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wiiscansin Department of Industry, SOIL AND SITE EVALUATION REPORT Page) of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
FPARCEL
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of
slope, scale or dimensioned, north arrow, and location and distance to nearest road. - 109 q_ %0
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION DATE
PROPERTY OWNER: / PROPERTY LOCATION
� - � (ZOMEZ 01 N G --� `(� T S t...) 1/4 S LO1 /4,S 37 T Z8 ,N,R ) 6 E {orJ�
PROPERTY OWNERS MAILING ADDRESS U LOT # [ BLOCK # I S BD. NAME OR CSM #
Iu '6 37-1 WSO " 5r. I 3 —
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE CWOWN NEAREST ROAD
SA 7-1 lU G V Ri 1. rlul S y b�
( LB (l - VO L _
� v G rr t_� Pt�z c� -sT. etza tx Ro
[3Q New Construction Use [. d Residential / Number of bedrooms 3 [ J Adcr Q,n to existing building
j J Replacement (J Public or commercial describe
Code derived daily flow 4 SD gpd Recommended design loading rate bed, gWI? 3 trench, gpd/ft
Absorption area required 3 S bed, ft 31 S trench, ft Mabmum design loading rate - 5 bed, gpd/ft • S trench, gpd/ft
Recommended infiltration surface elevation(s) L O S • Ll 1 ft (as referred to site plan benchmark)
Additional design / site considerations Y" l w/ S S IC '1 S ' TRk - ")A ) 30tAib
Parent material T't Ll Flood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system L1 S IRU RS [:] [IS ®U ❑ S IOU [IS EI U EIS f$ U
SOIL DESCRIPTION REPORT
Boring # Horizon
Depth Dominant Color Mottles Texture Structure Cor>sistence Ba.ndary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rRench
v.a `'I. i7- SO Z. 3 b �l. S • S li
1 1 Z - 1 -?.0 `u`ilL Y/3 _ st l zvri Ynft-
Ground 3 - 2b -J3 -S`92 31y - S1 1 e SUS W) U$' cs - • 5
elev. Sye s!g sc� o rn�1 P. . Z
� o fL 4 13 -y8
Depth to
limiting
factor
3 3'�
Remarks:
Boring# o -� lotiI7- - g\ Z.'F3�vx VVN it,Q •S
cu $ ZZ 104 fr_ V /3 S'l� Zwt s blt rn'f�- 0..s - • S . b
S) 1 sb�t wtv`f v q-S — •y .S
Ground
elev. Zl.yl > - `1R -V /y � S/a S�� oVV
co o
ft
Depth to '
limiting t
factor _
Remarks:
TName: Please Print Phone.
Arthur L. We a re r 715 5 OFq�
.`
Add res' _71-
egerer Soil Testing & Design Service -P.O. Box 74 River Falls-W 5b022
Signature: / ��- l g Z- 3 Date: �_ C1 7 00 5 7 6
PROPERTY OWNER tM SOIL DESCRIPTION REPORT Page Z of 3 '
,PARCEL I.D.# c�(O$- IQg - q O
Boring # FHorizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Muhsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch
3 ,c�
l Zb l0`i lL y/3 SO Zs b1r Yvl
Ground 3 ZO-30 - 7 -S y 1Z 31 S C "biz M U`k C -S _ , 4 • S
elev. �.S yR y!
1 4 �, yO y ��- y2 S!g S e 1 oy►-, tin � — rte. fa, • 2 i
Depth to
limiting
fa-10 ti
Remarks:
Boring #
13
j
I
Ground I
elev.
ft.
i
Depth to
limiting
factor
i
Remarks:
Boring # I
[31 _
_
Ground
elev. i
ft.
Depth to
limiting
factor '
I
Remarks:
Boring # I
i
i
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92) ,
PLOT PLAN Pa 3 of _
SCALE 1 "=
0 m w,X -1 pe
= off ---
Li3E -M BE Ppr CctRST Z.S' FizU1"1: _l` Q D_:- a'
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( 715 ) 423-01 69 1400576
CST Signature Date Signed Telephone No. CST #
Wisconsin Departrnent of Industry ' SOIL AND SITE EVALUATION REPORT P age of 3
Labot and Human Relations
.Division of Safety & Buikirgs in a ccord with ILHR 83.05, Wis. Adm. Code
COUNTY
- tr.
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 8
dimensioned, north arrow, and location and distance to nearest road.
00$ 10c1q— y.0
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RENEWED BY DATE
PROPERTY OWNER PROPERTY LOCATION
Ttt fLOM ? (3l I Au G e - R T- S W IN S W 1/4,S 33 T Z B ,N,R )(b E (or w�
PROPERTY OWNER'S MAILING ADDRESS LOT 0 BLOCK i S09 D. NAME OR CSM #
Iv 8321 y. Sp ` w ST. ls —2. #&1.
CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE (MOWN NEAREST ROAD
sAUJKJG \Jk0, *,k_j1 S '4 (-)IS) ERv GPrL 1V'1F510E ST.ctw1c fzo
[)Q New Construction Use Residential / Number of bedrooms 3 [ J Adg n to existing building
[ J Replacement [ J Public or commercial describe
Code derived daily flow q SlZ gpd Recommended design loading rate - bed, gpcW - 3 trench, gpdM'
Absorption area required 3 S bed, S trench, ft Maximum design loading rate - S bed, gpd/it ' S trench, gpdtft
Recommended infiltration surface elevation(s) l O S • (3 1 ft (as referred to site plan benchmark)
Additional design / site considerations Y" 1 uyhv'�) w/ S 'X '1 S ' T9k.)C1i - Y") I AJ . I ' o>= S PtAJb Ft 'L�
Parent material 0\j%: 'n Q,%_P e t A Tt Ll Flood plain elevation, if applicable N • R - It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN 11U_ HOLDING TANK
U= unsuitable for ter O S Eau ®S a U ❑ S ®U [IS o u [IS X1 U D S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure C;Onsistence Bamdary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rt',ndh
0 - 10`t ti- Z l z — S11 Z i3'* 'K1 V- S
-, vex
�OIrL y/3 Sl Zw19 Yn�1-
Ground 3 ?� - J3 - ) - S'9R Sly w"U c.g -`l • 5
elev. - I S `t 2 Ir/ �[ S y 1z S /g
l 4 33 - Sc)i Olvh m'F1- P. ' • Z.
