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HomeMy WebLinkAbout004-1035-10-100 ell on a~ a 0. 0 L c U O C~ N L _ O ' N C N E_ N o ~ > NO m L S L o --5. 0) 2 c 0 0 i 0) 0) E O E«~6. u~kL 3 _ O O F- O N _ O > N C O y O N a- a) 3 N L (9 aN T . O O~ (6 UOL c Z C O m c c -O m a~-0 000 -ornocc LL CO ? ~'C N N m'D 'U f69 E C (D -0 o c) 'D L 'D co N O -0 L C C (0 a F- co 3 m o Z N _LO E Z O E Z 00 a 4) LLJ 0 cu c z O 2 ~ I,' _ ~ N d 'z z UJ F- C E 0 ~J o I cl~ c • _o c p m 0 o a d Z Z a z N N {E IL' d lE ~ N c 0 r n o p y G a a y .0 O N Z > Lr) F- F- F- O N ~E ON IL ~ O a 2i 0 0 0 Z O ►i U) m N U) J U Z rn OR as %%INA O } OI O N C O O -x = O O CO CL 8 dI~ c m 46, 0 N ~n y ~ p O O N C 04 0) O~ O co N N C] d o 0 0 E N 0 0 V (O 0 a) O try~,~ C"r O W~ O N O L 41 _0 N p E U N C O L • yr„' °o U m N 0 N Z Cn o ~ - at a Fi a m d c „ E L c c *Ai r A 0 a 2 0 U) L Page 1 of 3 Wisconsin Department of Commerce D Division of Safety and Buildings MGM- h Com7"" Attach complete site plan on paper not less than 8'/z x 11 inches in size. Pla p include, but not limited to: vertical and horizontal reference point (BM), direct' I~FCE v En St. Croix percent slope, scale or dimensions, north arrow, and location and distance - rest road. P rc D.# pending CSM approval APPLICANT INFORMATION - Please print all informat! A V G C, Date R~Y d By Personal information you provide may be used for secondary purposes (Privacy La s. 04 (1) (m)ST v iri Property Owner ILE 1/4 S 15 T 28 N,R 15 W Brandvold Robert lot ame or CSM# Property Owner's Mailing Address 3004 CTHW N Town Nearest Road City State Zip Code PhoneNumber ❑ City ❑ Village 54027 715-772-4478 Cad I CTHW N Wilson WI ❑ New Construction ❑ Residential / Number of bedrooms 3 ❑Addibon to existing building Use: Replacement ❑ Public or commercial describe Code Derived daily flow 450 9Pd Recommended design loading rate 5 bed, gpd/ft' .6 trench, gpolfF .6 trench, gpolft' Absorption area required 900 bed, ft' 750 trench, ft' Maximum design loading rate .5 bed, gpd/ft' Recommended infiltration surface elevation(s) 99.4 ft (as referred to site plan benchmark) Additional design / site considerationsinstall 5' x 75' rock bed mound on 98.4 as u slo edge of rock w/ 1' sand fill Parent material loess over sandstone Flood plain elevation, if applicable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system I ❑ S® U I ® SE U ❑ S® U ❑ S® U I ❑ S❑ U ❑ S® U . SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD1W Horizon Texture Consistence Boundary Roots Bed ;Trench Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 1 0-9 10YR 3/2 - sl 2 m cr mvfr cs 2flm .5 .6 2 9-16 10YR 3/2 - sl 2 f-m sbk mvfr Cs lm .5 .6 Ground 3 16-24 10YR 4/4 - sl 2 m sbk mvfr cs if .5 .6 elev 4 24-30 l OYR 4/4' - sl 2 in sbk mvfr Cs I m .5 .6 98.0 ft Depth to 5 30-42 10YR 4/4 f2p 7.5YR 5/8,5/3 sl 2 m sbk mvfr cw lm .5 .6 limiting 6 42-56 10YR 7/4 - SSBR 0 m NP NP factor 30" Remarks: some mix 10YR 4/61s 24-42"• bedrock is monolithic 10YR 3/2 - sl 2 in cr mvfi cs 2f/m .5 .6 2 10YR 3/2 sl 2 f sbk mvfr cs lm .5 .6 ...............:.:F5 Ground 7 1OYR 5%4 - is 1 m sbk mvfr es if .7 .8 elev t2d 7.5YR 4/6 98.4 ft 4 27-55 10YR 4/4 10YR 6/2 sl 3 m sbk mfr Cw I m .5 .6 5 55-60 l0YR 7/4 - SSBR 0 m NP NP Depth to limiting factor 27" Remarks: SSBR is monolithic CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 665-2681 Address 11•0• Box 57, Knapp, WI 54749 Date CST Number Ref # 8/2/97 222774 151 PROPERTY OWNER: Brandvold, Robert SOIL DESCRII` ART 151 Page 2 of ' 3 PARCEL I.D.# pending CSM approval • Depth Dominant Color Mottles tructure GPDlftz Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed :Trench 3 1 0-6 10YR 3/2 - sl 2 m cr mvfr cs lf/m .5 .6 - 2 6-12 10YR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 Ground elev 3 12-26 10YR 4/4 - is 1 m sbk mvfr gs lm .7 .8 98.4 ft 4 26-37 l OYR 7/4 - fs 0 sg ml cs - 5 6 Depth to 5 37-77 10YR 7/4 - SSBR 0 m NP NP limiting factor 37" Remarks: irregular 10YR 4/4 is bands (1/4-1/2" (a) 26 28 30 34 BR is wk cemented w/ resistance to penetration increasing w/ increasing, depth- monolithic Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: 1~o~j ~JYa••~~ro~~- ~~,ot ,~1a.~. 2$-~Yw .,t6o is VA \J • lLu° O • Z w: ~ ~,o `++f H w C.T•1 w I-Lie LL C~ oo.o~ 11 ( Q`lo~•.,- ds 6-Y Wiscon,inDepartmentofCommerce SOIL AND SITE EV @N, Page I of 3 Division of safety and Buildings i r 83. % Attach complete site plan on paper not less tha 1 e n size. Ian Aunty include, but not limited to: vertical and horizontal reference point (BM), di io a fzpl _ St. Croix percent slope, scale or dimensions, north arrow, and location and distance to st road. Pa -e~ , ~ rr• s~_.. APPLICANT INFORMATION - Please print all informatio I pending CSM approval Personal information you provide may be used for secondary purposes (Privacy Law, .4Z . 4 (1) Re BY Date kj'' Property Owner ?Jim . Brandvold Robert G fE J 1/4 S 15 T 28 N,R 15 W Property Owner's Mailing Address Lot / 4 Y me or CSM# 3004 CTHW N City . State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road Wilson WI 54027 715-772-4478 Cad CTHW N ❑ New Construction ® Residential / Number of bedrooms 3 ❑Addition to existing building Use: Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft' 6 trench, gpd/ft' Absorption area required 900 bed, ft' 750 trench, ft' Maximum design loading rate .5 bed, gpolfF .6 trench, gpd/ft' Recommended infiltration surface elevation(s) 99.4 ft (as referred to site plan benchmark) Additional design / site considerationsinstall 5'x 75' rock bed mound on 98.4 as upslope edge of rock w/ V sand fill _ Parent material loess over sandstone Flood plain elevation, if applicable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank ® S❑ U ❑ S MU ❑ S® U ❑ S® U ❑ S® U U=Unsuitable for system ❑ S M U 7 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/W Borin # Horizon Texture Consistence Boundary Roots 9 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0-9 10YR 3/2 - A 2 m cr mvfr cs 2f1m .5 .6 5 6 2 9-16 10YR 3/2 - sl 2 f-m sbk mvfr CS IM Ground 3 16-24 10YR 4/4 - sl 2 m sbk mvfr cs if .5 .6 elev 98.0 ft 4 24-30 10YR 4/4' - sl 2 m sbk mvfr CS I m .5 .6 Depth to 5 30-42 10YR 4/4 f2p 7.5YR 5/8,5/3 sl 2 m sbk mvfr cw lm .5 .6 limiting L 6 42-56 10YR 7/4 - SSBR 0 m NP NP factor 30" Remarks: some mix 10YR 4/61s 2442"• bedrock is monolithic 1 0-5 10YR 3/2 - sl 2 m cr mvfr CS 2f/m .5 .6 2 5-12 10YR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 Ground 3 12-27 10YR 5/4 - is 1 m sbk mvfr cs if .7 .8 elev f2d 7.5YR 4/6 98.4 ft 4 27-55 l OYR 4/4 10YR 6/2 sl 3 m sbk mfr cw I m .5 .6 Depth to 5 55-60 10YR 7/4 - SSBR 0 m NP NP limiting factor 27" Remarks: SSBR is monolithic CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715-665-2681 Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref # 8/2/97 222774 151 SOIL DESCRIPTION REPORT Page 2 of } PROPERTY OWNER: Brandvold Robert PARCEL I.D.# pending CSM approval Depth Dominant Color Mottles Texture Structure oBoundary Roots GPD/f? Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-6 10YR 3/2 - sl 2 m cr mvfr cs lf/m .5 .6 iiiji 2 6-12 10YR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 Ground sbk mvfr gas IM Is 1 m 3 12-26 l OYR4/4 7 8 elev 98.4 ft 4 26-37 10YR 7/4 - fs 0 sg ml cs - 5 6 Depth to 5 37-77 10YR 7/4 - SSBR 0 m NP NP limiting factor 37" Remarks: irrcoular 10YR 4/4 is bands (1/4-1/2" (a~ 26 28 30, 34-BR is wk cemented w/ resistance to penetration increasing w/ increasing depth- monolithic Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: ~ 1~0~ ~J`~o,..~vo~cX- ~~►0'4- ~~~a.~. 1y~-t~l~-~J^•Z$-~~w -71 06 \V IL rc; ~ -tom ztt 'ia 4 J p Qc mo r wo ~r~r~a....e s~•..~-~ R- L \J • lLu° L wsli w w • $K .QQ2 ~ `~+►e a ~ S.~o.~ ~ S~ aJnnC c ~ Cs ~o.o~ ""7 FEB 4E3 4b Cb ;e i . 9 20 5020 VOL PAGE I~I KATHLEE}I IA M7CLSH'-' REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR hECORD 2905 D13R00Y MA RVEY MAP CERTIFIE-0 SURVEY MAP 0ER1IFIE LOCATED IN PART OF THE NE1/4 OF THE NWI/4 AND IN PART OF THE RECTFEEt SE1/4 OF THE NWI/4 OF SECTION 15, T28N, R15W, TOWN OF CADY, ST. COPY FEES CROIX COUNTY, WISCONSIN, INCLUDING LOT 1 OF CERTIFIED SURVEY MAP PAGESc 2 VOLUME 11, PAGE 3092. SURVEYOR: PREPARED FOR: PREPARED FOR., DOUGLAS J. ZAHLER MICHAEL & BONNIE HOLTZ ROBERT & BETTE BRANOVOLD 4 to S & N LAND 3050 CTY. RD. "N" 105 CUDD N1 COR 15 SURVEYING. INC. WILSON, N 54027 RIVER FALLS. VN 54022 SEC. 2920 ENLOE STREET HUDSON, WI 54016 - . - UNPLATT~D LANDS CT.H. "N" _ S 3 S8'S8~E~ 3 g 3,) -~..r.~ LEGEND ui S~474#54"E 306.55' (S83 58'58"E 306.53') (V SEPTIC VENTS w~2po "T - 4'54'` 85' °D 0 FOUND 1" OUTSIDE O t DIAMETER IRON PIPE ata SET 1' OUTSIDE DIAMETER O BY 18" LONG IRON PIPE. • WEIGHING 1.13 LBS. PER m • . • • • • • . LINEAR FOOT ROADWAY SETBACK UNE (100' FROM RIGHT-OF-WAY) I FENCE I NOTE: THE OR G NAL PROPERTY IRED I DRIVEWAY I WITH DOCUMENT # 715832 I I O I Z AND IS ADDING ADJOINING I I _ PROPERTY FROM DOCUMENT I s ( y # 287669. THIS MAP SHOWS r { I $ THE EXCHANGE OF LAND BETWEEN ADJOINING PARCELS I I~:-:. y AND HAS BEEN COMPLETED I r~-j N I m WITH DOCUMENT NO I I ryy~ jf_ N I ADDITIONAL LOTS ARE I d I HOUSE am $ .1, m r CREATED BY THIS I ( TANK WMJ DECK .pro Z w I > Iz INSTRUMENT.' I awn I LOT 1 pC,pry"' I 5.121 ACRES 1 cn 'ALL CONDITIONS, I (223,054 SO. FT.) RESTRICTIONS, NOTES, ETC INC. ON THE PREVIOUS I 4.888 ACRES C ERTIFIED SURVEY MAP OR r^SHED (212.938 SO. FT.) PLAT UNLESSROE APPLICABLE THERWISE EXC. R/W INDICATED." t~ I of wlsc ! 