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042-1088-10-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and quilding Division a INSPECTION REPORT Sanitary Permit No: 488254 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hanley, Robert & Joan I Warren, Town of 042- 1088 -10 -200 CST BM Elev: Insp. BM Elev: I BM Description: Section/Town /Range /Map No: 160 71;\ lt- �,� ,� 31.29.18.488D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. I - 7 c 1 16 b• /dam Septic Benchmark /! i Dosing Alt. BM 1 Aeration r Bldg. Sewer Holding SVHt Inlet SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 7 Dosing Header /Man. Aeration Dist. Pipe �.7 r ;lding Bot. System b , p /66 , 3 ok PUMP /SIPHON INFORMATION w Final Grade 14 ,-7 ✓6� - e fi Manufacturer ' GP nand? St Cover/1 S , I ` 39 Model Number TDH Lift �C� Friction Loss System He d TDH Ft _5 ) I :?� Forcemain Length I Dia. /j I Dist.towell . 76 SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length i No. Of T nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS •7S' SETBACK Y TE S S M TO P/L IBLOG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR .� Type Of ystem: I ' j ' 7 UNIT Model Number `t r1i r. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing I V t to Air Intake . C`� a, 1pi `� l j/ Lengt Dia Length Dia i Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7 Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ? Bed/Trench Edges Topsoil (. Yes [M No I S ires R] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #I: �'w ` Inspection #2:�/ Location: 632 100th Street Roberts, WI 54023 (NE 1/4 SE 1/4 31 T29N R18W) NA Lot 3 ;# „ t Parcel No: 31.2 .18.488D 1. Alt BM Description = 4-a Lp- 2.) Bldg sewer length - amount of cover = ' Plan revision Required? Yes * Use other side for additional information. lQ { / SBD -6710 (R.3/97) Date Insepcto Signat Cert. No. I Safety and Buildings Division County v 201 W. Washington Ave., P.O. Box 7162 X ST, C� ���� Madison, WI 53707 — 7162 EPiecat ry P i (to be fil in by Co.) 0 266 -31 S 1 11 *1,sc (6os) ZS Department of Commerce Plan 1.D. Number Sanitary Permit Appli�� �s84S -- In accord with Comm 83.21, Wis. Adm. Code, personal in Address (if different than mailing address) may be used for secondary purposes Privacy Law, s1 5.04(l xm) 1. Application Information— Please Print All lnformation RECEIVED 1 -- o� Property Owner's Name % Parcel Igo t N Block 0 �N Property Owner's Mailing Address Property Location ST. CROIX COUNTY ��� S F %, Section City, State Zip Code I Phone Number I {9 S 3 T �. y N; R1J_E oko IL T of Building (check all that apply) I or 2 Family Dwelling — Number of Bedrooms - ° '� V. /o 4t 5(7 pr(Q ❑ Publknomitnercial— Describe Use ❑City ❑Village oamship of Wca�9..v1. ❑ State Owned — Describe Use of III. Type Permit: (C heck onl ne box on line A. Complete line B if applicable) r A. ❑New System Replaoanent System ❑ Trratment/Holding Tank Replacement Only ❑Ocher Modifration to Existing System -- List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiratt6i ` Plumber er r c r IV. T of POWTS System: Check all that st k ❑ Non — Pressurized In- Ground ❑ Mound ?:24 is of suitable soil Mo < 24 in. of sui table soi ❑ At de ❑ Single Pass Sand Filter ❑ Consbucted Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobi2 Treatment Unit 0 Recirculating Sand Filter ❑ / Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gmvel4ess Pipe ❑Other (explain) V. DispersaVrreatment Area Information: Elevation Design Flow (gpd) Design Soil A P � lication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro d (sf) System + T ` - 17S" p 0 F " S Vt. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ 70 - 0 0 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - L the undersigned, assume responsibility for installation of the POWTS shown on tare attached plans. Plu MP/MPRS Number Business Phone Number Plumber's Name (Print) P lum s Signature 7`FI'— 33 --2 Plumber's ddress (Street, City, State, Zip Code) [ / LW ,l R1 W� SAl o,-.13 Vlll. County/Department Use Onl Approved ❑ =�cn Sanitary Permit es G roundwater Date Issued ssui g Agen ignaturo (N tames Surcharge Fee _ ` ? ❑ �RDenial J J - Q_ C&w; IX. Conditions SYSTEM OWNER:,, 1 Septic tank, effluent filter and W l' " "�' AAAA 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. Attach complete plum (to the County only) for the ayakm an paper not Ins than 81/1 :11 inches la atu SBD -6398 (R. 01/03) AA The area 15 ft. be low the dowaslope edge ai the System must remainundfstutbe�. Soil AMO Lo MAN Ad taV.o. /00. z OAP go ` r7, T67A/ ; a v 0 r� �. �xi sTf i3Cr• .� . SYSTEM SHALL o -. O HIS P RATE PER COM ORPO A PROPER .�€L OrI3ACE, 2)c ODEL# sr � /� C 0 rte.. �ofCe ti Safety and Buildings PO BOX 7162 commerce.Wl.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.w www.commer isco govsb, Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 28, 2006 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/28/2008 Identification Numbers Transaction ID No. 1265845 SITE• Site ID No. 712026 Bob Hanley - Dwelling Please refer to both identification numbers, 632 100TH St above, in all correspondence with the agency. Town of Warren, 54023 St Croix County NE 1/4, SE 1/4, S31, T29N, R1 8W FOR: Description: Replacement Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1072673 Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. ROM The following conditions shall be met during construction or installation and prior to occupancy or use: Conditra ♦ On page 4, the following adjustment was made to the total dynamic head (TDH) calculation as specified AP in product approval stipulation number 403 for the specified effluent filter: 0 p1 Filter losses = 0.50 ft TDH = 16.50 ft S A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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. ROBERT W ULBRICHT Page 2 4/28/2006 The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Peter E Pagel Private Sewage Plan R v' wer, , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 FCF /V�D De sig ners te Sewage tg Systems 715- 772 -3442 S APR 2 4 2000 AF�jy& SU/ tp /N. PROJECT INDEX Plan I.D. Date 1 1IR/l Owner P,01759RT tk?W 1, E - Phone l /S 7 yy 3 Y2 0 11rj;�' Address (e3 /0011V 577- Legal Description GpT t 3 CS S17 04 , 1/,4/ /0 2. PIN MG /O8 S •/0.72 00 N1;, 56, 0 1 .'3/, 7 RI e to . Town of County 5 �• C I�-O r C.S.T. ZyeNNy 74LBRIPct,7 4 " 95 ff3 Installer Local Authority / Supervision J 7l cc ll S T- C Rio f' - PROJECT DESCRIPTION - 71 S • .3 & 1 16 ( ?a A R014cama;u7 s ys7�5M FO e 4 3 60k�M . ,110,4J , sr 1) A rty ����n yy"dS - • A0 ysT�n -t 0/10 // A)l — Sil74Gt�f1 /1 s164�r4� ov T o r J.,p 6e 'Q.csY2 I S V &uE - (2S ' 51oe-=7 aF sAJD4-x 5flLF-T �p12 1?ROC"OPL S , !1 ROBERT W. fill - ULBnlrHT 3 . 