Depth to
limiting
factor
3 3'�
I
Remarks:
Boring# 0_8 ll�� -t1Z Z l2 - S� li Vx CL
Z '� Z 8 z.z 113 4 tZ y/3 - S - i 1wiS\M ynTi_
3 ii Z� �.Sltt -31y - s1 1 w+sb�t wfv iv a.s - •y ',S
Ground
elev.
1o o It
Depth to '
limiting
factor
Remarks:
TName: Please Print Arthur L. We erer 715 425 - 0165
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature / q�- f g Z- 3 Date: 6- lZ C) 7 CST N umber 00 5 7 6
PROPERTY OWNER C$T ' Ir�1GE'1k SOIL DESCRIPTION REPORT Page of 3.
,PARCELI.D.0 Colb — ly9 — q
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
3
zIZ — sl Z'f-s� m a- . s
IL y /3 — S i 1 Z'�-a h1r m 'Fv C
Ground a ZO-,3d Z -Sva 3J - al Cz b�Z Yn U % k CS % \ S
elev. -).S `iR V1 t — h• Z
s ft. 4 3D. U8 y �. y 2 s /�, s c 1 0 »� w► `��-
Depth to
limiting
factor
1
Remarks:
Boring #
13
Ground
elev. ,
ft.
Depth to
limiting
factor
Remarks:
Boring #
i
Ground
elev.
I i . ft.
Depth to
limiting
factor `
Remarks:
`Boring # 4
r
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD•8330(R,06/92)
PLOT PLAN Page 3 of 3
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23Q � ST ' , ° I7- 182 -
715 ) 495 - 01 - fir , M00576
CST Signature Date Signed Telephone No. CST #
w�.sconsin Department °f 1ndusay, SOIL AND SITE EVALUATION REPORT Page N. of 3
Labof and Htunan Relations
Di4ision of Safety & Buildings in accord with ILHR 83.05, WI Adm. Code
v a COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S .
not limited to vertical and horizontal reference point (13K, direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. DO$- 109. q- Y.0
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
T (LgNe O l'T I ^1 G 0_ GDff. - S w 114 S W 1 /4,S 3'�S T Z ,N,R T 6 E (or OW
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # S09D. NAME OR CSM #
Iv $3Z1 1 4 Sp " 5T. 3 �1 Poste �.s•wr.
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD
S A R1 JUG Vf AX* Sy767 ( I 68 t{ - L10 E t-U Gl'YLv_ 1 i - 'AmrjE- , sT.cmx wo
K New Construdion Use [M Residential / Number of bedrooms 3 [ ] Additi n to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow q S gpd Recommended design loading rate bed, gpcW ' 3 trench, gPd/ft
Absorption area required 3 -1 5 bed, ft 3 S trench, ft WAmum design loading rate - S bed, gpd/ft ' 6 trench, gPd1ft
Recommended infiltration surface elevation(s) l O 5 , U J It (as referred to site plan benchmark)
Additional design / site considerations Y"1 ov►v"> w/ S 'k '1 S " �.�C`L'F _ t"')1 Aj. I ' 0 P S %Wb Ft I
Parent material ov %ffjz G%.h Cl P Tt Lk. Flood plain elevation, if applicable to • R - ft
S = Suitable for System CONVENTIONAL I MOUND I IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDC�G TANK
U = Unsuitable for tem ❑ S EaU ®S ❑ U ❑ S O U ❑ S IO U ❑ S I] U ❑ S Q U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell p Sz. Cont Color Texture Gr. Sz. Sh. Roots Bed rRench
wX 2 1 _Z,p �u`t tZ
Y/
I
Ground 3 ?� -J3 - )-Syrt 31y — s� 1 �SUk W7 U$' C_ -S 1 -`1 • 5
J y J3 -y8 - I -S �2 vj � s/g
Depth to
limiting
factor
3 3'
Remarks:
Boring # m Ct, S S '
Z Z 8 Z z to�tz Y13 s Z>ns bl ti r�'�t- a, — •S .b
= a
3 2z Z� �.S`itz 31y� — s 1 1 sbk \j iv a-s - •y .S
Ground
I N V
elev. 'l,yl -)- yR y/y S 4Q sit 5 c o y„ — p. - 2
So fL
'ham
Depth to '
factor
limiting
Remarks:' �' X
T Name:— Please Print phone.
Arthur L. We erer 425-
V e re g%rer Soil Testing & Design Service -P.O. Box 74 River 1 Z 2
Sgnature. / _ 3 Date: 6 �Z CST Num
9 - 7
M00 5 7 6
i
� r
PROPERTY OWNER tM SOIL DESCRIPTION REPORT Page?' of 3
PARCEL I.D.#
Depth Dominant Color Mottles Structure GPD /ft
Boring # FHorlzo in. Murisell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tranch
3
O 7 1 �11Z Z 2 S L Z Is vrl. `�M- q.
m c S . s 6
Ground 3 10�b - 7 - V I 3 J y g 1 C IS b1Z )n U`�. C S
elev.
N -5 ft. 4 3b S40 - )•S `1R vj `�-,)- yR G/g
Depth to !
limiting .
factor ,�
10
Remarks:
Boring #
Ground
elev.
it
Depth to
limiting'
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to s
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
860.8330(R.06M)
�
3 P OT PL
Page 3 of 3
v
SCALE 1 "=
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�-- -- 28' XVL \oys
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C��� - lz -a7 ( 715 ) 425 -n1 fi5 _ M00
CST Signature Date Signed Telephone No. CST #
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT t
Owner ! e / II h �. i sr cRol:
Property Addres ,. � X 16 ,s- 44 f,, COtJNT�'
LONINGOFPC
City /State & G l ts✓ ►1 ��„�
�� I i' �• %may',
Legal Description:
g �.
