, Tries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
Dennis V S,6r l enson
Plan Reviewer
Section of Private Sewage
(608) 785 -9336
SBDA -7997 (R. IWN)
Page of 6
MOUND FO SYSTEM R
-40812 S95
A "1 BEDROOM RESIDENCE
�Czcip�s 3
2 b"
LOCATED IN THE SALZ 1/4 OF THE ME 1/4 OF SECTION l� ,T N, R 1S W,
TOWN OF Fj k,L lb sr, C(LOLX COUNTY, WISCONSIN.
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION. R�GEl� •�..
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER JUL 13 i
PA GE 6 of 6 PUMP PERFORMANCE CURVE
SAFEly 8, BLDGS. QlV.
PREPARED FOR
�.PM►�1 �+vYj � stJS�v G�SSL -�
q s 6 za - T - VI s T'.
tiv�o >rt_� wt S �o Z8 .
PREPARED BY
WEGEE =tER SL3 I !___ TEST = NG G�P����
ACID ® c . °•.....,..,, °•` �
Al L
DES I Gam! S�RV I CE `'
4:,c RFA • s
F.O. BOX 74 421 N. KAIN ST.
RIVED FALLS. V1 54022 Y +��.fJ
� Sr G I S
:: 6, vq CI
JOB NO. S `
PLOT PLAN
,Page . Z - of .
Scale 1 "
�s ->v_Q S95-40812
x '
wit_ g $ D2wj �
tlovsE o 3 bo 1
Bti1 d I N oT !o S ck��
1" n C S OF y C K D�`fWlt -u (�(O 1'C�31'A�DI
ns �op� 5 ♦zu vkL
qo of y��P�c
06
5
pRly� oR ti..i s v L-" Ft
�-2f1 s T t�R.utt''eT� 0►v
L t�-wry
L-Lz
�y J c Bo'oF3 =."1.
a e�a
oZ ��sTt�tZ13 Q I
^� AJ
1 I f 1
N . N I a0
( I
lo:
),FL cicl
(
eo ,- of= eft �ZC6q�
90 Ref �Mtec'� w000�
\3 - L LO C3,0 o+v 30�'�► of SID /Jv '-r'T SE Ho uStz� L%2WE2
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be \ gallon capacity manufactured by Qp�
l
5. Bench Mark SL- "CJUQ
6. Divert surface water around mound to prevent ponding at the uphill side.
_ Page 3 0f �.
895 -40812
Approved Synthetic Covering
, iz w" C- 33 Distribution Pipe
Medium Sand
_ H _ G
Topsoil – – _ - -_ -- F Elev. C'n 3
—�� E D
3
b
y % Slope
" �" Plowed
Bed Of Z- 2 � Force Mbin
Aggregate From Pump Layer
€ D Ft.
Cross Section Of A Mound System Using E Ft.
'. F 6-a Ft .
r,� a 'A Bed For The Absorption Area
,., G 1. o Ft.
A g.35 Ft. H k. S Ft.
Linear Loading Rate= 10.0 GPD /LN FT B
Design Loading Rate= o -39 GPD /SQ FT I 1'7 Ft.
i `O Ft.
K S Ft.
L tZ$ Ft.
M, W 353S Ft.
— L
d Observation Pipe -�
I- 8 K
A - -- - -- -- -------- - - - - -- - - - -��
•- -- - - - - -- - Force Main
Distribution Bed Of
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page Ll Of
Perforated Pipe Oetoil
S95 -4081
/ 0
End View
) Perforated
End Cop) �� PVC Pipe Install permanent marker
f �e
1 -4- at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
vr
PVC rl:,
1 _ '
Manifold Pipe
Distri ution ` r
Pi pe
I .,. ,
Lost Hole Should Be �
Next To End Cap
End Cap �,1 •�`:�
P
Distribution Pipe Layout S 6 3 11 1 C
X (6 3 Inches
Y 63 Inches
Hole Diameter i1 y Inch
Lateral l Inches)
Manifold 3 Inches
Force Main 3 Inches
# of holes /pipe 10
Invert Elevation of Laterals 4 Ft.