01160 = ,� '•, HUDSON, WI 4 � o " zPg.i PLOT PLAN VIEWS Z 2Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) 0 Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL LLJ CLEAN OUTS) 0 L DOSING CHAMBER CROSS SECTION & SPECS. V Z Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) P g .6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems " (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD- 10706- P(NO1 /01). -r te �, -�i M S 13ASAL T'a "' �W" S A M 'QE 1. P si Ri peep off — i >u cc.uniN� `Vit- &Xrs 7 - jA3 5 (3 !k.`�i �'T CA a - A It 5 2W-k_ `�2ock 55 R SATE CSE�9 y (� 6D M N 1`100 S'4N1� S hA /3� �t Ma fo t - ,3 -16 �X r57� (r " AT G� s T o/2 10 JUE. W111 2 �3 /J�• ►'o rt �T i s �Z��rot��D i4�t A jEw C 7 ,qp p-o o sad Shr11l 13 ADDO, -b Pftvt0tF fop.- I g" - fill o F )ersri New cc,-f �- NL?�"l� ��I DOi �f iD,�. �� S A A t( 6p— G�tIS�I �i6Gv�l> , 6 i5T i LI(r rft�e'AgT T ft- cTMe�OT TAAJ SW AAAV Ac U19 �RoDuc-fS 1 44iPe ' 'PO c 4) Ik- I tAs pt�;c `- x , ?I vm b�je i�us4All E72 `t Rrore 'f - �? Y VII F/ c�tp^ r q/'. �A�L72— (o Q DhJ ���E L�4yor�7 ' 1 r s� Fr R 3 Fr EWTRAC.. F o Rce M A6\3 X iwcl� 8 0 Fr. / O tu VARi .TOTAL. V (91 D t1 o f U» j E 3 PfS7 cE H o To r�4L, Uo /U.y�- D"Am ING .� INcHvS - r,j c t4 Fs FoQce�, MAIN Z HD1E5 I P! � 2 I P / J I DU1_RT E LEV ATjox O F LATeRAJ 5 sE � UEf�'SE SIDE VOk � �f'Q • T" WAL coo ur<T L PER FoR ATE D pi QE . D �v S %ry R�Mov�- All j)Rill (3uRR5 } ` Y , •• HeiE s t ocA �`- � Teo oA3 i3oTToM t EgUANY SpAc &D , ��. V ST Ri BuTtoN DSc 1 0 PIM © hAR GE RATE Po eACh LArP-R�4 L ��s 8.59 CTAL To TA l 0 f S T R i Q0 T o o is HAR CE FATE �dR 1V�T W O{2 K 3q. 3 `` t �'�f �l�- � �•� M��Ni MUM 16 D E TA i L_ 6 F L ATE - R A i.:_. C IDI 5 ' - o vE /1- i c OF , � 6 41 �;viS/f�D �IovvD 9�P U" Ew TLS" Gv ice, l4- «ESs r 1`�O ° SGvE� d �e 6R 5 lAA 41 if vT „ �1 Y.� eA p T l�UC /.3.4 // 114 �'S A) G— �O,(>�' • �o /� ��vT` 7�1�v To APE • 7&S&p PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOUS f,,4 JE of vE1JT CAP j N"C.X. VEMT PIPE APPROVED LOCKIM& UJ JUUCTIO BOX MANHOLE COVER 25' FROM DOOR, WEATHER •PROOF r�/ /4i�y(0106r'�,9/3E� WIUOOW OR FRESH AIR IUTAKE JEv4Vem GRADE I `I'MIU. COUDUIT -- �lE��lfi Cv � lh PROVIDE -- _ ^-�•- IULET AIRTIGHT SEAL 1 t f APPROVED JO{UT A S'K �� APPROVED .10 w/C.2. PIPE �N 1 ,N((oM ► �� W /C.I. PIPE %XTENDIU& 3' 0 � , 4 ( .�' - { �! LARK EXTEUDIUCs 7UlTO SOLID 501E �' d o 3.� �I� i (.' ONTO SOLID 5 a N i i ( Oki 1 ELE FT. �. PUMP --� '- -� 'L/SE OFF V. lgf D PI",) 6 - Sit vAP �(�� >+t `__ BLOCK KlStK EXIT PEKKIITED OUJL4 IF TAUK MAUIUFACTURER HAS SUCH APPROVAL SEPTIC E SPECLF / TIUIUS DOSE /I}SSV� �C1J>S� �N GI.t T.Q `!J z TAUItS MA UUFACTLIKER. IJUMBER OF DOSES: �`� PER DA`U TAUK SIZ£ : 7 5 0 VOLOME A GALLOMS DOSE If �J ALARM MAUUFACTUR£R" / wutz Alai IUICLUDIUG BACKFL.OW: Ga 30D MODEL UJUMBER: V• �" CAPACITIES: A = IUICHES OR GALLOI SWITCH TYPE• IUCHES OR �j GALLOI PUMP MAUJUFAGTURER VV . ;z bi/ . C. �' IUICHES OR _.1.:- _ GAL.LO! w MODEL HUMBER: / !y If P .- D = IMCHESoR GALLO SWITCH TYPE: kmy� kcx F i o *r UIOTE: PUMP AND ALARM ARE TO BE MIUIMUM DISCHARGE RATE 3 5 GPM INSTALLED OKI SEPARATE CIRCUITS VERTICAL DIFFEREMCE 6ETWEEU PUMP OFF AUD DISTRIBUTIOU PIPE.. 10-7 FEET "FAAfe S 1� CS + 141RJIIMUM NETWORK SUPPLY PRES�SiURTE / ........ 3 _�_- FEET EAC( Of { + S FEET OF FORCE MAID! X 2.. 58 F /oo FL FRICTIOU! FACTOR. 2 ` 1 FEET �(�V t S /7 TOTAL WiMMIC. HEAD = FEE IUTERMAL DIMEIJSIOMS OF TAUJK: LENGTH ;WIDTH • ;h10111D DEPTH s THIS POWT SYSTEM SHALL �I - PER COMM. �CF ':f- .CORPORATE 83,44. (2)c A PROPER FILTER MODEL # �, / 0 d 5 i A 7�C f f � ___._� k Mound System Management Plan �r Pursuant to Cohan 83.54, Wis. Adm. Code,, D Septic rank The septic Mattis shall be maintal4d by an individual certified to service septic tanks wider s. 281.48. Stale. The contents of the septic tank shad be disposed of in accordance with HR 113. Wis. Adm. Code. The operating condition of the septic lards and outlet Mer shall be assessed at least once every 3 years by inspection. The ohlld filer shali;be cleaned as neceamy to ensue proper operation- The fitter cartridge should not be removed unless proves are.. to mWsokb In the lank that nmy slough off 8w der when removed from its enclosure- t One litter Is equipped with an alarm, the tiler shag be serviced If tine. atazm is activated conli tuMly. intenMttent filter alarms may Indicate to surge flows or an i peni ft continuous almm. The septic toads 811811 have its contents removed when the volume of sledge and scan in On lank wmeda 113 the ft*1 volume of V* mac. t Ow contents of 90 tank are not removed at tine Inn of a trieroial assessmK nm*dsnwm personnel shall advise (he owner of when the mend service needs lo, be performed to maintain leas fm mw* mm scum and sludge accuumlelion In tier lards. The addition of biological or thennical additives to enhance septic lank perform Is generally not required. However. If such products are used they shall be approved for septic tw* use by the Deparrhwd of Conine m. Sudety and Puma Tarrhk The PUMP (fig) t8nk shall be iutpected at least once every 3 y fts. AN switches. alarms. and pumps droll be tested lo verify proper operation. If an effluent filter is installed within Ste tangy 1 shall be inspected and serviced as necessary. Mound and Pressure Distr Eft syst NO bees or shrubs should be pact an ice mound. Plantings may be made around the mound's perimeter. and the mound shall be seeded and mtrk:red as necessary to prbmd erosion and to provide some protection from frost perwiaftL Traffic (other than for vegetative maintenance) on the Mound is not recorarrwnded since soil compaction may hider serallon of Ore Infiltrative surface WNW the mound and snow compaction in ft winter will promote least penetiplion. Cod wea m InStAllalloris (October - February) d ch" Ghat the. mound be heavily mulched for fns protection. ' Influent quaNty into the mound system may not exceed 220 rngtL !3005.150 M91L TSS. and 30 mglL FOG. l 4us t Now may not exceed Maximum desiprh flow d in One pemnft for Otis installation. The pressure distribution system Is provided with a flusift point at tike end of each bWK and It is rewmrne iled Met esch Wrat be flushed of *=Mxdded solds at least once every 18 nton8hs. Whe n a pressure lest is performed t shouhld be compared to the hAd test when the system was Installed b detern>iw If oritoe dogging has occurred and If oritoe deanfng is nKgdmd to inalrAmb equal dtsbibu8on within the dispersd ca. Observation pipes within the dispersal cell shall be dhec ed for eMuent ponding. Ponding levels shall be reported to On owrwr. and any havers above 4 inches considered as an Impending hydraulic failure regtriing addillOrhal. more icegttent trhonibting. General This system shall be operated in accordance with