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AS BUILT SANITARY SYSTEM REPORT
OWNER -C`f r�//e r ��.1 era rl TOWNSHIP SEC'2 T_3e)N - RLW
ADDRESS e f 67 41 ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION / _ LOT /1/� LOT SIZE 1W
PLAN VIEW
Distances and dimensions to meet requirements of H63
4UBYTIII "]C WillitiN IOU E LL'i Uk
I
_. �.._
2
L NO
1 35 -
t, -
� 30
e
- z'- I di a e 4o t--hl Arrow
S C L
BENCHMARK: (Permanent reference Point) Describe- N
Elevation of vertical referen ,pe ;oint: >�� -�? _Slope at site.
SEPTIC TANK; Manufacturer: ? Liquid. Capacity
Number of rings on cover _, r Tanl�manholc cover elevation :
Tank Inlet Elevation: Tank Outlet Eleva tion:
PUMP CHAMBER
Manufacturer; ,� Numbex of gallons
Number. of gal. pump set for a cyc�e 9f gallons; gallons; tota capac ty of
distribution lines gallon; size U pump ,< head;
gallon per minute _;l horsepower_ _'' ;�r.an name of pump
�_{
and model number � , , >, �`, �.� l �
Type of warning eVice , d ,,Z
Fi07_,L)IN(. 'TANK: Maczufac:turer Number of gallons
I- Aevation of manhole cover
E'y at> ()t warning device _ - -.
SE�.'1,J'A ;E, PIT SIZE Number o�` p it s � - feet diameter
i t:•t>t 1.tquid dept seepage pit in - Ii i t pipe - elevation
til: SI : age p - t of l at �_0�1 feet. �
seepage P
inr_s widt.�t_ _f __leiigth i -- tile dt-pi h
'i t�PitCi!:, TKE?NCH. width length
o ,k;l,A C lON RATE ` A EK E UYI�ED / , AREA I1 BIJTLT �,
INSPECTOR
PLUMt3r:l� ON J011 ._ �-
LICENSE NUMBER " ' ; 4'
DEPARTMENT OF INDUSTRY; INSPECTION REPORT FOR SAFETY & BUILDINGS
LIBOR &•HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION
P.Q. BOX 9969 SEW E SYSTEMS BUREAU OF PLUMBING
MAbISON, W153707 F Mound Pressure Distribution
NAME ERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: PLAN ID NUMBER.
BENCH MARK (P Rent refer., p� ntl OESCHIB F Dlf LN'T FROM PLAN �— R -- —'— H[F. PT E1..6V.: CST At F. PT, ELEV..
SEPTIC TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. PHOPEHTY LINE: WFLL; BUIL)ING.
DOSING CHAMBER:
MANUFACTURER: LIQUIDCAPACITY: PUMPMODEL PUMP MANUFACTURER: WARNING LABEL LOCKING COVER
1 P O IDED: PROVtOEO'.
YES ❑ NO KYES ❑ NO
GALLON PERCY LE PUMP AND CONTROLS OPERATIONAL. PROPERTY yy L� JBUILDINt: AERINO�RESH
DIFFERENCE BETWEEN I»I* LIrvE t
PUMP ON AND OFF El ❑ NO J �� �' .�
SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction
shall cease until the soil is dry enough to continue.)
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM
and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
DISTRIBUTION SYSTEM:
er: WID7 : , LENGTH: NO. OF SPACING CENTER L NGTH: DIAMETER, MATERIAL AND MARKING:
T RE N EE TO CENTER: CH S: 1
1
w' I
v C
D DISTRIBU
DISTR. DISTR. PIPE TION PIPE MATERIAL &MARKING:
MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING:
D IA ..
NO.
PIPES.
DIA,:
PP
T ROVED
O A
R PIPE S
VERTICAL LIFT CORRESPONDS
s �`: DRILLED CORRECTLY: DEPTH OF GRAVEL
HOLE 512E: HOLE SPACING: D ILL D COR Y: OVE L
PLANS
❑ YE S ❑ NO
El YES
NO
SOIL COVER:
TEXTURE:
DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OFTOPSOIL: J SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑YES ❑ NO
COMMENTS:
SIGNATURE: itT l E:
DI LH A -SD D -6227 (R. 05/81)
DEPARTMENT OF APPLICATION SAFETY & BUILDING
INDUSTRY, ' FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property wner: Mailing A dress:
eN�v�ze•- - rn &-R
Property L tion: Cil"pUglago -or To wnship : County:
14J t /a /V�J %S Aol iT SO N/R (or) _X AL 6 �' Roy A
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
li 0 UN ! R �- C.L (If as ' �i) O 7
TYPE OF BUILDING
Number of
❑ Public ❑ Variance ❑ Other (specify) /Y) d b f fL 1�61 lc-- Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY 0n/e- '?C
HOLDING TANK CAPACITY
LIFT PUMP TANK/ Da 0A)t
MANUFACTURER: JAJ P, sC K S U /J C - R� C p c( U c+ S
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New D�r Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
,y( 0 / ❑ Alternative (specify) „ 6 cg&4)pjcl PiPeS,SVKe ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
9 Private El Joint El Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Sign ure: 4 MP /MPRSW No.: Phone Number:
✓ � P. e, 4 4- 60 1 r» P 44y9 1 (71f) & J ?V -3-37,?