Lot 3 Block Subdivision/CSM # CJa 2 j��a
%a a LJ ' /4, Se , T ? N -RjW, Town of Cg K � «I � PIN # 00$�
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer K 6.cs mac lvi Size ST/PC P Setback from: House — Z,� Well WeL P/L
Pump manufacturer 2c / /& a Model
Alarm location 61 l •c �'t' - a
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: 090 k 1 1 Width Length ol q Number of Trenches
Setback from: House 1 t U Well PAL s Vent to fresh air intake
ELEVATIONS
Description of benchmark 1 :` 1 P 0 Elevation G
Description of alternate benchmark t f Af, < ,M �e A 1c; Elevation f ! 3
Building Sewer t JV' ST/HT Inlet ��'' � ST Outlet 1G' , PC Inlet / U 2
PC Bottom �� .fig Header/Manifold Top of ST/PC Manhole Cover '
Distribution Lines O 1/ y 1 / r O O
Bottom of System ( ) U T. i ( ) ( )
Final Grade () 1 2 . (� ( ) ( )
Date of installation /V Permit number 3V 6 d State plan number 1
Plumber's signature License number ,�� 3 l1 Date / / ql
Inspector I
Complete plot plan e
>G
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
I F
x.
a �
S - Y '
b
INDICATE NORTH ARROW ---�
r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM v'
Safety and Buildings Division Count $T . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary�ejrpitJUo.:
Personal information you provice may be used for secondary purposes (Privacy , s.15.04 (1)(m)). 3 L 4 bb �U tpi
Permit Holder's Name: V' I Town of: State Plan ID No.:
PELOQUIN, TERRY & JENELLE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel &69 1 .: 1094 -40 - 0
�v -
TANK INFORMATION ELEVATION DATA A9800497
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Se ti IM,� - su�7� /pop Benchma w � x � 1,.11 113 /Oa
o In Vm 75� -` 1" �� / 543 1(S.?
Aeration _ _ _- -. Bldg. Sewer I S13 •� /
Holding St / Ht Inlet I 1 rr1 O�
TANK SETBACK INFORMATION St/ Ht Outlet IS1 7. j2— f
TANK TO P / L WELL BLDG. AirI to ntake ROAD Dt Inlet
irl
ept' `fsav �� 3$� � NA Dt Bottom 1!
osi ,v d NA Header / Man. 11D•63 l u
Aeration Dist. Pipe
Holding Bot. System 10451 �Ji, J b
PUMP/ SIPHON INFORMATION M Final Grade 1.1 1'13
Manufacturer _ _? Demand {� rW(u., iIS' � "S
Model Number ,J14`GPM 115' .Z.Z�
TDH Li Friction Systems TDH13,5�t �(�.( 1laV3 /cc
Forcemain Length �5' Dia. HH k Dist. To well
SOIL ABSORPTION SYSTEM
�_ BW4 , TRENCH Width Length I No. Of Trenches PIT No- Of Pits Inside Dia. Liquid Depth
IMEN 1 N Gl DIMENSION
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI Fl IVIO Manufacturer:
SETBACK B —
INFORMATION Type O I� / y - -- CH CH AM UNI Q N er. - -=
System: (p C{ `—
DISTRIBUTION SYSTEM
Header / Manifold I Distribution Pipe(s) r ' , x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Z Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)''
S � � S
LOCATION: EAU GALLE 33.28.16.499,SW,SW 2322 PIERCE/5T. CROIX_ROAe
wIese✓ rs saw)
55� •
bYolk� u p I C1 4> Z g� sa vl� .
li�nrevision required? ❑ Y s No
Use other side for additional information. 7
�( SBD -6710 (R.3/97) Date InspectoK Signature Cert. No
SANITARY PERMIT APPLICATION Safety and Washington Division
Vi scons i n 201 W. Washin ton Avenue
In m. P 0 Box 7302
Department of Commerce accord with ILHR 83.05 Wis Ad Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. 1 . C.' i O K
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes p Check it revisio t�vious application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION / t
Property Owner Name Propert }} ocation
u e- ��- ���G u j'ri .$ �i /4 /cri 1/4, S 3 3 T • N, R I L Fr(or) W
Pro y Ow er's ailing Address Lot Number Block Number
pe
v Gs' 3
L Stat Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned ity Nearest Road
E] vil age
Public or 2 Family Dwelling - No. of bedrooms MTo OF L` 6 , c e So e J?
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) L/
1 C] Apartment/ Condo ` y G _��
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
S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1, F� New 2 Q Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
______System - ___ - -__ System -- -- --- -- - --- Tank Only __ Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min-/inch) _ Elevation
L S t) '3 ? 60 3 ? 4 . l `! r 5 Feetl 16 Feet
Cap aclt
VII TANK in ltos Total # of r Prefab. Site Fiber
INFORMATION g Gallons Tanks Manufacturer s Name concrete Con Steel glass Plastic Exper.
App
New E a n k strutted
Tanks Tanks
Septic Tank or Holding Tank s 5-ee - yj ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber y"(j 1 ❑ 1 ❑ 1 ❑ El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum 01 s Signatu No Stamps) PRSW No.: Business Phone Number:
cue SLc,,�2
Plumber's Address (Street, Ci ,State, Zip Code)
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanit ry Permit Fee (Includes Groundwater a:22, tSignature ( a s)
Surcharge Fee)
pproved ❑Owner Given Initial
W ppro
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
w
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 -3151.
To be complete and accurate this sanitary permit application must include:
t. 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.
.
YP 9 9 Y . 9
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 mainstwater service; streams and takes; 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
' 2226 ROSE ST
LACROSSE WI 54603 -1905
isconsin T Thompson, Governor
Philip p Edw. Edw. Albert, Acting Secretary
Department of Commerce
October 01, 1998
CUST ID No.267341 ATTN. POWTSINSPECTOR
WEGERER SOIL TESTING & DESIGN _... ;-
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022 '
RE: CONDITIONAL APPROVAL `
APPROVAL EXPIRES: 10/01/2000
_.�a ' ` b tq98 Identification 1�luinbers
,+
ransaction ID No. 149560
S7 cRc,x
COUNTY / Site ID No. 161054
SITE ZONiNG Or -F{CE �f �\ Please refer to both identaficatxdn numbers;
Site ID: 161054 j`� ,..__� �� above, in.all correspondence with the
St. Croix County, Town of Eau Galle r' I , a en
SWIA, SW1 /4, S33, T28N, R16W
Terry & Junelle Peloquin
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 427613
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:
• 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(d), Wis. Stats.
• The total length of the mound is 121 feet.