LOX -t•ll� �1.1 �L6.8O Gp�
�t
Place lst hole 3 from center of manifold with succeeding holes
at 61 " intervals. Last hole to be next to the end cap.
• . P OMP CHAMBER CRO55 SECTION AND SPECIFICATIONS PAGE S OF E�
S95 "40812
VENT CAP
`' C.I. VENT PIPE WEATHER PROOF
APPROVED LOCKING MANHOLE
JUUCTIOM BOX COVER WITH WARNING LABEL
? 10' FROM DOOR, I2•M1U.
WIMDOW OR FRESH I
AIR INTAKE I
GRADE I
4 MIN-
COWDUIT -"- - -_-
M �
18 Inl. \
PROVIDE "
IMLF T AIRTIGHT SEAL
• � I I v
'7 N
all JOIUT A T- ag `e T tc ion 3 7 Nall comply i I I APPROVED JOIWTS
C; with TLP 83 15' and ILHR 83.20 I II
I I II ALARM
O
C hl
LLEV SI{ - -�
j.!.; PUMP --� OFF
t - ••`
COLICRETE BLOCK
3" APPRCWf
• RISER EXIT PERMITTED ONLY IF TAWK MAMUFACTURER HAS SUCH APPROVAL a gEQ01µ�
SPU
005E Y.I �p1,J�r (�( 2' T - I T NUMBER OF DOSES: 3 ' a PER DA4
TA M Ki MANUFACTURER:
TANK SIZE: t�So GALLONS DOSE VOLUME z 3 O - S ,
ALARM MAUUFACTURER' S` ���� 5 ` t S INCLUD1iJ6 OACKFLOW: GAttows
MODCL DUMBER: `O� 1 iJ CAPACITIES: A= 30 INCHES OR GALLOAI5
SWITCH TBPE' �'� 13 = Z MCHES OR Q L. a G{ LLONS
PUMP
P -,AMUFACTURCIt: ZO Ln C9 11 k C a �3 I U CHE5 OR 3b3' I GALt0A15
MODEL NUMBER: 3� D \ -7 INCHES OR 3 x ° 17 _- S GALLONS
5WITCH TYPE' �LIZCUZ WOTE: PUMP AMD ALARM ARE TO OE
MINIMUM DISCHARGE RATE 46.80 GPM INSTALLED ON SEP CIRCUITS
VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD.- 015TRIBUTIOW PIPE.. NI - 21 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .. 2.50 FEET
•F Bl7 FEET OF FORCE MAIM X � 52'F YDfT.FKICTIOU FACTOR.. O '� Z ' FEET
.^ TOTAL 09MAMIL HEAD = 1b'3C7 FEET
DIAMETER
INTERNAL. DIMLW5101J� OF TAWK: LENGTH ;WIDTH - 'LIQUID DEPTH 6Zu
BOTTOM AREA - 231= - GAL /INCH
AS PER MANUFACTURER -- Z 3 • 38 GAL /INCH _
S95 S12
' - 4 3/4 {t 7 3/8
HEAD CAPACITY CURVE TOTAL DYNAMIC NEAOtTLOW 1
w PER MINUTE
4 MODEL 137 -139 EFFLUENT AND DEWATERING L- 6 1/8
30 SERIES 1 137 -139
Feet Meters Gal. I Ltrs
8 5 1.52 104 394 o
25 - 10 3.05 79 300 o 0 4 3/4
15 4.57 64 242 _ 1
°¢ 20 6.10 36 136 -J
= 6-20- 0 °
25 7.62 8 30
u_ 26 7.92 0 0
f k 30 o 1 1/2 - 11 1/2 NPT
o 15
a 4
o
r
10
2 LL
5
I
12 3/4
0
U.S. GALLONS 10 20 30 40 50 60 7o 80 90 100 110 -
LITERS 80 160 240 320 400
1 I 4
0 FLOW PER MINUTE ' I�
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling single and three
• Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm. • Double piggyback mercury float switches are available for variable
• Mechanical alternators, for duplex systems, are available available with level long cycle controls.
or without alarm switches. • Long cords are available in lengths of 15 -25 -35-50 feet.
• Combination starters are available. • Over 130'F. (54'C.) special quotation required.