Plumber's Address: Name of Designer:
� ,r; caw, ,� C�c.� , `s ✓ e R e � �- J o L� �
COUNTY /DEPARTMENT USE ONLY
ign ure of Is i Agent: Fee:: O Date`. APPROVED Sanitary Permit Number:
P. 0 44ALI 1 tfl� �- lO 3O" ❑ ISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
f Form Change of ownership, building use or lumber requires a Sanitary Permit Transfer o m (67 -T1 to be submitted to the count prior to in-
9 P. 9 P q Y Y P
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod- Plumber
r DILHR -SBD -6398 (N.03/81)
Ulu INSP�:CTIUN INU-1VIDUAL SEWAGE SYSTLM
S 4 it 1, L d r y P t; r tit La--
S L 4 L L S U 11 L I L
MI': e 1 C w N I I I lb C1'U1X Ct)UIJL y
4TI O N
u L 11 S u L) d i v i b i 6 It
1 " I ' l C T A N K
I u 110 N"wOer of cumpartilik!LIL6
L UiIC V I I U111 wull
;NPING CiIAMHER
44110PIO PUQIP Manufacturer
)LUINC TANK
S Ion" Nutuber of CuwpI;4rL4jAgjjL:.,
P u 111 1) 0 r_ A 1,A i tit S y u t e. Ill
I ksLonev P row; Well 1 $ U J I d 1 Ll slo
"SURPTiON SITE
bed
I runs; Woll 127.
t0'( SI'vL ult L �NSIUNS
A
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w1dL11 UT Lretich f L Requircd
Lgogt.h tit 04CI► DepLh of Luck below rile 1n.
N ti m b u I" o f I i n u is UapL ji ui ruck over L11e - in
TQtill lal►gLj► of l lnaa► t L Uapt 11 t.) I L I I.e below grade i
U'to Latic U Lit. Lwaon I tiles f L slupu of pu r I Uu t L
TOL41 f L Ty pe u I CuV u 1
iT DIMENSIONS
Numboi of Gravcl arULIJ►LL pjCb YUtj n u
Uu I, ti I d v d lawij L w r I L uepch Ijt;:luw jlkle-t:
Tutal abti01'1i)L lull IL
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RECEIVEQ x
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State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
,
` '' Plan Identification Number
PRIVATE SEWAGE SYSTEM ONLY—
A l l
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private
sewage system to be installed a the above - mentioned location. The plans and specifications were prepared by
� t t
and received for
approval on
The soil and site evaluation was conducted by
The site meets the soil and site requirements specified in Chapter H 63, Wisconsin Administrative Code, for the use of
C
�.f�.. ,\ALL •. � . 1, `. F. �� A� K- C. i.s_. -s . k ., '_- ,� � •; � �. ' (". - \ _ _ _ a .
The proposed system is fora
Wastes from the building will discharge to a <T'f�`'P gallon capacity septic tank which will discharge to a R (2 C ) gallon capacity
pump chamber from which a pump having a capacity of .:v° gallons per minute against a total dynamic head of l r Q( feet will
discharge through a cN inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: O By:
B ounty
btkt�r T
Enclosures '`- �`• "1' j �G1i�/
DI LHR -SBD -6159 (R. 7/81)
me s Sargent, B erector
l
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
r- -- Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707 WA .+... -.�'� ( � Plan Identification Number
L J
Re: CLWZ. S1 r k"= = P. b�
PRIVATE SEWAGE SYSTEM ONLY—
�(' t
The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private
sewage system to be installed at the above - mentioned location. The plans and specifications were prepared by
A $ 1 and received for
approval on nC)*__C� 'o Q_x_
The soil and site evaluation was conducted by
The site meets the soil and site requirements specified in chapter H 63, Wi consin Administrative Code, for the use of
The proposed system is for a �aGl\ 'r \'—��
Wastes from the building will discharge to a JSI gallon capacity septic tank which will discharge to a Re)n gallon capacity
pump chamber from which a pump having a capacity of :: �6 _ gallons per minute against a total dynamic head of to?, O ( feet will
discharge through w inch diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of
approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation
of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this
approval and shall follow the directions or orders issued by the appropriate local or state authorities.
In accord with ch. 145 Statutes and ch. H 63 Wis. Adm. Code he plans and specifications area roved contingent u n compliance with
t p
P PP Po
the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional
engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at
the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall
become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the
Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight,
construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions
arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the
permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void
this acceptance.
cc: OWS By:
County
Other p p
Enclosures
DILHRSBD -6159 (R. 7/81)
mes Sargent, B erector
'� y__: {, .c• y�. kit r:, ��
Ptb 10001 -12178 .k
_]Up�per
ptv, x .
' Pa tai Of This Tonn With
' Aivo IfiIIF t+ sy s
AA
#u i pa►ndence MAIL ALiISREf k ox ,
MADt &OAr;.yY iSIN 537rkt
bAi'E: October 1, 1981
' 01VFr ,+► PROJECT: . 3i
_ Cc,
f
OCT 1 1981 Eugene KruizeW -� idec i
ZONING Alternative Sysstl�'''
- OFFICE • Nwst, N04, sec - 32, T. ` +
Town of Emerald,
Boldt's Plumbing & Heat St. Croix County,. WI
Baldwin s ,
Wisconsin 54002
$1- 05177; .�
PLAN ID. #
DETACH HERE
in. i »r+..r..::: +......v%:. -:. , .:�: . .= . °-•.. r w:: — ..._ ..a: — — — — — — — —'—s ....� ...:: +. ...•;a3Ayz.,r .ii g w a... r.+*
Y
Eugetse K R e s idence k 81 -05177
PROJECT NAME PLAN ID.,#
This is to accrtc►vslsd r of your plans and specifcati ins r the above�indicated project.
I le#unirtarsl, r�riew incl�ttes ths,.plan review fee,:#equired is $ v f
,. Plan accepted review. Fee received is $
., �.. Fee is being returned because of . ❑ Overpayment h.t Underpayment..
i. I Providing -one of the two c3tagories above is checked, remit correct fee in one payments
k �U ll
No fee has remitted. Plans submitted with no fees will beheld in abeyance. "�k 4
�� l m
0 Plans being returned.
A+dclitional information required. SEE BELOW.
1. Plan.Submission `
❑Additional information shall be!submitted in triplicate unless specifically noted.
❑ Plans not clear, legible or permanent.
ED All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2 )(a) tNisc nsn bode,
_.
❑ Affidavit enclosed.
#l. Alternate sewage Disposal. Systems (Mound Systems)a
D PLB 108 (Application for use of an alternate system). `
County onsite required (1 copy). ❑ Design calculations for pressurized distribution
❑ Cross section of mound. 0 Pipe lateral layout. ❑ Plan view of alternate.