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,
t. DATE RECEIVED 09/25/1998
FEE REQUIRED $ 180.00
6erard M. Swim FEE RECEIVED $ 180.00
POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim @commerce. state.wi.us
- Page of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE SVJ 1/4 OF THE SW 1/4 OF SECTION 33 ,T Za N, R
TOWN OF Gt'M�F , S`r• G�?�UC COUNTY, WISCONSIN_.
INDEX RECEIVED
PAGE 1 'of 6 TITLE SHEET SEP 2 5 1998
PAGE 2 of 6 PLOT PLAN SAFETY & BLDGS. DIV.
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT _
.PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
p.a. aux �bs P.0 . ll y
�3A�ow�ti , w I s4. Go12dctlo
E
U� CoM►AE 1NGS `
D Vp ' ETY
p IS ►aN �
NCE
I��EPARED BY EE GORK
WEGEE�ER SQ Z L . TEST I MCS
AND. �5�*4o@t
ES = G[V
1R11�
I3
F.R. 00174 421 K. MIK ST. *o � ®' � + RIPQ3 FNIS. NI 54022 s� ilp ARTHUR L.
715 - 425 -0165 g i W GE: ER
= D-915 P
6iLSvYORT}1,
• 15
10 ON
o° d �4
own
JOB JOB NO.
PLOT PLAN Page Z of (
Scale 1 "= 4Q '
n
tD- it
I N g.Z i
D �
s.l
Sal
�1 -I.pg 3
Q t --10y
30 of ZtiPV c F.n,
'Z.
/o7•S
cy -vtty . yz; cave i
N
to
rh
x
S
la p
LZL. L 0 0.0' OJV � I ZU P L Pty
%h Wl - Lrz . 1otL. S Gk 1 of STEEL FleQ c7 }t:1 0 3 r.
to nZ . ter LMT' so' PO4M 1tIOVK!D .Fns 'Pi's L 7—
8S�_
23 O T}f s1;
P�'Ic = ST•
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( z required)
4. Septic tank to be V000 gallon capacity manufactured by
\ bwe5Te � PS T. 1NC. Pur�P �'fC►✓k.'ry BE `1SO -. wt� `�'�' ,
5. Bench Marks S Na0 V i'
6. Divert surface water around mound to prevent ponding at the uphill side.
Page 3 Of b
Approved Synthetic Covering
�sTr� c 33 Distribution Pipe
Medium Sand
_ H �G
Topsoil F Elev. 10 . S
3
E j ��
b
.S % Slope
Force Main Plowed
Trench of 2 " -2 2" From Pump Layer
Aggregate
Undisturbed D z.o Ft.
Soil E - 1 - Z Ft.
Cross Section Of A Mound System Using F to Ft.
I Trench For The Absorption Area G N•o Ft.
A V_ Ft. H t• S Ft.
B 0 14 Ft.
I Ft.
Linear Loading Rate= L4 GPD /LN FT
J l0 Ft.
Design Loading Rate= 13-Z-5 GPD /SQ FT K Ft .
CORRECTION NEEDED
X3.5
L a Ft. SEE CORRESPONDENCE
Ai+e4m,*-te Position of Force Main W 2 9 Ft.
L
Force
B K Main
A �i— __ — — — _ • _— _— — __ — Y
w
W Distribution Trench Of
Pipe Aggregate
l Permanent J
Observation Markers
Pipe s
(Anchor securely)
Mound Using I Trench For Absorption Area
Page _30f
Perforated Pipe Detail
0
End Yisw
Perforated
End Cap.) I PVC Pipe .
Install permanent
at end of each lateral
Holes Located On Bottom.
Are EgaoAy Spaced
Q End Cop
* PVC Force Main
i
Distnoution
Pipe
Last Hole Should Be `
Next To End Cop
Distribution Pipe Layout
P uS .2 Ft.
X I S Inches
Y 3 S Inches
Hole Diameter Inch
Lateral 1 t l Inch (es)
Manifold — Inches
Force Main Inches
of hol es /pi pe l b
Invert Elevation of Laterals \lu•o Ft.
4
Place lst hole tee with succeeding holes at 3 S' • intervals.,
Last hole to be next to the end cap.
PLfA? CHAMBER CROSS SECTION ARID SPECIFICATIOAIS PAGE S OF �o
VEIJT CAP
4' C.I. VE PIPC WEATHER PROOF
APPROVED LOCKING MANHOLE
JUIJCTIOAI BOX ' COVER WITH WARNING LABEL
10' FROM DOOR, rFU.
WIMDOW OR FRESH I -
AIR IAJTAKE
GRADE I 40 mu.
trt, LLD � I
le Mlu.
COWDUIT �`- _____ -__
19`rllAl.� - - - - - --
PROVIDE I
INLET AIRTIGHT SEAL
I I I \✓
APPROVED JOINT/ . A Tank construction shall comply I I;j APPROVED JOINTS
with ILHR 83.15 and ILHR 83.20 I
ALARM
I I ON
c •f I
CLEV. FT PUMP - -j
� OFF
D
t,Zt 11. Lo0.00' COUCRETE BLOCK
APRWCL
RISER EXIT PERMITTED ONLY IF TANK MAWUFACTURE:R HAS SUCH APPROVAL 7 EDOPINC*
SPECIFICATIOAIS
DOSE
TAMKI MA NIJFACTIJRCR: `' P \�� >`C�1 NUMBER OF DOSES: PER DAU
TAWK SIZE - 150 GALLONS DOSE VOLUME t ��, S
ALARM MMIUFACTUKlER:
S - gyp S`{S�'I INCLUDING 6ACKFLOW: GALLONS
MODEL MUMBER: ` CAPACITIES: A= b INCHES OR 3`Z 0 GALLONS
SWITCH TYPE: 2.L'U` B = Z INCHES OR 3°I'b G(LLOU5
PUMP MAMUFACTURCK: ZO�lLl�`1T C z ! IZ IMCHE5 OR B GALLOWS
MODEL NUMBER: �a D= L Z INCHES OR Z34 "O GALLONS
MOTE: PUMP AMD ALARI pN E kS � t6
SWITCH TYPE: MARE 70 DE
MINIMUM DISCHARGE RATE 3 �' GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEILE BETWEEIJ PUMP OFF AND_DISTRIBUTIOM PIPE.. 2 " FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .. .. .. 2.50 FEET
+ 30 FEET OF FORCE !'MIN X - 2 F FACTOR.. FEET
. = TOTAL OtIMAMIC HEAD = 3Z FEET
DIAMETER I
INTERNAL DIMEAJ510WJ OF TANK: LENGTH ;WIDTH - ;LIQLIID DEPTH
BOTTOM AREA - 231= GAL /INCH
AS PER MANUFACTURER -- 1 GAL /INCH
HEAD CAPACITY CURVE
MODEL "98" 4 5/8 I
8
0
3 5/8
= 6 m O
U +
Q
1
4 3/16
a 4 5
0 10
2 �l•�
5 1 1/2 -11 1/2 NPT
0
I U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS I
80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEAD/FLOW PER MINUTE
EFFLUENTAND DE WATERING
CAPACITY 12
HEAD UNtTSIMIN
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
Lock Valve 23'
SKI 102
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
Standard all models - Wei ht 39 lbs. - '/ 2 H.P. 1. Integral float operated 2 pole mechanical switch, no external control required.