Standard all models - Weight 47 lbs. - P. SELECTION GUIDE
137/139 series Control selection 1. Integral float operated 2 pole mechanical switch, no external control required.
Model Volts -Ph Mode Amps simplex Duplex 2. Single piggyback mercury float switch or double piggyback mercury float
M137/139 115 1 Auto 10.4 1 or 1 & 8 - - - -- switch. Refer to FM0447.
U1371139 115 1 Non 10.4 2o12&7 3 or 5 & 6 3. Mechanical alternator "M -Pak" 1M072 or 10 -0075.
D137/139 230 1 Auto 5.2 1 or 1 & e 4. Combination Starter. Refer to FM0514.
El 37/139 230 1 Non 5.2 2 or 2 & 7 1 3 or 5 & 6 5. See FM0712 for correct model of Electrical Alternator "E- Pak ".
H137l139 200208 1 Auto 8.2 1 &8 1 - 6. Mercury sensor float switch 10 -0225 used as a control activator, specify duplex
' 1137/139 200 208 1 Non 8.2 2&7 3 or 5 &6 (3) or (4) float system.
' J137/139 200 208 3 Non 4.2 2&4 3 &4 ors &6 7. Four (4) hole "J- Pak ", junction box, for water fight connection or wired -in
F1371139 230 3 Non _3 2&4 3&4 o15 &6
G137/139 460 3 Non 1.2 2 &4 3 &4 or 5
simplex or pump operation, 10-0002.
' G1 molded plug 8. Two (2) hole "J- Pak ", for Watertight connection or splice, 10 -0003.
Three phase units require a control switch to operate an external magnetic or combination slarter.
CAUTION
For information on additional Zoeller products referto catalog on Combination starter. FW514;Piggyback All installation of controls, proteclion devices and wiring should be done
by a qualified licensed
Mercury Float Switches, FM0477: Electrical Alternator, FM0486; Mechanical Alternator, 4495; Alarm electrician. All electrical and safety codes should be followed including the
most recent National Electric
Package, FM0513. and Sump /Sewage Basins, FM0487. Code INK) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AfAIL T0: P.O. BOX 16347
Louisville, KY40256 -0347 Manufacturers of ...
SHIP T0: 3280 Old Millers Lane
OEza-ff fff" Louisville, KY 40216 /I,. p� S , 7 , ff
(502) 778 -2731. 1(800) 928 -PUMP L���� u�
FAX (502) 774 -3624
WsconsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord wit �•FL� i t Adm. Code
COUNTY
• '�' ST• `-l�lx
Attach complete site plan on paper not less than 81/2 d has in ize. Plan t Jude, but
not limited to vertical and horizontal reference point ( f re ctn /G of ope, or PARCEL I.D. #
dimensioned, north arrow, and location and distance o arest °�� 3 q- 10 y) - 6a
APPLICANT INFORMATION- PLEASE PRINT A IN MATIIDN REVIEWED BY DATE
ftV
PROPERTY OWNER: '� 4 J ATION
SU 3 fNQ 6 S� 1/4 M 1 1/4,S ) 9 T Z 9 ,N,R 15 E (ore!
PROPERTY OWNERS MAILING ADDRESS LOCK # SUBD. NAME OR CSM #
R S ( I z eo `IZ4 S 9 _
CITY, STATE ZIP CODE PHONE NUMB ITY []VILLAGE ®TOWN NEAREST ROAD
�J�ot�v�LLF till S4oZE fZls) b98 -ZO1y sp2tn�GF1�n -D zSo TZt sT.