111, Private Sewage Disposal Systems` s
t
C] Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides.
El Elevation of permanent reference point (benchmark). ,.
❑ Location'of area suitable for replacement system - provide soil test data..)"
Q Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldg%, lot lines, vae1. #, let rse .
Q Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precut..
, Construction detail and cross- section of soil absorption system.
• 3: i e
e' ❑Soil boring and percolation test onEHA16 completed byvert(fiedsoil tester (1 copy). .
a" ❑Complete data relative to anticipated use of bldg.: Q 3 copies - of RLB 60 enclosed:` J
y3
QDeed restriction required (f copy).
IV Holding Tanks
�* ..., �.l�+Cy #ite; A€. #iQl€l�(sg-ter11C. •., _- ,
� g._ aA
} Moldtn 'tank.`greementsigned by .owner and local unit of government '(sample,enclosed). t
Reason: for•installing holding tank soil test or statement from county (1 copy).
r {'
culations for" total lift pump discharge, head and gallons pumped per cycle.. r
e, length & depth of force main. r ,
tait, & model of ' pump or automatic siphons including size, -pump curves, drawdown. and average flow rate,f
:
0 CroSSL soction of lift purnp tank showing pump(s) or siphon(s)._
I
JI
AIF
Vk; Systams In Fi14 (Fi {{ must be placed prior to plan submission) s ;
i
Total area. , filled (fillAo oxtend 20' beyond edge of trench be f ore side slope begin)..:
.. ❑ Depth.and type of fill.
' �QCRpY ofi at�ite �portkf�. county or district plumbing upervi�r_ ... � ti :�t +�� z � � � A � l
w �
Length of, time fill has been in place: fi
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DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS
INDUSTFYY, CC DIVISION
HUMAN
f AND �EL ATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707
LOCATION: SECTION: 0 TOWNSHIP /MDti�PAtiW: T NO..BLK. NO.: SUBDIVISION NAME:.
Nw �/ �/ A-1 /0 N/R � lor► W �M r— A 14'L q
COUNTY: OWNER'S BUYER'S N 7 )qulze_e44A MAILING ADD S:
7'`: C RO /x �v c,�e E, n e.RAL_ J
USE DATES OBSERV O S A( E,
F5
BEDR .: COMM R.. AL DES I P ION: TESTS:
Residence NO. ❑Neweplace
RATING: S= Site suitable for system U= Site unsuitable for system LI t i�
CONVENTIONAL: MOUND: IIV- GROUND S STEM -IN -FILL HOLDING TANK: RECOMMEN SYSTE
osou osau sou os❑u EIS FA
�F•
If Percolation Tests are NOT required DESIGN RATE: S If any portion of the lot is in the ly
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevatio�
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B / 7 11 9 , �r �r0 1,no -06 O _ N - � a� 5 1 L 4 ;.�P 17-- - 5C, L
B- a ,�L ?9 /
B- 3 Ta'' 99 1o' `' 0-6 r �a « �� -7z
B- ?" - 7 D ; e,e 0 6,e-, t. M
�j
B" y d / �✓ �x o �.v� e C A u se In U f fL i•.� /- RO r�-�
B- ('r" — 9 _/D /S`' w Sli '7dp Sol L5
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PE RIOD 1 PERIOD PERIOD 3 PER INCH
P - ffo 90 3 3
P- 2 v " 5
P- '7 lf 3 '
P -.
P-
P-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop.
SYSTEM ELEVATION 9 S 7 "
I C 1 � 3 �
� i •f -� - � E 1 h �. I l
3 9. mom -� ►- - -
Y
�O
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print :- TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: 5; NUMBER optional):
.Q4.Q 6J, S v�"�' 4 A � �85� -337
SI URE:
DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page- Property Owner, 4th page -Soil Tester.
DI LHR- SBD-6395 IN. 03/81)
r
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner _r s 69 t c e S d
Property Address r r4 1 L _ 4 a
City /State AFr ) J Lat ,*z p � cc) i s
Legal � Description:
��rA i
Lot A Block � Subdivision/CSM #
N aA ' /a '/4, Sec.. , T .Sd' N -R /( W, Town of t=ar► e� D PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer hit o L ves w-wA Size STIPC 16 Setback from: House 4L Well Pldk; �Aiz)
Pump manufacturer mac, t AO „ 4Mode1 '5 t4 elo
Alarm location r �j
(HOLDING TANKS ONLY)
Setbacks: Service road ent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: J Width 9 Length Number of Trenches
Setback from: House R6 Well/�� P2 ' S Vent to fresh air intake �9
ELEVATIONS r
Description of benchmark C X7'+'1 � 'T" c�it3 f f -� / 1k` -x- Elevation
Description of alternate benchmark d 4 c U N, T Elevation O Z, Z 3
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom ` / ►/ ! 7 Header/Manifold c Top of ST/PC Manhole Cover C�
Distribution Lines 9 9,, O ( )
Bottom of System ( ) ( ) ( )
Final Grade
Date of installation / / Permit number - �� /`��„ '� State plan number :2-3 9 0 �
Plumber's signatur j> - t oin License number - zY Date / /
Inspector
Complete plot plan �
1
Y s i
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 VIE ,
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INDICATE NORTH ARROW
III
Wisconsin gepartment of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 34463 7 Permit IX
Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)].
Per - 'b1V' : MARCUS ❑ CitYEl Town of: tate Plan ID No.:
CilZ1C:1C V1V PPIIEERRAALL ���9 _ - r,,,�„s • �a �
CST BM Elev -:- Insp. BM Elev.: BM Description: rcel Tax No.:
�. 1 4�_� 010- 1051 -70 -000
TANK INFORMATION EL VA ION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic -^ ISWA Benchmar00 3. 2 -( 03.4 (&D • D
Dosing U .q �} /02.2-3
Aeration Bldg. Sewer ' So ?'K. �Z
Holding St/ Ht Inlet c t,2}
TANK SETBACK INFORMATION
TANK TO P / L WELL BLDG. Air I ntake ROAD
ir
Septic feo >60 .25 -- NA Dt Bottom
Dosing , >/OD $'O 25'� _?$�f NA Header/ Man.
