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C I z a I 3 CD ° nom o a N ° z �?CDO3s y :3 C: '< -0 EF =3 =3 Q O 0 7 y a jO0' CD 0 3 0 (n - �. ° CD w I CDv W as ti ° 6 ° cn v I I SOj a 0 A I CD CD Dc O m ti O CD I o O p CD o b ° o o C- ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Ad ess City /State 1 u W W ovt o Legal Description: Lot Block Subdivision/CSM # /V '/ ' /a, Sec. q , TAN -R 17 W, Town of 1a a PIN # -IM — �U SEPTIC TAN DOSE CHAMB -- HOLDING TANK INFORMATION: Tank manufacturer e M Size�ST/PC' / ? Setback from: House Well a P/L � Pump manufacturer &zot Model VII (5 , 2'941 1, - Alarm location (HOLDING TANKS ONLY) Setbacks: Service ro ent to fresh air m ate�Line� Meter locatio Alarm loca n SOIL ABSORPTION SYSTEM bU Type of system: b vi Width � Length �_ Number of Trenches Setback from: House (? Well :S& P/L tW Vent to fresh air intake ELEVATIONS Description of benchmark �r C - Elevation Description of alternate benchmark Elevatio Building Sewper�,, ST/HT Inlet 3 3 ST Outlet �— PC Inlet PC Bottom 0" 1 3� Header/Manifold Top & Manhole Cover Distribution Lines O 10a .a.- O ( ) Bottom of System ( ) () ( ) Final Grade () () ( ) �� , / `C Date of installation /21 /� erm><t number State � p lan number 7 9 (O (0 Plumber's signature - DP<L E k D _ License number �5 Date Inspector Ri r A Complete plot plan( � l� � �� , Cro1� C,�v �►' �� P ' � � �� t � its -bur 1f 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 ole cover. • Show alternate benchmark, if applicable. / 1 7 � �d PLAN VIEW C !.� q u z , •`wi INDICATE NORTH ARROW S -- uc 1.4u Q�1� /� O to to !e % %'�, „ '�^L V ic?) — � rJIV `4 5 I • V06onsin Department of Commerce PRIVATE SEWAGE SYSTEM Count f Safety and Buildings Division bT . CROI X . INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarjNTi V-: Persorial information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)]. HANSON CHRIS /HANSON, JON CiE y lwmp Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel &24Q:1015 - 30 - 000 ��v L00 T Z� ,i I ✓or i TANK INFORMATION I' ELEVATION DATA A9800203 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing �/ 1 7SOa .J .12:� /0' L C4 Aeration ` Bldg. Sewer DSO 59 ' C IS' Holding St /It Inlet q3 • 3 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake 0 1 2 j , 3 a?. Septl � NA Dt Bottom 3 Dosing �� t �j J NA Header / Man. o? Da Aeration NA Dist. Pipe /OSO� ;7s J0':; Holding Bot. System � PUMP/ SIPHON INFORMATION _ Final Grade Manufacturer " Demand ``� �b �5• i,t « � _. �� S 9 9 Model Number 31-OGPM I I SM 5.0 /OS O/ /(� TDH Lift gf,, Lriction� System TDH) _,A, f �j O1 f Forcemain Length Dia. '' Dist. To Well SOIL ABSORPTION SYSTEM BED / R NC Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMN I Z DIM SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING manufacturer: SETBACK CHAMBER INFORMATION TypeOf 1KAr1.., , //-- o e m Nu . System: OR UNIT DI RIBUTION SYSTEM /Manifold , Distribution Pipes) ➢ x Hole Size x Hof Spacing Vent To Air Intake Length �= F Dia. � Length � Dia. '� Spacing � r '/ g� 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 E) Yes [] No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: PLEASANT VALLEY 9.28.17.82,NW,NE 1753 CTY ROAD Z lJl OKS;i — � 7,30 ( — "W�11 �bcc.. 4 •eKCd`vacincs v on vno�..�cl u�oq, 1�c�/�►�1 — QavtS'rd✓1 ,� JQ>.�3 99.5' gq.ls /" &Ovv^ �� , f f 0 �, (� 3 te, c,W G��GYr��'l�Yl �, y . � 5!r B 1 s• (0 �p a 1/�ee ' Sad . 1o1ls`lle ✓ �+en.�G�ytf a,►-(� 3 . S� •=1 o d' t�•eQ� caactii Plan revision required? ❑ Yes (( No �� Use other side for additional information. y 7 SBD -6710 (R.3/97) Date Inspector Signature ert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i I, I � =ti ti Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 \* 6consin Tommy G. Thompson, Governor Departm of Commerce William J. McCoshen, Secretary September 04, 1998 CUST ID No.6306 ATTN: POWTS INSPECTOR BOLDTS PLUMBING AND HEATING INC 820 MAIN ST PO BOX 87 BALDWIN WI 54002 (af RE: CONDITIONAL APPROV APPROVAL EXPIRES: 09/04/2 D Identification Numbers Transaction ID No. 78669 Site ID No. 7325 SITE: Please refer to both identification numbers, Site ID: 7325 / above, in all correspondence with the agency. !;E St. Croix County, Town of Plea NW1 /4, NE1 /4, S9, T28N, R17 Joyn Hanson FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 17972 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: • The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. • A 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. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/07/1998 FEE REQUIRED $ 180.00 &RD M SWIM , POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JSWIM @COMMERCE. STATE. WI.US Page/ 0f6 Straw, Marsh Hay, Or Synthetic Coverina AST CS Distribution Pipe Medium Sand Topsoil H F �c 3 E a % Slope Trench Of 2 Force Main Plowed Aggregate From Pump Layer Undisturbed D Ft. Soil E , /Z Ft. Cross Section Of A Mound System Using F r 75 Ft. 2 Trenches For The Absorption Area G /,c% Ft. A y Ft. H /•) Ft. �,� J B /oo Ft. � Signed: c (�_ Ft. �® License Number .220853 K /0 Ft. Date: �- 9 _ 9g L 12o Ft. J g Ft. Alternate Position of Force Main I // Ft. �.. W F L jA IF �-t B K C —_ -- —_ — _ _ —_— Force -- — — — 0 — — — Main W 0 servation Permanent Pipes Markers P.o �W o ly 011ji • M M V) Trench _ Trench Of C� 2 2 2 ' Q Co M ►�► Pipe Aggfegate �0► PRj MEN D P E E p1ViSi E P S CO Mound Using 9- Trenches For Absorption ti p on Area Page Of Distribution Pipe Detail For A Four Lateral Network Alternate Position Of End Cap / Force Main .\ P % PVC Distribution Pipe PVC Force Main P X-.., Moles Equally Spaced PVC Manifold Pipe On Bottom X S t X X 2 * Last Hole Should Be Next To End Cap * 1 T P Y9 Ft. S 1p Ft. X Inches Y 3I Inches Signed: /,� � - �L, Inch License Number: ZZOg S,3 Hole Diameter A Date: i Lateral Diameter /Z, Inch(es) � g �� Manifold Diameter Z Inches Force Main Diameter Inches I Holes Per Pipe 3 Invert Elevation Of Laterals /D/. Ft. L Page 3 Of 5 COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI Vent Pipe with (No Scale) Approved Cap, +25' ; Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof Approved I Warning Label Junction Box Vent Cap 12" Minimum Final Grade -� 6" Minimum 4" Minimum 6" Maximum Quick 4" C. I ' ' Disconnect 18" Minimum Insp. Pipe -- I 1/4" Weep � Hole Baffles nn � �L� i i Approved Joint i A w /C.I. Pipe Extending 3' Alarm B Approved Joint Onto Solid Soil On , w /C,I, Pipe C Extending 3' Onto Solid Soi Off 6 D Conc. Block E " /e v, 87 I�Lw 3" of Bedding Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: `f Per Day Gallons Per Day /�fio 1 Doses: /�D Gal Ions Volume of Backfl ow:.......+ gsc4 Gal 1 ons '55 Tank Manufacturer: 44,)e i 's e. r Total Dose Volume: ........ 7 Gal l on•Zs c 5- Tank Size - Septic /Pump :_/ZSO 50 G allons ons �� z2e . 95 Alarm Manufacturer: �c 7-1 Model Number: -q Capacities: A inches or Gallons Switch Type • • r c u r „+ B - Z — inches or Gallons Pump Manufac ao : (3, + Chinches o ZGallons2C)5 Model Number • G�JE' 5'ta + D 2 in ches orGa1 l on Minimum Discharge ate: q , b Total....._ inches orZ 9y ,7 Gallons Vertical Difference Between Pump Off and Distribution Pipe: / Feet Minimum Required Supply Pressure:... .............. • ....... +Z, .5 Feet /50 Feet of Force Main x /- 5,q Friction Factor /100Feet: + 3 _Inch Diameter Force Main Total Dynamic Head: ... = Feet 17, 13 6 Internal Tank Dimensions: Length,? ; Width g4 Liquid Depth Si gnature f. License Number ZZO & 5 Dat I A oil 11951111111111i oil %9vgm■■■ ■■■I �■■■■■■0■■■ ■ ., 00" MEN= ■■■■11111111 �■ ■■■11111111 2 MRS, com MENEM offinulkNo MENEM ■i�'��i�� ■i��ii�i��i�ii�i ■ ■■■d■■�i■■nii��■n ® ■ice. it•i ■ ■ ■ ■1 ■ 1■■■■■■■■■■ ,,.■ ■pia ►� ■ ■ ■ ■ ■I 1 ■ ■ ■ ■� ■ ■ ■ ■■ • �■ ■fit ■•� ■ ■ ■ ■ ■ ■ ■ ■� ■ ■ ■ ■ ■ ■ ■ w. •, ■ ■ ■ ■ ■ ■�� ■.� ■ ■� ■ ■� ■ ■ ■■■ ■■■■■■■■■NN■■■■■■■■■N■■■� ■�T.- !