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 aflemator 10 -0072 or 10 -0075.
M98 115 1 Auto 9.4 1 or 1 &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 wired4n
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
Forinlonnatanon additional Zoellerproductsreferto catalog onCombination Starter, FM0514;Piggyback All installation of controls, protection devices and wiring should be done by
a qualified
Variable Level Switches, FM0477; Electrical Alternator, FM0486; Mechanical Allemator ,FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed including
the most
- ,Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm 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.
i
NAIL T0: P.O. Box 16347
Louisville, KY 40256-0347 Manufacturers of. .
SHIP T0: 3849 4 0 Run Road
Louisville, KY 40 211.1961 PUMPS S NCE l9�,9�
P1UMP !O_ (502) 778 - 2731.1(800) 928 -PUMP
FAX (502) 774 -3624
Wimonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildngs in accord with IL.HR 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 SI GQ Al SE
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. ri g - `b cl q u - ?AO
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
_7 R'rvj S UlU LrL.LZ 1=- 2ZA Q U IV - GOVP+eT 5 ►tit 114 S►N 1/4,S 33 T Z$ ,N,R I, ( E
PROPERTY OWNERS MAILING ADDRESS LOT # . BLOCK # SUBD. NAME OR CSM #
C�•o. Box. l 5 3 - 0- Vut`. VL 1 3318
CITY, STATE ZIP CODE PHONE NUM ER ❑CITY []VILLAGE [MOWN NEAREST ROAD
�'� D w l ti Iti S o o Z ( 6t3� 5 370 0 G PrL.L - t�tL� '_ ST'• �1zcvX
[ J New Construction Use Residential / Number of bedrooms 3 [ J Additfion to e xisting building
(><J Replacement [ ] Public or commercial describe
Code derived daily flow `1 So gpd Recommended design loading rate bed, gpolft trench, gP(W
Absorption area required 3 S bed, ft2 '� ;,l S trench, ft Maximum design loading rate bed, gpd/ft trench, gpolft
Recommended infiltration surface elevation(s) `i:j ° t - S it (as referred to site plan benchmark)
Additional design/ site considerations Y -N-) IV/9"y 9 4 "T) -4 , r- j A/t h tai^ 7 ? - V ' of Sin p P , - ( .
Parent material Flood plain elevation, if applicable )J A ft
S = Suitable for system coNvENnoNA . MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FU HOLDING TANK
U= Unsuitable for stem EIS O U F�[ S❑ U ❑ S ER U [IS ®U ❑ S Ru ❑ S lid U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consis�nce Bmdryy Roots GPD /ft
in: Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'R t>nd1
1 o -S iotic�31 Z sil Z sb s as \ •S
�� Z 8 - ) bti tZ 316 - s � � Z �n s bh � � C s l v� • s . 6
Ground 3 zA 3 S `� R 3 �� � 1.5 tz S 6 s 1 0�, tin `�' - NP • 2
elev.
v sya fl
Depth to
limiting
factor
Z13
Remarks:
Boring #
1 o -`t 1o"lR- 3lZ s�\ z'Fsb �s1� C-S N� .S
Z•
3 ll 33 S� tZ 3l Q1 • L c \ w, 'F1/ " f "Z - Z
Ground
elev.
1 06.0 fL
Depth to
limiting t ; , St
X
factor �NING
Remarks:
CS T Name.--Please Print Arthur L. We erer P hone: 715- 425 -0165
egerer Soil sting & Design Service -P.O. Box 74 River Falls, 54022'
Signature: L 8 7 Date: 9 _. Z
M00
CST Numb
I
PROPERTYOWNER 1- C7Q`11N SOIL DESCRIPTION REPORT Page ? -of_L
PARCEL I.D. # C J 0b 1 o 0 1 Q Qo -1-00
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tiench
3 o -9 io tcz 31 Z b� s h cs • S - 6
z q -�4 ..lo`�� 31` � si 1 Z - `Fsbk ''rr �S 1v•� . S -b
Ground 3 )4 - 1-slip- 3lY C 7.S�t2S/is
N1� -
elev.
1 '�-o ft. €
Depth to
limiting
faj to r
i
is
Remarks:
Boring #
13 17-:kSj- in dN rrs W rvLV V
0� Q1, a S S '
Ground ? f L wvni < " IM Mo U)U6
elev. E
ft. �
Depth to '
limiting
''factor '
�t
Remarks:
Boring #
Ground
elev.
ft ;
i
Depth to
limiting
factor
Remarks:
Boring #
' Ground #
`elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLA Pa I of 3
SCALE 1 "= p
- 0
Ltrr
1 N $•Z _ cm
ca i Ai 1 1ri'LS WfS2l�A .
o i
�.3 eL
r LrL to- a
j Va ✓
s .
v1
�1
7'
O
x°11 1 eL l0o.0' ow �k ltz- C' PC _
of S EEL FeQ cti
WI-r0- - M DM frj LM8T SO' Fv4M MO\JK A
1 ,
6 � , 8 so .