Aeration NA Dist. Pipe 1 3- 3 1 9
Holding Bot. System 3.q9 q LL
PUMP / SIPHON INFORMATION Final Grade
Manufacturer J aw Aoio Demand
Model Number s�� �g4lGPM
TDH Lift&O;V�J Lriction / System TDH t Ft mead
Forcemain Length Dia. 2 W Dist. To Well ESQ
SOIL ABSeR.PTION SYSTEM
OW TRENJCH I Width / Len th If No. f T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIM N 5 I - DIMENSION S
SYSTEM /L BLDG WELL LAKE /STREAM LEACHIN Manuf rer:
SETBACK
INFORMATION Sys e m / 3 3` > rJ. OR UNIT CHAMBER Number:
System: �'—'°"
DISTRIBUTION SYSTEM
Header /Manifold u Distribution Pipe(s) 0 x Hof $i e x Hole Spacing Vent T�± Intake
Length Dia. Z Length Dia. �_ . Spacing /'/ .7b r �
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) � �,J
LOCATION: EMERALD 22.30.16.321B, W,NW 2411 CTY RD 4 Mil S;
yy
l.J � ,2 f S, c I �.:.{t I�O.� tf f o+1
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4,L is
W eu >--L� fe C_�� . P � tee. lan re I iedd?�p Yes A No 0L 2� DO Z 6
Use other sloe for additional information.
at_ .Ins Sin _ eJ Cert. No
SBD -6710 (R.3/97) Q. ��q 6 �f ���l
T
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPIXATION 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 t�e' system.-on *per not Cou
6
than 8 112 x 11 inches in size. Crat X
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government programs S- C F" Q Check it revision to previous application
30(jP4T,y State Plan I.D. Number
[Privacy Law, s. 15.04 (1) (m)). _;q1j 90
1. APPLICATION INFORMATION - PLEA Xt K 23 49
Property Owner Name Pyope(t tion
o
/ f(or) W
Clete /C_S,0/j 401 , 4 1/4, S T 3 , N, Rlep
Property Owner's Mailing Add Tin er
ss er Block Nu b
e4vil ;ZLO 4- <9
City, State Zip Code
0!11 a jPhone Number Subdivision Name or CSM Nu b
72' I V7 er .4 C/
II. TYPE OF BUILDING: (check one) E] State Owned 0 Lay Nearest Road
- P [] Village 0-01-
0 Public Pg 1 or 2 Family Dwelling - No. of bedrooms kTown 0 1 ,,
BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) - I Ill... /1; - 1-1
1 [-] Apartment/ Condo - (2110-16-"3�7
2 E] Assembly Hall 6 E] Medical Facility Nursing Home 10 E] Outdoor Recreational Facility
3 E] Campground 7 E] Merchandise: Sales/ Repairs 11 E] Restaurpiritif Bar/ Dining
4 [-] Church / School 8 n Mobile Home Park 12 E] Service Station / Car Wash
5 E] Hotel / Motel 9 [:] Office/Factory 13 E] Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 n New 2. pd Replacement 3. E] Replacement of 4. E] Reconnection of 5. [:] Repa i r of an
System System Tank Only --------------- Existing System ---------- Existing System
B) E] 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 E] Seepage Bed 21,4 Mound 30 [-] Specify Type 41 E] Holding Tank
12 El Seepage Trench 22 [-] In-Ground Pressure 42 [] Pit Privy
13 E] Seepage Pit 157 K 64 43 El Vault Privy
14 E] System-In-Fill 0",Ailiiilo 2 - 0
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7
E , Final Grade
ti
q Required (sq. ft.) Proposed (sq. ft.) (Galsidayjsq. ft.) (Min./inch) eva ion
:S-0 Z 7,5_ :�S _7S_ </—SQ/ A Z� q Feet 1-Z Feet
Vil. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION =� Gallons Tanks manufacturer's Name Concrete Con- Steel glass App
New Existing structed
Tanksl Tanks oQ ZjJ6A 125K
Septic Tank or Holding Tank 106"o // 1:1 El 1:1 1:1 1:1
Lift Pump Tank /Siphon Chamber 445z, El r_1 I El
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum er'sNa e: (Print) ignat e: (N tam s) PRSW No..; Business Phone Number.
I Plurrkr' S 7 U;�M FPN oorA� 46 17
141JA', /--)� i 'Z
Plum belills 1Wd ress (Street, City, StAV6, Zi �,pc14� 14
.5 _
47
IX. COUNTY / DEPARTMENT USE ONLY
[] Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued o Stamps)
Approved F] Owner Given Initial N Surchar Fee)
Adverse Determination
X. CONDITIONS OF�_APPROVAL /REASONS FOR DISAPPROVAL:
SBD-6398 (W OV94) DISTRIBUTION: Original to) Conro One cop To: s & Ruililin niviion, Owner, Plumber
r •
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:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7_
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2x 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.
Safety and Buildings
15837 USH 63
HAYWARD WI 54843 -8107
TDD #: (608) 264 -8777
N visco ' nsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
August 10, 1999
CUST ID No.227618 ATTN.- POWTS INSPECTOR
ZONING OFFICE
TOM GUSTUM ST CROIX COUNTY SPIA
N13450 937 ST 1101 CARMICHAEL RD
NEW AUBURN WI 54757 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 08 /10/2001 Identification Numbers
Transaction ID No. 239049
Site ID No. 177963
SITE• Please refer to both identification numbers,
Site ID: 177963 above, in all correspondence with the agency.
ST CROIX County, Town of EMERALD; 2411 CO RD G, EMERALD 54012
f NW1 /4, NW1 /4, S22, T30N, R16W
Facility: MARCUS ERICKSON 2411 CO RD G, EMERALD 54012
FOR: MOUND, 450 GPD.
Object Type: POWT System Regulated Object ID No.: 483398 c(1l' t t�
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in OF SAf
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use: f — sEE CO tF
1. This plan action is subject to designer comments on the plan.
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. The area 25' below the downslope edge of the mound must remain undisturbed.