0 DOUGLAS J. SZ N Z C I ZAHLER m I S-214 I -15.Q0' 4.0't H I I; S ~ Q m 1 305.08' L N89 59'25"W 320.08' b (N89.40.21 "w) jum (O 2~ p SOUTH UNE OF THE N1/21 OF $ g THE S1/2 OF THE NWI/4 0. m UNPLATTED LANDS SCALE IN FEET 1" 100' --'-----v-~-- 100 O 100 S1 /4 COR. SEC. 15 THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6527-01 DATE: 06/27/2005 SHEET 1 OF 2 SHEETS ~Ir Vol 20 Page 5020 Z60£ d$vd TT 'TOA 21383M Wlr .l8 031-080 1N3Wnd1SNl SIH1 6£-96 i Z .40 ! L 33HS ~~-ti~-t•V~s~~Zi 19661 ' ~w 30 AVVO ~C~S1H1 031vd JN I.13/I dnS ONd 7 d383M-N3S 73N ti081-S 83s3M •w S3wur 1334 - 3~VOS O I HdVdO lp, OOE 051 0 051 ~ : 09t, sIAA k3-I!VA JNl8dS '1003 dv3Nl7 d3d 9970/ + tr061 S ONI HO13M 3d1 d NOd! .03 X .1 139 0 u3n3N1 '(13S S7dNKi' 13d1d NOdI .00 X 1) '91 Sao ,n I N01103S 90 83NHOO bil S ZI HIM O O N N O OIL W Lt4un "d (p r.: p OeAU.Iaiftl p s/ep C ¢?r'~telG~.sl ,90 'S0£ M.I Z ,Obo68 N - - - aaaalwu~o~ s~~n:.~ X96,_ t 0 ,per ~q _ o z `6.3Y 15 :C 0 O :C :Z nj Oo :Z :-o V 0~ N :-p :D O ('13 'OS 589 'LOZ) rn v_ :r cD :D Mid '0X3 '0d 11 'b P :v :m •1 d '09 008 'LIZ) G r4 :o S3MOV 00'9 I 10 N :D O v ~ :D ~dd3 ri+ :U) n N lD _ :N e- Ot m 3Nl 7 X0 d 1 .....IqD / H bil MN -tpil 3S o w 3H1 j0 3N 17 HI HON „89,85S,Fg S rn w ,FS 90F F5 •soF N + H : ^tT.:.^. . _14 y1 ol~ '(JNIHV39 o3wnssv) _ . o ro SaNVI 031lVIdNn S-3NN 17 3H1 N0/ O1 030N983938 3d3d3d 38v SJNI dv38 .7= tol- '(13S 3d1d N0d1 „tZ X „1) '91 w M011039 90 83N800 0/1 N -~~O IOAGNVUG 1)J380H :803 03bdd38d STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER D _ pp 2 g 1991 AfY Y rcan /n I~ r ~EU R~C~I~E ADDRESS 00 y (4y 1?J W; so v-, Uj1 Syo.-) 7 SUBDIVISION / CSM# ^J A LOT ~ SECTION 5 T S N-R IT W, Town of C ~~I Y ST. CROIX COUNTY, WISCONSIN PLAN VIEW Nof~,~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ht C9 w t 11 cam-- ~a0' o ri Q a \ o , I I CO. ROAR N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /DO /o? OF syeel relict 1?0s1 PPr",4cl ororl e. ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~,'~✓ester.✓ hreC_AS~ Liquid Capacity: Doo &C0 Setback from: Well 13V' House _10/ Other Pump: Manufacturer ~}1'~rpi►nk~;G Model# S W 33 Size Sw 33 Float seperation 9 Gallons/cycle: /S-3 Alarm Location Lose ~AS .N,eti-~ .SOIL ABSORPTION SYSTEM II Width: Length 11 8 Number of trenches y X 9 y &&k rc~c h Distance & Direction to nearest prop. line: olO ~.45 Setback from: well: / S O House I d Other ELEVATIONS Building Sewer /a -372" ST Inlet. 1 3 -10" ST outlet ~ = 1 Iz PC inlet PC bottom 17-(f,'lz Pump Off 1(9- Header/Manifold g y,~ Bottom of system CI 41 Existing Grade 10' 1" Final grade DATE OF INSTALLATION: 0 q(0 PLUMBER ON JOB: Ur-ls l3A~e~P LICENSE NUMBER: 00 110 NB INSPECTOR: T,'M I k nN PSon 3/93 : jt r - Mscorisin CYepartmentof Industry, PRIVATE SEWAGE SYSTEM County- Labor and Human Relations 8T. CROIX .Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION P BRANV~3LD em BARRY El City El Village C] Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: X Parcel Tax No.: 0- _7S TANK INFORMATION ELEVATION DATA c. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic CGS G~JBenchmark /25 Dosing Aeration Bldg. Sewer /3 lot) Holding St/ 4 Inlet TANK SETBACK INFORMATION St/OK Outlet ~ Vent TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet Septic NA Dt Bottom }/GI>~ 12.5~e Dosing NA Waahjgd Man. p Aeratio NA Dist. Pipe S '7 U~ Holdi Bot. System a i9, 3 3 PUMP / SN INFORMATION Final Grade .28.o$eprK Manufacturer Demand t Model Number 57 P I 37 P ro✓~ ~ TDH Lift LOSS 90 Had r TDH 1,1 Ft Forcemain Length Dia. - f' Dist. To Well >/,o SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. epth DIMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACH f SETBACK INFORMATION Type O CHAM !'r? ! Model Number: System: tv~~ /CD OR IT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe ) x Hole Size x Hole Spacing Vent To Air Intake Length _I Length Dia. Spacing ark. I r I (Y SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons resent, etc.) ~/03.9 LOCATION: CADY.35.28.15W, SE, NW, COUNTY RD ~+J f Plan revision required? ❑ Yes 0'0-0- Use other side for additional information. 171111 15_ > 7 SBD-6710 (R 05/91) Date Inspector's Signature Cert No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 ` • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. o"X • See reverse side for instructions for completing this application State Sanitary Permit ' Number The information you provide may be used by other government agency programs ❑ Check 4 fevksoCno pNur6viouapplicacidn [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION _S - Property Owner Name Property Location GC/~C 6-ot0 X4-114 AIA-A 4, S .1- T ,7* , N, R S-E (o Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number S diwsiew-Ptaw►g or C$l A Number. Q Z l~Lto.✓ 0.2 S> 77.2- 8 d • 7 'II. TYPE OfrBUILDING: (check one) ❑ State Owned Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms -3 2rTown of Z40 .IV o Qs, 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax NNumber(s) 1 E] Apartment/ Condo C/ - 0 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/ Mote[ 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank 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 W Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy 13 ❑ Seepage Pit 43E] 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 LSD TS .37G Z /a 3.3 Feet /oe• 3 Feet VII. TANK Capacity in gallons Total # of Site Fiber INFORMATION Manufacturer's Name Prefabe Con- Steel - Plastic Aper. New Existing Gallons Tanks concrete strutted glass App. Tanks Tanks r Septic Tank or p d00 I / A/ ;214W, t. l~l El ❑ ❑ ❑ ❑ .Q em Elolem9bef 1 Lift Pump Tank So G.SO « ® El El El 1:1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's N me: (Print) Plumber's Sign ure: (No Sta s) MP/No.: Business Phone Number: E e3.?7 ~1S C77d-.S.t4e Plumber's Address (Street, City, State, Zip Code): T ~,S ~~/il~t.✓ l.J- IX. COUNTY/ DEPARTMENT USE O WY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Iss ng Agent Signature (No Stamps) Approved E] Owner Given Initial Adverse Determination Surcharge Fee) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 05/94) DISTRIBUTION: original to Caunly, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. ' 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. . . To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax num0er(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 Farnill 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 lire B if permit is for tank rt-placerrer r, , onnection, or repair. V. Type of system. Check appropriate box depending on system type. V!. absorption system information. Provide all informatio-i requested for number; th,ougn 1. VII. arik information. Fill in the capacity of every new/or existing tank., list the Iota galiom, n jrrJ)~r of tanks and ~r, lacturer's nar,e, ~ndicate prefa1) or site constructed and tank material. C,., ipl(? te for alp ~,,otic, pump/siphon and ht-) ; tanks for :his systern- Check experimental approval only if tanks receive l experim gin:: ~orodutt approval from VIII. Respunsibi!rty statement Installing plumber is to fill in name, license number w,th zpprolz i& orefix (e.g. MP, etc.), add, es s ant; phone number. Plumber must sign application form. IX. County / Department Use Only. X- County / Department Use Only. i),-Jfic;3ti-~ns no: or tha-) 8 1/2 x 11 ircr - °ted aunty the plans must ii (~~01 :,!are, 17i,t,`,._~ tC? SCc1ie Or ~Nlth COi~"1_, 1 L ~JdlnC~ ank,,s), septic '-r„ - -''nt 1nF"5. bu ike,S puf;=i~~ Or 41phon o I e _;ilding <.erved; ~IV ~a tS, ' volur -1 n c? c,., If l: D) cross Section »>t S' >~er. !I Jf Si-7i ) information- GROUNDWATER SURCHAPGE E?]~nC.`e.,1rjJCsurchargesjees)for anumberr,i Jli.edi SWhlcl-'can - i IJiese s,_ircharges :ire used for mon0orlr g gr<'U It%Af>:]t'" COr Investigations i 1 esta b, i,SI .ie'-'.? o `i.a iur '1. - H G7 'v O O • > c*t T 9Fi'0102-4 r E® o > APR 2 4 1996 cn y Z SAFETY & BLDGS. DIV. 0 a ~ ~ y h 1 aA * o i ch ~ ~O ~ v o p ('1 r ~ Q a z °.r 0 1 ~ ` O o o o ~ d ~ •w T a7 t" i f:i 1 o O cf) ro, a N"= w C~ Ce) m . N r e f 1 ~ 6'ra 7p ~ ~ `\N - z t ~3 ~_o ~rx~~-+wa r cn ro ro 1 I 1 11 1 I H 47 ~ O O L4 L4 rrrtrtrtrtrtrt ~o S96' 01024 y z i T A V a n ~ CD M i. w I I r ro I b• c ro I ~ I £ ro I I ram` r~ w ` bd n I w O N w h-h a cr o : n owl a I C~ I'd H'o' ' w r:~ ro I z QQ L I' ( i Z fxEt' , N a c~ rt - r f N ? 1i...- t=J COD ~7 T v b cJ' rr b m d N• y I ID t-I yt~ rY Z~~ (i"1 . N C, e f M c S f ~ ~Y is M O 0 H 3 ~VX Hrrrr rt rrr . cart rat ? r ~ CA fr • o m f Y. ~ a ~ ~ h cn w a 0 M y l \C Or n O cn 00 o z 03 o x ti 0 co') d ~ T ~ I ~ G7 rrl cn cs rtn rn o `Y I rr, \ I Z C' J I I•I O ~ 9 O a v: '-G ~zHr H c 'b L4 ~ m th 9 t7l CTl rt rt rt r r, ri H H d~ rxj r, z 7 ~ [17 7J ~ H H H ~ O rn z % 'b C m n a C\o w ~1 m y ~ o "cn n m y w C n' F j t C Vlt,,\n 110 \ A a H m C n o r r ti \ I 9 CYi n R t ( c m o cn w 3 a o h I71 m rh b n 9 ~I CIO :3 fi. 9 m h U) ^1 I y • t O M a COMBINATION SEPTIC TANK/PUMP CHAfdBER 9 o 1 Q ~4 - •.ti C! ent. Pipe-with (No Scale) Approved Cap, +251- -.Approved Locking Manhole Cove r% From Buildings With Warning Label Attached . n Weatherproof Approved Warning Label Junction Box . vent Cap ~ 12" titinimum 6" Minimum 4" Minimum " Final Grade--\ 6" Maximum' 4"• C. I. Quick : Disconnect H 'r Insp Pipe 8" Mini mOm 7 • ; 1/4" Weep c Hole Baffles n Approved' Joi nt ; A' t w/C.I. Pipe;..:.,..-- Alarm 64 Extending 3••' B Approved Joint Onto Solid Soil on 6; 1w/C.I. Pipe i C Extending 3' Z3.7 Off Onto. Solid Soil oiViatON OF ahs , iA. ANU D Conc. Block SCE a ~ into -sl. i) DC°t~`!'GE 3" of Bedding Under Tank-/ and Alarm Are On Separate Circuits Number of Doses: 3 ,2 Per Day i .Gallons ' Note: Pump Gallons Per Day/ of Doses:Lz&,-,P Volume of Backflow:......14i- a Gallons •o Gallons Tank Manufacturer: .~c~A1r Total Dose Volume:. .......