*M■■■■ ME! ■NM■■■■■■■■■■■■ ■■■O ■ • r ct ,Po1. Z - a w• Z4 N �, O o • 0 ro c� Q w w 0 A 4 ; y' b o � � W 3 to � ° 0 y t oo 00 Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 Box ashingtonAvenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • AttaLh complete plans (to the county copy only) for the system, on paper not less County than 8 v2 x 11 inches in size. S�"` • See reverse side for instructions for completing this application State Sanitary Permit Num er Personal information you provide may be used for secondary purposes heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. /763 U 3 Rd. Z State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION I # ;; , . a 6 - Property Owner Name / Property Location /4 A1,E" 1/4, S T Nr R /7,1 ( W Property Owner's Mailing Address Lot Number Block N� }b 1 C/ G? I^ -SOr� � r� > / /v City, State Zi Code Phone Number Subdivision Name or CSM Number l� (75' ) 796 -Zzy l3 31�0� II. TYPE OF ffUILDINU*. one) ❑ State Owned ❑ It Nearest Road y Cj Public 1 or 2 Family Dwelling - No of bedrooms ° Tow OF ePSQnI zlk Cf' > 4C0/. III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 9 a9. 17-3A 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 ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ------ -------- ________System__ __ Tank Only Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number .3 /I 2V Date Issued 1 _ V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 2,t4!1Mound 30 ❑ Specify Type 41 ❑ Holding Ti 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Priv 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Fini Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i h) Elevat G DO 1 -5'p o j Da /. 2- /V f// • 3 Feet /03 Capacit VII. TANK in Ca gallo Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin Tanks Tanks strutted Septic Tank or Holding Tank ESQ j> Zo OD � � s r - ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber r ❑ ❑ ❑ ❑ I ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Pfumber'sSignature: (No Stamps) MP /MPRSW No.: Business Phone Number: ct /c Z% " i�c L , i,-- i4 aA AV 22085.3 715- G8 -33 Plumber's Address (street, O ,}tate,Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Ag ntSI Approved E] Owner Fee) Owner Given Initial 9 Z 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 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: I. Property owner's name and mailing address. Provide the Legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required b the county; E) soil test data on a 115 form; and F) all sizing information. p Y q Y Y 9 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 Division 1 SANITARY PERMIT APPLICATION 20 W. Washington Avenue NTI;consin I n- accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 •• Attaeh complete plans (to the county copy only] for the system, on paper not less County than 8 112 x 11 inches in size. c,. • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes 5eheck it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. Z State Plan I.D. Number 1. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATI N I } 7 +� Property Owner Name Property Location �h 50 Yom-" 14 NE 1/4, S T Zg , NOR 17 4(o W Property Owner's Mailing Address Lot Number Block Num e�j d Q T /GPI^ Soy- J� vr. City, State ip ode Phone Number Subdivision Name or CSM Number A/0.-""YJan. LG � ( 71 5') A76 -zZY 1 11. TYPE OF B ILDING: (check one) ❑ State Owned it� Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms � V own pF T /e —S V Cf T of U III BUILDING USE (If building type is public c heck all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo V 3 S. 17. g a 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. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________ System_____________ Tank Only______________ Existing System _________ExistingSystem e I B) ❑ A Sanitary Permit was previously issued. Permit Number _31501 Date Issued 1 _7 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. /in h) Elevation Soo G3 Feet 103- 3 eet VII. TANK Cap acit in gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank Z51 ,U �'�� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No,Stamps) MP /MPRSW No.: Business Phone Number: Plumber' Address% S1;reet, City State, Zip Code):, i z� t'tsf / 5 �j r 7e_ O IX. COUNTY / DEPARTMENT USE ONLY ' []Disapproved Sanitary Permit Fee (Includes Groun water D ate I ssued Issuing Age t 54 tam Surcharge Fee) 'Approved ❑ Owner Given Initial ,E — 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 i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a.time of renewal any new gcitpria 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 / ReneWW'Form (S6D -6399) to be submi t to ttw-k 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 h ,l I description n r m r f r the r. Provide t e e s de n t o and parcel l x nu be s o wh n mailing dd ess o de sc eta e e I. Property owner's name and ma a g p p O p Y 9 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 thatapply. ; IV. Type of permit. Check only one on line A. Completeline B'if permit - is fbr 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. V111. 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 Iors hors tanks; distribution boxes; soil absorption systems;'replacement system areas; and the location of the building servfd; 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), crosssection 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. SANITARY PERMIT APPLICATION 7DILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERM # MENNO 'Attach complete plans (to the county copy only) for the system, on paper not less than x 11 inches in size. ❑ a's'? l 1 12 cn if revis on to revwua application 8 -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INF MATION - EASE PRINT ALL INFORMATON. PROPERTY OWNER P i S ffa PROPERTY LOCATION pP?SO Soh A1V Y4 AoW Y4, S T,zg, N, R 17 8 (or W PROPERTY OWNER'S MAILING ADDRESS i LOT # BLOCK # , /� �Gd6 � Cj OrG �6O► -570k bl-J, �V CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 1( 7/5 7% - 22 II. TYPE OF BUILDING (Check One) F state Owned CITY ��PL�S417/ l✓A� NEAREST ROAD ❑ Public JR 1 or 2 Fam. Dwelling of bedrooms EL T AX NUMBER(b) Ili. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. � New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 � [:1 In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 45049 1 5L00 S'b Z� /VX 1 Feet A03. Feet VII. TANK CAPACITY Site in ga ons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks 1 Tanks structed Se tic Tank ZC 145 v LiftPum Tank/ r 000 1 . RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: D Ic ' C ' >~ , �' pis 68� -337 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater a Is Issued Issui Signature (No Stamps) Surcharge Fee) & Approved ❑Owner Given Initial /�/� Adverse Determination l� V X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) Safety and Buildings 2226 ROSE ST LA CROSSE Wl 54603 -1905 N viiconsin Tommy G. Thompson, Governor Depa of Commerce William J. McCoshen, secretary May 27, 1998 CUST ID No.6306 ATTN: POWTS INSPECTOR BOLDTS PLUMBING AND HEATING INC 820 MAIN ST PO BOX 87 BALDWIN WI 54002 RE: CONDITIONAL APPROVAL Transaction ID No. 78669 APPROVAL EXPIRES: 05/27/2000 SITE: Site ID: 7325 St. Croix County, Town of Pleasant Valley NWI /4, NEI /4, S9, T28N, R17W JOHN HANSON FOR: Description: MOUND Object Type: POWT System Regulated Object ID No.: 17972 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. Adm. Code. • 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. 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. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, DATE RECEIVED 05/07/1998 FEE REQUIRED Q $ 180.00 BARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JS WIM @COMMERCE. STATE. WI.US P.o.w.T.s. Condi� APPRnVED t BOLDT's i�VLL 1 UV L1J 1 Aai.AW J.4" A. PLUMBING & HEATING INC. "Serving You For 40 Years" 820 Main Street Baldwin, Wl 54002 (715) 684 -3378 Fax (715) 684 -3144 page of S v Z 8 6 6 9 Date: Mound System For A 4 j3edroom Residence Located in the NlJ /4 of thel 1/4 of Section-?