Conran 82 Wis. Adm. Code. and shall maintained in acmdance with tie' component Manua! (SBD 10572 - P (R. tiMH and local-or state rules pert itdng to system maintenance and maintenance reporting. No one should ever enter a septic or pinup tank since dangerous gases may be present Met cold cause death. Septic and Pump P tank abandonmertt shall be in mince with Comm 83.33. Wis: Adm. Code when tier tanks are no longer used as components. &4ft Or PAP lank manhole risers. access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed walardW upon the coon of service: Any opening deerned - unsound. deferdift. or sub)ect to failure must be replaced. Exposed access openings greater !bath "K then in diameter shall be secured by an effective ticking device to prevent acddentd or h wVwkzed entry into a tank or component. ContingMy Plan 11 the 9 system proper er operating condition. any of Its is become defective the tank or component shag be r or repiscwd to keep She It the dosing tank. PAR. Pump controls, alarm or related wiring becomes detective On defective Component shall be inmedtately repaired or replaced with a component of the sarne or equal performance. If the moved component fails to BMW wastewater or begins to (11c118rga nwslewaler to the gnoiehd surface, ti will be repaired or replaced In its' location by increasing basal area if be fealcage occur or by removing Wogkaaly dogged adsorption and dispersal mew. and related piping. and rig said components as deemed necessary to bring the system kilo proper condition. Questions on the operation or maintenance of this system should be directed to your county zwft or health in F SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO THIS SITE, DESIGN, AND COMPONENTS } OWNER's MAINTAINCE-OF.SEPTIC SYSTEM POWTS (landowner4 is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of,this system. The owner is required -by code to submit all necessary - maintenance /inspection reports to the co ntro lung ,auth;orities. SPECIFIC CONTACT AGENTS sue' C(20 j *. Governmental authority/ inspectors: �rs•3 ylp 0 * Licensed responsible fir providing an operation/ maintenance "Users" manual: ff �R- J �� y � S --7 y. 3 3 z Z /e 7 40/ S * Licensed service / inspection agent other than installer: T1P/ G T /• * Electriclan,.for pump, electric controls, wiring units: gvt?0&72 S /Wc7W ic��R..J IMPORTANT OWNER MAINTENANCE RE i7IREMENTS I. Winter traffic .(Sledding, shove*ing, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter vacactl on resulting in no water use) can also lead to freeze ups. 2. Water conserva needs - to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of g a ls. daily. 3. POWTS are not desiged to accomodate wastes from a garbage- disposal unit, or any other unnatural sources of waste Any introduction Of such waste - materials will overload and destroy this system. 4. I€ a power 0:1tage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer 'immediately for advice. 5 - Neglect of the vegetative' "cover (the ce erosion Preventive) Its insulation S. traffic also candes troy l t a he t system. It IS m paction REGULARLY WATER THE VEGETATION OVER A S. O the �Ystem beneath IS NOT sufficient YSTEM. alone t0} Effluent in �l cover- maintain a 6- Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and por Into the system: on the mound basalareave been incorporated Inspection pipes), cleanout terminals on th level e pressurized laterals, at each tip - for flushing and cleaning the laterals out -. The fitter system in the tanks (via a locked above ground cover /manhole)- onl a licensed properl person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. i Wisconsin Department ofComrrterce SOIL EVALUATION REPORT Page 1 of 3 DMsion of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code Count ST. C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must ,< include, but rat limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. (/ Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. no •�� ' 2 6-0 Please print aH information. a by Date Personar #nfonnation you P—Me may be used for secondary Purposes (Privacy law, s. 15.04 (t) (m))• U 3 Q / Propert Property location l � be rf Han le- 5 Govt. Lot N L va 5 l;1/4 T 2 N R/ 8 E (or 0@ Properly Owner's Mailing Address Lot # I Bba # Subd. Name or CSIM (0.32 /00T" 54 f eet - - CSM 5' /70y0 Val /0 2 diy State Zap Code Phone Number a City ❑ Vi ll ag e /zobert5 5 'YO 3 �g (�TOWn Nearestficad , W I Z ( 715 ) 7-W -,3410 W Alp-R zr N UU T r' ❑ New Construction Use:lR Residential / Number of bedrooms 3_ Code derived design flow rate 'y S O GPD 61 Replacement ❑ Public or commercial - Describe: Parent material _Si 1 •/ Sect: / ftm:;� Flood Plain elevation if applicable _� �~ ft. General comments 0 ve r j t,- j 11 and recommendations: Area X Spot Tested suitable for a RECEIVED mound (RO.W.T.S.) system using sand fill. JUN 2 9 2006 L�1 # � pi g Ground Depth 9 a ft ST. CROIX COUNTY Depth to timif�g factor �0 3 _ fn. Horizon Depth Dominant Color Redox Description Texture SMxk a Consistence Boundary Runts GPDift in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-1/ l01'R /( — Q 2 f bK M-Fr a 5 3{ 2 Il - 19 Ioyp, - SiCI 2 M m F i C 5 3 19- 63 7.5YR V' /` - S ► 2 v K WI i a w 63 - 7 5 YR. 2. vc blc mfr F 211 # © Pit Ground surface elev. / 9 •DT ft Depth to limiting factor jn. —� Sol Rate Hottzon Depth Dominant Color Redox Description Texture Stnrchrre Consistence Boundary Roots GPDW in. Musell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 l 0 I u --ep 3/ ► - ;2 2 b 1c 1'►')fr a S 3 of $ 2 11 I IV14 - s iCl 3 Yf bK m¢ i 9S 2-,tf 3 25-16 - 7.5reYl — 5 0, / 2C by- m fi Lf S - 7 .5ra 5/ I s 3 bK Mfr as - /.(0 5 (03 -4, LK. :.times ton • Efliuerit #1 = BOD > 30 < 220 mWL and TSS >30:5 150 mg& • Effluent #2 = BOD < 30 < CST Name RIO - _ mglL arxi TSS _ � mgll. Signature nn U /br t:h 93 Adams Date Evaluation Condticted Telephone Number 2S /z l a "e ve P21n/Ei vl- eG w / l ORIGINAL f a zw 3 o yo NAND -t: Y 0yd, /Odes• /0.2dZ Property Owner Parcel ID # Page 2 of 3 B 131 ff ❑80MV P Ground surtace etev. 95' ft. Depth to lima ' g factor in. c Rate Horizon Depth Dorninant Color Redox Description Texture Struchre Consistence Boundary Roots GPD/IF in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 0-9 10ye3/ i 1 2rn r mf a 3vf 2 -l8. Iv YK 'Y - 5 irJ 3 f bK fi S Zvi 3 IB zq +o -F I{ ' rR 51CI 2mbK mfi Cs !v� .4 (� s - 715 rW /` S 2-MbK {-i - - 2 .3 Boring # ❑ Pit ground since elev. ft. Depth to rmmitmg factor m• Soii Application Rate Horizon ! - t Red= Desa4ion Texture Structure Cor�stence Sou T rxilary Roots GPDIfF in. M Qu. Sz ConL Color Gr. Sz Sh. 