°1~. tic/Pump: ooo~~so Ga ons Tank Size-Sep Gallons Al arm Manufacturer: s. ELEGTAO Model Number: Capacities: A-2Pnches oro -Gall ons ~L r + g I nches orb switch Type: zv~ • ~ 7 ziOLf' + i nches or~Gal l ons. Pump Manufacturer: yoIr Y, ric + Dnches or -al l ons <AJ - inches or7Gallons Model Number: Total Minimum Discharge.. ate: ,18 08 Vertical Difference Between Pump Off and Distribution -Pipe{L.0-Feet Minimum Required Supply Pressure: F L_Feet of Force Main x y Friction Factor/100 Feet: o T eet o .1 _Inch Diameter-Force Main Total Dynamic Head:...=As Feet Internal Tank Dimensions: Length si N; Width Liquid Depth_ License Number 7 Date -,~o- Signature ~E-~Q E~rr SUMP/ EFFLUENT PUMPS Features Performance WS/DS25 WS25A1 S96-01024 • Completely submersible DSIWS25 - 114 HP - MAX. SOLIDS 112" - 3300 RPM automatic sump/effluent pump. 28 • Available with. wide-angle "piggyback" float switch 24 (WS25A1) or diaphragm type "piggyback" switch (DS25A1). • Cast iron constuction with non- r 20 corroding ABS volute/base. LL • 1/4 HP, 115V oil-filled motor Z 16 with thermal overload o protection. w • Anti-clog thermoplastic J 12 impeller. AMPS T • Can be used without switch for o 8 1m, 115V- dewaterin um 8•r' DS25A1 portable 1 /4" NPT discharge with • adaptor included for 1 1/2" NPT 4 discharge. • 10' replaceable power cord. 0 9 Weighs 14 lbs. 5 10 15 20 25 30 35 • UL listed sump pump. U.S. GALLONS PER MINUTE SW SD25 33 • For sump and effluent use. 28 SWIS025 - 114 HP - MAX. SOLIDS 1/2" - 1550 RPM SW25/33 • Automatic models available with wide-angle "piggyback" 24 ` float switch (SW models) or FULL LOAD diaphragm type switch (SD W 20 AMPS AT 1s,115v. models). Also available in LL 8.0 manual models. <1e • 1/4 HP (SW/SD25) or 1/3 HP =,2 (SW/SD33), heavy-duty, 115V F oil-filled motor with thermal a overload protection. • Rugged cast iron construction. 4 • Non-clog vortex impeller. • Long life lower ball bearing. ° 5 10 15 20 25 30 35 .40 45 50 Sintered top sleeve bearing. U.S. GALLONS PER MINUTE • Carbon and ceramic mechanical shaft seal. SWIS033 - 113 HP - MAX. SOLIDS 1n" - 1550 RPM • 1 1/2" NPT discharge. 2e SD25 33 10' replaceable power cord. (20' 24 / optional). • UL listed sump pump. W 20 LL 0 18 W FULL LOAD 115V. ` O 10.0 8 4 4 20 25 30 35 Z,-, 5 10 U15 .S. GALLONS PER MINUTE 40 5_A. 50 31 co - Wisconsin.Departmentof Industry, SOIL AND SITE EVALUATION Labor-and Human Relations , Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed b Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location .t V©Govt. Lot J f 1/4 N /5 $1+~CiN,R 15 (or& Property Owner's M ing Address Lot # Block# Subd. Name # tU 20PJ:lJG 0FRCE 3 DO 6 e& 1Pd . N N.4 N.A. A/ City State Zip Code Phone Number e4r4s F~ ,vn ,4017 W/ J'-~~27 /S )772-11V 78 ❑ City ❑ Village To A/ i New Construction Use: 0 Residential / Number of bedrooms ;~RJOX Addition to existing building W' a ❑ Replacement ❑ Public or commercial - Describe: jV, A . Code derived daily flow 5D gpd Recommended design loading rate 0 3 bed, gpd/fi2 0-4 trench, gpd/ft2 Absorption area required /,00 bed, ft2 &da f trench, ft2 Maximum design loading rate (9.3 bed, gpd/fl2_0_,_j71__trench, gpd/ft2 Recommended infiltration surface elevation(s) bk' ~.Qei, . ~Q3 3 Lo~it> uy /-Oft (as referred to site plan benchmark) n Additional design/site considerations 7ic/ 70i E R-~) 04 A10l~ix~Y Parent material Wel4no/ J/ ham Flood plain elevation, if applicable A/.4 It S = Suitable for system Conventional Mound' In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ®U ES ❑ U ❑ S ®U ❑ S ®U ❑ S ®U ❑ S i U SOIL DESCRIPTION REPORT 8 t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench O 2 aik 2. Zl /D 41qty sb k . Ground , elev. ft 2,1- "0 Yle / .S i v m ~r Depth to limiting Yip 51t, C.2 d' 7.S Y/R 'lo s4 1 / r P N, P• ct .11 Remarks: Al, P, - -1n-E e;;:J, ZiJ ed &Laa" Boring # a Zf-L CA (615 66 b 19-12 v 31 9 abk f 3, / Y 4 r C S Ground -s 7) / 7f c + rr C S 12: 3 elev. Depth to , limiting fa gr - Remarksc-cd'~1 CST Name (Please Print) Signature )5a5P)4-SS Telephope No. Lt`t A K ,~c ~7/S~ Z35-1,1~35~ Address Date CST Number 42 / s'v~ , /LI,a~,-h a.?'~o6 / PROPERTYOWNER A)' SOIL DESCRIPTION REPORT Page of r3. , - PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / '/I Ll.bk IYl r S .J! b Ground _ /D Y t'$~ • f~ t^ .Ini-/ S elev. ' /6-~n q IIII Depth to o a 61 / limiting factor Remarks: Boring # C) a /0 a/ 0 3- 1A 24 /0 y v M'- 6 Ground ~5 el v. P, P, Depth to limiting fact r Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # /O R, -VI i b k m fr 5 6 2 D Y'C 3%~ A• i sbk mfi' ,s d) L 3 a - - 0214 Sk as/P r1 m~e NP. Ground elwt. Depth to limiting factor / 2A ' Remarks: .Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) l w ~ 3of-3 ~ cn ud r~ cn n cn m ct pi m 0) ct r H (D t O Fl , ct OX (D " C] "c O Co i Ca fi N O cct O 0O - W Ul (D ¢ O ?C c [v C~ ct rOi O n 0O d O O Fl- (D O Ali cr ¢ O ~l ct ¢ O (D Ul p1 N- rt P;v W En 'C O a N (D (D W r- ~ ~J ~o (D Q, li C f O ct I ~ 5 O ~3 ~o c y.. 05%09%96 08:51 $ COUNTY CLERK 10003/003 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 :forth should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property Barry L. Brandvold Location of property SE 1/4 NW 1/4, Section 15 T 28 N-R 15 W Township _ Cady Mailing address 3004 County Rn N Wilson WI 54027 Address of si,3050 -3-56 County Trunk HWY N Subdivision name Lot no. Other homes on property? Yes X No Previous owner of property Robert L. & Bette A. Brandvold Total size of property 5 Acres Total size of parcel 5 Acres Date parcel was created 4-15-96 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes X No Volume 1175 and Page Number 570 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WATUWTY 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. 543076 , 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. Easement (Does Not Apply) Si ature of Applicant Co-Applicant 4.......: - 05/09/96 08:50 $ COUNTY CLERK 0002/003 r STC-I0S SEPTIC TANK MAINTENANCE AGREEMENT St Croix County OWNER/BYJYER Barry L. Brandvold MAILING ADDRESS 3004 County RD N 3050 PROPERTY ADDRESS 4W County Trunk HWY N (location of septic system) Please obtain from the Planning Dept. CITY/STATE Wilson, WI 54027 PROPERTY LOCATION SE V4,-NW _ 1/4, Section _ 15T 23N-R. 15 W TOWN OF Cady ST. CROIX COUNTY, WI SURDIVISION , LOT NUMBER---- CERTIFIEDSURVEYMAP 4-15-96 , VOLUME -L l-, PAGE 3092, LOTNUMBER 1 Recorded May 1, 1996 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 o~:ier agrees to S;:bm.t±~ St. Cro:Y?..ning certification forth, signed by the owr!er 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 trust be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED:~~ 'u DATE: .7 St_ Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 542956 LOCATED IN THE NE 1/4 OF THE NW 1/4 AND IN THE SE 1/4 OF THE NW 1/4, ALL IN SECTION 15, T28N, R 15W, TOWN OF CADY, ST. CRO I X CO., WI. PREPARED FOR: ROBERT BRANDVOLD 3~- N 114 CORNER OF SECTION ~l0 15. ( 1" X 24" IRON PIPE SET). NOTE: BEARINGS ARE QUARTERCSECTIONHLINE. VIP ATTED LANDS_ N'o (ASSUMED BEARING). I~ M T. . H, u.. , N„ 58 E 306a.5 3- - 306. 53 f- M - _ S B3 1 58' S8 " Z - M i cp ~ NORTH LINE OF THE M o M SE 114- NW 1 /4 rn HIGHWAY~SE z s 9 TRACK L lNE j J 0 ~ w t7 H 10 p Q .M~, d► co: - N o cn: ~y,V~ 11 Z: Z: J: LOT 1 0) z _J: 0: W - 5.00 ACRES o: W: rn (217,800 SO. FT.) 3 W: F-: 4. 77 AC. EXC. R1W F-: Q: (207,685 SO. FT.) ° Q: J: J: a: Z_: ° N Z: 0 z F." 0 1 '961 : PROVED COUNT`( .~•.~~^r; rf;ensiva Plarw~ir Zoning and Parrs Committee IY 89040' 21 ' W 305. 08 if -ot rs-cord d w,'s li r~ 30 days of approval deft r .UNP.l,A?:MR..1,ANP.$. ro val shafte % Flo ~I N M ~ 'Z"W fooo ~ e . R !.14 CnPNFP OF SFCT ! nN ZD43076 I' I, STATE BAR OF WISCONSIN FORM 1 - 1982 II I I! WARRANTY DEED DOCUMENT NO. R80Fi'ICE t ST. CROIX mil, V VI Seerd for 14wd This Deed, made between Robert L. Brandvold and ! r V Bette A. Brandvold, husband and Wife and each I! MAY. 2 1996 a I~ in their own right t'~ 3v Q Grantor, t„~e,,•; and Barry L. Brandvold, a single person Grantee, Wltnesseth, That the said Grantor, for a valuable consideration THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURNADDRESS conveys to Grantee the following described real estate in St. Croix Richa sp-rr Law Office County, State of Wisconsin: p Spr.t Lot One (1) of Certified Survey Map dated April 15, 1996, recorded May 1, 1996, in Vol. 11 of CSM page 3092, as Document No. Part of 004-1034-50 542956, located in the Northeast Quarter Part of 004-1035-10 j of the Northwest Quarter (NE} of NWJ) and (Parcel Identification Number) and in the Southeast Quarter of the Northwest Quarter (SE-41 of NW4), all in Section Fifteen (15), Township Twenty-eight (28) North, Range Fifteen (15) West. 8 FEE This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor - I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I all easements, restrictions and rights of way of record. i I and will warrant and defend the same. Dated this 2 day of May , 191k_ (SEAL) (SEAL) Rpbert L. B (SEAL).-'E- - x (SEAL) Bette A. Brandvold AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. County. 000)0 3~0 d rw G A `~1 ~bm 3 `D G m IWO _ P O I co .T„ L z N Z p W to 6 .r N • N w a (CD a y w a K ONO a OS m <O p H, ? m p~j 3 m y N Q O N Cn n't N C m 0 a O n 3 F ur °o G w co o d m c° a o CO) -9 CD W CD p V I ~ ~ 3 CO a II CD CD cn C) C) M 0 3 OOO Z o < z CO) CO) w N O'1 IOf M G v CD N ! O v L" _ CD d N 3 d O I a ~ N z O D D o o o m CD c I w co o A ` A I n N z 0 { A U) W M N U1 a CD Z c Z y Z CD f vp q d o;~ a j m ad m a v I 3 d o C CL a CD CD = CD o pco a_aa T Q p 7 G m o _ z CO. ~°p °-'s0 0 N CAD N O y (n CO O LO O m O-~ Opp cn j'N~C7 3 O ! N O m O n a fi a 3 g d ~sao.v CD = p 01. (D C O j 7 O] O d N a m C.. y < O N m C CD 2'v 0 ~ N.