--, TUN 9 1111 W; Town of P/e Asa/�f L /-0 //e ' , C e-O ,' x County, Wisconsin. Index R ECEI VE p _ � Page 1 of 8 Title Sheet SAFE r �1AY 198 Page 2 of 8 Plan View Cross Section l v Page 3 of 8 Distribution Pipe Layout Page 4 of 8 Pump Chamber Page 5 of 8 Pump Performance Curve Page 6 of 8 Soil Evaluation Report Page 7 of 8 Site Plot Plan Page 8 of 8 Mound System Plot Plan Prepared For: O p, ^ O ;A DEP _ ARTMENT OF COMMERCE Of 7Y 1N" /5G 5 La ✓.s S ° � ✓''� &� , • CORRE DENCE Prepared By: Dale Hudson Certified Soil Tester / Master Plumber #220863 1 BOLDTS PLBG. HTG. Fax 715- 684 -3144 May 26 '98 06:51 P.02 Page.Z_Of L_ Cross Section Of A Mound Using .A Trench:For:,The Absorption Area Medium Sand Fill � 1 F 6" Topsoil E D. Trench Of - 2h" Aggregate, Plowed Layer 6" Below Pipe, Covered With 0 Ft. Straw, Marsh Hay Or Synthetic Fabric E .off Ft. G A6> Ft. F Ft. H /. :�r Ft. Plan View Of Vund Using A Trench For The Absorption Area Force Main Distribution Pipe Fit e r Permanent Markers Observation Pipe W 4� l K II T� Y I Trench Of � - 2 Aggregate I A + Ft. I Irk Ft. K /Q Ft. W Z3 Ft. B Ft. J Ft. L /51 Ft. Gt 7'Y��o -..� license Signed: Number: Z Z O� �,� Date: 5 -.Z4- 9o' DOLDTS PLDG. HTG. Fax : 715- 684 -3144 May 26 '98 06:51 P.03 - 5 at ZS I oistribution Pipe Detail For Two Lateral tletwwork s Holes Located On Sottom pyC Force Main End Cap Are Equally Spaced }� X X P11C Distribution Pipe Y p P X r last Hole Should Be Next To End Cap (04`5 ly Inch P Ft. Hole Diameter r Lateral Diameter y Inches) Inches "— Y Inches Force Main Diameter Inches # 0f Holes /Pipe Invert Elevation Of Laterals 40/ ►5 Ft. Signed: License Number: Number: Z Date: 5'— 2e; �q I BOLDTS PLBG . HTG . Fax : 715- 684 -3144 May 22 '98 13:50 P.04 M J ' g O PumP CFiA.r^.GE.R CROSS `_EC . 10'J AQ0 SPCCIF IC.AT VCQ*T CAP `I" C.I. vE�,IT PIPC WCATUFRPROO> arFRpVEO LOC /..�lC. JUUCTIOU OOX MAIJHOLE COVE P. ? z5' � ROn GOOK. IE "MIU. WI/JDOW OR FR ES W 1 AIR IWTAKE I GRADE 16' MIN. COWOUIT �-"" ---- - - - - -- PROVIDE — INLET AIRTIGHT SEAL I II v APPROVED JOIIJT A I I I I I APPROVED JOIIJI I ALARM EXTcmoIlJ6 3' I I ONTO SOLID S01', G I I OIJ ELEV. a FT. - PUMP -� -_1 i I to . 0 fr - I D N COLICRETE BLOCK I RISER EXIT PE.Rr lTCED DULY IF TA►JK MANUFACTURER HAS SUCH APPROVAL SEPrIc E SPECIFI'CA7;I0MS D06L I' 'TAWKS MAEJUFACTURER: "� re WUM OER OF DOSES' PER DAU TAWK SIZE: �1 °470 GALLOWS DOSE VOLUME ALARM MAIJUFACTUKER: �' G O INCLUDING 6ACKFLOW Z - GALLONS AIODCI 1Jl1MpER: r f - CAPACITIES.' A=/ ORl- Zf' # / - ? 40 GALLONS SWITCH TYPE: /�erG�tr'Y g= IIJCKES OR GALLONS PUMP MAMUFACTURCR: u c = S��Y uJCME5 OR 'd C,ALLO►JS MODEL NUADER: , � ,/ � y3 � D INCHES OR - 4 ' 7L GALLOWS gW -r /� /c Y G MOTE' PUMP AWO ALARM ARE TO DE P1INIMUM DISCHARGE RATE -f �� y GPM / INSTALLED OW SEPARATE CIRCUITS VEKriCAL DIFFERENCE DETWECN PUMP OFF AUO DISTKIDUTIG" PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE / . . . . . .. . . 2 • 5 FEET 4. !.3 - - FEET OF FORCE MAI/J X FX.o rtFfKlCT 7 I0U FACToi -0 8 FEET TOTAL 0y1JAMIC. HERO = � _ FILET WTERWAL DIME.AJSIOWG OF TAWK: LE`JGTH f ;WIDTH �� ,iLIQUIO OEFTH ILI� 7 Z d r 0 3 SIGUED :- Ge+c T7 110E1JSr DUMBER: DA7E: ZZ -� � r — { } �oh✓1 Q�so� — e4 F — Bulletin CL2.1A, July 8, 1983 • For Homes �� • Farms • Trailer courts Model 3885 • Motels (Supersedes Model 3870) • Schools Submersible M • Hospitals Effluent Pumps Effluent Pump • Industry • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to'_'" or drainage must be Discharge Size z" NPT. disposed of quickly, Semi -Open Impeller quietly and efficiently. 3 vane design. threaded on sna units use impeller locknut to pre:•:- t a back -off. Pump out vanes on bacxside o` for protection of mechanical spa' Casing Volute type for maximum efficieoc/ Stainless Steel Fasteners Heavy -Duty Solids Handling Series 300 stainless steel for r r Dependable Capability to 3/4" resistance. �►�✓ Mechanical Seal Ceramic vs. Carbon sealing faces, stairieQ- spring and Buna N elastomers Maximum Temperature 1 /3, 1 /2 H. P. 60 Hz 160 °F. Capable of Running Dry Single Phase 115, 230 Volt. without damage to components 11 a Motor Specifications 1 /2, 3 /4, 1, 1 H .P. 60 Hz Motor Fully Submerged in high grade turbine oil for permt;i Single Phase 230 Volt. Three Lion of bearings and mechanical seal ai d Phase 208 -230 460 Volt. efficient heat dissipation. Motor sealed fr . environment by rugged cast rc Bearings Heavy -duty all ball bearing coast Stainless Steel Shaft Series 300 stainless steel for cc:r ro:i, resistance Threaded shaft. Single Phase Units 90 All Single poase units 11)ve overload protection with autom3'c 60 Three Phase Units Overload protection in starter unit 2' ?b 460 volts Threaded shaft 60 Hz operation. W 70 Power Cord W Water and oi! resistant. Epoxy seal on mots u r 60 acts as a secondary moisture barrier in caso c? Q damage to outer jacketing. Corrosion re'sis'ar', X 50 gland not U Single Phase Units a 40 1 /3, !h H.P models equipped with 1 of 16 Z SJTO with 3 -prong grounding plug ':. 1. models equipped with 15' of 14 3 STO pov ci - cord. H F O 20 SPECIFICATIONS ARE SUBJECT TO CHANGE 0 WITHOUT NOTICE. 0 0 10 20 30 40 50 60 70 80 90 100 110 120 [q GOU LDS PUMPS, INC. GALLONS PER MINUTE l�J SENECA FALLS NEW YORK 13148 M ` ' Wlsconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page P L of Bureau of Integrated services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete she plan on paper not less than 8 1/2 x 11 inches in size. Plan must County not : vertical zontal reference point BM direction and �� ' include, but limited to rti cal and hori poi ( ), �T �� , C Y a 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all informatlon. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location 7 t, TYart.SO Govt Lot /l�/�t/ 1/4�1/4,S 9 T Zg ,N,R 8 (or� Property Owners Mailing Address Lot # Block# Subd. Name or CSM# /-5'6 5 - ✓/ s A I City State Zip Code Phone Number ❑ City ❑ Village Nearest Road Arr�ino�C� Gr�.' (7is) 79�- Z2 /.� e as a✓:� Ct , Pr..� Z 0 New Construction Use: ® Residential / Number of bedrooms Addition to existing building �✓� ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6dQ gpd Recommended design loading rate ' Z bed, gpd/ft •3 trench, gpd* Absorption area required - SOO bed, ft2 560 trenC Maximum design loading rate ' S bed, gpd4t 6 trench, gpd/ft Recommended infiltration surface elevations zo ft (as referred to site plan benchmark) Additional design/site considerations ^ i< Parent material Si l- �, 5e C4 m G 77 Flood plain elevation, if applicable A S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 19 u I 0S Cl u EIS ®U ❑ s o u I ❑ S A U ❑ S - , R u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 6 -5 /4' 3 Z A le r 5 1 SL m y- AS 2m •Z. •.3 Z 6 -1- 1 toY7 5 1-V o 4 C , 2 in A ei,7 4,r- cs Z ^2 . 6 Ground 3 V -31 10 YA ! /9 /Jo C, 2,* .TgK 'e n ✓-Jr,r C w / el8 C2 cj '7 yie SC C r N ' ! "�" • Z ' 3 Depth to limiting factor �in. Remarks: Boning # _ , SPY /z e,, s," s6 vhf a S 2- .Z .3 Z- zom 6 1Y a 3 loy s a n i f , mv -(. - C W j '• Ground 3 Z /d/ ' C Z n/ '7.5 y 5 $ C f / - Fv - elev. Dep to factor .TZ in. Remarks: CST Name (Please Print) Signa re Telephone No. ale 1C. a c -, S ;M �. -�' c co� o-✓ �. ' ?/_ -69 Address Date CST Number �Z C� n ; , 5� . Q co , ►,- Z o PROPERTY OWNER �� I/JSOI'i SOIL DESCRIPTION REPORT Page ' '• V of PARCEL I.D.# Boring # fiorizon Depth Dominant Color Mottles Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench 3 / 0-/ /D y/<' z /Vo s' "K 1n ✓ it QS m 3 -/3 75 YA � ow e, Zen S M ✓ Cs 2 , * 5 ; 16 Ground 3 3 3 , 5 % oA' s� ,z �» S 7� m ✓-�' C t.J Ap • 5 . i d elev. g r. 1 7 ft. 0- /OYJe S 1,5oyg SG 1C r /"-P, Z, : ' 3 Depth to limiting factor 36 in. Remarks: Boring # Li Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench Boring # L3 Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) cf"y col co C 3 n fl a 0 0 Q w W 0 �z N3 LA N X al -a .D IA -v tA BOLDTS PLBG . HTG . Fax 715- 684 -3144 May 27 '98 08:54 P.02 ..� M a � o N � //mi-� \ '�► 0 � o v o q o• � •Tip -- .� t a � � o i 4 w Z DC � r 0 •� 7 M M d d o � o z a Ci vc 11 Q d z 1 �� v R1 Q• Q o p It 0 a z 0 0 c� Q w W 0 T � A � o 3 LYI (� tA Gz.. s tA •s N w 3 W isconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and - �_ ' 2 ! percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # • 1 J/ a4 p APPLICANT INFORMATION nt all i/r n Re ' wed by Date Personal information you provide may be us i onda ur es rivac-rJ ", . 