'Eff#1 'Eff#2 F Bonng # ❑ Bonng ❑ Pit Ground surface elev. ft. /D epth to knbV factor Sod Rate Horizon Depth Dort Color Redox Description. T Structure ConsWence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Etf#1 'Eff#2 Effluent #1 = 13OD 5 > 30 < 220 mg& and TSS >30 < 150 wKyL ' Effluent #2 = BOD, < 30 mgA,. and TSS < 30 mglL 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. ssaaswtx.sroo) I I NA.�� -£`� P��E 3C-F 3 Ulbricht &Associates Private Sewage Consultants 2812 10th Ave. s� /V Spring Valley, WI 54767 �/�/� S - = cord To uR - 'T /ON w IJZ" -fit/ SCA 30 ��• 7 0 f- s ysT�F'`` 13,v —� 5 7. �60 7"t� -�=�- a RINA # 21 EXISTItjcq Ell - TO nilA1Jt- Lew MOVE D 7b C.OV4ER or.) st:�P-rtL_'Mmy" ��S = � -1 • �, fib' a ion O CP �b PUMP PAD = Fr 7. 9 0 GL io �� q 6 l'• 7fo �o 1 A'P7 13 g OVl 62� 32' N S£T BA Q _ S° 1 A. 3 B�2M l-�-� usE ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q ` ,W Mailing Address 3- loo t Property Address �p E/—�S 0_),7 � d (Verification required from Planning & Zoning Department for new construction.) City /State f," tka Parcel Identification Number Z — [ @ $ —10 ;�D o LEGAL DESCRIPTION Property Location N.F'/4 , CF— ' /4 , Sec. , T _!P�EN R_L1 W, Town of tiJdyjmqy` Subdivision _ , Lot # . Certified Survey Map # - 7 0 � , Volume to , Page # 7 _ Warranty Deed # 5 ; 0 * ,�� , Volume 0? ;L , Page # _ 0 � Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number edrooms A/ 76 S A LIRE APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 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 R a i 116t- Al residence located at: N, ' /4, JE 1 /4, Section' 4, Town ;,,7,_ N, Range 1$ W, Town of l,C��.►��.v� , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 005 - Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known) Age of Tank (if known): (Licensecf Plumber Signature) (Print Name) C® - rut 7FI (Title) (License Number) MP /MPRS __3 R-c� (D e) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) —A DOCUMENT NO. STATE BAR or W18(;oNom rOjLK I stasyrfm me mcoft &ArA WARRANTY oho 520455 ii r Mv;r 7 ISTERIS OFFICE ST. CROIX C0. W1 Tbda Deed. made between ..11er.ton..Z...jjMWe=an .......... fteV lbr Record FEG OFFICE T .............................. ........... ....................................................... .................................. ... ........... ............................................................. AUG 2 9 1994 ....................... ........ . ...... . . . ........... Grantor, 92 A 1W . _ja .. jq at and .... Rober H , his a y. .................. . ... .•..• ....... ....... H Of Deeft .......................................................... Grant*% That the said Grantor, for a valuable w ns id era ti on ...... ....................... ......................... ............ ............................................... — conveys to Grantee the following dw ree es a ... ... CrAix gum*" TO County. State of Wigemgn nt National Bank of River Fails P.O. B ox 1 E6 Lot Three (3) of Certified Survey Map in iver FF_a_JS, _Wisconsii 54 Volume Ten (10) of Certified Survey Maps, Tax Parcel No: ..___......_ .................. Page 2764, as Document Number 517040, filed O'D in St. Croix County Register of Deeds office on May 25, 1994, being located in part of the Northeast Quarter of the Southeast Quarter (NEk of SEk) of Section Thirty One (31), Township Twenty Nine (29 North, Range Eighteen (18) West, Town of Warren, being Lot One (1� of Certified Survey Map in Volume Nine (9) of Certified Survey Maps, Page 2692. This --J ......... boonestead property. no (in) (is t) Together with all and aiasnl" 04 b and appurtenances thereunto bao An& ----- MPrtom.Z..._ warrants that the title ' V' " adef-as " in fee simple and free and clear of encumbrances except easements, restrictions, and rights of record, if any, and will warrant and d th mur Dated this .......... .................. day of ............ kkis q ....................................... ..................................................................... (SEAL) .(SEAL) (SEAL) .................................................................. .................. ..................................................................... (SEAL) ............................................................ ....... (SEAL) • •••-••••-- •- • •••-•- ••-• ......... .... .......................... • ................................. ............... ................ AUTRANTICATION ACKNOWLUDGURNT Sighatu"(s) _________________________ _______ »_.___--- ______ °-••••... 9TATZ OF WISCONSIN ... ...................................................... .......... .......... autbenticated this ____-__day at .... .. . .......... fteonaRy am* before me this »L r -- -day Of -____AUgu&t__.._.., a.%- so above Amw ............................... ....... ......... . ............................. • 1kr1Qj0L_K@ --- limmazzam . . ........ . ....... ......... .............. ........... ..... .... ............. .. .. TITLE: MEMBER STATE i ME OF .....».....»._..».------ . WISCONSI . N ......... ......----......_.. . ...._-.---»_.-_ ».... ..._.... ». (if not, .... ......... .................... ---»_...--.----•--••---••-----------• ................»__..___........-•-•-•- 111 stbOrbW iY T WiL iii;;i4 . - - - me -------------------- - ----_. ».-- --••_ ------ ....- .......................... fs be so ------- - Who 41300116611 the 9# 1 is the same- THIS INSTRUMENT WAG DRAFTED ey 0 ............... ....................... Ri r Fall WI 54022 ' ' . . . ........................... (Signatures may be autheatk&ted or acknowledge& B y . ....... --- .. . ................. 01111111111t7i W* a" not necess&27,) p1raflon .................. 4.l - •-- • ... ONaam Of persom ven►ng in Any top-itY AUW be %ma W PrIbud )aloe WARP—WrY Dl= VrIwelm"11 whea" Is" On I-WSJ Dusk 00. U& 1111'W aka.. Wilk r id r P� Kyx - i / • 1 � , ! . .. J �/ FILED '1 MAY 2 5 1,994 ► 4 517040 JAMES O'CONNELL 5 Register of Deed$ St Crok Co., MQ 6� CERTIFIED SURVEY MAP —' Located in part of the NE'k of the SEk of Section 31, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in the St. Croix County Register of Qpeds in Volume 9, Page 2692. Y H .'n E} Corner of LFGEND n Section 31 t Aluminum County Section " Monument Found \✓ N N 1" Iron Pipe found d U t.f Q 1" x 24 Iron Pipe Set, o w o N weighing 1.68 lbs. per W N linear foot N � ' W s c z is Existing Fenceline i+ N ...... 100' Roadway Setback Line UNPL471 i EI'D LANDS � 33' X33' N89 0 43 "E 529.49' 93. ' 36.34'— I LOT 3 3.00 Acres Including R/N i 130,677 Sq. Ft. I o 2.79 Acres Excluding R/N N 121,709 Sq. Ft. UOI DI (01 t D of C[I i)l zi M o r n t . - ,,. �� N69 43 04 E 529.49 3633' H wl n� o 493.16' WI 4 - EDT 2 4. Privy o N cl JI rn 0 C) Acres Including R/N o o ; 130,682 Sq. Ft. o 40 m v]�.al0i o =71 r 2z House o O' r P " D 121,719 Sq. Ft. C2.74 Acres Excluding R/N Nell N i Y G MY "Slot! 36.31'— 44 .18' I ��p S89 ° 43' 04 "W 529.49' Zonksdsnd Li yr `r TE�I L_ /a19)5 I I v i.