2.3 O 11} sT;
98 -187
c � _ � (715 ) 42A 65 I+I 00576
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
- OWNERSHIP CERTIFICATION FORM
OwnerBuyer / e- p t Ti, d-t- o e- /b Q u +'n
Mailing Address P U, )14' ,r S /3� �C��, , h, / j . s Lt a o z
Property Address `c r e. , A 6? v : J
(Verification required from Planning Department for new construction)
City/State 12u 4 "'41 Parcel Identification Number �' V c� L-/ Gv y
LEGAL DESCRIPTION
Property Location ' /., S y., Sec. T 2 f' N -R�W, Town of Z
Subdivision Lot # _3
Certified Survey, Map # ��G �� �Z , Volume / 2 , Page #
Warranty Deed # Volume &� , Page # U Z
Spec house ❑ yes W no Lot lines identifiable N 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-
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/we, 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 exp date.
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 describe by virtue of a warranty deed recorded in Register of Deeds Office.
u
77
SIGNATUR9 OF APPLI 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
Wiscdnsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count 6T . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita;y.P�r� yo.:
Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. SLLU LL�J
Permit Holder's Name: ❑ EAU
a �LcL e Town of: State Plan ID No.:
ELOQUIN, TERRANCE EA GA
CST BM Elev.: Insp. BM Elev.: BM Description: Parceldb4. - 1094 -40 -000
TANK INFORMATION ELEVATION DATA A9800415
TYPE MANUFACTURER CAPACITY STATION BS 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 ROAD Dt Inlet
Air Intake
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 `riction System TDH Ft
Forcemain Length Dia. I-( Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN 1 N DIMENSION
SETBACK
SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER Model Number:
System: Fj I OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: EAU GALLE 33.28.16.499,SW,SW 2322 PIERCE /ST. CROIX ROAD
z ry
•r
/� '1 "t �. 1�f � �i , �v,� � °r� � a*a � � �'d. '�' "�, �'�.. � > ��„� +,d .•` 7��r. T r ,!�....t_a..� ��` p� ,./ �--. � s.,
fey � yam' �7. �{ ,((_�
L4 1 ' 1 ,�.� / � I.l,� / • { / !.^ :.4 k...�.� % l.iAr 1
Plan revision ir�d? r ❑ YLZ [�No
Use other side for additional information. C/ 9
SBD -6710 (R.3/97) Date sped ' s Signature Cert. No.
Safety and Buildings Division
Iti sconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes ❑ Check if retbef t�ous a plication
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Name // Propert Location
'
e�i"a n 1 e_ ( u t'� rl s4/1
i4 TO 1/4, S 33 T2if , N, R «for) W
Property Owner's Mailing Address Lot Number Block Number
PO l3o /6
City, State / , Zip Code Phone Number Subdivision Name or CS �u ber
1 3 4r lda.r A �✓,`s 4_quo Z (7is-) GP �s3Zv lJo !2 / z
II. TYPE OF BUILDING: (check one) ❑ State Owned [I itr _ Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo _ J - qV - Go v
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of - 5_ ❑ Repair of an
System System Tank Only Existin Syste Existing System
------ -------- ------------- ----------- - - - ------- - - - - y----- y----------- y-- - -- g- y----- - -- 9 �- -
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12 []Seepage Trench 22 ❑ In Ground Pressure 42 Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI ABSORPTION S YSTEM 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
Ca acit
VII. INFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New Existin Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank r ? S� ' 4'4i es �C�rl ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamberl I I I ❑ 1 ❑ 1 ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber' ignatur Stamps) PRSW No.: Business Phone Number:
I Zy
-�`Z -3 Y ? S ? S �g� 22 66
Plum Addresl (Street, Cit ,State Zip Code): // r 5
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved jfinitary Permit Fee (Includes Groundwater D ate Issued IssuingAgent Signature (No Stamps)
Approved [:]Owner Given Initial ` I Q� Surcharge Fee) It G
Adverse Determination / OQ !�
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divisio , Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
f 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 property 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 -3151.
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
DIIHR.
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.
Owner's name San. Permit No.
H63.05 PLAT PLAN
Show:
Location of building served Nq Dosing chamber
Septic.tank Vertical/horizontal reference point
Nq Building sewer aA System.elevation is
ED Effluent system PR Well
NA Replacement system area Property lines w /in 50' of system
N A Distribution boxes Scale = , o dimensioned
�q - Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Mini. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan
3
LoT 1 t; —
w l^►l SAC ��l Ctr poa T
1
-F/
N
�,,, v rr.,`�- •P�LtU y
vi x �'M?TW Y-.
r^ ��vvg� -UU1V
7
,
8 sq. Sa'
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued,St.CroixCounty and theSt,6oixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
Plumber's si.gna ure License No. Date
llll � ve�t�w+rwaw 11JS"fhl.� VAcR,F1UUT PRpor
f l u SecT PRQcor
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t
I
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IS
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LN Lam' Ptx�p OV Zt� � LV G 6 �D
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585797 STC - 106
VOL 1351_ PaU381.
PRIVY INSTALLATION AGREEMENT
St. Croix County, Wisconsin .pv g
�J1 - ,r , \ MT Sy
PR I NSTALLATION AGREEMENT -COPY TO BEATTACHED TO THE SANITARY PERMITAPPLICATION
PropertYOnr(z)' Reserved for Recording Data
Mailing Address: 1,6S
1 3�'Z)ww WI svooz REGISTER'S OFFICE
ST, CROIX CO., WI
5k) 1, SW 4-, S 33 T 6a N W R 6 E o Rend for Record
city. village owns ,p L
6ftu_p' AUG 2 5 1998
Parcel Tax Number:
W8 )oqy- (to -iao 4:10 P M
toga Description: `Dr 3 OF esM 1N �;ret�as -P< t ` �,tj�
VOt-. ZZ. , CPptlse 3318 Re sfer of Deeds
OZkq
1. No plumbing will be installed 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 SO Ft 25 Ft Min. 75 Ft
Sealed Vault 25 Ft 25 Ft Min. 7S Ft
4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code.
S. 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, Wls. 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.
Pnnte ner s Name s
�1Z'Q PCt�I R OU N Subscribed and sworn o before me on this date:
Owner s gnatuce:
y Pubes
t
My commission erkp es
NOTE: This document was drafted by the State Department of lndustry,16bor and Human Relations,
Bureau of Building Water systems.