15.04 (1) (m)). s r Property Owner ti Property Location C IO A t? rl- I �! , Govt. Lot N j 1 1/4,S l T N,R f 7 H (or)o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# , � �,lf /77/1 ✓ s COUNTY City State zip ode . Z Sir ❑City ❑Village Nearest Road Q 1 /5 e as a v1� P, C't , 1�ry Z 4 t Al New Construction Use: (� Residential / Number of bedrooms Addition to existing building Alb ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6dQ gpd Recommended design loading rate ' Z bed, gpd/ft L 3 trench, gpd/ft Absorption area required ,SO bed, ft 5 trench, ft Maximum design loading rate ' S bed, gpd/ft to trench, gpd/ft C i Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/site considerations �I Parent material Si / �� -SE O�i` »'7 G 7� Flood plain elevation, if applicable i 1 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S O U NI S ❑ U ❑ S IN U [Is ' 2 U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ylj� e. -I C_ •Z :..3 . _ 2 5 .2 I �� ` /fZ 5 �� oll r, s,' 'V2 V 'r- Cs 2-k") •5 Ground 3 21 -31 /o YA ! fig Aja t, s 2 s(, ,rya Vrr C W elev. 0 �' G� � 7 YIe � .SC � C r ✓/?`��"' 'z ; , -� i Depth to limiting factor in. Remarks: Boring # r /nY �Z o h � s,'� se�� ✓-��r c� s Z, . Z � . LI Z- c-l�, ze /n s 2- Yi 3 Z' 3 0Y4 V1 A /7 6-K m c w Ground Z- JdY 5" C Z �7 5 1, 5 g sC Y' M r elev_ . Depth to limiting factor m in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number LO 153 �. !f'I SOIL DESCRIPTION REPORT # r PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .Trench 0-4 /D ye 3 z o tle— .3 2 -/3 7 YA 5 8 Dne, s; Zen s m V � C: _s7 2r* • S ; d Ground 3 3 , 5 % ( o/l (� S� .Z m S 7` r� ✓-� C W elev. 9 /7 ft. z ot 1 7 , 5YR 79 SG f /C r I»-P'v. Depth to limiting factor _U in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G I D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Boring # Ground elev. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) cf • �a✓ Z JN Cb Zj— o o. a, Q w to W � z J n1 -0 N 3 L V x �• ti i � U N a 0o N 60 o N N< r - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM W Owner/Buyer cJ O r^i S $ Oki Mailing Address d Property Address ! "r `vl S 7 �'3 C )U z (Verification required from Planning Department for new construction) 4 City/Stage Ala, n,=aa Gt/,; Parcel Identification Number LEGAL DESCRIPTION Property Location ,r w %, AC /, Sec. � , T ZS N -R I7 W, Town of I&S fd Subdivision Lot # Certified Survey Map # Volume _ . Page # Warranty Deed # 3 Z 3 03 Volume -3 Page # J0 Spec house 11 yes 2/no Lot lines identifiable (B' es ❑ n y o SYSTEM �M. AINTENANCE Improper use and maintenanceof your septic systemeould result is its permatnc+e failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner; if neededby a licensed pumper. What you part into the system can affect &e frmction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 7.oning Department a certification form, signed by the owner. and by a MWXr Ph=b=.jotmXTmanP1:umber, restrietedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping.(if necessary), the septie tank is I= 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 Commence 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 Zoning Office within 30 days of the threeiration 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 of the property described ve, by virtue of a warranty deed recorded in Register of Deeds Office. ' - SI GNATURE 6F APPLICANT DATE « « « « «« Any information that is mis- repre=ted 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 ICY r DOCUMENT No. + STATE BAR OF WISCONSIN FORM 3 1993 Two fIAcs a[ ron aECD11D+N0 DATA ' CULT CLAM OED 532303 — = s' rX S .V 'I Susan M. Hanson aJkia Susan Hanson ' a / t /a Sue a.rci �a - � - - - -- __--------------- AUG 9 195 , ....................... ........ .......................... - , It claims to Christian C.__Haneon� al � �.etiein � 9:30 A. M anson,.. alk/a �)lri.. Hanson ........ ......... - - --- .. -- ................. l �'..r: U, A - � •- ••• - -- ---•---•••-••---....-•---•...........-•----- •-- • . ............. •••• - -• -- -.. -- ••........... I Fes; .�ctCayu ................. ......................... . . . .•• ••. _..............._.....�_ ___ the following described real estate is ---------------- St • . t I County. 0 State of Wisconsin: atTUa» .e V I Tax Parcel NO: .............................. East half of the Northwest Quarter (j of NWk), and the West half of i the Northeast Quarter (Wk of NEk), all in Section Nine (9), Township Twenty -eight (28) North, Range Seventeen (17) West, Town of Pleasant r Valley, St. Croix County, Wisconsin_ ' 1 j I 1 i } is . not homestead property. This P Perty (�[ (is not) t a: Dated this _..-------------- .8th i --- ...Dacamber - - --. 199 da of -------- ....._(SEAL) ............ (SEAL) .......... • -- - t I .Susan M. Hanson----------- ••------- -------.. .................... .. . ... .. .. .......... (SEAL) - - -- - ............................... ......... (SEAL) s ........................................ . ..•--_.. iP ~ AUTHSNTICATION ACKNOWLEDGMENT Signature(s) --------------------------- ------------------------------ -- 87ATE OF WISCONSIN as ............................... _ ............. -- -- — St. Croix County. authenticated this --.- ---day of...___.-- Personally came before me this - --th - - - -- -__may ,. _December •• ------ • - -_ -_ -� 19 - 94... the above nam - ................................................. - --- - - - - -- ----- -•---- - - - - -- Susan M. Hanson ------- --- ................................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not. anthorized bq 5 ?9f.06. Wis StatsJ - see ow °. who ezetu the tare)oing i ledge the sum lr THIS INSTRUMENT WAS DRAFTED BY � Vrr z- d --- F� -a k�- .DAMSON.. - ----- K_ J ;Y• n + t t.... .......... •- - - - - -• -- - - - - -- Ea ' I i ___ 022 - - - - - -- Pi y �?t ............County, Wig- (Signatures may be authenticated or acknowledged. Bot1k COA1 < not, state expiration r are not necessary.) aake t + .=' 4urr CLAIM DSED STATE 1 aie' WIS » 2 µ•ise..nwin 7. xa1 01.1,k re. Inc. F la S II '� , FORM 2 - 1 • o 1 o m f r IM ° �1 CD ID co a CD c °.: c > > 3 v p o N a s CCD W cn a 3 N tD O O. W C N CD -- y A 7 N ` N N I 7 CO O O (D j U V rO�r� Cn N N a O y n° N C ONN w R 0 0 N CD �_ j 7 CD D i O 3 7 w v CO c W C Ot v C CD (� (n Z D a C, w to G D T 0 1 w eo w m co m N a c co ° a o 03 ca o CA) c CL o _ 7 N N° oi N�aII w� N m c cfoo N 0 Qo, CL n r to N co ao v N 3 •.°•. C t�1 z 000° 0003 O L 0 CL v CA ch CL v O 0 T Q v 0 0v CD cp 'e m d CD 3 ° cn w (D C ; o Z I 0 0 D D D D o o o Q a O a !r• CD CD c UI Q c ; a 3 3 Z 3 A 2 CD n cn N .r 0 I A Z 0 m G) 0 Z id o W � W m 00 n a z 0 A� H z w z m I I CD CD a oc 27 D a rt�-a a -4 y CD 7 S O O D) O G C a y N - 0 -- o N C S 7 z a m e no < z a CD z (o ] w m in D) 0 ;:L = ao 0' =r �0 m _ o vmMo ao 0 y0o 3 0. CD 7 C. O A 3 w c m Q o. -0� o m a v r. I I �y0 I o 0 a 0 0 ° co CD oro csa O O c''q Parcel #: 024 - 1015 -30 -100 02/01/2006 09:40 AM PAGE 7 OF 1 Alt. Parcel #: 9.28.17.82A 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JON M & KELLY J HANSON O - HANSON, JON M & KELLY J 1753 CTY RD Z HAMMOND WI 54015 -0528 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.650 Plat: 3601 -CSM 13/3601 SEC 9 T28N R17W NW NE BEING LOT 1 CSM Block/Condo Bldg: LOT 1 13/3601 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 02/25/1999 598357 1406/54 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 87499 362,300 Valuations: Last Changed: 04/10/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 23,700 197,100 220,800 NO PRODUCTIVE FORST LANDS G6 9.650 54,000 0 54,000 NO Totals for 2005: General Property 10.650 77,700 197,100 274,800 Woodland 0.000 0 0 Totals for 2004: General Property 10.650 77,700 197,100 274,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/0411998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 -Parcel #: 024 - 1015 -40 -000 02/01/2006 09:44 AM PAGE IOF1 Alt. Parcel M 9.28.17.83 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner CHRISTIAN C HANSON O - HANSON, CHRISTIAN C 1790 THAYER ST HAMMOND WI 54015 -0528 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 9 T28N R17W SW NE TOWN- SHIP Block/Condo Bldg: PLEASANT VALLEY. Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09- 28N -17W Notes: Parcel History: Date Doc # Vol /Page Type 09/24/1998 587660 1359/455 WD 09/24/1998 587658 1359/450 WD 07/23/1997 1134/406 QC 07/23/1997 837/557 more 2005 SUMMARY Bill M Fair Market Value: Assessed with: 87500 Use Value Assessment Valuations Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 18.000 2,400 0 2,400 NO AGRICULTURAL FOREST G5M 22.000 9,900 0 9,900 NO Totals for 2005: General Property 40.000 12,300 0 12,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 22,300 0 22,300 Woodland 0.000 0 0 1 Lotte Credit: � Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 , (i�� ""� a I �� ` �� " � f �•' .. . FILED r 9 FEB 0 8 1999 ► 12 KATHLEEN H.WALSH Register of Deeds St. Croix (i0a WI � CERTIFIED SURVEY MAP LOCATED IN THE NW 114 OF THE NE 114, OF SECTION 9, T. 28N. , R. 17W., TOWN OF PLEASANT VALLEY, ST. CRO I X COUNTY, WISCONSIN PREPARED FOR: NORTH OUARTER CORNER CHRIS HANSON SECTION 9 - FOUND UNPLATTED LANDS COUNTY MONUMENT ...... . . _ _ _ _ _ _ NORTH L I N E OF THE NE 114 S89 ° 44' 07" E 2630. z „M S89 44' 0 7" E _ S89 44' 07" E 512.50' °- • • • • • •• _ N8 9_ 0 4 0 7" W - — 736. 76 C. T. H. n 1 1381. 27'� N S89° 44' 07" E 317. 1 I ' — NORTHEAST CORNER • g g I SECTION 9 - FOUND z h a I COUNTY MONUMENT :r- :� o BUILDING SETBACK LINE I � M :v DRIVE I I a xousE tk 0q, DECK o r m :v o I �r— MOUND SYSTEM °'- co ; a � ;cn N, LOT I G N 10.65 ACRES : Z < N 464, 014 SO. FT. 10.16 ACRES EXC. RiW q m A 442, 393 $0. FT. .• ,► � n 2 i i m ••'p2� ' � 6 l°J L5 Q U L5 _ . S87 ° 2I' 1I "W 484.71' JUN 2 t I UNPLATTED LANDS ST.CROiX000NTY .. ............................... SURVEYOR'S RECORD LEGEND O SET I" X24' IRON PIPE WEIGHING 1. 13 L BS. PER LINEAR FOOT F . BEARINGS REFERENCED TO THE NORTH L I N E OF THE NE 1,14 OF SECT 9. (ST. CROI COUNTY COORDINATE SYSTEM) - 1 " • 150' SHEET 1 OF 2 JAMES M. 46ek -s =18 980508 TH S INSTRUMENT DRAFTED B JIM WEBER RTC ER�AIZ(D�URVEYING Vol. 13 Page 3601 N PLEASANT VALLEY /RUSH RIVER PLAT W E T28- N9 R17W �1 See pages 115 -116 For Additional Names. Fr ®Farm &Home Publishers, Ltd- HAMMOND PAGE 36 r ' else Allrn Charles 1 t 4 r Charlene Hansen W �� t Leven & 1 inn s a Steven Wilco K E Merritt 80 26 " JSK e t a ) ee Kenton 1Pa bo v8k D 9 e V kn g M & Br 39 ( 38 �t:� o n & v Famt1Y 137 Richard g elnbuch 79 1— Hanson $ xo € Wna° crust s Mn Gregory Lorraine z Pennon 1 ■ effreY ' Trust i64r Bwiwho 846 '63'""° 5 Thompson I Merritt A� 162 55 AVE � - toe ' 134 99 nut 79 m 35 2 u �etk cal. 72 c & Herbert 94 0 ■ Sun & Veda - r• nut , ' a on e S&K2 Ridge T'r utf24 ' 1--34' 110 rn son n�v von rrr� a ` Loren jr � I 57 " I Farms 72 ,a" q azByn wl j Frms ax awes 126 &M mm 56 9 Smeester ss sM tat 75 40 amour e tam 78 200 � o � mdrlckson " 9 I AVE 34 D &T 40 )ettr� 5 SK nav i I 9 Z N ,� Maruyo ahicia o 20 & Cynada 63 20 nlsitty 'Inc 2 sd+ smeester 0 Tis ' &. j 28 H De on6 C $ Ia 55 d & &P 21 M Herman & zt Schulte Christlan 115 + W & J-*" aJ-*" a & eoowe KM Margaret ndn ddie rs Delores ' Bros Hanson .I TKillulenhy & !aura Bonnie s�ao VRemiuen , Erdman R uette 77 ohm& Heinbuch 1 160 1 149 Ltd Moe 185 32 s�'S 60 m David 9 O Z. 174 Robert u 21 a S Halvorson 80 em�� Wm & lane arl n � & q ' &Mary ' 78 l2o Schwartz me �.. See 2wal z d Daryl & 1 arY na.mo rn Eric ±. Alan & Lurene Fairmont 1 Patricia E 11. 1 "•.. g S rtes Mm arg a uo ~ 00 B Trust 80 136 261 Kurt 40 6 Boom 4AOdaht Born ' Bahnsen 115 Farms I s 7 S c& b 80 344 E Inc D Mar & O 135 w rtes gg1 40 80 159 mow m 1 U r ' 2 __ -- Carolyn N6 40 -� - M & B Tbman 7 --- '--- `"_' V1 6 N --,- ,: Duane e,rw P ship u 4 1 n s I Q N9 Fredrick Kurt esvton urn ,: 150 Afdahl I g Wm & Glen & : z 3 >�• Owens Famil Scott Gerald & S Dazlern Dawn x i' a �) iz z r S wow,w I 152 jj� 7rust9'Owrns Sharon Stoppel120 r S w Mohn so Dmne ov.r, vas & r 80 179 1 4fddahl aT 220 ° � can sae M 8 ' e & 3 s ,�>eae. Gary , 40 35th VE Bruns 40 rr rvrta soon 1 aro,•vr 7twmas DOI' d Richard F Leslie& `r Vaugn & Sandra M „ a readall • & Mary bm. � " 1 Eleanor Walton Inc Karen $Bck 40 70 a, Cool AnbY'w 6sWneu Weber 120 N 0o m c .am a Bomaz Alan & 35 Morpn 80 3 r4 154 159 !arson Robert & Jayne yy n , w si4o 11nc lim Bradford 46 w &Barba+ G Ma ry� Family 60' fi0 79 Frederick 1 & Mi a rs s9 Tc Sos D& i la , S,N s 35 &D souy.l r n. AM& Lenertz $taut 3B 80 " y e U 128 i R & d i s zo 64 46 , a aM ac 30Th A I E 5 15 eta! D Dairy 2 7 O KAi 2 _ — _ smlN ltticnei s a ° aM amr Manber mi{jt Falrntont 40 39 D&S Fa LLC 39 7 Bo Reil Herman & Schulte gr H her Fanns p 2 john r4o Delores Bros s 1 atobwv & Z �'� T Anderson u�i L Inc V Ebertz W clew& Heinbuch Blum 155 o as 145 PJ, rm ✓ 40 rdnk IncaBas All� Iobn Trust & lame 7 }' 40 a c 63 k 160 T , "° 33 120 80 � t 8th AVE . Joel & ., - fl - Wtdspert r en & l- 3 Lawrence 0 Cindy RoF/ & y ; In 19 w SBos elen v A r ohCyn 120 Do s 0 Schultz ti r Man. 1 OW 'x In acobson 81 38 � Ne �h Kim & btken - m.r 0 4aneat ohn & obn ,i•,e,r.a Raelle rm. T ., I _ 40 OiOthyy E e,mano aw ao 40 jorae SO l� r� F ., -._. -� - �1 - -f - _ �' - — _ eo Maule 72 c to --JF - P MRS & a erimont Y 118 r; t James Zsr i so sauce Betty s `� 40 Plerr 79 40 18th AVE Fosse 78 ° 80 40 )4'0 s°° 40 io w Jacobson 80 s� 20 � _ 1 20 0 , Chada & DD— ,� MaK PH 11 y �O` Langer L i Colby I Soft �Ye` v 9_ 1" PT9 40 163 lu - Maxine Eric & & eW ao 40 James sum I SRI O Mlcheue 1 40 Cr 2 a Bazbara' ' M I& Dowd «� 61 swouen se ac 20 Berg'` r� Eric . 68 sander r Harley on _. & 130 9 loh000 ] ... $tyellEOn &Rory rty 1-1 B 80 eo 5 I g plhy & lama Trust & Oebora ubeR i� 40 N H & uth K &D Robert .wren 1 Cheri & Mary r 150 Manktm BO Joseph & 1 & Shama , Holdi ro•n y Marlon 27 „ .3 �1°'al" da 10th AVE a0 - 141 _ No � LTD 8 Sharon 11} s y uIB"� 2 t7 u . Koenig 82 80 111 56ada 49 _ - _ - _ ] - ,®„ Michael Michaol - — _ --•� - — ' Robert & 20 F 3 oede lull & �� na orn spike tib 1 Tlmmers 1 thI «n Ines Biwa. il0 a 0 `rho son 20 22 40 109 K erry Kathleen Swenson Sreeman ft AV Licht ' Swenson 77 159 ioseph vswm 84 A E .�� Mac & Rose r °vows, y Ke 120 30 W 231 N Francis & (,0 ury 55 - Karl a a m avaerB lr may . V 1 Eleanor mad, & carol Kazlson 7� y r 40 m r8 yy Cha E SehOtgrn 80 20 t Eells 20 o M Lebo Rust 48 20 y S cvn Barbara & As. 9 r �a ads T & Robot Mark & &Nancy V�Idmbe° �& obn Alan & n o ameid.°a 40 'RP 5 &o p Weyer 80 Michas Ton yy Cannon Kathleen ) N . Dallman Rwm- a rest 120 Hoh 14 34 vsavm M°d`kCO eanne F{arvey & Dooea a River y Moeua o 77 Owens (A )anfieY 122 Ranches �_ 80 & odd David& 153 _1..F aklceY Th�oen $ elkema 'rr•& °e• LLC rich 60 coayer Its aria 9 2 PIERCE C UNry Phone Toll Free: 877 -684 -5125 Building In Local: 715- 698 -3800 •, ,.. St. Crlox Toll Free Fax: 877 - 684 -5126 I A11 County zIL g � 698 -3801 �t since 1987 Local Fax: 715 Cell: 651 - 261 -2258 KIL � Locall Fxpect the BestlOual ty Servrc e, Quality Doors! owned and Craig Willem + � ► operated! 104 Trient Drive Owner g■''�'� P.O. Box 245 °'h , Woodville, WI 54028 20 : PW PLEASANT VALLEY— RUSH RIVER — •O60T# T 28 N. R.l 7 W... 19 Stevens '� C ^ • SEE PAGE / 1 I AVE. H e Kcnfnn b a N °� o� v � o CC w/r a �r ssa 4 • 11a7so17 C� p i tl'� p 6 Li /ia/r Chas- /ene 9No � 0 �� c� T Merritr a o%ar '9 / /en D b • Jeff / wi r° C7eorye rRS /sso a f Val �)5a' n v aa �i n' 0)0 Nfiyvie ao 4 ,� Hansen [ h /quist, McLauy cS W de w � � tl' ^ Cr •' fDe /oreS CWo 'r ,B /ee�e /i67 Lor 5 /3947 c7ohn a Loock rai ne • /376 Merirtr Fo mSx. ChW /stiansrn 94 eo.sa s7 /22G2 .a r 0, � 73G9 • - / sun - � d9c la 1 cvn w be h • 3//4 =7141 N 0 3492 ppq,, oiet C w �" • San a.K: • Lam .:>c •� b F /ms .b v`u0 Forms /z6 v C `� N ac. 0 0 ene v b / A % b\ .77 Peabody^ 7dz zso s F % JarncsE va me/'f �' u�tl Ise °J� _ �W un, ands tk- so `a� y x C Tahn aaQ� ao y Wa C /027 N • , 40 .ion G a °hnso p bv.Q z • 70 � •.7L (7� �� I g° AVE. e ll 2 ms Herman Q �u • ,/� (Terr p Pose c • eNy F i /ianl L27 Li He /n6ucfj, Do rs u aa e <Tah son v s 6 � . 'emu r ye s ^ etux •�/3rosa NenricFso// Q E 7s O eka/ n �so Hen /nk 40 y ss2 m, Sx /9d9B k• 11 ` /S9 'Qober't /bo B /GO /,fie if. G. W..Po�a /d t ie � CrnonH .°au /f fl /an s zwa 3o O /se , f M /e S m s saa a.�dcnbery ar6o_ 6 a� <Teanr> ar /ey �aGY/ s L • \ / 40 ,7G.Z • 612 7G Owans 299 dah _e, G /enS 7 778 '0g sa Fa :rr>,onr Dawn cSte //n a � Farm.s recent q Owens Bana c. / /en C h '¢° E Z V C 3 b C 7G/7; '0 F BO • 5• • /5868 Vi, e� /5 011 �sha bB J :J� $ E�y a • ro Fiao sic 0 �. W N • \ l ``\ v Du /sz.,a.R. b J tl 0 tl 0 a � a C C % 0 flJa /e a w b� O v I ' � �tl q�Q to ? �0 N� p Od� • c$fo� r °a/ �v� \.v�0 r`7 %ion Ha man aykrrrs J p rtson • D _ \�. 