4. Abandon failing system per COMM 83.03(2).
5. The designer proposes to install a Midwestern Pre Cast, Inc. 1000/650 combination tank.
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.
SM 5 ely, DATE RECEIVED 07/26/1999
FEE REQUIRED $ 180.00
l ^ ,� FEE RECEIVED $ 180.00
A RICIA L S ORF ,POW �PLANREVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART'code: 7633
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project 3 Bedroom Mound
Owner Marcus Erickson
Address 2411 Cty. Rd "G"
Emerald, WI 54012
715- 265 -7725 #
Legal Description NW NW S22 T30 N,R,16W
! :1F `iiC� RAE
Township Emerald County St. Croix w1Y tLD►NGS
Subdivision Name csm vol. 4 -page 1141 Lot No. N/A PENCE
"SPUN
Parcel ID Number 010 - 1051 -70 -000 G� �j
Plan Transaction Number Z ` 0 � 9
Index and title sheet Page 1
o w� % C1 Mound calculations Page 2
Mound drawings Page 3
OMASD. =N Pres. dist. calcs. and laterals Page 4
W GUSTUM @Z TDH and pump tank drawing Page 5
1201 Plot Plan Page 6
Pump Curve Page 7
Designer Thomas Gustum License Number D1201
Signature Phone No. 715 -658 -1344
Date 7/23/99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
SBD- 10462 -E (R.05/98) Page 1 of 7
•
Performance Data
32
Pump Characteristics
Paagt /Motet Unit St1ltnersihle
Meaeal Models OSP33M1 OSP33M2 It 24
Amemalk Melds OSP33A1 OSP33A2 P
x
Horsepower 1/3 10
Fell load Amps 1.8 4.6
Motor Type Split - Phase
R.P.M. 1750 o e
Phase 0 1
Voltage 115 230
0
Holtz 60 0 10 20 0 50
CAPACI -U.S.
Operation Intermittent
Temperature 140 °F Ambient Total Neva oet) 4 8 12 16 20 24 25
NEMA Na R GPM I /3 NP 60 55 48 39 28 7 0
lnsdotiem Chess F
DUMP S114 1 -1/2 NPT
SA& ttendan S /8- Dimensional Data
Unit wool SO lbs. 3.7/8 e-3/4
S•t/e
Power Cora 1a /3, sJTw, 1 181 3, SJTw
101 :tae X20 opt.) o� std. 1. #j t„Mtixwin kdo
4•1!4 1 -1/2 NPT 2 u"
my my 11/1 lnd
Nd for Materials of Construc 3. PWPM MW
1111 041110 steel 3.3/4 4. k w4ia8 ad 1t Ok
wr Ip $xW*
Lrbrketieg OIT Dielectric 011 S. We "I 61 del N
Motor Housing Cast Iran wA. y"
Kodxtls.�i thw
Pomp Casing cost Iron saoficalrnswt�rxl
own
Shalt Steil
Mednekel Sal Foos: cater /Ceramic ,
Shaft Seel Seel {oily: Ness
Sprkw Stainbss Steil
Ioiows: tang -H 12 -1ie
s - M
Impeller P
tr0ate 11.3/4 PUM
ON
tipper tearing Sb* Row tat Be&*
Lower Bad" Single Row tell taring
Ieso I Cost Ina
FestemKS Stainless steel PUMP OFF
AURORA /MYOROMATIC Pumps Inc.
1840 6ansy Road, Ashland, Ohio 44805
(419) 289 -3042
aeon 70� 7-
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tscons n Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to new - moo 010- 1051 -70 -000
APPLICANT INFORMATION- PLEASE PRACL.-- tNFORMATIO EWE Y
I Y ATE y
PROPERTY OWNER: PERTY LOCATION
Marcus Erickson ' ` <J LOT NW 1/4 NW 1/4,S 22 T 30. N 16 )&or) W
PROPERTY OWNERS MAILING ADDRESS " � BLOCK # SUBD. NAME OR CSM #
2411 Ct . Rd. "G" `` t na csm Vol. 4- g 1141
CITY, STATE ZIP CODE - 1{ONE N X Y VILLAGE gYOWN NEAREST ROAD
Emerald, WI. 54012 (1 -^ Emerald Ct Rd. "G"
New Construction Use [xi Residential ! fi . b6r room [ ] Addition to existing building
Replacement [ ] Public or comm era i al�tie�cr
Code derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft
Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate • bed, gpd /ft2 - 5 trench, gpd /ft
Recommended infiltration surface elevation(s) 99.20 ft (as referred to site plan benchmark)
Additional design/ site considerations system el. based on contour line of el - 98.20'
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDINndNK
U = Unsuitable fors stem El S [3 ®S ❑ U El S ERU E] S C$U ❑ S E2U El S
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed Trttch
1 -11 10yr3 /2 none 1 2msbk mfr gw 2f .5 1 .6
La 2 1 -21 10yr4 /4 none sicl 2csbk mfr gw if .4 .5
Ground 3 1 -37 10yr4 /4 none sl 2csbk mfr gw na .5 .6
el ft. 4 7 -55 10yr4 /4 c2p 7.5yr5/8 sl 2csbk mvfr na na .5 .6
Depth to
limiting
factor
37"
Remarks:
Boring #
1 0 -17 10yr3 /2 none 1 2msbk mfr cs 2f .5 .6
OEM 7
.... .. 2 17 -25 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 25 -35 10yr4 /4 c2p 7.5yr5/8 sicl 2csbk mfr gw if .4 ':.5
Ground
4 35 -65 7.5 r4 4 c2 7.5 r5 .6
elev. Y / p 8 sl 2csbk mvfr na na .5 Y /
9 8.5 ft.