Wftonsin Department of Industry S AND SITE EVALUATION REPORT Page of 3
y Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
_ � COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S'fi GQOIX
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. 6O $ - `b 9
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R D Y DA
PROPERTY OWNER: PROPERTY LOCATION
'T�1 _. ?_* f�YW SU1�I ETLL� 1�— �LC� Q U l 1V _GQV -�eT 51 1 1/4 S W 1/4,S 33 T Z$ ,NR I ( E (
PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
i=1•o. 8ox �� S, 3 — e.gr -t vu�_ vZ 3318
CITY, STATE ZIP CODE PHONE NUM ER ❑CITY []VILLAGE (MOWN NEAREST ROAD
�'0 -D► I /.1 w S o o z Q f S7 68 -S3 'v
Ib New Construction Use 1>4 Residential / Number of bedrooms 3 [) Addition to existing building
Replacement [) Public or commercial describe
Code derived daily flow y1 SO gpd Recommended design loading rate v bed, gpd$ �fl trench, gpolft
Absorption area required ^ q bed, ft 1yA trench, ft Maximum design loading rate 1-� f* bed, gpdfit N`'A trench, gpd/0
Recommended infiltration surface elevation(s) 1'�' A It (as referred to site plan benchmark)
Additional design / site considerations Q•zr—a" K Ev17 y k j�_T PR I y y
Parent material C - n L%- Flood plain elevation, if applicable P A ft
r S = Suitable for system �� MOUND "ROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U Unsuitable for s stem ❑ S ®U ❑ S ®U ❑ S [AU ❑ S ®U ❑ S RU [IS U >
SOIL DESCRIPTION REPORT � -01n1G 1*0t fWT �7
FU1 N 51_P_V dV
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Bourxlaly Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed re�rtdt
RR �N _
1 O -8 l�`12 3� Z
t ak 1 sll z sb s es \ •s �
2 8 -� Iu�Itz 3�6 St, Z►n Sblt ��1 Cs VA • S ,6
Ground 3 2A- SLl R 31 � C�.S tzS f; Sc 0 Y►1`�►' - NP 2
elev.
to .$ ft.
Depth to
limiting
factor
Z C)
I
Remarks:
Boring# �,g� CS 1� -S � • �
L LI z 4 - �' 1 bby1Z3�<o _ sil 3�sb>t �� CS lv� • s .�
Ground 3 11 33 S `� R 3 ez• Z
elev. w r',
1 -o ft
Depth to
�
t
limiting
_ sr C g 8 w
factor
..
Remarks: -
TName:— PleasePrint Phone:
Arthur L. We erer 715 -425 -0
egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Sgnature: qB— L 8 Date: —Z — p CST Numb 00 5 7 6
PROPERTY OWNER V 1fV SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # 0 0 $ - 10 0 1 - Q O — 2.00
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
in. Munsell
Qu Sz. Cont. Color
Gr. Sz. Sh. Bed Tnench
3 0 -9 lo-.R- 312 3 �1 s h cS • S - 6
Z lrs `1it- 3 1` si 1 Z `�'sb d �S 1v� • S .6
Ground 3 )y 3 S �• S `i (z 3 l Y C 1 ..S`t2 S I'd s c
elev.
1�a •� ft.
Depth to
limiting
factor
Ll
, r '
1
Remarks:
Boring #
�o olv LITS w - U v
Ground < \4 " Mo t_Jh/6
elev.
ft.
Depth to
limiting
i
'factor ;
Remarks:
Boring # ,
Ground
elev. i
ft. '•
Depth to
limiting
factor
i
i
Remarks:
Boring #
` Ground
elev.
ft. ,
Depth to
limiting
factor
Remarks:
SBD- 5330(R.05/92)
PLOT PLAN Pa 3 of 3
n SCALE V'= 1 40
o ��T R� siku
00 Br'l Z
tZ- l0 6. °
$•Z
0
8,3
to
t�L Lot
v+
M
7
i
LYL t00.0� obi � tr UN LPt
of STEEL F-J c ti -
i
u6Z 8s14.so,
`ho
23 Sr
( 715 ) 4 .5 -n1 65 M00576
CST Signature Date Signed Telephone No. CST #
V r.
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
O UYER 'r1z Wz -R hJ G(�:
MAIINIG ADDRESS
PROPERTY ADDRESS e� l'2 rc
(location of septic system fian the Planning Wt
CITY /STATE
PROPERTY LOCATION S1 1/4, Sw 1/4, Section 33 � T �`d N R W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION —' LOT NUMBER
CERTIFIED SURVEY MAP 5(.3 )g Z , VOLUME N , PAGE 331 , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------
Owner of property
Location of property SW 1/4 Sbv 1/4, Section 33 ,T 2- N -R L W
Township N� G A- Ll? Mailing address
� fox l6 S - D�vl ,
)-J) SVDOz
Address of site
Subdivision name C s Lot no. '-
Other homes on property? Yes No
Previous owner of property - y--1 tx3xj(� (IyT1A/GqR
Total size of property 39. $
Total size of parcel Z S . 7
Date parcel was created _ �" 3 l , L 11 9
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes L-- No
Volume 1 and Page Number _ Z � as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, 'by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. S (3 L{ P y qI , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co- Applicant
Date of ign ure Date of Signature
STA[E BA-R Ol WISCONS(N FO !> 2 _ 1982 f
II WAP �i DEED �q +
DOCUMENT N0, i
III
�1
Tyr on e E. _ q
$T. CPO!x
� Tyxv Otting a sit _ale p� rsCU't II i' I • • CO)" �1
AUG
conveys and warrants to r iY3r SJ1 A Pela u n s � jf+ S I 1:30 P
�Pel i hus a ria - �E'. J I '
THIS SPACE RE$rRVED FOR AECORDIN., DAM
NAME AND RETUAN APCAI;S.'
the following dmribed real estate in _qt- Qr County,
State of Wisctmsin: f a. 4( 2 1
t
8 -109 4_ -4 -000
PARCEL ID6NTU+6ArrON SUM8ER
I f
Lot 3 of Certifier) SM-ley Map filed July 31, 1997 in Vo lume 12 of Certified
SurveY Maps-, Page 3318, located it, SW 4 of SWA of Section 33, T28N, R1 6W, Towr
of Eau Galle, St. Croix County, Wisconsin. u
TRANSFER
If I
I '
I
This— is Mt homestead prt,perty.
a 40 t
Exception to %-, mdtrtics: Easements, restrictions and rights -of -way of record, if any.