4 `V I�� /60 �� R ZaB 32 //G. 0/' C_ Ann ' • \ 7N AYE. ../ce /zo �/ay hJ Z, .v Land�r �0 9783 Fa. moor moo. [TO/, N r'K. 4 cSr/42U/ Farms, Inc. • W 9 f W C r2° Sm: %h y ` Weber .PichanQ' a/rn V fda o /,50 y� • l �Toan M SmTfi tsz. ea 6o Q O G /enM /NiiQ c y oe s v✓a /tan W . 4 n eo 2 �� Wiese Ca y -?cob o.. /ao y3s zoo rse.73 /`� ,. W W �P/ch f,� • • • • 6 • 78 n Q s • • R a Iq • 0 f • • �cghsch Sc/iu /te s aar W ,' 236,/8 � Uu OS. Bo � %0 �f1 Vs n 5 Farimonr • c De F y� Farms, Inc. Inc. y b U i tl � �' � �` a/o 0 � . SB GS e7onr /999 � g 0 • Mn • Eugera • Lawr a NpQO • Howard ext fan �C: �cb[Ssds Vt Bergh, o. \ tl Li /an Q� l•\ FsK. ice b ' iTohn s /bo eta/ T .Bakke h Pos E 0 Luis. Z Do oth 9� • nSG/7 R son R� 0 /S 40 y �7aA? . Ne 120/7 Oo don r3a,E.Ea VE' '' reo atux i.b 4o Ctl 7L7s Oho to ri7 4O /9y ¢O /bo • • /bo Q), o-'' /G.o \Q v '� &_aA e3 • ' f n o/ �+!R A(7/le. Tim Lcon Km Leon ,t y • \ ��° tR ae//e X7,1- .� cTo/a e s °n /bo Cyj��d tl 4° e t Hi-/ • 40 40 40 B,p Q Pie son / Nq -; • : 4i: 40 79.12 I le y0p N • d C b C Cl /es N B • Federal y Tekse C.0 00 w� p rfh �.$ �, -n r o ' � Ch as J Lary r ,k� Land Bank • Cray o C� v e i5C 40 7 w . o. 4o tba 9 40 of St Pau/ T 33 � U C'Qrf • s/ J 26856 /ia.79 Tekse d U `o � d izo o c� � ' oO 5 t / y Tbyc - it W. %/a q a7ames 39.6 v W Q q ro0 //Q9Pl7 vita E� c Es ° c C/a cTeGiY 49 John tr G12 �y /erae 2796 • A'oduCfiO/7 rFbberf' � /co/rn son hwo How Credi f Aus' /rum 0 b 5 rba a 2g ,B arnrcc d oia 4926 Hzrociat /on M� lC /scn. �co 4Os 40 BO by (.v' rzo B4 Keen S. U �e /y � � • B/acFwe// ,�l O l cTohnf Juhe • • BO .loan Fiea ¢r7 T � y 'C�' y Ferris C/ar ncr Mao Ouc F/a/xxs A. ., /zo /.126 • • 835 • , cSa66y cS e'n ion rcken tE/eo/we A/ s � eo wv � ra4B4 �3•� a trf a /zo o a >°e/7 rzo Tusf 1 • l N. OQ m 76. s L a o y A/oq a 119-7 Marie Oft �/ //2S 30 4° er Willard f Tusf • vcy • Ytcniyy£ • abb • • C • j. • i9a.- y YY ' rLfa/Ye Off' `6A /exonder Doerr �{ 0 g loo /1/oh 0 /sa Otf 40 \ w �� a T r Z1 :: _ l Kgren WbC ior>c C e S IY �S u Y Tcfna 0 % s� 4� C p 0 C+ NTERV I AV Qnia /son Her Bo/4 y � 'tE city �sLv son tl v LO✓ e /eo ONrn L. b� o tl 0 F! /an s ,Pith d 9 4 ` g° Weya� Ue /7 % \ C iTearrrsa • _Y Peterson � �0 � Oweru /, j¢ �` horn � Bruce F7 Hocjo ltA. 6 J / M¢p 6 /s�Inc. 4-0 M C I aT. /do • ill P/ERCE COUNTY CRO /A PL EASANT VALLEY MYER TIYP, r� PREPARE FOR THE WANG &SONS Tom's Electric FMRE INSULATION Motor Service CELLULOSE BLOWN MOTOR CLINIC I Div ATTICS & SIDEWALLS (715) 698 -2421 Brian Wang TOM VANDEBERG - Owner (715) 772 -3186 Route One 111 River Road East Wilson, Wisconsin 54027 Woodville, Wisconsin 54028 Parcel #: 024 - 1015 -30 -000 02/01/2006 09:35 AM PAGE 1 OF 2 Alt. Parcel #: 9.28.17.82 024 - TOWN OF PLEASANT VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner CHRISTIAN C HANSON O - HANSON, CHRISTIAN C 1790 THAYER ST HAMMOND WI 54015 -0528 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1753 CTY RD Z SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 29.350 Plat: N/A -NOT AVAILABLE SEC 9 T28N R17W NW NE EXC LOT 1 CSM Block/Condo Bldg: 13/3601 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09- 28N -17W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 09/24/1998 587660 1359/455 WD 09/24/1998 587658 1359/450 WD 07/23/1997 1134/406 QC 07/23/1997 837/557 more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 87498 Use Value Assessment Valuations: Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 3.000 400 0 400 NO AGRICULTURAL FOREST G5M 26.350 21,800 0 21,800 NO Totals for 2005: General Property 29.350 22,200 0 22,200 Woodland 0.000 0 0 Totals for 2004: General Property 29.350 43,900 0 43,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON WI 53707 NEB, NW , 4, S9,T28N —R17W ❑CONVENTIONAL 9ALTERNATIVE [tatePlan LD.Numb— Town of Pleasant Valle lfassi nom, Y ❑Holding Tank ❑ In- Ground Pressure �7 -02701 CTY Road Z NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Jerry Henrickson 7542 Emmanuel Ave. S. Cottage Grove, MN 55016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REF. PT. ELEV. I Name of Plumber. MPIMPRSW No.. Cou nty: Sanitary Permn Number: Dale E. Hudson 6629 St. Croix 96062 f SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: (WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES [:]NO E NO BEDDING: VENT DIA.. VENT MAT L.. 'HIGH WATER NUMBER OF ROAD PROPERTY WELL BUILDING: VENT TO FRESH FEET FROM A LARM. LINE: AIR INLET: DYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPAC IT'y PUMP MODE I MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO DYES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND co NTROLS OPERATIONAL NUMBER OF 1 PROPERTY WELL BUILDING BENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) YES L1 NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 FORC LENGTH DIAMETER MATERIAL AND MARKING E or excavation. (If soil can be rolled into a wire, construction shall cease until E the soil is dry enough to continue.) MAIN" CONVENTIONAL SYSTEM: �y WIDTH. LENGTH N . PIPE SPACING. COVER INSIDE DIA. #PITS LIQUID BED/TRENCH TREN MATERIAL' PIT DEPTH DIMENSIONS H GRAVEL DEPTH FILL DEPT DISTR. PIPE DISTR PIPE R. PIPE MATERIAL NO, DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE CO' ER. ELEV. INLET ELEV. END PIPES LINE: AIR INLET: FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS L] YES 1:1 NO 11 YES ❑NO DEPTH OVER TRENCRBED DEPTH OVER TRENCH,BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES. 11 YES ❑NO ❑YES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: F3EDITRNCH 'WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. EC VIA' XiON A11 ELEV. ELEV DIA ELEV. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF'. PROPERTY WELL: BUILDING: FEET FROM LINE. ❑ YES 1:1 NO ❑ YES 1:1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) 1 Zoning Administrator SANITARY PERMIT APPLICATION COUNTY T DILHF4 In accord with ILHR 83.05, Wis. Adm. Code 5� G � STATE SANITARY PERMIT## —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. % —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES ® NO PROPERTY OWNER PROPERTY LOCATION J —, ✓'/ � S /%F'/4 , VO14, S 4 2 T z , N, R /7 $ (or PROPERTY OWN 'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER O VILLAGE : P��Qs/a// NEAREST ROAD, LAKE OR LANDMARK Coflu v e rJ 5'S1�/� r z f 5 35 ✓ Ile V Cf . .Z 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 17L OR ❑ Public (Specify): AI 4 III. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1. a. ® New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. ❑ Conventional b. X Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. idi Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 500 �"OC� /44.3 Feet IM Private ❑ Joint ❑ Public VI. TANK CAPAC Site in gallons Total ## of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank 12 OCA — `" 4 D ❑ Lift Pump Tank/Siphon Chamber C o DOO i i ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) . MP /MPRSW No.: Business Phone Number: -Dale Z-, g 1 SO /I , c%e e, 11a. 4g " 715 Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ## - Do le .35I /3 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: e / - ," ', 5" $ 6S1 -3Z-o IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee Groundwater Dat e Issuing Agent Signature (No Stamps) M Approved ❑ Owner Given Initial ? charge Fee y Adverse Determination / X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, (308- 266 - 381:5. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the systern is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP etc. ), address and hone number. Plumber must sign application form. Fill in designer name if P 9 PP 9 applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use b count or resaon g iven when ap is disap Y Y 9 PP PP Complete plans and specifications not smaller than 8 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; 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. -------------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation Is more � commonly known as the groundwater protection law. This change in statutes was the resu't of ove: 2 years of steady negotiation and public debate The groundwater b !i Groundo Ater included the creation of surcharges (tees) for a number of regulated practices which Wiscor4irt`S a can effect groundwater. The surcharge took effect on Julie 1, 1984. All of the water tha° buried arasre is used it your building is returned to the groundwate through your soil absorption, u� system or the disposal site used by your hoicing tank pu - npe , The monies collected through these surcharges are credited to the groundwater f nd adminis- lerec by the Department of Natural Resource,. These funds are used for oniior c} grounr_i f water, groundwater contamination investigations and establishment of sta-rdards Grcum,,wate , s wcrth protecting. 