Depth to
limiting
factor
Remarks:
CST Name: -- Please Prin Gary L. Steel Phone: 715 -246-6200
Address: 1554 200 New RichrnovQ, WI 5401
Signatur : Date: 6 -12_ CST Number: m02298
r
PROPERTYOWNER Marcus Erickson SOIL DESCRIPTION REPORT 'Page 2 'of 3R
PARCEL 1.134 010 - 1051 -70 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench
1 -11 10yr3 /2 none 1 2msbk mfr cs 2c .5 .6
2 1 -28 10yr4 /4 none sicl 2msbk mfr gw lm .4 .5
Ground .,.. d ..'..
3 8 -37 10yr4 /4 none sl 2msbk mvfr gw if .5 .6
elev.
9 4 7 -55 10yr4 /4 c2p 7.5yr5/8 sl 2msbk mvfr na na .5 .6
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft. —
Depth to -
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Marcus Erickson 1554 200th Ave.
CSTM2298 NW 1 4 NW% 4 S22- T30N -R16w New Richmond, WI 54017
MPRSW -3254 town of Emerald 715 246 -6200
N
1 =40'
BM.= top of concrete slab by entrance door of garage @ el 100.00'✓
Alt. BM.= top of air conditioner @ el. 102.40 I
� D
Ir
�"3 2 ,�
/�' 3
1
o p-
Gary L. Steel
6 -12 -99
I I
I _
t ,
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
C D
Mailing Address of .� t
t
Property Address
(Verification required from Planning Department for new construction)
City/State ,_= 0 1 Parcel Identification Number
LEGAL DESCRIPTION
Property Location d>w %4, Ad&. % 4, Sec.P , Tje) N -R_&_W, Town of d
Subdivision /y A Lot # .
Certified Survey Map # , Volume Page # l 1
Warranty Deed # �t , Volume Page #
Spec house ❑ yes g no Lot lines identifiable lA yes ❑ no
SYSTEM MAINTENANCE
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.
I
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I
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.
O l
SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT ` DATE
* * * * ** 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
W. I 432PAGE 2ft /°
STATE BAR OF WISCONSIN FORM 2 • 19" K ATHLEEN
EGISTER OF DEEDS
ELY DEED WARRAIN ST. CROIX CO., WI
�a 3 This Deed, made between B ernard J. %fortel and Bet tv_J_Mior tel• RECEIVED FOR RECORD
husband and wife. _ __ — 0647 -1999 9:30 PA
Grantor, conveys and warrants to M arcus G. WARRANTY DEED
Erickson and Dianne H. Erickson, husband and wife, s survivorship m arital CERT 11
ERT COPY FEE:
pr operty , COPY FEE:
TRANSFER FEE: 119.70
Grantee. RECORDING FEE: 10.00
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, Sate of Wisconsin
(The "Property "):
Recording Area
Name and Return Address
L)AVI( - ' J. ESTPEEN
304 LOCUST T' '
kJOSON, VA 54016
lo- wsl- �o-000
Parcel Identification Number (PIN)
This is homestead property.
That part of NW1 /4 NWI 14, Sec. 22- T30N -Rl6W described as follows: Lot I of Certified Survey Map recorded in Vol.
4 of Certified Survey Maps, page 1141, as Doc. No. 375247.
Exceptions to warrant ea. Easements, restric ions ant; Al.�nts - way of record, if any.
Dated this —�--- ^day of June, ! 099.
z�
' Bernard j orlel
/
• Betty J. Morte
ALMHENTICATIJN ACKNOWLEDGMENT
Signature(s) Bernard J. Mortel and Betty 1. Mortel, husband and STATE OF WISCONSIN )
wife ) ss.
authenticated this JkV day of June, 1999. County )
Personally came before me this day of May,
4 ~ '
' . FORM NO. 985-A
MGMi1N.Cmp�,®
37 5247 CERTIFIED SURVEY MAP N0. 1141
Part of the NW4 of the NW4 of Section 22, T30N, R16W, Town of Emerald, County of St. Croix,
State of Wisconsin, as described in Volume of Certified Survey Maps, Page 1141
as Certified Survey No. 1141
CERTIFIED SURVEY MAP NO. 1141 BEARING REF. TO WEST
` I LINE NW V4 SEC. 2 2
T30N R16W ASSUMED
I BEARING NORTH
UNPLATTED . LANDS .
f 1
NW C01 NER SEC. 22 , T30N , R16W _
P.O. B. "G" — _._ _ — N V4 COR
_ 4 H.
�� N87�045 ' 00' �'-w SEC. 22 1 320. 00'
0, '
45 .00
Q 1286.97'
33.03
10 O Q 920 33 , QQ ..
O Q
O
J 386,760.00 SO. FT. t Q
( q
N 8.88 ACRES INCLUDING R/W
= 33.03 LOT I 8.65 ACRES NOT INCLUDING R/W N
I3 92 OO E
" _
1286,97' 8�o p
I ��. S 87 ° 45 00 E 2 '
1320.00 0 z
n' M
Z• M
q c0
N
�. • 3/4" ROUND IRON BAR
WEIGHING 1.502 LB /FT.
W 2" IRON
i . ALUMINUM PCAP WITH APPROVED
Q x
f-
a 0
Z• N SCALE 1 "= 200 R 14 1981
ST. CROW COUNTY
W V4 COR. SEC. 22 COMPREHEkSIVE PARKS PLU*aja
AND ZONING C
SURVEYOR'S CERTIFICATE
I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify that I have surveyed,
divided and mapped a part of the Northwest 1/4 of the Northwest 1/4 of Section 22, Town
30 North, Range 16 West, Town of Emerald, County of St. Croix, State of Wisconsin, more
particularly described as follows:
Commencing at the Northwest corner of said Section 22;
Thence South 45.00 feet, to the point of beginning;
Thence continuing South 293.00 feet;
Thence S. 87 45' 00" E., 1,320.00 feet;
Thence North 293.00 feet,.;
Thence N. 87 45' 00" W., 1,320.00 feet, to the point of beginning.
Said parcel contains 8.88 acres, more or less.
That I have made such survey, land division and plat by the direction of Eugene
Kruizenga. That such plat is a correct representation of all exterior boundaries of
the land surveyed and the subdivision thereof made. That I have fully complied with
the provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations
of the Town of Emerald and the County of St. Croix in surveying, dividing and mapping
the same.