[ ] New Construction Use M Residential / Number of bedrooms 7 [ ] Addition to existing building
j� Replacement [ I Public or commercial describe
Code derived daily flow 1 O S O gpd Recommended design loading rate o- 3 9 bed, gpd/ft2 _ trench, gpd /ft
Absorption area required 9 bed, ft t - 1 5 trench, ft Maximum design loading rate o. S bed, gpd/ft 0. 6 trench, gpd/ft
Recommended infiltration surface elevations; OL 1. 3 ft (as referred to site plan benchmark)
Additional design/ site considerations fAW-3 W/ 8 .3S x L Q� S ` 8 QzZ . V I N . \ S 4 a P S ft _A F=i L L
Parent material 5 l - Xt t - Flood plain elevation, it applicable lV- A. ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK
U = Unsuitable fors stem ❑ S Io U WS ❑ U I CIS (O U ❑ S IOU EIS IOU [Is ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
IQN S o.b
- ).s 7 R 3 Y Gr- s Z rn S c-S
Ground 3 S `t tZ 4// y S
elev. l 1
- )-s 2 S / e)
ag.o ft. 2Z - s P__ y/ £t / t� 3 s C_1 0W- M
Depth to
limiting
factor
Remarks:
Boring #
1 Z rn s b w�'F�,, 0-3 o --S o.
311_ �nx Z << Z q -18 ► t� \ R y l y - s i 1 Zm sdk w> `F�- cs - o. s o. L
r: ?<: < <:
3 A Zy y/
Ground
elev. ft. ZVf 3) S `112.. y / 1 , S `f rz S 1g S Q- 1 � Yvt T►.-
a
Depth to
limiting
factor
Remarks:
CST Name: - Please Print Arthur L. We erer Phone: 715- 425 -0165 .
e Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: _ = - Date CSTNumber
1L`T9 M00576-
PROPERTY OWNER L-N SOIL DESCRIPTION REPORT Page • of l
PARCEL I.D. # y- M t 41 - 6 0
Depth Dominant Color Mottles Structure GPD /f
Boring # Horizon in P Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trendj!
3s o -9 tiO`tR 3f3 S�1 ZVn min - u.S
Z 9 1 6 . L u4tz VAI T► a.s
Ground V A / wi S 6► w V f-�, ct' _ 6 • t(' o=S l '
elev.
, I S 'I ft. L) Z) -V (3 S `-trL Yl l .S s1f; s c Ow. rK `�� - — i
Depth to
limiting
factor
I ,
J
Remarks:'
I
Boring #
ra.13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
:I
I +
Ground '
elev.
ft.
Depth to
limiting't
factor
Remarks: i
Boring #
C
Ground
elev. I}
ft.
Depth to ;
limiting
I;
factor iffil
Remarks: �- -- — - - - -- - - - - -- --
PLOT PLAN pa 3 of 3
SCALE I"= L4 O '
trpL
w L
tiovSEs o 3 bn'
t n
sin c x _
��R K Deywel.� -- •� _
L.�WN
L'L QS�
%a i
1uoT cAMPRc-T
M I r oz aasTvlzO� 0
I (�
2gi - I
i
i oo
I � I
j
I
'EL 9.q q4 5 i
uT. o►= 9�ci �� q7 3 3S,3S- - -is��l
90 h—* Xx�
i
mo,p I or l 3kST' m of Stb)JQG s�-? sE �uS)t� faRA1k _
9 S_l�Z
a4v Y .emu" S L PT S ( 715 ) 425._,01 65 M 00576
CST Signature Date Signed Telephone No. CST*
f -
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER RAYMOND & SUSAN GESSLER
MAILING ADDRESS 956 280TH STREET, WOODVILLE, WI 54028
PROPERTY ADDRESS SAME
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE
PROPERTY LOCATION SE 1/4, NE 1/4, Section 18 , T 29 N -R 15 W
TOWN OF SPRINGFIELD ST. CROIK COUNTY, WI
SUBDIVISION f , LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME Q5 PAGE y 3 , 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 re to the St. Croix
County Zoning Officer within 30 days of the three year ion date.
i SIGNED.
I
DATE: S_
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
r
ti
STC - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------
Owner of property RAYMOND & SUSAN GESSLER
Location of property SE 1/4 NE 1/4, Section 18 ,T 29 N - 15 W
Township SPRINGFIELD Mailing address 956 280TH STREET,
WOODVILLE, WI 54028
Address of site SAME
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property _C1r_)12_,A �as ri�GS
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? _ Yes No
4 Is this property being developed for (spec house)? Yes ✓ No
Volume CtS3 and Page Number 43 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. �� 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.