3D - f , ` ?98 ,=;.03;86) to tt 3 �� ,r � • f i.y � � f � y!. k 3 . Le down OLM . rowwwo4o _ .. *Metbar oft y Sr .••.i~. �.. . l�irir `iw.�t�iw�.�t91t`l+.riin..t►. ',f�u,IR.!„��r � M a . >~�wr eui7te�st ,�' � • .......:......:... nut* iMa et 1lntsrr� s,nars w •. ,� #' aE antboast Quarter { of MW and the Ian ` 3 . ` 44 Qatar Oh ad! � ss • `Lot C" - (14' awn. TPw o f Plaaaaat *UQ . - ft: cftjx '� 1.`; •_ ` r . ,� 4 ' ?r Mle�dslea6l. us loci s ?bio ... ......... MIN OW prapoltf WF4b -ast) � 4 1'Mdmm � Nreisw the pnepwor �1s pup -to V4 at ..th&IX_ 1la e:t. «w ........... ...:....» as :wee Ito) i••• S,,.SOQ�dO... as Mtn anoatMast tbi,+�INAsiet; ssd(b) tr bM aaw at S. .« ......... eepsti�.ia► i Ye>yt i 1M byin« _ ieeat mdse to 16" SO lino sob AL,�. >� uMNilrw as �z�.00, or tprs,ab1t cat or before the ft dsr •! ttssth, be:ivaieo immoary 1, 1966, with iatsrsat at ltlf per aaatta; said ooietlftp. app`3iei final 0 0 iatereet and the rafter as principal reed to continue mtil tht� dap of Jar, 1996 when the ba2a ws of Interest sped principal is dull asd tx, pswbiat. bewwse. the saws oegtandinp b Mist am bo par to to ee or M s On. ......... Mt .:;,.. At p «..�. » «.....w.., 10...26_ ( the not ogr de%). 7 saw defaak in pgawat, interrst " axrae at the rata d ... ►...'K wit b ��t� par "Run M lira �� Smoot witb indade. out limitatim� ddbmqueat interest' Sad. upon aegalwaUm er . ' e So", 3 prhwbd Woman). 408ond bp Modest slood 'Was 8161 Iw$ on Me sham papaseaI doR be q*M Mat to iateeest se, the unpaid alanao at the rats, ' Paid speei6ed and then tb prleteiy�l, amsa k ow be pevpaid wait ws& prominm or foe apoa principal at any tima.dlal- ......... ....... «....., il.�.. . 4 tba walk sd asp psepspnietk. this e=VMk ehdl not be treated as In default with eospret to T as the empoW balwas of pfto*4 aid interest (and in such case accruing interes troy month to gf i Iwo Gies dN *usint thA cold YACeMoidness would have been x ataie as Mat sp ab"s; provided that mont*'paymuwmts shall be continued in the event oj ere& et Of WW"w w essdsoiatiss, tbo ea:damnod ptuntiM being thereafter excluded hersfrom. a tarebaesr states that Purchaser it satisfied with the tide as shown by the title evidesse sob dttet to Parr !tr egy� newt: 8onl. Pkeuhassr agswe to pap time east of titers tllb wMenes. If title evidoe" is in the form of so abrleaat. it doh , r ;. he robdow by Vosidw ustp the two porchaee pries is paid. r , :r tatahaaa W" be entitle to take pease"Ioa aj the property so ............... Nove�ber 29 1! 65 a Soso -w-• , a � e 'e Wo - a 11 R w "Pew 14t w' !s at w SIMO N { At iM wrst d a is pywdt • h i s (iiMR ii - rwbp- my Ibaiiallras . Y b. isair at aadbr a "* ANON l t , � Qqr. fNilas to li0tlq' spadth pevurirance a( '4 btrreat unem, at tb rate i• �' �'� MY�itr b wkial .. tM! irspaafy Hill M iiitbiad s! r Vi�sire Sao at lrnl br w odi6o pureirsse N fMi r Mad t. 11ia Ri4Nat adMd aR {111N• In wemsw Caw �4 �lMl atgr rih► W dw + paaar @11411 be b tw�irrRAre abaNS` r kw ar b NOM SIP w d ' aeWs 49 f6rodom ra of ME Is OW3" am ' ise► aetiarer w�Ni nab. brsaa.. and P when me aeft b ► AZ irr 4AW waywdY Ow q aiMr t=64 is first �s w�laa _M I costraot ally ai sreuritp s� sr sdor� aas�4�nae whb ld Vemd` bs eab w when d a V � r ar�i ilWl baeosa law airi pyywrlN uo aq . osl�lisdii� agaisr! do pry ► �` ttraneM b M"yarinnr)iN ally : > ann doe ond�rF thin as atrs& P+rnllaaar , 00 make any am i IsM M and ap payllfanta M sale by pwvb w 14— bo tom., W ddwlt witboot wahl�g sq odnr ambeogaaat or prier ddauk of FaeiaM an sow SdN ati tlri tbsAanet airlN bo aM irran M go 1Nnri6 of the lK a yq�, liar ] ue irt w h ip do W@ d 1i vd as riSiq In w aw0mat Saki agraaa to join h� 1 ..LQtil....... day' . ..- .....Yock 11at ... ........ ............ .» s x: ................ ... ....(SSAL) is Hsnsickaon ku� G. Thorson as Trust" iii" • ' dat ed T 1920- Doris Hsnrickson mmrY1 A. rsoa as Trustee usds! jn • ............... ... .......... .......... ... ..... . Agreement ••dateld• June - •25,..1g70• AUTUNDITIOATION AO=MOW L11DOVISSIT w Sigaatore(e) D-f ....•J QY....X� IG .� �1�..1WD STATIC OF �M! T � ................... .......... Itsricopa ~' i ...... ..................... .......... _ ..._ - M iyddfire 1t tki � k .. "' s _MarG _G. Thorem . 0 �Tr isti w • 09, .. �s; ..1�8 .I ' ....... :. i4 �ate� �uiit - - 3 ~ ................. TITLIE: MEMBER 8TAT11 BAR OF WISCONSIN and Meryl • R. 1lioison as TsfySM (If not .. Agreesent dated June, �� 4 sothorbrod by 1 706.06. !►b. Slata.) to me known to be the ponoa ..A........ SPIN, `! t�lureln foregoing i and aekaewbdv As samm THIS INSTRUMENT WM � °`"�>�£`r� • .... ......» ..........8arola D...... i�6i� ........ g?�. f " �...: BI, SOY .... ............................... 3aldtrin a . I 34 .. C -. ,� ,ri -- =.•• Notary Mile MULCOPt..00. , Ar ( S i not - be audwwtka%d yr aeknowlr�sg �* My Cbssbaioa is Permanent. (It at. •Df�nnarMk .w.w In w .r.ew eAwm be bpM �l a l.rw Bite: ....... ..�. .� .... .... ................ s+ �+ Slam a Wboonyin C Ady of 9. Cmk I bin* go* Nat : hue and mved a py of the doomm* on Me tend of record in my office and has been tanpored by me. Attest Ma r c h 20 T9 8 7 .lames O'Cnnnell J. mes O'Connell Register of Deeds u �� deputy APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed b the owner of the PP P g Y s 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 I%V-Qw Location of Property 1 4, Section _ , T �0 N - R W Township Mailing Address Subdivision Name Lot Number 1117 Previous Owner of Property _ `1G �S Total Size of Parcel A� �/u`'� Date Parcel was Created Are ali corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yes �� No Volume and Page Number ZZ 3 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed vuta aa... 3: -. - lkhet --re - r iaga- - € -iied -wlt -h - -the-- Regi-s- ter --o-f - Deeds 11f fire 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ee&U6y that att statements on thda 6oAm ane tAue to the beat o6 my (om) F now. -edge; that r (We) a.•n (ire) tt p, ne,1 (-5 ) o 6 -thc "ori". t deacttbed in thi. in6o4mati.on 6onm, by vi tue o6 a wahh.anty deed neeonded in the 066ice o6 the County RegiAten 06 Deeds as Document No, V 7 *75 g ; and that I (we) pnesent.fy own the proposed site 6oh the sewage pos s ystem (on 1 (we) have obtained an easement, to kun with the above de cA bed pn.opeAty, bon the con4t4u.c ion o6 aaid system, and the same has been duty neeonded in the 066ice o the Coin Reg i-6ten o6 Deeds, as Document No. ) . SIGNA RE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) �A DATE SIGNED DATE SIGNED H z H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z Cl a (� � H OWNER / BUYER' C512 , U.- cdcso ROUTE /BOX NUMBER TS f2 T��ar��/e S Fire Number CITY /STATE �offQq� �rro ✓e , �� ZIP PROPERTY LOCATION: AW 1 4, *Zd k, Section 9 T ,Z N, R _/7 W, Town of �leay712� ��? y St. Croix County, Subdivision All, , Lot number AIX Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_ y 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho E I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Of ice within 30 days of the three year expiration date. :- S, DATE St. Croix County Zoning Office P.O. Box 98= Hammond, WI 54015 715- 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B D I LDINGS VISION INDUSTRY; P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115 MADISON, WI 53707 HUMAN RELATIONS (H63.090) &Chapter 145.045) A N: TOWNSHIP /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ' / / Y /R RI (o P/eos 61611 �� IfI 1 A COUNT) S B ER'S NAME: MAI Lf NG ADDRES 5 Ccob e — ,reee-y 75 ...�/�?