4
DATED THIS _ DAY OF 1981. THOMAS G. KUE TER
Registered Land Surveyor
� 1 �
� '�'��► � FILED
s Volume 4 Page 1141 J AN'7 1982
S yea a cow"
MIS am w DoW
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Y
Shef40 Performance & Dimensional Data
40
SHEF40
30
F-
W 20
Y.
10
0 10 20 0
(98.4298.42 0 50 60 10
P
6 (168.27) 1.All dimensions in inches. (Metric for international use).
) 5 5" 11 (1 (127)
2.(omponent dimensions may
3 -718" vary ± 1/8 inch.
(98.42)
3. Not for construction purpose
j unless certified.
3 -718 DISCHARGE
(98.42) 1 -1/2" NPT 4. Dimensions and weights are approximate.
FLOAT
SWITCH 5.We reserve the right to make revisions to our product
and their specifications without notice.
I0 HYDROMATIC
11 -3/8 " 10 -3/16 "
I (288.92) (258.76) .
3 -5/8"
f (92.07)
2'(50.8)
7
i
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT
G&ERAL INFORMATION (ATTACH TO PERMIT) Sanitary 3446 37 Permi IX
Personal information you provice may be used for secondary purposes [Privacy La K s.15.04 (1)(m)).
Perl)ftld @ift
'A e: MARCUS j���j
❑ City Y Town of: State Plan ID No.:
CST BBM V1V Insp. BM EVev.: BM Description: Parcel Tax No.:
010 - 1051 -70 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Ventto Airintake 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 I Lift Friction I System TDH Ft
oss H ead
h rcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer:
SETBACK CHAMBER
INFORMATION Type O Mod 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
Oepth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No ❑ Yes �No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATION: EMERALD 22.30.16.321B,NW,NW 2411 CTY RD G
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. F7P
11,,, — Date Inspector's Signature Cert. No.
Safety and Buildings Division
SANITARY PERMIT ilPPL TION Bureau of Building Water System
201 E. Washington Ave.
In accord with ILHR 8 05, Wis. Admr Cpa P.O. Box 7969
J Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for th'e system on ijaper no�ti'es Coun
r "' 1 it , ��, ` 71 C t X
than 8 112 x 11 inches in size. ;,r -,� ! c CO
• See reverse side for instructions for completing this' application State Sanitary Permit Number
Ica
The information you provide may be used by other government ritypiograms ST CrO(X El Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. -; (/1 � COUNTY � State Plan I.D. Number
I. APPLICATION INFORMATION - - PLEASE �Nk i17 Cto f�? 0
Property Owner Name \ P *6 o tion � O
`�4.: 114, S Z T , N, R /W/ re (or) W
Property Owner's Mailing Add Less L'otNUtrrber ` ,^ Block Nu be
/LJ /Fi A
Ciiv, State Zip Code Phone Number Subdivision Name or SM �ugtber '-'
Z f
II. TYPE OF BUILDING: (check one) E] State Owned [] it Nearest Road
Public Pg 1 or 2 Family Dwelling - No. of bedrooms O jif Town g OF
lin. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1�2. • I �• 321
1 ❑ Apartment/ Condo 4' _066
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant / Bar / Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box online A..Check box online B, if applicable)
A) 1 _ ❑ New 2_ $ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an
S yst em
__ System_____________ ________TankOnly______________ Existing System ____ ____Ex1st)ngSystem
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 XI Mound 30 ❑ Specify Type 41 []Holding Tank
12 []Seepage Trench 22 ❑ In- Ground Pressure r j_., � 42 ❑ Pit Privy
13 ❑ Seepage Pit )C� 43 ❑ Vault Privy
14 ❑ System -In -Fill 9,$'• ZO
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 (sic . ft.) Proposed (sq. ft.) (Gals/day sq. ft.) (Min. /inch) Elevation
7J 3 '7S'r s�"� A L q 4 7, 20 Feet • z Feet
Gapacit
VII. TANK in allons Total # Of Prefab. Site Fiber- Exper
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks r
Septic Tank or Holding Tank d0{) El El ❑ ❑ El
Lift Pump Tank /Siphon Chamber 45z ❑ ❑ ❑ ❑ ❑
Vlll. RESPONSIBILITY STATEMENT -
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum er's Na e: (Print) Plum is Sign ture: (N tam s) IMPNPRSW NoZ �, 17 Business Phone Number:
Plumbe s ddress (Street, City, Sta , Zip ode t
l S7!
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Iss ng gent Signature (No Stamps)
�pproved [] Owner Given Initial ' Surcharge Fee)
Adverse Determination
X. CONDITIONS OF_APPROVAL /REASONS FOR DISAPPROVAL:
AAa ST4V Cra +. at. PA." CL
ST CROIX COUNTY
r SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ZT I Cle - set J
Mailing Address c;� ~ � ,� r
a
Property Address !
(Verification required rom Planning Department for new construction)
City/State . 60AS -' gi t Parcel Identification Number <.I/& -- 16 5--/^ ?
LEGAL DESCRIPTION
Property Location A&f 1 /4, Ajd� I /4, Seco , T3d N -Rjj�—W, Town of h2ZAgZA Q
Subdivision 16A Lot # (Jib
Certified Survey Map # Volume Page #
Warranty Deed # 4 Yycry , Volume 1 Y3 Page #
Spec house ❑ yes �' no Lot lines identifiable lA yes ❑ no
SYSTEM MAINTENANCE
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 fimction of the septic tank as a treatment stage is 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
A� `
c
,cam_.. �� FLl /kJ 9 9'
SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** 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
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
Inch- pounds Metric
Residential or commercial? r (r or c) (y or n) L� Replacement system?
Creviced bedrock site? n (y or n)
Slope 2 %
Wastewater flow rate 450 gpd 1703 Lpd
Depth to limiting factor 25 in 63.5 cm
In situ soil infiltration rate 0.5 gpd /ft 20.4 Lpd /m
Contour line elevation 98.2 ft 29.93 m
Use standard fill depths? x OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
Center or end manifold a (c or e) Hole diameter 0325 I in 0.125, 0.156, 0.188, 0.219, 0.25,
0.281, or 0.313 inch only.