~ N 3O ='o N > g> i = y O q 7 S A o `q N Q N CD ~ ba 69 ~ My `A O~ ti f o e o N c O' 3 d o C7 `~1 ~ ~ eD I ~ v ~o ~ eo c C • CD co # n CA 3 A Z N Z o w L- o w o z K) ° o DOi cn o° • o y 0 o N 0 o 3 c CL j A .K ° !5. CD m 0 n cu I =r N~ N a 0 ~ 0D o C3 o to Oyo~Won lzu @ N O I H N `I N W CS N O ! O O a O 0 0 x 2 c a n CD I c~ s 06 y o `O p ~ a o 3 y ai I a 5 y y '0 6, A to 3 O to nI c n A ai N co ~ D. fD 4 N (D o CD rz N 3 a rn 0 -4 CL -4 CD r) O Z c, o O rn rn o l~ O L cn c Z co co M co CO I o COp CO N 0 c N co co C n Ul ! Q y Z OOOaI OOOa " `i• (n ~ ~I O o N 0 N r :2 A = I a. N N to o 9i (a A = I m A 0_ G N Q. .A+ N 7 N Z 'y D D o z 0 4 ~i O O o a < co ° w -I I I M CD m m m 010 c c I w ~ I Z m c3D -4 CO) z I ~ I j W N CT cf) 00 M CL CL C ~ G ~ .P Z7 O :i C w Z Ut I N Z I y Z m~ m N Ul o I ! m as =r a ct ~Q~ c c° 3 3 a c0 'D 0) O y CD CD C O N CD M N C N c~D 3 0 z T w 0 a m 0 Z0 •a 0 o, N uj O fD fD C 7 'r1 ~Ci_~ su c O c•~ d y N? 3 m m m c °con°~N~ z 3~ o 0 mmcoo"°'w a a 3 0= CD o a y o O o° 3 ac :3 CD o C N N 7 y Z I p• s7 N 0 7~ a~ g_. w 7 0 CS 3 CD -4 0) O= ° M. Cfl o y 0. (a S CL C1 0 N on ~x ~ Q_.-la ° m o w'-0 y ~ p~ p CD da) CO0 =:E N7 NC,°=cG `z G V O O. O' 01 0 O 07 7C Cp O O ~ O ~ y CD O a 0 g l o m CD c d N m cD O o En @ c =r E 3 Z f0 m m ~'?cd cc a = ys, A N Q 7 O m 7< 7=C CL O7 0 S 0• CD 0 O N O N (0 OS) Q 0 00 ! 0 mom >>30 Mo N N a< .a c v c 3~ ,cv . m ° i c y .D a Ch CL m° o ,z a ~ a, CD CL min a m mo c. 3~ o p o o w m 0 R ja CD t-4 o c Q o i C) I ti Parcel 004-1034-30-000 01/12/2006 02:16 PM PAGE 1 OF 1 Alt. Parcel 15.28.15.229 004 - TOWN OF CADY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner MICHAEL W & BONNIE J HOLTZ O - HOLTZ, MICHAEL W & BONNIE J 3050 CTY RD N WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 3050 CTY RD N SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 15 T28N R1 5W 40A SW NE EZ-U-1181/523 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-28N-15W G v Notes: Parcel History: I's ~ b~,r Date Doc # Vol/Page ap hype 11/29/2001 663FRR ~77E/287-~ WD 0772311997, 1179/393 WD 07/23/1997 1135/179 LC 07/23/1997 945/259 2005 SUMMARY Bill Fair Market Value: Assessed with: 106566 Use Value Assessment Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 14,000 86,000 100,000 NO AGRICULTURAL G4 38.000 4,000 0 4,000 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 40.000 18,100 86,000 104,100 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 6,500 45,200 51,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 c ti O' c 0 c d rw O L- Z O N (A (7 O p y 8'0 n O ~p a N 41 --I (D N (D co L 0 n o -I 'j 4O C 0 0 w O 0 CD I o ffA toll to O p tp m N a ° w 0 co a c o ~l N W O N O> O) O c 0 Coon N w c O 3 ~ M M T d » 0 0 o z 0 o dq Cal) S (A w U) v 0 , n I a d tD N I ~ V'~ N y (WD o O O a ° c~ d (D x in (a c CD m 3 (D p. Z fD A z 7 J C ol CA CL z 0 A 3 z C71 z rn m C A Cl) C7 pp pp O O O -p' O N N a 0 pZ CD O y Q fD ° N o tD fD c N to 'D to !y fA a d O tD 7 o N `z S a c c. 71 S S O 7 N N v c uj (D 'O N:E a .no c n 0 a 7 3m-.° 26'(D02) pl z a C CO o S 7 O 5D CD O -o C N wCL U1 Ln m0 moo 0. 10) ce o b' o y D a D 0 -a CL CL w f7~m ° v aam f2~3 'CDC ~~f° a CD 3 3 E n y a m(-D ZO § N x a c°~(o~~ (om `A a m°° 3 0 m o m o w CD w a < c CL <D CL fn CM L c CD a 0 o CD oo v ° to O v A o c 00 CD ' ~ w ST. CROIX COUNTY ZONING DEPARTMENT,,, - AS BUILT SANITARY REPORT ` t Sc,Q Owner ~ ° n 4 f I s f, 4 n 81-16 W e j~S uS U (5~ Property Address z 9q 5 CtF-( c City/State h e U~/ l e y W, S l L , io Legal Description: Lot Block Subdivision/CSM # Ul/ t/4 bLi_ V4, Sec. TAN-R )s W, Town of C a N P 1Z SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer west er.i Size ST/PC j 4S01 A.50Setback from: House N 1,4- Well IL~P/L Pump manufacturer 20 !/ele Model q V Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Mo t 4,n d Width Length Number of Trenches Setback from: House Well Ir;" P /L Vent to fresh air intake ELEVATIONS: Description of benchmark C c h ! h ? e-4 F- 1 4 U Description of alternate benchmark Z- r S / Elevation v - Building Sewer UG, L ST/HT Inlet ST Outlet PC Inlet ~I S G PC Bottom • S~2 Header/Manifold ? Top of ST/PC Manhole Cover ~U Distribution Lines 1 ( ) Bottom of System ( ) ~'1 7 . ( ) ( ) Final Grade 9 7 2 ( ) Date of installation l /10/ Permit number State plan number 2 S~UV S Plumber's signature a~L License number 2 2.3 7 S1-, Date 07 ~f Inspector k 6, V11 In Complete plot plan Or r NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW CanG2;~C ipROM gyred ; ti 0 ~V ~f C s i J~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: N Safety andBuildings Division INSPECTION REPORT CRC O(K GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.: c Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 344513 Perm t H hi r' Name: ❑ City ❑ Village Town of: State Plan ID No.: S~OLQD~IhRS OF JESUS CHRIST CADY cc 5- i CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: o•p 0 t sty Q04-1034-30- QO TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a b Benchmark is , r n Dosing . P~ JrQ Aa. f m ~r D/`& a Aeration Bldg. Sewer 3 12 !ID .Oe. Holding St/Ht Inlet , T1 TANK SETBACK INFORMATION St/ Ht Outlet 9~'. `f( TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic p S~~,t✓ NA Dt Bottom 6 , SZ Dosing r` AL w / NA Header / Man. S, fl ,(f 0~- Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 26 W OD.s$ f!j Model Number APM TDH Lift ' `riction `o-~ Systema~ TDH \oJlFt oss Forcemain Length Dia. HH 4 Dist. To Well SOIL ABSORPTION SYSTEM (BID TINWeH Width Len th l es PIT No. Of Pis Inside Dia. Liquid Depth MVIENSIONS DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI acturer. o e Number: INFORMATION, Typeo f) qp r _ CHA System: jC1U OR NIT DISTRIBUTION SYSTEM Header / Ma `ifold Distribution Pipe(s f ti ,r x Hole Size x Hole Spacing Vent To Air Intake Length A~ Dia.ZM Length Dia. L 'T Spacing [ 4t SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes No ❑ Yes ❑ No r ' G . a COMMENTS: (Include code discrepancies, persons present, etc.) (P ~U 9 LOCATION: CADY 15.28.15.229,SW„NE 3073 COUIKY ROAD N C:~/ r,~-ems-- 0 9 I G 4+ Plan revision required? ❑ Yes ® No Use other side for additional information. 03 ZZ p I - 6 Y, SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: e p s P k 6 e p e r 7 v 6 g e t E 3 E e v k ' Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue ~ A~consin P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, W1 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County (7 than 8112 x 11 inches in size. J . • See reverse side for instructions for completing this application State Sanitary Permit Number 3 Personal information you provide ma be used for seconds ~qy y secondary purposes El Check it revision to previous application o [Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. berr 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMAT! N Propert Owner Name ^ f~ Property Location v e.s G~ r ,'r c v 11-Al ,'e / lyvik k: 1/4(1& 1/4, S T N, R ly-4or) W Property Owner's Mailing Address Lot Number Block Number 30 7 3 Cit , State Zip Co¢a Phone Number Subdivision Name or CSM Number Sry ; lit Ile ti"Y ? (his-) ? 7~ X17 I1. TYPE OF BUILDING: (check one) ❑ State Owned CI ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Q Town OF Cr,~ fl 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 28, ~S, jZ9 1 ❑ Apartment / Condo 'Sp Po /T -/d 2 E] Assembly Hall 6 E] Medical Faceity/ Idursing 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, 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank Only ______________Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 Seepage Bed 21 g) Mound 30E] Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] 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) G _ Elevation ~ DU "I S 2. L 32- .33 y Feet V l?, 5 ~ Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank ✓ ~G 5 U / G 5'~V EY- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for instal ion of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu is Sign at r o Stamps) PRSW No.: Business Phone Number: Plumber's Address (Str , City, State, Zip Code), S04 r...", /&6%_ J-p IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued cIssuin gent Signature (No Stamps) VA/pproved E] Owner Given Initial Surcharge Fee) Adverse Determination lb'1D X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber T INSTRUCTIONS i 7 A f 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 4 Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: L Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI_ Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and 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 contamination investigations and establishment of standards. i Safety and Buildings 2226 ROSE ST LACROSSE WI 54603-1905 TDD (608) 264-8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 19, 1999 CUST ID No.267341 ATTN. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 05/19/2001 Transaction ID IdID(N at ers o. 225005 Site ID No. 166 SITE: `i Please refer to both identification numbers, Site ID: 166160 t " rho above, in all correspondence with the agency. St. Croix County, Town of Cady r „ Facility: Penial Christian Home FOR: Description: Mound Revision CCVJ Object Type: POWT System Regul tpjl v~26'Wi9 44655,8,, The submittal described above has been reviewed ce with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19 Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/05/1999 ` FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 j MOUND SYSTEM Page \ of ' • - FOR ~N~~`r S LLB-C~►w G ZUU?~ S _ LOCATED IN THE S W 1/4 OF THEN 1/4 OF SECTION 1 S , T Z%N, R \.S W, TOWN OF C11j~{ ST• C~Z=UIX COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 of 7 PROJECT DATA PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAIN VIEW-CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 DOSE CHAMBER PAGE 7 of 7 PUMP PERFORMANCE CURVE i PREPARED FOR i clp P ~1.