S tune of Applicant Co -App cant
sr_ /7 -1�-s 0 6-1 rl -g �5 -
nato. of Sionat.ure I of sian,,ti,ro
DOCUMENT No. - -�� - WARRANTY DEED 1 1 TWIG &VACR RcsCnv[D Volt gccoltolMa DATA
J STATE BAR OF WISCONSIN FORM 2 -1Y�
• 1N ,, r+
- -_ _ _ __ _ REGISTER'S OFFICE
d 9�PA,,E �,�
ST. CROIX COe WI
Reed for Reooed
Gloria Marti, f/k/a Gloria Hastings 1 Nov. 2, 1987
................................................................................ ............................... 1 of 9:45 A
.
...... .. ........................... �..
....... _ ... ................. jl
eonve y a and warrants to ... nd
}�� n ..................... t.... ..... a .--..- ••••._.............. Rplaf�roiD
.......... Susan. L... Gassier.,.. husband. and. w i_f e ... ............................... I
.................................................................•-._....---...... .................._............
.................................................................................. ...............................
................................................................................... .............................�
.............. .................................................................................................. i' *[TURN TO
I IMenomonie Farmers Credit Union
. .............................................................................................................. t 860 - Cad ar Ba1dwin wlr 5444 _
the following described real estate in ............ _ St -� • Cx� •,.•._. County,
State of Wisconsin:
Tact Parcel No: ..............................
( II South One Half of Northeast Quarter (S' of NEB) of Section Eighteen (18),
i Township Twenty -nine North (T29N), Range 'fifteen West (R15W), EXCEPT
Commencing Thirty - three (33 feet North of Southwest corner of said South
I' One Half of Northeast Quarter (S� of NEg); thence South Thirty -three (33 feet;
i
t thence East Thirty -three (33 feet; thence Northwesterly to point of beginning.
: 1 j
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This ..... S.- Ater. ... - ....... homestead property.
X"R (is not)
{4I
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Exception to warranties: Easements and restrictions of record.
� I
Ii
28th October
Dated this - ... --
8 day of .
.. - ,
17 j
............................
(SEAL) .......... ........(SEAL)
• ................................ ...... ... ................ ...... • ...Gloria Marti, f /k /a . Gloria Hastings
.... --...... ............................... .........................(SEAL) .......... -- ....---......_.......I... .........................(SEAL)
AUTHNNTICATION ACKNOWLEDGMENT
Signature(s) ............................. ............................... STATE OF VI OHIO
sa.
.....................•--- .._.......------------•---..._. ..-----.._...__... ---•-- County. -y
authenticated this ........ day of________________ ___________ 19 ...... Personally came before me this _ Q[
x ..day of
-- --•----- _- -•-- - •-.., 19.8 the above named
• .......................•---°-----•-- -•- •...___....___.._•....._ --•- :
°" °"' Gloria f/k�a Gloria Hastings__,__ ___
'• .....................................•.._._...--- •-- •--- ••- •-- ••- •••- •• - - - - -. ••-----•------• .................................................................
TITLE: MEMBER STATE BAR OF WISCONSIN
(1f not, ........................................ ...................
authorized by 1706.06. Wis. Stata) to me known to be the person ....... -_ -, `rNo- executed the
fore g instrume and acknowledge - . i lame.
THIS INSTRUMENT WAS DRAFTED BY
Thomas A. McCormack . •- •--- - -• - -- ----- - - ----
......................................•---..__.. .-- •-- ••- ••••- ••••••-- ••- ••• - -• Be ty Ann chulte
Baldwin, WI 54002
'--- •-- •--- .......
__ __ _________ ______ _______ ____ _ _• Notary Public _ . County
(Signatures may be authenticated or acknowledged. Both My Com ission is permanenc.(If not, sta xp
ter - eiration
are not necessary.) date: 1w IT.)
"Naar of person Bening In am espaeity should be typed or printed below their signatures.
�NrslsrCa�py®
STAT BAR OF
roaw N o. s — 1 182 Stock No. 13002
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ALL UTILITY LOCATIONS AAZ APPItOXIM.ATE
AI'tD ARE MEASURIED IS'ROM THE RACK SIDE OF ■ at�
THE HOME (MASTER BEDROOM ROOM SIV K). J V V
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