Lateral spacing 0.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 3.00 ft Not a final calculation.
Number of laterals 1 Pump tank elevation 87 ft Outside bottom of tank.
Forcemain length 70.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only.
2.067 in Actual I.D.
HOLE DIAMETER CONVERSIONS
118 =0.125 114 = 0.250
SYSTEM SOLUTIONS Inch-pounds Metric &32=0.156 9/32=0.281
Estimated daily flow 450 gpd 1703 Lpd 3116=0.188 5116=0.313
7/32 = 0.219
Absorption cell
Design load rate & area 1.2 gpd/ft 375.0 ft 34.84 m
Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd /m
Design width (A) 5.00 ft 1.52 m
Celt length (B) 75.0 ft 22.86 m
Depth of cell (F) 10.0 in 25.4 cm
Sand filter
Upslope fill depth (D) 12.0 in 30.5 cm
Downslope fill depth (E) 13.2 in 33.5 cm
Basal area required (gpd/infiltration rate) 900.0 ft 83.61 m
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.5 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.15 ft 3.09 m
Up slope toe length (J) 8.00 ft 2.44 m
Down slope toe length (1) 9.40 ft 2.87 m
Total mound length (L) 95.30 ft 29.05 m
Total mound width (W) 22.40 ft 6.83 m
Project: 3 Bedroom Mound
Transaction Number: Page 2 of 7
MOUND PLAN VIEW
observation pipes (typical)
J
22.4 ft A= 5.00 ft 1.52 m A
6.83 m B = 75.0 ft 22.86 m
W B J= 8.00 ft 2.44 m
I K i= 9.40 ft 2.87 m
K= 10. 55ft 3.09m
_
95.30 ft
29.05 m typ. obs. pipe
(anchored securely)
I = down slope dimension = absorption cell (AxB)
J = up slope dimension O = plowed area (LxW) k
K = end slope dimension 5' (152 mm)
T
MOUND CROSS SECTION
subsoil cap D = 12.0 in 30.5 cm
lateral topsoil G H E = 13.2 in 33.5 cm
invert 99.70 ft _ _ _ F = 10.0 in 25.4 cm
elev. 30.39 to F G = 12.0 in 30.5 cm
ASTM c 33 H = 18.0 in 45.7 cm
D Sand Fill E
sys. 99.20 ft y
elev. 30.24 m 98.20 ft contour
29.93 m elev. 2 % -�
slope
D = upslope fill depth plowed layer
E = downslope fill depth Note: Absorption cell media will consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell wall centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Deep chisel plowing to break up top layer
Project: 3 Bedroom Mound
Transaction Number: Page 3 of 7
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 5 ft 1.52 m
Length (B) 75.0 ft 22.86 m
Lateral specifications
Number laterals 1
Holes/lateral 25 holes
Lateral length (P) 72.00 ft 21.95 m
Hole diameter 0.250 in 6.35 mm
Lat. dis. rate 29.13 gpm 1.84 Us
Sys. dis. rate 29.13 gpm 1.84 Us
Hole spacing (X) 36 in 91.4 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) Place X in red
X' one choice 1 1/4 in (32 mm) box of chosen
from the options 1 1/2 in (40 mm) diameter.
provided. 2 in (50 mm) X X
3 in (75 mm) X
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) _
X' one choice 1 1/4 in (32 mm) None required.
from the options 1 1/2 in (40 mm) No choice necessary.
provided. 2 in (50 mm)
3 in (75 mm)
4 in (100 mm)
Distribution system contains: 1 Lateral(s)
LATERAL DIAGRAM - END CONNECTION
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area.
Laterals centered over the A & B dimension
end cap
P
Last hole dirilled next to end cap I<- X-->I Laterals & force main of PVC Sch 40
Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5)
equally spaced • = permanent end marker
Inch-pounds Metric
Lateral length (P) 72.00 ft 21.95 m
Lateral spacing (S) 0.00 ft 0.00 m
Hole spacing (X) 36 in 91.4 cm
Manifold length 0 ft 0.00 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 2.00 in 50 mm
Forcemain diameter 2.00 in 50 mm
Project: 3 Bedroom Mound
Transaction Number: Page 4 of 7
TDH and Pump Tank Drawing
Total Dynamic Head
Operational head 2.50 ft 0.76 m
Vertical lift 11.90 ft 3.63 m Are laterals the highest point in the
Friction loss 1.03 ft 0.31 m system? Yes 'Where. u
Total dynamic head 15.43 ft 4.70 m If no, what is the highest elevation
Dose Volume downstream of pump? —J
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 12.5 gal 47.3 L back to tank? ('X' one)
Minimum dose 125.0 gal 473.2 L x Yes
Drain back 12.2 gal 46.2 L No
Dose volume 137.2 gal 519.4 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover with
7F I tether proof warning label and locking device
grade levels junction box alp rade levels
disconnect g
alternate
4" vent pipe electric as per NEC 300 and E-- outlet
Comm 16.28 WAC location 16'(46 cm) min.
wall of pump approved
chamber or outlet joint
combination tank
A Provide 1/4" weep hole or anti -
alarm on siphon device as necessary
pump on B
Grade levels
pump 87.8 ft C - pump tank manhole = 4" (10 cm)
Off elev. 26.8 m i k minimum above finished grade
D - vent =12" (30.5 cm) minimum
above finished grade
87.0 ft Pump tank elevation
3 " (75 mm) of bedding under tank 26.5 m bottom of tank
Tank manufacturer Midwestern Pre -Cast
Pump tank capacity 17 gal /in
Pump tank volume 650 gal
Pump manufacturer JHydromatic i Inches Gallons
Pump model number Josp 33 o A 22.2 376.8
'o B 2 34.0
Alarm manufacturer S&J Electro E C 8.1 137.2
Alarm model number 1101 p D 6 102.0
Project: 3 Bedroom Mound
Transaction Number: Page 5 of 7
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