/�?G'�'!G/f: /�°. S O i.,C'O , C �• USE DATES OBSERVATIONS MADE IND B COMMERCIAL R I O TS: Residence New ❑Replace p7, �7 RATING: S- Site suitable for system U- Site unsuitable for system !J ONVE T NAL: MOUND: IN- GROUND -PR E: S S EM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM:(o tional) 0s Nu 1 2S au a s (2u [Ds EJS Ou If Percolation Tests are NOT required IDESIGN RATE- If any portion of the tested area is in the under s.H63.09(5)(b), indicate* �� Floodplain, indicate Floodplain elevation: — 7 1 PROFILE DESCRIPTIONS BORING TOTAL P H T 0 GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 4q ELEVATION OBSERVED EST.RTUH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) r� i ,� B- / '0, 9/- Nd/7�' �• ,r /O�I� 33 "i�7�8h•SG / u�/lihf e 13-2 J�, 1 A el 4 1d 1 Z 912 5 C- 4 �1 d ' B_ 3 �•25 9�•37 A len& 3 -a' "fir 9" /• '� �f �/ �`� I B- B- B_ PERCOLATION TESTS F!y TEST DEPTH- WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER J11CME9 AFTER SWELLING INTERVAL -MIN. PERIO 1 PERT D 2 PERIOD3 PER INCH P -3 - ' /% • P- P- PLOT PLAN: 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 slope. SYSTEM ELEVATION II I N i -- _ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative 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: -Do Ile 4"; -ZZ- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 5 o / 11 / :SAD /Z 3 /.3 7�_ -3 06 CST SI TURE: i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02182) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To he a crxnplety and accurato sail t Ft, l eport 11 1W.d iiulurle: 1. Complete legal description; 2. The use section must clearly indicate whether tows is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5.' Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as rertuiled. , SOIL TESTS MUST BE FILED WITH THE ' \ LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st -- Stone (over 10 ") SR -- Bedrock cob — Cobble (3 - 10 ") SS - Sandstone gr — Gravel (under 3 ") LS — Limestone *s — Sand HGW - High Groundwater cs — Coarse Sand Perr. -- Percolation Rate med s — Medium Sand t ^4' -- Well fs - Fine Sand Bldg - Building Is — Loamy Sand j -- Greater Than *sl — Sandy Loam < - Less Than *1 — Loam Bn — Brown * A - Silt Loam b! -- Black si — Silt Gy -- Gray * cl — Clay Loam Y Yellow scl — Sandy Clay Loam R Red sicl — Silty Clay Loam mot - Mottles sc — Sandy Clay tA' -- with sic — Silty Clay ,f - few, fine, faint x c Clay r common, coarse pt - Peat rrn - Many, medium rn — Muck E_i- distinct p - prominent hi_? High water level, Six general soil textures surface water i for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securin sari' ti� of-I n; #_. This, county or the Department may reques* verification of this soil test in the field r �� i „- t <,,_ W ; A complete uet: of pian,, for the privatr.! sewage system and a permit applicati !, .; no:')priate !;rr a!fthonly in ordo, to obtain a permit. - f ile sanitszry l�,ermit n w iw to the start of any const'ructicn. ' T s 1-1 (`•--y a Z AC � � � coo `V `� $ 0 4 k- - -� �° ,max ;,.., • .r• ^ Nj ;Z O v 1 `� h �► ° , Q ` Ol in o q V p a Z QO M M J�q � i/ 1 v n QJ � Q �:• C+ Y �- ° o:• a NV o C Sz i. Page / Of 3 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand ' H Topsoil - __ _ _ _ ' G 3 u fir ` l; % Slope Bed Of 2 2 2 Force Main Plowed -t max `" ~ „ '{ . Aggregate Layer From Pump t x D / O Ft. fiction Of A Mound System Using E /�� Ft. f.htu4t+rP "' �p.`lliw u• /aaYnrs.+r <etr 3r. i "�"r••+ y r F • Ft . ;.. �.� �,ri_ A Bed For The Absorption Area G /.p Ft. Signed: � w A /O Ft. H S' Ft. B ;O Ft. License Number: K Z � 2 Ft. } Date: 7 L 7, �9 Ft. r d J �•t� Ft. Alternate Position T 12 Ft. of Force Main W 3 Ft. L J Observation Pipe � K -------------- - - - - -- -------- 09 - ----- - - - - -- ----------------- - - - - -I Force Main W o - - -- Distribution Bed Of %J- 2 2 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using B F g Bed or The Absorption Area i k Page z Of r�Y "r f 4 Perforated Pipe Detail , f; 3 # End View Perforated End Cop `e �" PVC Pipe Holes Located On Bottom, r; S Are Equally Spaced PVC Force Main * r From Pump PVC Manifold Pipe Distribution Altsrnale Position Of Pipe Force Main From Pump Last Hole Should Be Next To End Cap End Gap Distnbution. Pipe Layout el a P R G•O S 3.0 x Signed: Y • s� Hole Diameter Inch License Number: �G /�� ,I,gral / Inch(es Date: %� -° 2/ `J? 7 Manifold Z Inches r Force Main 3 Inches PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS - - -VEMT CAP 'i "C.I. VENT PIPE WEATHER PROO APPROVED LOCKING JUNCTION BOX MANHOLE COVER 'N 25' FRCM ODOR, � WINDOW OR FRESH 12 MIIJ. AIR INTAKE I I GRADE I ,, I 4" MIN. IB"MIIJ. CONDUIT �— — —.___ W AIN. \��9 _ —_ —_ a -' INLET 1PRTOV ppESEAL APPROVED JOINT A x f ''? 4µ t c ,! �j I I APPROVED JOIQ W/C.I. PIPE r±"°�`� *' kr' "' ` "L I I I W/C.I. PIPE ' EXTENDING 3 I Al G TEND 3 � X E ,,G` ` w) \�'.. I I ALARM ONTO SOLID SOIL B ya`i tl �y ,r ONTO SOLID SOI x ti P ��',��1 .� - I I ON J' t „,.. PUMP --- OFF D CONCRETE BLOCK RISER EXIT PERMITTED OUL9 IF TANK MANUFACTURER HAS SUCH P G SPEC.IFICATIOUS SEPTIC AND DOSE TANKS MANUFACTURER: WMBER OF DOSES: P R pAU TAM K L I Z E 1 2 7C..�' t" < c; �� GALL0IJS DOSE VOLUME: / LLO 5 ALAR MANUFACTURER: A !� ✓'n — CAPACITIES: P,= 29172 IUCHES OR 5 ,,,,LLO►JS MODEL WUMBER: 6= 2 INCHES OR - � ' GALLOU5 SWITCH TYPE: wee-- ir....f "' A�� pp _ l f v- C= :.. V� 4 2 1NCHE5 OR � 03 7 GALLCAIS PUMP MANUFACTURER: ��> ��/,/ �{ D= 1 1 2 WCHES OR ?- CALLOUS b?�5 . LJZ4..3 >. ". MODEL NUMBER: 3 � NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: _— _,J%F'r/'C�/ Y INSTALLED' ON SEPARATE CIRCUITS PUMP DISCHARGE RATE 70 -2 GPM G VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE... FEET /c , � -I- MINIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET -I- FEET OF FORCE MAIN X FACTOR.. 5Y FEET�� k_u TOTAL DJNAMIC HEAD = 'py FEET IMTERR:IAL •DIMEMSIONS OF TANK: CE -M6�H - - W4f) --H _ LIQUID DEPTH �- OP S I G N E D: �G�c�. G. 1 4.z LICENSE NUMBER . DATE. — �A yy �' /�en✓'��nso�'I Bulletin CL2.1A July 8, 1983 e For • Farms H omes __ GOULDS • Trailer courts Model 3885 • Motels (Supersedes Model 3870) v • Schools s ' " Submersible • Hospitals nt Pump Effluent Pumps Efflue • Industry • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to 1 / or drainage must be Di cha ge Size disposed of quickly, Semi -Open Impeller quietly and efficiently. 3 vane design. threaded On shaft 1 hrer ph,ls,' Units use impeller locknut to prevent accidencii back -off. Pump out vanes on backside of impell- for protection of mechanical seal Casing Volute type for maximum efficiency. Stainless Steel Fasteners Heavy -Duty Solids Handling Series 300 stainless steel for corrosion Dependable Capability to 3/4" Mechanical Seal 4 Ceramic vs Carbon sealing faces. stainless stye' spring and Buna N elastomers. -•- - -- Maximum Temperature 1 160 F 1 /3, /2 H.P. 60 Hz Capable of Running Dry Single Phase 115 230 Volt. without damage to components. Motor Specifications 1 /2, 1 Motor Fully Submerged /z, /4, 1, 1 /z H.P. 60 Hz � in high grade turbine oil for permanent lubrica- Single Phase 230 Volt. Three Lion of bearings and mechanical seal and Phase 208 -230 460 Volt. efficient heat dissipation. Motor sealed from environment by rugged cast it r Bearings t u' Fvd Heavy -duty all ball bearing construction Stainless Steel Shaft Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units 90 All single phase units have built -in thermal overload protection with automatic reset 80 x Three Phase Units Overload protection In Starter unit- 208 -230 or ' 460 volts. Threaded shaft 60 Hz operation. 70 r W �: ,$� Power Cord W Water and oil resistant Epoxy seal on motor e'd LL 6U � acts as a secondary moisture barrier in case of Q damage to outer jacketing. Corrosion resistan. I 50 gland nut. U Single Phase Units Q 40 V '; HP models equipped with 15' of 16 3 Z ` SJTO with 3 -prong grounding plug 1. 1': I r' 0 30 models equipped with 15' of 14; 3 STO power cord. O 20 r , SPECIFICATIONS ARE SUBJECT TO CHANGE 10 WITHOUT NOTICE. 0 0 10, 20 30 40 50 60 70 80 90 100 110 120 rn GOU LDS PUMPS, INC. GALLONS PER MINUTE u SENECA FALLS NEW YORK 1314E T 3 c . M ` r [� ? ul Vo- Qj l J ° � fL j . v � � h v► � .c _ _ _ .o v a N j Ul M M M n ( x �c ^\ V Ca C) J tU ♦ y Q. N ZZI