~ l fit-- G~Z.1,S1 LtC1`1 1i~1'1~ S ZU h.l G v R-~ \ ~1 i l~ I 5 u 0 jJ:v nV Coll ~E RECEIVED P ~aP CaM~ik p1l4GS gEPPRjMSPF a MAY - 5 1999 RU~SpO SAFETY & 'BLDG DIV. SEE CO PREPARED BY PIP, WEGEE=zER SO = L TESTING r~ AND At DES T iCN SER~.J I CE w~"~qA D-9iP P.O. BOX.74 421 N. KAIN ST. s. RIVER FALLS. MI 54022 115-4c5-0165 d~ ~~•~••••'°T~fiLS \s A ZZJLSl0Kj OF T+}pT PtA'h) ~~Juw&p \-ZO-99 i T~~S r~e'cZO►v YD ►vo , Zd~716 5-3 ~ s rr-~- Z-1> 1vo . ~ 6 61.60 JOB NO l J PROJECT DATA Page 2 of '7 This mound system will serve a 4 bedroom building providing sleeping rooms for 6 children, 2 caretakers and 1 floor drain. There will be no meals served and no showers taken in this building by the children. The caretakers will likely shower at this building. The main dining hall, showers and laundry are located in the existing facilities located approximately 1 mile West of this site. ANTICIPATED WASTEWATER The most logical sizing is Camps-no meals served-15 gal/person. 6 persons at 15 gpd = 90 gpd 2 employees at 20 gpd = 40 gpd 2 showers at 15 gal each = 30 gpd 1 floor drain at 50 gpd = 50 gpd Total = 210 gpd The system is designed for 750 gpd to fully utilize the available suitable area and to provide for additional loading if it should occur. TANKS 750 + 750 = 1500 gal minimum capacity required. A 1650 gal Midwestern Precast, Inc. septic tank will be installed with a 1650 gal Midwestern Precast pump tank. PLOT PLAN Page of Scale i 4 O M~ _t)o Ivy' QjanQ t m-r UR '3 . ~ ~ E31~•H I- E=2 ~ X00-0 or.~ SPl1zE 2A` s'~8t~ 6R~~~ Q~f$n S a ~c- 1k C "1 of o{ C° Est ,,,0 5 s' of y pv c w~ I rv • y.Z." Cuv~ ~n -L - E--• luZ_~' ors lUP aF p~PU4 ~U~ ~O t+v G . LU C 1~'1-~Vtv 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 h SO gallon capacity manufactured by '►~1 ~ ~ ~ ~S`T~'C~J P~z~'r~8 1 ~ ! !v e . uM p Tf~*~ k. `R~ L~ t L 6 5~ G fK- 1~1 ~ p ti/~~ . 5. Bench Mark S S., A E3uVL 6. Divert surface water around system to,prevent.ponding at the uphill side. Page S Of Perforated Pipe Detail 0 End View Perforated End Cop. ~\e~r PVC Pipe 1. a.S Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spared Q S P PVC Manifold Pipe lI PVC Force Main Ibl Distn ution Piee Lost Hole Should Be I Next To End. Cap End Cap P 3~•o Ft. Distribution Pipe Layout S Ft. X 4 8 Inche, Y U b Inches Hole Diameter <!y Inch Lateral 011 Inch(es), Manifold Z Inches Force Main Z Inches # of holes/pipe V) Invert Elevation of Laterals98-Qi Ft. N Place p~ 1st hole 2-from center of manifold with succeeding holes at U 8 i n+-or'( Ya1 c T_-4- 1-1 a., t... .,..__i ~i.. ..7  . ~+~..a . i+uo lavic l.V LC 11CX L l..V 1.11C C11U Gd~l. -7 o_~= t5 - * • HEAD CAPACITY CURVE 3..7/8 s 1/4 0 MODEL "98" 4 5/8 s 25- 6 / 8 6 20 ® O + a O 15- 16 . k3/4 J H 4- 2 p 10 t0. 371 ~O. 5 r 77, V68 1 1/2-11 1/2 NPT 0 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENTAND DE WATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 4 3/16 20 6.10 25 95 L_J Lock Valve 23' SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1/2 H.P. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.4 1 or l &7 - 4. See FM0712, for correct model of Electrical Alternator, E-Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4) D98 230 1 Auto 4.7 1 or 1 & 7 - float system. 6. Four (4) hole J-Pak, junction box, for watertight connection or wired-in E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10-0002. 7. Two (2) hole J-Pak, for watertight connection or splice. CAUTION ForinfonnationonadditionalZoellerproductsreferlocatalog onCombination Starter, FM0514;Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable Level Switches, FM0477;ElectricalAhemator,FM0486;MechanicalAltemator,FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FM0487; and Single Phase Simplex Pump ControVAlarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ANY 941L TO: P.0. BOX 16347 (aezzlAwff Louisville, Cane 347 Manufacturers of.. SHIP T0: 3649 49 tare Run Road Louisville, KY 40211-1961 QvaurrP~uPS SNCE /~9.9~9r (502) 778-2731 •,1(800) 928-PUMP FAX(502)774-3624 Wiscod►sin Department of Industry, S OIL AND SITE EVALUATION REPORT Page of 3 ` Labor arid Human Relations 4 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY r Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST = C~~lX 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. O (2~4 - 1 D 3~4 - .3 p APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWED Y DATE PROPERTYOWNER: So~A~~2S OF SESvs C-l~ L3-r PROPERTY LOCATION C. /0 ~E1JttTL C~{-~Z(S T7 7~YJ 1~ p6•~ e 69W. I_9T S YJ 1/4 N E 1/4,S 1 S T Zb N,R \ 5 E (W PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR CSM # Z of °t S OITV-~ 'tom " - - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD S~Zlnl6 VfitlN~l,wl Su~b~ (~LS)~7Z-3~~► GtV1~4 CT-►~ Ny New Construction Use (j Residential / Number of bedrooms [ j Addition to existing building j Replacement bCj Public or commercial describe s~ +p t5vT- s LEeCmrJ 6 awl S 4, PLC14 EE~z Code derived daily flow uw gpcu~160 f~T- LISD> Recommended design loading rate - bed, gpd/ft2 • I trench, gpd/ft2 Absorption area required 3'1 S bed, ft2 '8 S trench, 112 Mabmum design loading rate S bed, gpd/0• b trench, gpd/ft2 Recommended infiltration surface elevation(s) a1--1. S ft (as referred to site plan benchmark) Additional design/ site considerations wWv hn'~> wl 5 'x --'S '7%QQ Ctt . M t "t M UH \-Z-4 o f- SAT \b FI Parent material LOe5S vv eVZ G LAr-t ISL. T] L L Flood plain elevation, if applicable A. It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S 0 U ® S ❑ U ❑ S 0 U ❑ S ®.U ❑ S ®U ❑ S I RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerldt k: • i ~-9 tp~-t R. 3 1 z St.1 Z ~sb>-c v>1`Fi~ e S l~ • s • b I. Z -ZO > o`'l ~ 31 Io s t l Zvn S~`~C tirt ~'lr e w - , s . L Ground 3 Z.o --Z j 3l S 1 t► t S b t 111 uii - Cry - _ . 5 - , 'Lft z-I -S-Z S `~R 31 S Ht?- S~8 S t abtL - p yn`Fh • Z Depth to limiting factor Zia Remarks: Boring # _ o-tz ~o~~ Utz s►1 Z`~'s~1c r,1-~`r ~S 1~ .s Z Z 1~ _z.l. 10Lf tZ ~1(, g1 t Zw, sbk Vn`F►- ct,Q - - s 3 ZI-31 ~s~tR Sly - S I ~m sb ynv'F►. - ' .s Ground _ el l It 3)-S 3 S tZ 31y S'-t 1Z t 1O+'L • 2 ,CIVIL' ; • I Depth to t'A 14'. limiting t 99 l factor ST '~EjOIX 1 r (NTY ZONIN OFF Remarks: \ TNarne-Please Print Pie Arthur L. We erer 715-425-0 " - egerer Soil Testing & Design Service-P.O,..Box 74 River Falls,WI 54022 *nature: Date. CST Number. tz a 01-o Z 1--) -~9 220254 So~DX tTT.-- S of PROPERTYOWNER 32SUS QtMIST SOIL DESCRIPTION REPORT Page of _ PARCEL I.D. #.-.0014 - W-14 Boring# Horizon Depth Dominant Color MotUes Structure Roots G P Dlff Plus, in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bodrxby Bed rends Z °►-Z-L lp `t R- 3/ Sl I ZSblz Y►'1 CS - S c2s Ground ~.S`llz fly ~•S`~¢S/E3 s ~nv'Ft. Gw 3 , elev. >°~ft. 30- 13 S '-t2 31 -i • S`-1 R s/ 6 S e p Depth to limiting factor , z 6, L Remarks: Boring # } Ground ` elev. 3 ft. i Depth to limiting factor i l Remarks: ' Boring # Ground i elev. ft. Depth to 's limiting factor € Remarks: Boring # Ground l elev. " ft. Depth to limiting factor Remarks: nnn oO~nJn nr n,rn PLOT PLAN Page 3of 3 SCALE 1"= yO ' 0 r' Du yv~- c-'-"P kvr 02 D 1. SN~z p `T}t1 z t'T'f~ , , ~ L -I :kA 8.1 -z8 ~+"li+J- _ IAO-D on1 SPtkE ZoY ~°fBoi.JE GR.^~ -Z Mai 11J tU" Dltj, I~IrVF -met, 5 ~i,96~ Nlo 0 gofi° ~n Z ertiF~Z - tl • LUZ_0, wo lUP of o w~,`~ ►itrr~ p~Pos C-a Uo (715 ) 42q-0165-- 1400576 CST Signature Date Signed Telephone No. CST # Wiscon§in Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of l Labor and Human Relations Dmsioabf 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 S`r_ CQ,p not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista n' a.fpst road. 00q_ 103k4_ 30 APPLICANT INFORMAfitO'N=PLEASE I i~INFORMATION REVIEWED BY DATE I~ J PROPERTY OWNER: so uo t QaS ~ L9T PROPERTY LOCATION 404-6GT-SW 1/4 N31E 1/4,S lS T 7- N,R lS E( W PROPERTY OWNER':S MAILING ADDRESS F F` k° i99 LOT # BLOCK # SUED. NAME OR CSM # Z°i1°LS cTN ` 1VV CITY, STATE ZIP PHO ~DCITY []VILLAGE DOWN NEAREST ROAD Sp}~ING~~Vl ~vl Su ( ICY Ct'~ QTt}" N" New Construction Use [ J Residenti ~ S [ ] AdditiQn to existing buikfing ] Replacement [~J Public or comma ' sarii~l1- SL~tiPrnr G t2+,uwtS1 PLn Y+;LS Code derived daily flow uZb gpd CDM%fJ PO- VS~Recommended design loading rate - bed, gpd/ft2 • Z treich. gpollt2 Absorption area required 3~ S bed, ft2 '1 S trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) on. S It (as referred to site plan benchmark) Additional design / site considerations MUk-pt-p w / S 'Y- 'l S' -T lZ N .k( , M I N l MU M 1Z° OF Sf1'~ (i t_L- . Parent material 1 ~ 5 o0k32 CSACLfVL ~"Lk Flood plain elevation, if applicable t-1 A . ft rU= itable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM MI Flti HOLDMIG TANK suit able for s stem ❑ S KU ®S o u ❑ S U El S ®U O S L9U ❑ S ~ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in, Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer& 1: \-1-99 . - ZO Ground o-- S~ ~ V 0z_1 F-Y gt= L) w C(Y~1 U ~ elev. ft -Qk,3 Llti Q*J z-- 51-49 . Depth to Pt QAQN G P! 1p~!"r OF R LSh L LS t'Nt L ` ~rU limiting factor X~J o R V:_ Zle~. W M E N c' K)C lfv t1ftrzW Z- C LZO ~o p Remarks: Boring # D CzKj iv \,J, yj S me-I rT _1 G S w R e- fl! , 1-5 fts QvrZt't6 S fl~ o IANO L aAfn U t_ OF Ground o wG l t't~S Svg Wt't; 7` C F- tpr : elev. s L L UN s 3 o1z L G1 U ft Depth to limiting factor Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 ress: egerer Soi Testing & Design Service-P.O. Box 74 River Fa11s.X 54022 Sgnature: Date: ; L pl 0y9 CST Number: 220254 Wisconsin Department of Industry, SOIL AND, SITE EVALUATION REPORT Pape t of t D n q Saffeety Relations di gs µ .in aocoTd with ll;,HR 83.05, ws. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches insize. Plan must include, but SY- CQ.p flj( not limited to vertical and fioriztintal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road:. 