+ ks CiN �M c OWNEB m if ns` neewdod Merton Timmerman withiw30dWSOf 633 North Freemont N N c appravirttwe River Falls, NI 54022 0 Ci ttpptVVW Woo* be o .� "A Z void Scale in Feet SE Corner of 0 50 100 200 Section 31 Vol. 10 Page 2764 r #' S TC - 104 =k AS BUILT SANITARY SYSTEM REPORT C �d lv Y Y DRESS r lG�1T/ s' ey-ts z./ SUBDIVISION / CSM f C 51; ,'lCY 6_ LOT 9 SECTION .3% T a2 4 N -R IZ' W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM — 1 11,7- q , j e C C i I I N D I C A T E NORTH ARR �-, Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic Lank manhole cover. BENCHMARK: 6:eL P,_ Q 6L-f; Z1 5 — ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ��es�e�1 Liquid Capacity: 7p� Setback from: Well House j! Other Pump: Manufacturer .Z.,� Modelt y Size Float seperation Gallons /cycle: //7 Alarm Location lYac�.y SOIL ABSORPTION SYSTEM Width: 02 e Length l Number of trenches Distance & Direction to nearest prop. line: a,.:� � 7 X�- ; Ile, c( Setback from: well: House 74 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet 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 Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: " Lab�Qr'ancl.W. Relations INSPECTION REPORT ST. CROIX Safety an`d Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sa n ita ry Perm it No.: P fY s N $ERT ❑ City E] Village L Town Town of: State P1Xk lan CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /oar TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - 1. . ,� Benchmark 00 - /1 Dosing Aeration Bldg. Sewer Holding St /Ht Inlet 13 b g 9 0 , 3 �� TANK SETBACK INFORMATION St/ Ht Outlet d,y `Ole TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet (j� Air Intake Septic ya S / A�w(p i � NA Dt Bottom /L. Dosing >av l /,.�L 35 >50� NA Header /Man. L / J q / Aeration NA Dist. Pipe Ll V�/ Holding Bot. System y� PUMP / SIPHON INFORMATION Final Grade Manufacturer f Demand z Model Number 1 GPM TDH Lift .� Friction S y stem TDH �.,� Ft Head oss Forcemain Length lV ' Dia,j' Dist. To Well SOIL ABSORPTION SYSTEM V � BED/TRENCH Width n �/ Length V I No. Of Trenches PIT No. Of Pits Inside Di Liquid Depth DIMENSIONS o2 / DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING anufacturer: SETBACK 9 CHAMB INFORMATION Type O / Moe Number: System: `yvt5 �a 3S u OR UN DISTRIBUTION SYSTEM Readeo Manifold Distribution Pipe(s) r , l x Hole Size x Hole Spacing Vent To Air Intake Length __q_ Dia. Length Va / Dia. 4 Spacing-4 Ilq li SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over l l Depth Over I LI xx Depth Of xx Seeded / xx Mulched Bed /Trench Center 1� Bed / Trench Edges l a `� Topsoil � El Yes No &Y es No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: Warren.31.29.18W NE SE Lot 3 100th Avenue � r r r� r Plan revision required? ❑ Yes I No ! ,, Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH s 2 r SANITARY PERMIT NUMBER: y E E 9 F 3 SANITARY PERMIT APPLICATION cou 'i G�'a�llnlr� In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than ❑ I -1 CI0 8% x 11 inches in size. Check if revision to p evious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION g t /�E''/4, S T , N, R E (or P OPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1,4.07'4 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5 - d Check one CITY AREST ROAD II. TYPE OF BUILDING ( ) El Owned ❑VILLAGE ; &TOWN OF: ❑ Public LA-1 or 2 Fam. Dwelling -# of bedrooms "L PARCEL TAX NUMBER( S) 111. BUILDING USE: (If building type is public, check all that apply) 0 , /;2 Id' J'F'o �y 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Uhl 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 ## Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: \ 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYBT�EM ELEV. 7. FINAL GRADE �,,) REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION J �° ,'5- /U- �Sr S �Feet Feet VII. TANK CAPACITY Site INFORMATION in aa ons Total ##of Con- Steel Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Plastic App Ta nks Tanks structed Septic Tank or Holding Tank X deJ l Lift Pump Tank/Siphon Chamber OL VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: ( Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued I I Issuing Ag t bignawle No S m (Approved El Owner Fee) Owner Given Initial Cy�y GtJ Adverse Determination �'!� CJ /! C •� 1 c� X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1 ' f 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received P PP Y experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) SAFETY & BUILDINGS DMSION State of Wisconsin Department of Industry, Labor and Human Relations, October ll ,1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ROBERT ULBRICHT I 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S93 -03514 FEE RECEIVED: 180.00 HANLEY, ROBERT NE,SE,31,29,18E TOWN OF WARREN 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 obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. �! Si erely, ames Quinlan Plan Reviewer Section of Private Sewage-- ( 608) 266 -3937 O RIG I N AL BBA-79M 0 011111 " ULSAICHT & ASSOCIATES CO. R Desig of Engineering S ystems 655 O'Neil Road •Hudson, WI 54016 g g g t ants y 715- 386 -8185 Private Sewage Consul PROJECT INDEX DILHR Plan I .D. # S 93 Jo 35'1� Date o CT• Owner /r?o3E,pT :- T A.✓ /�ftdL�y Phone 7 /S' 741 -3 2- Address (p Z S /OD Syo 2.3 Legal Description C'sM 5o (0y5 �- lI. 9, 1'�. 2- 2 — Go # / 6.0 iF S N>yi y , R i8 ec.) 7 - Town of 4t14;e'� AJ County C.S.T. ,� /,b,P� GIaT 057i 2, 8K-? Installer. Local Authority/ Supervision sr. COI.wTY Zo"3i'�!r �Ef'T PROJECT DESCRIPTION -9 ,v �Xi5Ti v !r 3 ?3 P/P�" 1 ) ? ff oUS E / 5 13, /;v 6 - /J 2 G Gt A SAD /.3 y 7'K4 1 14A) 1 S . v -uYZ }/ 54rk Ard Ovz x `/ �- p�/ l✓E� ( IVr Gv9T��P S�� /LE �,ri sTs� Y Ve i S` ��ip SdiL rP�po/2T y �'!O � 3t' �/ S T >riVj . S° r /S iht j��,P•�: /E , /3 v 7" 5 ��4 SO AM //y S�TuR�T� A , �D /o M vS T /3 �" �i►R'� F � /� /�rr� ST,pv � rvit'c� , Pg.l .PLOT PLAN VIEWS S n v-03514 Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS a 1` ® �� Pg.3 PIPE LATERAL LAYOUT�'� ?