' Au slr A.D.. 19 8
jj Dated this.. ..._ .. day of 9
_, ._.._� ... _, �. _.. I{
(SEAL) _ <' �' G'' { L (SEAL) I
nTorle
I
(SEAL) I�
I
i1
I
AUTHENTICATION ACKNOWLEI)IGNIEN r
ii
I j Slate of Wisconsin
�I $ignaturc(e) r
St. Croix.
County. Ik
i authetrtiratcd this day u1 _.,. _. l9_... re�xtally came bt•foie me this 1 1t17 ..,— day Of l
she abotc named j
• I" 0 1 P_ r ,tyn
I`
IM P NtLNtDrR STAFF TSAR OF WISCON51N _
I �!
(If trot, — ....._ —_ ___ .... _ : _... ...____ •...... • - - -• I
(1 authorir.etl by §706.06. Wis. Scats.) Bct"nda Pu'�� � to Ix the p Son -._who vxecutrd the fixegoinh
Notitry Pu t t�
.I , " -- • .= and ackr+o c
W dg? zr,.
the ye.
1 THIS INSTRUMLNT WAS DRAFTED BY State of ,� c.�
Atto Krishna Og1
f ends Po
Hil -son WI 5 4016 NId i c, County. W IS.
(Signaturc, may be awhentivated or ae crnrvledged. $,,nh ate nut +:y :�., MmLSsion is permanent. (11 n / 1 ,, state espira6nn data.
�� nt�••S.�.zry.) __ _ ! 1 9
• r4amoz of pcmvi clgnuig in an) cipoklI; :hoc. id by .),xd nr pnN4 Sr1aw cliff,, agnan-rn
STATE RAK PF ��'1 , ONctti °;[nr:r•i Lr�:P � v L'a ,ire.
I
WA RN. TI' DI•Lil F1,rm No ]
i
8 FILED
JUL 3 1
1997 ►
L ff.
ReOIsterof Deeds 2
SL Crobc Co., m
Ss3182 �
CERTIFIED SURVEY MAP
BEING THE SW 1/4 OF THE SW 1/4 OF SECTION 33, T28N, R16W, TOWN OF EAU GALLE, ST.
CRO I X CO., WI.
PREPARED FOR TYRONE OTTINGER
WEST QUARTER CORNER
Z SECTION 33 - FOUND NOTE: BEARINGS ARE
10 w 3i4" REBAR REFERENCED TO THE WEST
LINE OF THE SW 1 /4.
�ot°I ( ASSUMED BEARING)
o'er UNPLATTED LANDS
Im WEST LINE OF THE SW 1 i4
I 466. 69' S ° 42' 54 'E g'
433.55 1 320. p
I 33. ! 4' 853. 40'
1 286. 95' -
33 33' HIGHWAY
100'
`SETBACK LINE
I I .
o Ow Ow
� � ` �0 r
° Arnow O
:O I_w0)
Cn
0 0D
n
w _
I
o �c
:v m �� W N Z G
: Io I m •°� m y n O 0$N :D
> n m :-�
z I O cn y v "' : rn
N O S84 ° 42' 00" E y y
p 466.70' W r
I O
rn 3 3 14, 433. 56 $ z
r.
mm�AN 8 :°
Co
00 I� m N�OOO
V � n
rn no �
I 0 1 m . N 0) ` HIGHWAY SETBACK LINE
6 s y �......... ....... .
433..56' .4 1 288. 06' .. w
io
466.
"-- • • • .. 854 O'
_N8g°42; Q0, 854.5_' .. ..-_
l32 /. 22 _ l32 /.
SOUTHWEST CORNER PIERCE -ST. C _ N8 ? - 4
SECTION 33 - FOUND • ............. Rp,�/ -_ 00 "w
COUNTY MONUMENT ••••.•..
' I �A?R ATTED LANDS �,.,•,�, SOUTH QUARTER CORNER
j I I SECTION 33 - FOUND
COUNTY MONUMENT
APPROVED 0W%$
0 SET I" X 24" IRON PIPE WEIGHING AI 2 6 '97 ��^ JAMESIlt. �
1.13 LBS. PER LINEAR FOOT. w1EeEiZ
ST. GRGili "1' 8. 1 804
Comprehensive Planning SPRING VALLEY
Zoning and ` Wis.
1"-250' Parks Committee �' •
JA
If not recorded NEL SE E Y 1 NG
I® within 30 da of DATED
0 50 250 500 SHEFp�
1�a s�k{i511t
97087 THIS INSTRUMENT DRAFTED BY JIM WEBER null and void
Vol. 12 Page 3318
i
t
DESCRIPTION
A parcel of land located in the SW 114 of the SW 1/4 of Section 33, T28N, R16W,
Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows:
Commencing at the West Quarter Corner of said Section 33;
Thence S00 °00'00 "E along the West line of the SW 1/4 a distance of 1319.35' to the
POINT OF BEGINNING;
Thence S84 °42 "E 1320.09
Thence S00 0 02 1 52 "E 1319.81
Thence N84 °42 "W 1321.22';
Thence N00 °00 11 E 1319.36 to the point of beginning.
Contains 39.84 acres (1,735,214 sq. ft.) subject to Pierce -St. Croix Road right -of -way
over the southerly 33' and subject to 230th Street right -of -way over the westerly 33'
thereof. Also subject to any and all additional easements, right -of -ways or
conveyances of record.
SURVEYOR'S CERTIFICATE
I, James M. Weber, registered land surveyor, hereby certify: That in full compliance
with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of
the St. Croix County Subdivision Ordinance and under the direction of Tyrone
Ottinger, I have surveyed, divided and mapped the above described p oft%nd
and that this map is a correct representation of the boundary ther C,�p/V�
y
J e
Dated this Z'1� day of r��,y , 1997.
C SPRING �
Z L
James M. Weber S -1804 EY /
NELSEN- WEBER LAND SURVEYING i
O �
NOTE: The parcels shown on this map are subject to State, County s,
rules and regulations. (i.e. wetlands, minimum lot size, access to parcel, etc). Before
purchasing or developing any parcel, contact the St. Croix County Zoning Office
and the appropriate Town Board for advice.
SHEET 2 OF 2
97 -087 This instrument drafted by Jim Weber
Vol. 12 Page 3318