0 C) ~b3~ - 30 REVIEWED BY DATE, APPLICANT INFORMATION-4~LEASE PRINT ALt INFORMATION - PROPERTY OWNER:: so l.fl lIMS or- zwua C1 LST PROPERTY LOCATION (=1 u _\_*'1'eP31 V;L -G9W-LOT- SW 1/4 K3 E 1/4,S ) S T ?~b N,R X S E ( W PROPERTY OWNERS MAILING ADDRESS . LOT # rl(# SUBO. NAME OR CSM # zolcltS cTN ` N" ^ CITY, STATE ZIP. CODE:, PHONE NUMBER []CITY []VILLAGE -TOWN NEAREST ROAD Sp-1z.cn~G k)rcl t wl Sum 1s) -1-7 Z- al-7l C Za t4" cv"..... . New Construction Use Residential / Number of bedrooms [ ) Addition to existing building Replacement Public or commercial describe SlvtAxn~ S'LTT1,'PIn/ G lc?-'uuwl S 4E ~1wPUu Y~LS Code derived daily flow 14-Lo gpd CD$EsVi~J Fe t- 4S) Recommended design loading rate - bed, gpdtft2 • 3 Uendt, gpd/ft2 Absorption area required 3-1 S bed, ft2 '-s '7 S trench, 112 Maximum design loading rate bed, gpd/ft2 b trench, gpd19 Recommended infiltration surface elevation(s) °l-j. S it (as referred to site plan benchmark) Additional design / site considerations r U"_,b w / S 'X "1 S 'lV ey" . 1.1~ I rv I MU M X-e or- SffhD Fi Lt- Parent material totSS pUtat Gr_fMLftt. ~_n t-L Flood plain elevation, if applicable N A . ft S = Suitable for system cOWENTIONA MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system O S KU N S ❑ U ❑ S M U ❑ S ® U ❑ S 991.1 ❑ S [kru SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxby Roots GPD/ft in. Munsell Qu. Sz. Cent Color Gr. Sz. Sh. Bed mrich is bQ p -Dom qo 13, Ground o- - SCII'I- Ls \)QZI w U C i~> B elev. it N~~LIAJCIC4V ChJ z - Y-q9 Depth to R L"RIN G P 1 1~~ -tr ~4t-31' 0,F t t-S 1-N L 1'o limiting factor _T" IF 2 0 R-1 t~b 1 t~Z 13 w tTIl Me- 0_ f--)D l1v 1 Zuv Z . R 1?.c~ 3 eo >v S Cl Remarks: Boring # v cA)"J fvv S w M-LJ G Na7 )"z 30T-s w R C.l ► PaU t eU1z tZCi S' o Wv) I U 1~- OF E3 Ground o LWG L It :Y Sus . wtf ;7- BPS ti-C elev. S ~L C U g 3 otiZL Gl u It Depth to limiting factor Remarks: CST Name:-Please Print Phone: Arthur L. We erer 715-425-0165 ress: egerer Soi Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Sgnature: Date: CST Ntrmber { U,~-~3 U 1 l °i °19 2 2 0 2 5 4 so~/S eh S,;e~ S-Abe/~/ Wiscoi,sln Department ustry, SOIL AND SITE EVALUATION REPORT Pam of 3 L iscoll ~d HUman Relations .►'~LLT.~' ^ n of Safety 8 Buildngs in accord with ILk1R 83.05, Wis. Adm~ Code ! l 5(-rn COUNTY C,~'LO yc Attach complete site plan on paper not les than 8112 x 11 inc e ' not limited to vertical and horizontal reference point (BM). direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. Q04- 10•3y- •30 APPLICANT INFORMATION-PLEASE PRINT ALL h~IFORMAT N n - I REVIEWED BY DATE PROPERTYOWNER: SoC.Q~~tS OF XeSUS Cti'Sz-L37T PROPERTY LOCATION C ,h) ~E~l~ ~L C IS'T7 L-~ pr i 68W. I: T SyJ 1/4 N F,1/4,S 1ST Zb N,R kS E ( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 7_0101S o--rt N " - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rOWN NEAREST ROAD SPRtnJ 6 V ft~y, hll Su"~6l (~1S) ~7Z - a» ~ G f~~~-( c1~1~- N y E New Construction Use [ J Residential / Number of bedrooms [ J AddibQn to existing building [ j Replacement Public or commercial describe STUN tiovr is ~1 h ry G 'iz~" S 2M P~Ay s Code derived daily flow 'A ZAa gp6:341 Go hT' 4Sp) Recommended design loading rate - bed, gpd/ft2 3 trench, gpd/ft2 Absorption area required _ 3'% S bed, ft2 3 S trench, ft2 Ma)amum design loading rate S bed, gpd/ft2 . 6 trench, gpdflt2 Recommended infiltration surface elevation(s) ~`1 S It (as referred to site plan benchmark) Additional design/ site considerations r »vtv►~ wl S '><_1S' 7TLQWC1} , Mi ry1 m Vm Yz' o F SfVvU Fi t-t- Parent material 1. oeSS tzy Lir~z G ~~t kt_, -)n L Flood plain elevation, if applicable N A. • it S =Suitable for System CONVENTIONAL MOUND KGROUND PRESSURE AT-GRADE SYSTEM IN 1 FILL HOLDING TANK U= Unsuitable fors stem ❑ S O U ®S ❑ U ❑ S o u ❑ S ®.U E] S RU ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundsty Roots GPD/ft in. Munsell C)u. Sz. Cont Color Gr. Sz. Sh. Bed hii- w~ a_°I tp~-► tz 3 I a - s1,1 Z `Fsbli. vh~r e S l~ . S , b Z z.0 lo`-t tz 3) b - S 1 1 -Zara sek N-',~~ e - , s . L Ground 3 Zo-Zl -1.S4 2 31 1 s 1 1 w~ sbh ui- C>~ - ' y .S elev. °lZft z~-SZ S `~R 31 1~ $ '~R SAES Sal Y ° Sb1 c - _ p yr1`Fh Np • Z. , Depth to firriting factor Remarks: Boring # _ o_t~ l.o~tcz 3t-t_ s~1 z,~F's~k ~~1- eS 1~ •S 3 Z 1~ -zl. l0` 11Z ~l b - S:j Z►~ sl~h WI-IN aW - . S 3 Z1-31 ~s~,.rz~/y - s 1 l m sU ~tv~- e~ - 'y 'S Ground t cSblz - elev. 31-S~ S R 31y S`~R S iY~ Sad oo,, 1^'t'~1' - N~~ • 7 q6.~ fL Depth to lirrdng facctolf 'Remarks: TName.-Please Print Arthur L. We erer Phone' 715-425-0165 Box 74 River.Falls,WI. 54022 . egrer Soil Testing & Design Service-P. S@nadire: O Z Date: CST Ntunber mob// ~L 220254 PROPERTYOWNER sews 0-yo-L(ST SOIL DESCRIPTION, REPORT Page of PARCEL I.D.# ooy - 103y -30 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Cons~tenoe Botxry Roots Bed lieridi Z q-Z,L t0 %I V- 3) si i Zw,sUlz wl`~ Cs _ S . Ground 3 30 • S `1 fi- 31y S ~'1 Yrt elev. v'F4. C,,." , 3 u .gft. 30-U.3 S '-12 3/ y • S~ R S! t3 5 e ~ p Depth to limiting factor z6" t Remarks: Boring # - C1 Ground i elev. ft. ~ t Depth to limiting factor Remarks: Boring # E3 Ground elev. ft. i Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: cnn oo~nir+ nr,~n. PLOT PLAN Page 3of 3 SCALE 1"= yQ ' gv~ 41, 88 LAW A J ~ Y W v I i ct.*~VP rmr t 'Nil v)~ o Er1.9~1.8 ZS ~ 8.3 L \\Z51 FrLckn -ts ~I"1i+1- ~t . loop' orv Sp\k~ ZoY ti°'~@t~E GR~vp ,4= .Z q~, 1U" Dlr. !~I►vE met. IL c'). 540 _ O \XVI ~N ~ • L~Z_~ oN hiP aF C~ p~PU4 C"a Bv~LD „v G ~Q~/~J`~ `V VV vW 99-oZ (715 42~-ni6s ) 1400576 CST Signature Date Signed Telephone No. CST # Safety and Buildings 2226 ROSE ST - N*isconsin LACROSSE Wl 54603-1905 ~ Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Department of Commerce January 20, 1999 CUST ID No.267341 ATTN. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 _ 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 01/20/200 ' Transaction ID No. 207716 SITE: Site ID No. 166160 Site ID: 166160 Please refer to both identification numbers, JaL?ty-. St. Croix County, Town of Cady -Outj v / above, in all correspondence with the agency. Facility: Peniel Christian Home: 2~114Vu0"~'`'~ J FOR: , Description: Mound Object Type: POWT System Regulated ObJec o.: 446558 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: i • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required, Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 01/20/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 &rard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 ~ Page \ of MpUUD SY ST r1l, VOR G pw►S • g~~ g f ' F F. 1 S► T~ CONSIN ' E 1/ 4 OF SEXTI C LINTY ► WZS Swl/4 OF TO ST• c~-7 D IN THE T~ OF G INS S$EET T GE 1 of ~ p~0 J E T px A S PAGE 2 of PLOT I~Vt~CR~' IYE GE 3 of pT,t►I~ BUTIOx PA E 4 of ? DISTRZ MgER E ~U QOco~~ pAG of 7 OSE GiK G DC oy PAGE 5 D PERF PAGE 6 of ? ivy PAGE 7 SQ D Fp I God PREP~'~ _ S-es 0V ~ ~-o~~s G~~~,K1J ED s~~ "'G ~ AN ~ g 199Q SPFEj~ & g~pt;5 i~}1± 1 T v~ ~ = W gERF eLs ~E ~ E _ ~ 1SA1X SS ~~►C d t • Ml 5ao22 ~~s~~ , ~ "~A F'~~x FMS-~ Rl 15 a~-otb~` 1."1~~ qo)_o7- O 3013 wiTA Page 2 of 7 This mound system will serve a building sleeping rooms for 16 to 18 children, one floor drain and a maximum of five employees. The employees are comprised of caretakers, office staff, etc.. There will be no meals served and no shower or laundary facilities in this building. The main dining hall, showers and laundary are located in the existing facilities located approximately 1 mile West of this site. ANTICIPATED WASTEWATER The most logical sizing is Camps-no meals served-15 gal.person. 18 persons at 15 gpd = 270 gpd gpd 5 employees at 20 gpd = - 100 50 gpd 1 floor drain at 50 gpd = - TOTAL = 420 gpd The system is designed for 450 gpd. SEPTIC TANK 450 + 750 = 1200 gal minimum capacity required. A 1200/800 Midwestern Precast, Inc. combination tank will be installed. x Page 4 Of 77 Approved Synthetic Covering 1~sTM C 33 Distribution Pipe Medium Sand _ H ~G Topsoil F ~ Elev. 3 D 3 b ,S % Slope (Force Main Plowed Trench of k"-2k" From Pump Layer Aggregate Undisturbed D O Ft. Soil E \•ZS Ft. Cross Section Of A Mound System Using F 0-4) Ft. Trench For The Absorption Area G n Ft. A Ft. H I- S Ft. B ~S Ft. I \ S Ft. Linear Loading Rate= G-tZ)GPD/LN FT J Ft. Design Loading Rate= 0.3 GPD/SQ FT K . \1 Ft- L °t1 Ft. A+t=@#n:a+e Position of Force Main-----___, W Zi~ Ft. L J I B K Maitr A 4- W Distribution Trench Of 2~ - 2 2.. Pipe Aggregate I Observation Permanent,/ Pipes Markers (Anchor securely) - Mound Using I Trench For Absorption Area 0 End View Perforated End Cop b`ed' PVC Pipe mm~ . yo~~a `ace lJ~- as Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop * ti PVC Force Main 4 Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout 3 P X1,5 Ft. X 3\ Inches Y 3b Inches Hole Diameter ley Inch Lateral Inch(es) Manifold Inches Force Main " Z Inches # of holes/pipe tZZ Invert Elevation of Laterals 98.00Ft. Place lst hole ~$N from tee with succeeding holes at 3b4 intervals. Last hole to be next to the end cap. • Combination Septac,Tank and PUMP CHAMBER CROSS SECTION. AND SPECIFICATIONS ' PAGE E OF 7 y -VEAJT CAP WEATHER PROOF JIIIJCTIOU BOX . 