••••°°"'° - �•�o� �;�, Pg.4 DOSING CHAMBER CROSS SECTION ROMnrW DD 2 HUDSC R Pg • 5 PUMP PERFORMANCE SPECS _. l yyts. OR 4 _. f —Prior To Plowing- Installer will carefully shift or orient mound position ( toe line and area under bed agaregare) so drowiu elevations across slope are as uniform as possible. Suggested elevations (staked on site with lathe markers) are shown herein and on pg. 2. Do un 25 H. below the d0w03100 edge 01 1118 Soil Abso�plion System must remain undislurbed, „ _ , v = E,t ISTi,) G- jP�vE B Z Zp , 6/E v 4- rio,uS --- i i OF . : O � av `� New U,ti 593 Gh�.H/it`Tz o 5- - - ❑ (WfE.rS SON /PETE � .) SET (aRiuE I k � v ' l y PSG �1 ?E sir I � r3 o sue. tFle NIX T Vb — u>oo k -- o �� Lutil EL -iEvAT 1Cdxj S T31 7y /�G' �XiST��(r 3 T�EDI?M H-ou s E S Y S Tt � E/E 111tT/o.v 9S SQ ORIGINAL Y - .... INVERT o/ IfTc /S E GEU ,tTioyS T' of R OCK ��• 27 z Of S _ — • Top of � _IAT•E�'6LS ./ Page Synthetic Covering Distribution Pipe Medium Sand G s y f rem Topsoil __ __ _ frevrrn•w 3 f E D -� ' ELe uATt o "a 4-% Slope UNf R t U Bed Of Force Main Plowed o Aggregate Layer koF okm To6 uNE D /' a Ft. Cross Section Of A Mound System Using E /3 Ft. A Bed For The Absorption Area F • 7S Ft. 111 8118 5 0. below the 18WIS10 a fil 01 11 ;; Ft 9 A g Ft. H S Ft. Soil A1161000 System must 1101 Witt B Ft. K /d Ft. L &? Ft. ,. ,a3; • , Ft. Ft F in W. 1 8 Ft. 93 -03514 I Observation Pipg W --------------- - ----------------- - - --•I (tems � -�- r Distribution B ed Of i �t Pipe Aggregate Observation Pipe Permanent Markers A ve- C1pPF10 Roos Pion View Of Mound Using A Bed For The Absorption Area DAii- A/4 TE Flo yid r,4131e o �r ��'oPosEO gifts f►-L • Page 3 Of S • 0/ 1/o/v,4, A0 Z� Fr �F Z �Vc FoRcF //4s r kle- Perforated Pipe Detail 21�J Ri'Gti T Fo.° VA t! albir V14C U j i I'oAv End View )Perforated _�,/ End Cop \e ,y� PVC Pipe Ja�a'0 ante . Holes Located On Bottom, 1Y Are Equally Spaced R PVC Force Main .7 PVC Manifold Pipe Alternate Position Of Distribution Force Main Pipe Last Hole Should Be F End � Next To E d Co P S93 End Cap Distribution Pipe Layout P 22 n / /�w� Ft: R A/ /our l��ie Z sioE�u,�,/s X Inches Y Inches Hole Diameter y Inch Lateral Inches) Manifold �- Inches Force Main Z Inches �.� W of hol es /pi pe �0 Invert Elevation of Laterals 9410 Ft. • !� I S rR %l3 v T /vim lei se 4,e y C t Kok 6 4 C It 14 7 4 / 7 0 Z- ?zk, O T; S 2 -7 ) • i R i T/ L7 �' GA. �'9TE" ;R 2 D? To � � ST /3U o,� S ARSE N�C�lvo�P�' 1��Si'G>v VS1 G - /9- A r I I I y; y Ei. ' N HEAD CAPACITY CUR VE 3 7/8 6 1/4 r 2 3o MODEL "98" 4 5/e I 8 `' 25 e I I 3 5/8 6 20 m 0 o � + 15 4 3/16 4 10 _ 1 1/2 -11 1/2 NPT 2 5 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 8o 160 240 0 FLOW PER MINUTE . r i TOTAL DYNAMIC MEAD /FLOW PER M!,,LITE +�a EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS /MIN FEET METERS GALS Li RS 5 1.52 72 273 10 3.05 61 237 � 15 4.57 45 170 20 6.10 25 95 — 3 5/16 - — i Lock Valve d3' 7 S93 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for dunlex systems, are available and a Mercury float switches are available for controlling single and J supplied with an alarm. three phase systems. p Mechanical alternators, for duplex systems, are available with or a Double piggyback mercury float switches are available for 'without alarm switches. variable level long cycle controls. SELECTION GL.OE t 1. Integral float operated 2 le mecha 1C81 switch no external control r . e Po required. Standard all models - Wet ht 39 lbs. - '/� H . P . HP 2. Single piggyback mer ;wry (loaf switch a :rouble piggyback mercu ,float 98 Series ry C ontrol Selection switch. Refer to FM0477. Model Volts -Ph Mode Amps Sim lex Du lex 3. Mechanical alternator 10 -0072 or 10 -0075. ` M98 115 Auto 9 1 .0 1 or 1 & 7 _ — 4. See FM0712, for correct model of Electrical Alternator, "E- Pak ". _ , N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. 098 230 1 Auto j_ 4.5 1 or 1 & 7 — 6. Four (4) hole "J- Pak ", junction box, for watertight connection or wired -in sim- 236 _ 11 Non 4.5 2 or 2 & 6 3 or 4 & 5 Alex or duplex operation, 100002. 7. Two (2) hole "J- Pak ", for watertight connection or splice. V. CAUTION For information on additional Zoeller products refer to catalog on CombimAion Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quail- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; fv'alchanicai Alternator, tied licensed electrician All electrical and safety codas should be followed induct FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and .^simplex Control Box, ing the most recent National Electric, Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). j RESERVE POWERED DESIGN For unusual conditions a reserve safety factors dfi�ineered into the design of every Zoeller pump. MAIL T0: P.U. BOX 16347 Louisvill ;•, KY 40256 -0347 t/ Manufacturers of .. . 0 SHIP 70: 3280 0 Allets Lane r �p OE�LE�P l7. � � A L / � s � Lout ;�vwr, KY 4,i� 16 QU 7YPl/MPS �NCF ��JJ (502) 778 -2131 • FAX (502) 774 -3624 ........... i Labor and Human Relations Department of Industry SOIL AND SITE EVALUATION REPORT P ap • � Lbor atl ..._ Of DMsidn of Safety 3 Builclings in accord with ILHR 83.05, Wis. Adm. Code COUNTY /o TD�r'I Gs�,vE -5 T C / X 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 PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: a4 YEX-5 % PROPERTY LOCATION 'Wo 3+= k T John f {AN L- E y GOVT. LOT NE 1/4 SE 1/4,S 31 T - I ,N,R lo E (or) 1 ,; PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK N SUED. NAME OR CSM If C g to o fie- S - / 6 5 P, /.0 G— CJJTTY STATE ZIP CODE PHONE NUMBER CITY pv ILLAGE ZVOWN NEAREST ROAD K a B Ele T'5 . /s_ 5 vo Z 3 (� /5) 75q- 3 5'z0 Gf/9R�PEti /U U [ J New Construction Use [AJ Residential / Number of bedrooms 3 Ex �STl vG ) [ ] Addition to existing building y�J Replacement P el [ J Public or commercial describe - rO - fL 2 /?E 7 .vE 1 Code derived daily flow 4 150 gpd Recommended design loading rate , S bed, gpd$ - G trench, gpoltt Absorption area required 375 bed, ft 3 -1 -5 trench, ft Maximum design loading rate - S bed, gpd/It2 G trench, gpddt Recommended infiltration surface elevation(s) Pft - It (as referred to site plan benchmark) Additional design/ site considerations s•T� Su. ,g « ov cy �o.P �!D U�J� S'yST�� Parent material 54 S' 6 7 SAN Ti.4 60 S GT Flood plain elevation, if applicable ti• ff It S =Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑S DU OO S ❑U ❑S ®U ❑$ ©U ❑$ DU [Is ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consist Bardary Roots GPM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed qhr6 F 142- - q Hoye y/y �, / 2 f g A ., �,e f c Ground 4 y' / 0 re /! 1 s, 2-, f, 56k /* jc Ce f e s , s elev. ft. / 2 0 - 3S -7 s yl //�,' 5 2, f yw Depth to /3 3S- s5 s y� y i : s A4 �/ �' y,Q /Hl 7' ' 5 firriting C 55 -_21 7, ,P 5 /(� , SW Gw� SCI 2, /m, h ,k �► � �' — . �� , s Remarks: Boring # [2- D- io z/3 s// Z,�,,shk 4-M1;� 3f �s , s•= .� 9 -l7 / °ye �/ �/ 511 2 ,f Shl( f e5 , 5 � Ground elev. i3 7 - "7 yf? y/� 2, s 4/� 51 2, f, 5d& It �I p / /� c 0 -6 /•5Yz 5 &' " " J`G/ 2 "W `Shk /w� _Tt� l Depth to ng ' I LI I f� ` a „ �4T �� � � �4'7v�E1� i�ES �vE .vCDrJ 72 G7 27 Remarks: /��P /'Za�v T33 5y " ( " w�5 SATV�P�tTL7 CST Name: - Please Print /Tadf - lf ?.l LIS if i - CA 7 — Phone: s- �2 0 / " U'57 72v. /YVosd,� Gc� i � - y - y 3 es r - 2 , YP2 . alure: ✓ X Date: CST Number: �o R 1V ��� •\ � 2Gl�t r Gf,.� °3 Y ORIGIqA ti ,� ,il/r�Pi �'oC.