'i,C.I. VEAIT PIPC APPROVED LOCKING - -:.10' FROM-_ODOR__ AMJHOLE COVER '.JIUDOW OR FRESH wAR.NIUG-Pr6EL. ASR IuTAKE rol.)D r 6 H n-x . t 18' Mlu. y°1uS1oecno►,3 PIPE PROVIDE I I/JL-ET AIRTIGHT SEAL I III e~FF~~S ~ I III v APPROVED JOINT A I I I APPROVED JOINT: R I III W/C.I. PIPE°RP~C W/C.I. PIPEa Tank construction I II ALARM shall comply with I ILHE (83.15 and 83.20 o I II 111~ 611 C I I qo•b~ LLEY. FT. PUMP-~ . OFF D CONCRETE BLOCK 3" APPR~eL RISER EXIT PERMIZTED OI.ILy IF TALJK MAUUFACTURICR HAS SUCH APPROVAL IUDDINE SEPTIC E SPEC.IFICATIOI._1S DOSE }•11~yU j' -N Q 2: t 5r w u m r OF DOSES: -6 PE. FL DAy TANK MAIJUFACT URCR: TAWK :,IZC: tZ'130 P600 GALLOWS DOSE VOLUME t S •S. ~tJ~} SL[S`~`~ II.ICLUDING BACKIFLOW: ~Zb 3 GALLONS ALARM MAUUFAGTURC.R: MODEL IJUMBER: 1Q~k `4W CAPACITIES: A= Z~~ IUCHES OK ~b3", CALLOUS SWITCH TtIPC' B= Z MCHESN)R L1_1' ~G~LLOIJS PUMP MAWLIFACTURCR: C= IL)CHE5OR 1116'"~bALLOUS MODEL NUMBER: S~ D w g INCHES OR a'yGALLOUS 'rv~, z 19q. 9 SWITCH TYPE: MOTE: PUMP AUD ALARM ARE TO BE MIIJIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEFLUILE DETWCEIJ PUMP OFF AIJO-D15TItIBUTIOU PIPE.. FECT + MII..IIPIUM WETWORK SUPPLY PRE55URE 2.5 FEET Z~ FEET OF FORCE MAIM X A`~ F 00rT.FKICTIOU FACTOR-. p'32 FEET TOTAL OtIUAMIC HEAD = 1 S FEET Pump chamber DIAMETER IMTEKLIAL DIMLWSIOMJ OF TAUK: LF-M&TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231 GAL/INCH AS PER MANUFACTURER = Z 1 _U S GAL/INCH i ' w 3 15/16 ►-16 5/32 ~r 1~C or- J s , HEAD CAPACITY CURVE a 5/8 "53 - 57" - "55 - 59" SERIES 1 1/z -11 1/2 NPT 25 TOTAL DYNAMIC HERO/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 3 15/16 6 _ -4 50 SERIES . 4 1/16 Ft. Meters GaL Ltrs. 2 U 15 5 1.52 43 163 Q a 10 3.05 34 129 , Z p 15 4.57 19 72 J I I h to- Lotk V•Ive: 19.25' , O H 2 2g . 08 S 10 1/16 0 U.S. GALLONS 10 20 30 a0 50 1 3 3/32 LITERS 0 80 160 FLOW PER MINUTE sKme sKase CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 25', 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Standard cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required. Standard cord length - non-automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float M53155 and 57159 Series Control Selection switch. Refer to FMO447. Model Volts Ph Mode Amps Simplex Duplex 3. Mechanical akemator'M-Pak' 10-0072 or 10-0075. M53155 & M57/59 115 1 Auto 8.0 1 or 1 & 7 4. See FMO712 for correct model of Electrical Altemator, E-Pak. N5365 & N57/59 1 1 Non .o or s or 4 & 5 5. Variable level control switch 10-0225 used as a control activator, with E-Pak (3) or D53/55 & 7 1 Auto 4.0 or 1 7 (4) float system. E53155 & E57159 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) tole J-Pak, junction box, for watertight connection or wired-in simplex or 2 pump operation, P/N 10-0002. 53 Series - WL 22 lbs. 57 Series - WL 27 lbs 7. Two (2) hole J-Pak, junction box for watertight connection or splice, 55 Series - Wt. 24 tbs. 59 Series - Wt. 30 lbs P/N 10-0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, FM0514; All installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable Level Float Switches, FMO477; Elecbical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be fallowed including the most Altemator, FM0495;Sump/Sewage Basins, FMO487; and Single Phase Simplex Pump Control/Alarm recent National Electric Code (NEC) and the Occupational Safely and Health Act (OSHA). Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturers of . SHIP 70: 3649 Cane ane Run Road i.r Louisville, KY 40211-1961 Quurr hua+as S~cf /9.99 - (502) 778-2731. 1(800) 928-PUMP PUMP !O. FAX (502) 774.3624 it s -a • ' * " ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -Sig 2,'e rs C E- ~l t~ 5 r S L ~0 4 r~ S C ,1 14G i-( E Mailing Address S c h t y (V S~~ ~.h (/4 /~e v 4J 5 "~(?G Property Address AJ (Verification required from Planning Department for new construction) City/State -5 ip,2 , Parcel Identification Number 6C)Y -10-S e`, LEGAL DESCRIPTION Property Location 14, I~ZL `A, Sec. s , T b' N-R { S W, Town of C 4 d Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume r Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM NL4Rg1ENANCE 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 The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joumeyman 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 Zoning Office within 30 days of the three year expiration date. GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the perty d cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. /r/r7/ r NATURE OF APPLICANT DATE 7 Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Y' ST%TF HXR •,F \k'ISCONSIN FORM 1 198' N'ARR_kNTY DEED C•~CuMENT NO RIM- y1( - 19*3 MAY 2 3 136 This L.ed, :adetensre,. Phillip A. Irwin and - Bonnie_ L. Irwin, husband and wife and each 9:30 A. h1 in their own ;fight Jesus Christ, a non-profit corporation . Granter. Witnesseth, That the said Grantor, for a saluahle consideration 'IaVE ANC !E A:,; P1 l0nseV5 to Grantee the foiL+wing dc,crihsd real .-state in St. Croix Uounty, State of N%ivtonsin: r ~ The Southwest Quarter of the Northeast Quarter r (SW4 of NE;) in Section Fiftr:en (15), Township Twenty-eight (28) North, Range Fifteen (15) West. 004-1034-30 (Parcllden:.'icanr \ mhcrt i This deed is given in consummation of that certain Land Contract by and between the parties dated April 1, 1994, recorded August 14, 1995, Vol. 1135, page 179-181, Document No. 532461. Bonnie L. Irwin joins in the execution of this deed for the sole purpose of agreeing to convey ny interest in the subject property pursuant to the Marital Property Laws of the State of Wisconsin as said laws may exist as of the date of exectuion of this deed. E his not home,tead pr,perty (is) (is nut) Tur.,ther with all a-1 singular the hereditament<and appurtenances thereune.) Monging. Cry^tor warrants that the title is good, indefeasthie in fee simple and free and clear of encurr.!-Tances except all. easements, res'_rictions and rights of way of record. and wdt warrant and defend the sar•e. Dat,-d thi!. 19 day of April N96 - - Phi)i A. Irwin - (SEAL) ~Lf _Bonnie L.. Irwin AUTHENTICATION ACKNOWLEDGMENT t' STAI E OF VVISC'ONSIN -ut st urr;>) Phi;,lp_ A, Lrvfn and__ t5. Bonnie- L. Irwin, husband and wife PIERCE county 19 96 Per, -,nalh_ came h_o,'L ,fie this 19 d:rc of authenticated this day of April April ig 96 the ah,--r named Phillip A_._ Irwin aid Bonnie L. Irwin, • Robert J. Richardson husbartd_and wife TITLE: MEMUR \T\TE H"1R OF 4~ISCONSIN (If not - - .s y authuriied by Wis. Stars-) to me l.n awn to the lie- n 5 sHtrs~E~~~ the~ ' i fore oinr instrument and i :!:'der Inc. THIS INSTRJML"! 7 NAB -A- iEn BY ~ W V ~f LLL1r~~~ t'C C 1 ~ ~ ? ROBERT J. RICHARD': )N t Attoi fie at Law, - Sho, c;n Bower'I Spring Valley, Al 54767 -our\ Pa.'.iic Pierc- Connie. N i . ma_, he authenticated or ackn<twledgcd. Bath are not V1y is permanrn! tit not, late ctpiration ,tate: (Sip- ,_c% necc,sary t March 21 I ; 99 I '\amr, o.t i... ..i{.,_.p h,.•.;'il ry .-cd ..r ,n;.S I=ri, , th~.: na;ur. w%RR%%I1 Di}•r SrVrf R tR nF I- ()%'I, 10 1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor w*d Human Relations ST. CROIX ,Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.: SOLDIERS OF JESUS CHRIST 1i CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded 1 Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Cady.15.28.15W, SW, NE, County Road N Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i i i i ^a:.~^ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau a Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. <ST CPO[ • See reverse side for instructions for completing this application state anii arryy'P/err'mit Number The information you provide may be used by other government agency programs O Check it~ v sio to previous application [Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name P operty Lo ation 1 /4, S T _j? , N, R SE (or G ~1 ®F s CXZ52~A , _W /4 AIP Property Owner's Mailing Addres Lot Number Block Number City, St Zip Cod Phone Number Subdivision Name or CSM Number 11. TYPE BUIL ING: (check one) ❑ State Owned It~ Nearest Road ❑ VII age ublic 1 or 2 Family Dwelling - No. of bedrooms MoTl5wn OF 44, III, BUILDING USE: (If building type is public, check all that apply) Parcel Tax er(s) O - 1034- ✓(W5 1 ❑ Apartment/ Condo 2 E] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 E] Outdoor Recreation tlity 3 ❑ C mpground 7 ❑ Merchandise: Sales/ Repairs ining 4 [G CChurch / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF RMIT: (Chet my one box on line A. Check box on line B, if applicable) A) 1. Jew 2. eplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ......System systemTank OnlyExisting 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 410 Holding Tank t vy 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 420P' 13 ❑ Seepage Pit 43 [Blault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site FiberExper. INFORMATION Tanks Manufacturer's Name Concrete Con- plastic glass App. New Existing Gallons strutted Steel Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW o.: Business Phone Number: ~ I et AY -<O 4 Plumber's A dre Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved sanitary Permit Fee (IncludesGroundwater ate Issued Issuing Ag t Sig nture(No am Approved ❑ Owner Given Initial` surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber a INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation - 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administeator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. ' VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and 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 contamination investigations and establishment of standards. DESIGN COMPUTATIONS y 0% n - 0 O ~l ~a y~ I Project No. Remarks Computation byG Date AI/Yhe i Project Name • 4 Checked by Date C > / Title/Rem ~oG io i! ~2rrlna rn v 9 1✓/.✓.., s 4~~h Sheet of STC - 106 PRIVY INSTALLATION AGREEMENT St. Croix County, Wisconsin PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION. Property Owner(s): Reserved For Recording Data ~l?L P, -,c nq Ad ress:~~ ^U !l~ ^ Loc uon: S T N R E or W City, Village, Township Of: Parcel Tax Number: Legal Description: syy yj; ~g r,J.r 1. No plumbing will be installe in the privy. 2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permii to install such a system has been issued. 3. A privy vault / pit shall maintain minimum setbacks as specified in Table 1. Table 1 Well Building Lake/Stream Additional County Setbacks Open Pit 50 Ft 25 Ft Min. 7S Ft Sealed Vault 25 Ft 25 Ft Min. 75 Ft 4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code. 5. Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self-closing and vault ventilators should terminate at least one foot above the roof. 6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code. 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the register of deeds in a manner which allows its existence to be determined by reference to the property where the privy is installed. Print Owner s Name s Subscri ed d swo n to befor on ate: NAI' ~ - Owner s) Signature: No ary Pu is M commission ax{~iFes NNC N L5 E NOTE: This document was drafted by the State Department of Industry. Labor and Human Relations, ryBureau of Building Water Systems. KEFtNM N. 80q"TECgE{L II NOTARY pUBUC STATE OF WkSCONNN u c r>vc e 4 Fr4MN, I 4,~ ~td a~ 'AS J y" NYQl11 yo-4 e S~,1n00 a Y cx ♦ 1n ~C i e P ~ t K~r soti-te-~ahl Sari HOLDING TANK SERVICING CONTRACT Contract Date I D ` 1 aJ This contract is made between the Holding T nk Own r(s) Name(s) and Pumper's Name ~,Oaj,~95 OF *T&513 CM5T, 1A C- t4 I I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) A L Set ZZ0A/N ~j E~t1, "7 3 >r~►'Sl~i r~ 7ZJh y~ -Vila 4104! ~ _ j?Aj) A6 Q FT itJ ~S r 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; - f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) Subscribed and sworn to me on this date: OF bus ~ -15► 1C, ' I Today's Date rN N~ ~O.e oA X/ Pumper's Name (Print) I Pumper's Signature Notary Public Signature G,- i KEJV NOTARY PPUBUCAHL II ~o v 1 t 7 MATE OF WISCONSIN "Li MY Pumpers Registration Number ' C i s' , piration A 04 rdD s Drafted by Eil/A✓ A - WisCohsin Department of Industry, HOLDING TANK AGREEMENT Safety and Buildings Division 'Labor and Human Relations Bureau of Buildings and Water Systems Document No./ Plan Identification No. This agreement is made between the This space reserved for recording data governmental unit and holding tank Agr ment Date owner(s) County or Local Governme al Unit Holding Tank Owner(s) 5T CRolx COVAI-Ir D15 OFs~s,efsTi (called Municipality below We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description) 2e Z W T" A) X/ fec Return To or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of grope ntain nt of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. As an inducement to the County off to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59, Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats. 2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contractor the owner's registration with the municipality. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the municipality within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality. The municipality may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is insEalled~ NNm N. SQRTEDAHLIr MARY PUBLIC OF O er(s) Name(s) Print Notriied Owner(s) Signatur ATE Subsc ibed d sworn to before on this d i Notary Public Municipal Official Name - Print Municipal Offical Signature 1,0 7 X)20 s-A(-w / My commissioa- Municipal Official Title - Print The information you provide mdy be used by other government agency programs [Privacy Law, s. 15.04 (1)(m)I c.f c, 17 1. l1-N 0 CO) O O N O 3 v 0 CJ ~1 _ c 3 M CD ' m CD co 'o W • T 7 CD -0 4t M (D A) M 3 `CD 3 \ 3 - K w Cl) chi m O N 0 o ~ O i 3 O N! 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"7 = NcD-cn < 7 n 0 I O fD N Cil F CD N O 7 S < cO~DaA ° 7 xw, c Da gcnf m nao Z 0 CD - a) 3 T7 _ 03 OO r. <v _cc 4 Dl O CD D) N C (P O C I S N 7 n 3 z N 7 O n a I = 'o N a 7 O O 7 N F a C - v N 3 Cp n S n CD - N o Co C< 0 S (O a F~ O a pa 7c 0-0 " N N 7 5 3 0 COD O a 0 CD N ° N na 5 a° o c CD 3 < T m ~mmQ 3 N N- 7 7 0 a N 7 CD 7.. (D O v°z n~N CD a mina cn o m CD0 a 3~ 7 a 4 m CD w° w 0 0 0 0 w :a C O CD Parcel 004-1034-30-000 07/16/2007 08:52 AM PAGE 1 OF 1 Alt. Parcel 15.28.15.229 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HOLTZ, MICHAEL W & BONNIE J MICHAEL W & BONNIE J HOLTZ 3050 CTY RD N WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Prima Type Dist # Description 3050 CTY RD N SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH 3xI3 Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 15 T28N R1 5W 40A SW NE EZ-U-1181/523 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 11/29/2001 663586 1776/297 WD 07/23/1997 1179/393 WD 07123/1997 11351179 LC 07/23/1997 945/259 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/09/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 14,000 86,000 100,000 NO AGRICULTURAL G4 38.000 4,400 0 4,400 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2007: General Property 40.000 18,500 86,000 104,500 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 18,300 86,000 104,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04117/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 469 I 460 • 458 • 454 • - - - 454 439 1 440 • . i I I 415 - 404 • - - - N4e7"H C!N I : 4 3~~ ~Q L - - - f4DD i 392o L • S pfd 3 0 93 Ln • ^n 382 • - N o I • 374 . ,~J~ • / l J M I .355 ~v i 160 M5 - - 1~5 . 339 ~ 338 • i • 329 314 •323 • 322 • i 311 o ^ • 305 Ave M i 2" 0 290 • •289 M • 293 I 274 • _ _ L__.. _ -_1---__ e273 - I 274 • - - 273 • 266 i--- - 262 • - - - • 251 - - - 2il 241 - ~ - - _ 250 232. 239 248, 22 246 • I - I ' I i , • 219 214* Ave. I M M _ l I I • I ~ i i i w CD I ~ ~ • Z8T I I ~eAV 4302 'A ~ ~ VI 6TZ ! I I i I i 1 ZIZ L 6£Z • ~ Z£~ I ' _ T - TbZ ! ~ z • 9b; Otl i ~I • biz r--- i 68Z • • 06Z I 0 wr----~ to i ~ • SOE • WE TT£ I j 17T£ 6T£ • ~I 6Z£ • - S bE i Y ~ SSE • j I 6SE • N • CC? • 08E I I i bOb I Sib I II I I ~ 8Tb I 6£b I Tbb • • 8£b i Parcel 004-1035-10-200 07/1612007 09:19 AM PAGE 1 OF 1 Alt. Parcel 15.28.15.234D 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/23/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HOLTZ, MICHAEL & BONNIE MICHAEL & BONNIE HOLTZ 3050 CTY RD N WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 3050 CTY RD N SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.121 Plat: N/A-NOT AVAILABLE SEC 15 T28N R1 5W PT NE NW & SE NW BEING Block/Condo Bldg: LOT 01 LT 1 CSM 1113092 5.OOAC EZ-U-1181/525 NKA CSM 20-5020 LOT 01 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 15-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/13/2005 800214 20/5020 CSM 04/03/2003 715832 2194/139 WD 01/30/2001 637673 1580/592 WD 07/23/1997 1175/570 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 171,100 199,100 NO UNDEVELOPED G5 3.121 2,000 0 2,000 NO Totals for 2007: General Property 5.121 30,000 171,100 201,100 Woodland 0.000 0 0 Totals for 2006: General Property 5.121 30,000 171,100 201,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I A fo O 3 'o m 0 o C 0 A. 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A c0 n ~ ~ 0 :E @ co 0 :E a) c_ Loll 2 CT °n cc_ CO O a N i W 0 a Q O0 C. p CD 7 CD : N O 1 m 0 m 0 ~ ,2 CDd ~ o i CD CD DO v A o 0 0 0 0 0 w A g o o ` w ~ 776pp,.~r ?97 STATE BAR OF WISCONSIN FORM 1 - 1999 6635436 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Soldiers of Jesus Christ. Inc. by its RECEIVED FOR RECORD President Kenneth N Sortedahl Grantor, and Michael W. Holtz and ii-29-2001 2:30 PM Bonnie J Holtz as survivorship marital procertv Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED the following described real estate in St. Cro ix County, State of Wisconsin EXE?1DT N (the "Property") (if more space is needed, please attach addendum): CERT COPY FEE: COPY FEE: TRANSFER FEE: 390.00 The Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4), RECORDING FEE: 11.00 Section 15, Township 28 North, Range 15 West except that part lying North of County Trunk "N", Town of Cady. Kenneth N. Sortedahl joins in the execution of this deed for the sole purpose of conveying any interest he may have in the property, and more specifically any interest by virtue of the Land Contract dated April 1, Recording Area 1994 and recorded August 14, 1995 in Volume 1181 on Page 523, being Document No. 532461. Name and Return Address Red Cedar Bank OF P.O. Box 100 Boyceville, W11 54725 Together with all appurtenant rights, title and interests. 0041034-30-000 Parcel Identification Nutnbe (PIN) (f This Is not homestead p perty (is) (is tot) Gran arrants that the title to the Property is good, ' feasible in a simple and free clear of encumbrances except subject to all easem frictions and rights-of-wa ecord. Dated this "I day of September , 2001. * * Soldiers of Jesus Christ, I . b Its President * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. DUNN County ) authenticated this day of Personally came before me this day of September 2001 the above named Kenneth N. Sortedahl TITLE: MEMBER STATE BAR OF WISCONSIN (If not. to me ]mown to be the peKWn(e).utbo executed the foregoing authorized by §706.06. Wis. Stats.) instrument and aclmQl~fd~heti~te. THIS INSTRUMENT WAS DRAFTED BY Kenneth N. Sortedahl H 11 WA-Ren SDrIn¢ Valley. Wisconsin 54767 Notary Public, Statie My Commission - ~6li[~1F9t' 'te: (Signatures may be authenticated or acknowledged. Both are not necessary.) tc * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Food du Lac, WI STATE BAR OF WISCONSIN SOa655-2021 WARRANTY DEED FORM No. 1 - 1999 p o fD 0 0) F 3 0 0 C CO 1 > > 3 K 1D V v at c lot cn 3 x z cn 3 c_ z o w cn n cn °o °c • ? v 3 u o s s v R o o a a W O- tD 7 CD N j W Q m S 7 0 v! W fD Co O ►'O.►, O N D c G) O O - O N S- Dpi 3 N• O O '1 C D_ ~ a oN No -u w y c- 0 O N w O O OA 0 0 C 0) -u o N OA fD 0 C CD O O to 3 3 7 N w O O ~1 N Co co C/) ? N C D. N.. 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