> 10D9,f710 v o` 'mac- CK /4 /ate 6- j>o 7 A.) y A067 o // 51ie0 C/_ �'¢s 4.les_Z2 71 1� //¢7i`y 5 I'P U c � v PROPERTY OWNER A) 4L F SOIL DESCRIPTION REPORT Pa 1- 3 PARCEL I.D Lo f / C 1 4A W G L --q P F s 7 � Boring # Horizon Depth Dominant Color Mottles Texture Structure cons is�noe Roo GP -2 in. Munsell Qu. Sz. Cont Color Gr. Sz= Sh. Bed rtt 1 3 v 1 /9l � //-/6 /o y,2 S. l 2, 40f Ground /32_ /('ly /O y,2 � �(, S� �.Mi, bkf ►' CS / s , ft. /J 7, S YAP � - F, ,5 k /wI I De p th to G SO 7 s iQ 1 6 C� 5 , �4/� s/ f slw ,r►, ► ` • y 5 limiting fac Remarks: Boring # El 1 P T 13 v �v ESP Ground --- elev. 5' 1 o f.5 _ Depth to limiting i factor Remarks: .�},pF �� y l.5 O T S r. T A'8 IC FOR /r l . 9 P o v -J L7 y ST E - '--L1 . Boring # I Ground elev. ft Depth to limiting ' factor = Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 000nro ncavm JAM090 .:1 30 y a • = 13 ,4ce,,E P/Ts 0 2- ZP � E /ElJi1- T�o.uS 13 3 a 9y.5 ya � Sly B qz 1 - , ° - — A a� El Gy BM sET �R � uE y y Nix r To 56 u>oo fEtiCllr post WWII ELiEVAT SON S l i �XiSTi�Cr 3 T3E02Nt r3 Z, cJ �/, 66 o lr7 R� l sE 3 9 x - 76 i �E 9 .So 5 .� TE'M / G' tT /o,c� &.W Of- �- 31 3' CERTIFIED SURVEY MAP Located in part of the NEh of the SEA, of Seption 31, , T29N, R18W, Town of Warren, St. Croix County, Wisconsin: N - 5 LEGEND � o r E} Corner of 4j 4j t`w - w Aluminum County Section Section 31 d Monument Found ' `•'' s w c b O 1 x 24 Iron Pipe Set,-; •o � weighing 1.68 lbs. per linear foot .. 1, 'L' +t Existing fenceline�, N CM N 100 Roadway Setback Line o L N 0 b t'7 N W O O1 'n o C N co I ' I �J' ( T T r1 ^' •� p U P .A T T LV LAI D'S , uv- m -- - - - - -- - - - -- 3 3' 1 33 m o .c N89 °43' 04' "E 5 A.9' f � 493.15' 36.34'•— UJI C 01 _ -J; LOT 1 o ° (A o _J �r 4J � .0 t 3 W LEI 6.00 Acres Including R/W ce W Cn W d UJI UJI 261,359 Sq. Ft. X41 I'_t Q I N 5.59 Acres Excluding R/W _ N 243,428 Sq. Ft. p N rn. ; JI 0 11 t I z n F— I cn "' . WellA I r House 0 LLLJJJ OI —I C, 0 . • b N 36.31 cc - 493.18 A S89 "W 529.49' UNPLATI TL:-D `ANDS AL S''•i p W L b. YHA r q cD N ++ N C N N 6 OWNER M "' ■ M C1 W.S. Clapp Estate Wi � , 'W" Tom Lane ' Under the direction of: •� q `�s s r r , 973 65th Avenue �- Roberts, WI 54023 SE Corner of SCALE IN FEET SE 31 0 50 100 200 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page Of Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER PROPERTY LOCATION 8110 " T JOrt>J /�/��U� -Ey GOVT. LOT ,1 1/4 SE 1/4,S,?/ T z ,N,R / J E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # V�� � 2G 28 oa 5' 7 Asti saw p f CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE N NEAREST ROAD 4j15. syoz 3 ( - )/S) 7 y1 34 �vly, 1 _It_l 1 /tee - 14 f7 Ivr New Construction Use [ W*esidential / Number of bedrooms 3 [ ] Addition to existing twilling I I Replacement [ I Public or commercial describe Code derived dairy flow y✓�� gpd Recommended design loading rate • S bed, gpd1ft trench, gpo1ft Absorption area required 375 bed, ft2 3 7 S trench, ft Maximum design loading rate 5 bed, gpd/ft2 • 6 trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material S�t�T /�t�o S/. Flood plain elevation, if applicable Nom ft .v rsu =Suitable for system CONVENTIONAL MOON IN GROUND_PRURE S DE ❑S TEM FIB ❑S ING TANK = Unsuitable for s stem ❑ S ff� [ 11 ❑ U D S C� Cf SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bouxfary Roots in. Munsell . Sz. Cont. Color Gr. Sz. Sh. Chl Bed rerlctl - io z , z Shy S of � o / /3 / f ,� • s C. /0 0 1Y — 5 11 2 ." Sk Cs 10 , S . C, �- s Ground 3 � —� /Dytf' ylP ' �� /f' S6k elev. 7 Depth to limiting fac �� Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name: — Please Print 6 6 0 j 7 Phone: -7I5- - 3 ,96 �l�S A ddress: / / _ i� � L /2!� 1�Soa / �yalP �/- - �' CsT� yez Signature: rpa 1 Date: CST Number: 7�' 7 r se — 7' ) ill zO _ o �y3 -o3rly i y PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITiench Ground elev. ft. Depth to limiting ' factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i .......... Ground elev. ff. Depth to limiting factor Lj Remarks: t Boring # Ground elev. ft. Depth to limiting factor I Remarks: con oonnio nc in� r • 1 / „_ 3 0 " 7 S i 9y.5 13 yO 3 9Z So Lo r I- 3 Lo T Z. 3 0 5 ) - -- 6 sEr �RiuEy y NEXT rp CO�p�vE-R �O � l�Gd 1� FE-vcE poSr i ELEL/FTio,u O WWII , EL4EVAT lom 5 l EXiST��Cr 3 T3En Rr1 (3 GG ' 0 117 F��� Ndu 3 9.Z 76 /3y 9/ 30' 6 Y 5 TE'M /E //. , t Tio,v w/ w rif - /..a FILED MAY 4 251 ► 994 D JAMES 0' 517040 CONNELL S Register of Deeds 6 SL Croix Co., WI 6� CERTIFIED SURVEY MAP Located in part of the NE; of the SE4 of Section 31, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in the St. Croix County Register of ]weds in Volumd 9, Page 2692. v N M } ' E} Corner of N N H ET GEND A n Section 31 s (9 Aluminum County Section 11 {' r ' Monument Found o� .l 0 1" Iron Pipe Found N u.l O 1" x 24" Iron Pipe Set, '• o ° o ^ o weighing 1.68 lbs. per linear foot L W N N r ° o x T Existing Fenceline C) 4M L ••••••••••••••• 100' Roadway Setback Line CO c o A �N� �_ ��i T EID 1- 4\N ID - - - -- 33' `33' I N89 "E 529.49' 493.15' 36.34' — LOT 3 3.00 Acres Including R/W 130,677 Sq. Ft. - - o °O 2.79 Acres Excluding R/W — 121,709 Sq. Ft. N (,71 N 01 O (�I � -• 1D v �� 01 �I ch rn M o d' rn �I N89 °43'04 "E 529.49' 36.33'— W co LLI I n 1 0 493.16' �., W r WI E !I M N o _ N _ (n I 41 0 JI x — N LOT 2 (0: Privy °o crn.r o C - 1 0 3.00 Acres Including R/W o y Gi 2 130,682 Sq. Ft. N W 0, c House . 0' Y 10 -T 2.79 Acres Excluding R/W Well 'r —' -1, APP V ED 121,719 Sq. Ft. N N •` I W , N b L M,ky 2 51W, 6 ' 36.31'- 49 .18' �omfxaheresivs F'iar+nir S 8 9 ° 43'04"W 5 2 9.4 9' y w Zoning and T 1_ ,?,NN � I Pwks com1wtteo OWNER e if not vecordsd Merton Timmerman within 30 days of 633 North Freemont N N appaava+ldatw River Falls, WI 54022 �, M O fh N ly' mvar' SlfBtf'lics i o ~ Scale in Feet ' SE Corner of 0 50 100 200 Section 31 Vol. 10 Page 2764 SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify, that by the direction of Merton Timmerman, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NE 1/4 of the SE 1/4 of Section 31, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in the St. Croix County Register of Deeds in Volume 9, Page 2692, further described as follows: Commencing at the E1 /4 corner of said Section 31; thence S00032'24 "E along the east line of the SE1 /4 of said section, 761.22 feet to the point of beginning thence continuing 500032'24 "E along said east line, 493.61 feet; thence S89c)43'04 "W, along the south line of said Lot 1, 529.49 feet; thence N00032'24 "W, along the west line of said Lot 1, 493.61 feet; thence N89043'04 "E, along the north line of said Lot 1, 529.49 feet to the point of beginning. Above described parcel is subject to right -of -way for town road (100th Street) and all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate Town Board for advice. Vol. 10 Page 2764 2 C � . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /QoB EleT A#- }��NLE/ ah� �0AA1 �• 11i4,V MAMING ADDRESS 628 - loon-/ sr. Ro;Relgrs, f6a 502.3 PROPERTY ADDRESS 632-160r# S T /2Q ;W--R , t,,✓l 0 -02-3 (location of septic system) Please obtain from the Planning Dept. CITY /STATE Ao3ERTs w/ PROPERTY LOCATION NF 1/4, 5F 1/4, Section 31 T P—'? N -R f $ W TOWN OF I '412ge, -4 ST. CROIX COUNTY, WI SUBDIVISION d /Ar LOT NUMBER CERTIFIED SURVEY MAP 5110 46 , VOLUME PAGE 274 '/,LOT NUMBER 3 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) w disposal system i in proper operating condition and 2 after i and ins the on -site aste ater d sp al sys e s p p p g O P 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 g q g 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 ration da SIGNED: DATI]i lO - �$ St. Croix County Zoning Office Government Center 1101 Carmichael Road l iudson, WI 54016 11/93 � I • bocUMENT NO. STATE BAR OF WISCONSIN FORM 1 -198= TM's se"' acsg"go FOR ascoac'" 'DATA I _ WARRANTY DEED _ 520455 VOL 1 9 rasE(j REGISTER'S OFFICE ST. CROIX CO., %% This Deed, made between .. Mer toa..E....Ti.minexman.......... Reed for Re =d ...................................... ...•-•-----••-•-•---....... ........................................ AUG 2 2 1994 ...... .......................... . . . .. .............................. .... M ......... ••- •- •- •- •- -_..... Grantor. at 9:20 � A� and .... RQ.ber>ti ... M. -- Hadley.. and . .Joan - . .. . H Hanley, . .................,,,>r...(�' - h>,�sbanc�_. -end__ wife. • as - • survivorship • - ......... -tl .._.11rcgexty. ........... ..... -- •.•... •-- ......... aterottae.da ---•--........ ............................... ................... •-- ......... ----- - -• -•- ., Grantee, Witnesseth That the said Grantor, for a valuable consideration...... asruft" To conveys to Grantee the following described real estate in ...� t_x_. �e1;A_7.X.......... rSt National Bank Of RI Y @1' Falls County, State of Wisconsin: P .O. Box 1 66 Lot Three (3) of Certified Survey Map in ever alts, Wisconsin 54022 Volume Ten (10) of Certified Survey Maps, Tax P" No: .... ............................... Page 2764, as Document Number 517040, filed in St. Croix County Register of Deeds office on May 25, 1994, being located in part of the Northeast Quarter of the Southeast Quarter (NEC of SEk) of Section Thirty One (31), Township Twenty Nine (29) North, Range Eighteen (18) West, Town of Warren, being Lot One (1) of Certified Survey Map in VoliIme Nine (9) of Certified Survey Maps, Page 2692. ,.j" u 1 � This...-is - not _ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ...... Medan ...E...•_Tialmerman......... .......................................... ................................................. warrants that the title is good, indefeasible in fee sh ple and free and clear of encumbrances except easements, restrictions, and rights -of -way of record, if any, and will warrant and defend the came Dated this .......... I ��.. A s t day of ........_...ngu ............ ................. •• •-- • ...... 19.9 ........ ..(SEAL) �4?t... (SEAL) Merton E. 'Timmerman ................. .......................... .• - -- ....(SEAL) ....---•-•--•-- --- ............................ ......................(SEAL) • AUTERNTICATION ACENOWLaDG KXNT signature(s) --------------------------- _ ------------------------------- STATZ OF WISCONSIN .. .............. _................................... . (}/� ?/t�G L as. �rR - -- ...--- •- •-- ....-- •- ..... - -- County / authenticated this . .......day of________ ________________ _ __ 19 ..... Personally came before we this .- .!_...........day of ------- – ----- Au&US1 .............. 19.9. the above named .................................•---.....------. _........_............_........ .......... s�.IL._.......-•--- - -... 0 • ---•- -•- ------------------------•--•---- -._.----- ---- ---- •---- -- - - - -•_ ... -........................................................................... TITLE: MEMBER STATE BAR OF WISCONSIN °--•------------•-•----------------------------- -•- --•- ........._••--- ...._.... (If not....... ..................................................... :--- .................... .._.................... ......................- °- -•• -•. authorized by 1 706.06. Wis. Stab.) .o me knovn4o. be the ............ who executed the forego t>]ent' LdFhowledge the same. THIS INSTRUMENT WAS DRAFTED BY t - •-- •- •---- •• - - -- - -•• -- Ca L. Cayloxd,.__At�tslxneX ... t River Falls, R 54022 ; V� r) '5 .._ - • - •- -• -.._ ........ ........ ............ Notary le ....! . County Wis. -- (Signatures may be authenticated or acknowledged. Both My cc rdeut, (If not, state expiration are not necessary.) .. •. ...4G_.. �'..�...... _, -19.) date: ... -. °-. *Names of persow sisnina in any capacity should be typed or printed bdo'e their eisnauures. WARRANTY DEE STATE SAN OF TfISCONSM Wiaeonefs IAX&l B6uk Co. Ise ROME FO RM NdA I :• -'19113 Yilwauk". Wk. S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property 14N LC=)/ o gJ ON M. Location of property /VE 1/4 SF 1/4, Section 3 1 ,T Z? N -R W Townshi pARE/v Mailing address St. , k btA-7t , tv► Address of site 632 - /DO 7 w ST 80 .89190 - S W/ 6YO23 go Subdivision name /A Lot no. 3 Other homes on property? Yes X_ No Previous owner of property 106Ai - ON E. 77 !/i1eAmo4,N Total size of property 4 �P ac. Total size of parcel 3 u c-• Date parcel was created �� , pq Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number recorded with the Register of Deeds. lAZP 6, a7 ------------------------------------------------------------------- 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. 5 , 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. gnature of App 'cant Co pplicant f0 — 'Ov8 — Q' /0 -z$ - ?Y Date of Signature Date of Signature • s9999 80I goo000 .. ®0mm900�09 ©slogan 00000000000008000 ©68 ®B9® ©000000000 ®oocolonel x00000 D ©08 ©© ©8000000000 X00000000 ©0000000 Bm0 0 D8 ®88900000080000 00 ©0D ©800000 0000©© ©0000000000 00880 . -D ©88889 ©008000000- -®BBB© ®888 ®0000000- 08�00008000000000 ©880000© ©80000000 - . © ©0 ®000000000000 ®����� © 00u0loo0000008000 080 ©0�� ©00000000 © ®890800000000080 �©00i00000o000000 v9®®©000oo0o000on • 10000008000080000 08000000000000000 Bill lo00o008800n • ®99 ®080000000080 ������� ©8000000000 0 ©8888 .. 0 ®�® 8080808080880 ����������,t�! ����■ '�s■ � ©© ®0888008888000: ��������� /. - ���������� � ®0 ©08000888800 _ 80 / /����/■ ■I ■ / //■ ©®o0000o000o08000 ��� ®. 02, _ ©800696 ®80 ® ® ®� ©80 %x► ME /MI %'I■ 0 ©880 © © ©0D ©009 ®88 /� / /� ► //I N /. //■ _ KA WA W-1W,1FAWoW-1b spa M ■ ®�//SIEI.///// //I //I ■/II/I ■I /,�/ %/� _ •