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CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT` REr6,\iE0 V Owner Property Address i City/State G << a� - :E Legal Description: Lot 3 Block Subdivision/ - S� � t /4 ,a t /4, Sec. - T, N -R I W, Town of 5,�� s�f PIN # i�� - 7Z -eeO SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION i Tank manufacturer Size ST/PC/ / Setback from: House Well , PAL Pump manufacturer Model / s�,� Alarm location - (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark — ,4,p, „{ n,, �� _ Elevation Description of alternate benchmark Elevation ,:2,0i Building Sewer g 2 ST/HT Inlet ST Outlet �7 s-5/ PC Inlet s y3o PC Bottom RS : ( Header/Manifold Top of ST/PC Manhole Cover PJ, Distribution Lines ( ) () ( ) Bottom of System Final Grade () () ( ) Date of installation /-2 Permit number State plan number /�?S9 Plumber's signature License number Date Inspector 2 Complete plot plan I t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Coun Safeb;,and Buildings Division "I' . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitayfare0o.: Personal information you provice maybe used for secondary purposes [Privacy W, s.15.04 (1)(m)]. Permit Holder's Name: RYSE, CHARLES a Town of: State Plan ID No.: �5 CST BM Elev.: Insp. BM Elev.: BM Description: � 1 Parcel MIQ - 202 5-70-00 0 TANK INFORMATION I teEVATION DATA A9800575 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ' Se ptic J00-V Bench M Dosin Aeration - Bldg. Sewer 15 5 Holding St /Ift Inlet 4 7 -7 9-7 , kY TANK SETBACK INFORMATION St/ FVOutlet 8 , 7 TANK TO P/ L WELL BLDG. Ai to ROAD Dt Inlet Air Intake � 7 Septic � NA Dt Bottom �l � uf� B 3•� � Dosing YI S5" 5 NA Header / Man. 5`• 6 j p j Aeration NA Dist. Pipe Holding Bot. System n)0'? PUMP/ SIPHON INFORMATION Final Grade Manufacturer w Demand �a e7o ,Z S Model Number WeD ' q6 , roIGPM TDH Lift'`, Friction . hii Syster? TDHZO.!&t � Forcemain LengtV Dia.." Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width L t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ` DIM SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distributiiion Pipe(s) C $ IxAl ole Size x Hole Spacing Vent To Air Intake Length Dia. Length p a 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 _T Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No C] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 7.30.19.566F,NE,NE 398 169TH AVENUE— LOT 3 C a v Plan revision required? ❑ Yes No Use other side for additional information. 9°l SBD -6710 (R.3197) Date I nspectorl Signature e Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue N* Ikonsin I n accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI ',53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State' anitaryy e Nu ber Personal information you provide may be used for secondary purposes E] Check if revis�o to prevlo plicacion [Privacy Law, s. 15.04 (1) (m)]. (aIrL& State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location Al 1 14 1 /4, S 7 T N, R E (or) Property Owner's Mail ddress Lot Number Block Nu er City, Stote � Zip Code TP hone Number Subdivision Name or CSM N m r ) p II. T YPE OF BUILDING: (check one) ❑ State Owned E] it earest Road Public 1 or 2 Family Dwelling No. of bedrooms _2 Ei Io w a n OF 1 " III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment/ Condo 3 19 ' 5&&), 3 _ S — 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, i applicable) A) 1. ❑ New 2. ❑ Replacement 3 jR Replacement of M'Reconnection of 5 ❑ Repair of an ------ System ________System _____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 (,Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 3 Feet Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank oP — S Lift Pump Tank /5rphanftrrmtrer '�- ® El I n 1 1:1 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation of the onsite sewage system shown on the attached plans. Plumb r' ame: Pri Plumb sS atu oS s) , MP /MPRSWNo.: Business Phone Number: � C Plum er's Address tree , C' y, State, i ode): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing ent signature No Stamps) Approved [:]Owner Given Initial / �/� Surcharge Fee) • PQ' rod 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 1' .1 J q \ ' v i 1 _ i 1 N I I Safety and Buildings • r * isconsin Phi 15837 USH 63 HAYWARD WI 54843 -8107 Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce November 16, 1998 CUST ID No.224263 ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/16/2000 Identification Numbers Transaction ID No. 185846 Site ID No. 1 SITE: Please rep too � ! nuiibers, Site ID: 163536 above, in AW cevzthe agency; ST CROIX County, Town of SOMERSET; 398 169TH AVE, SOMERSET 5 RO NE1 /4, NEIA, S7, T30N, R19W MMERCE Facility: CHARLES BRYSE RES MOUND SYSTEM 398 169TH AVE, SOpMR CO cO BUILDINGS FOR: Description: MOUND SYSTEM i Object Type: POWT System Regulated Object ID No.: 435124 S EE RESPONDENCE The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 10/28/1998 - FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 CARL J L P SPECIALIST BALANCE DUE $ 0.00 Field Operations (715)634 -3484, CLIPPERT @COMMERCE.STATE.WI.USI�R -' �I I RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project CHARLES BRYSE Owner CHARLES BRYSE� Address 398 169TH AVE Gu SOMERSET WI 54025 Legal Description NE -NE -SEC 7- T30N -R19W Township SOMERSET County ST. CROIX Subdivision Name Lot No. Parcel ID Number P,O,W.T. Plan ID Number Conditionally APPROVED INDEX SHEET PAGE ONE DEPAFTMENT Of COMMERCE MOUND CALCULATIONS PAGE TWO 0IV OF SAFETY AND BUILDINGS MOUND DRAWINGS PAGE THREE PRES. DIST. CALCS. & LATERALS PAGE FO SEE GO P0NDENCE PUMP TANK DRAWINGS PAGE FIVE PUMP CURVE PAGE SIX PLOT PLAN PAGE SEVEN s�.Jn Ac: Aee �A T 7 Designer KIM A O Qk4NELI, X License Number Signature Phone No. 715 -755 -3145 Date 9 -25-98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 146.10, wls. Slats. SBD- 10482 -E (R.04M7) Pagel of 7 OPTIONAL WORKSHEET 1. MOUNQ SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Continued- I. Wastewater Load, Total Daily Flows 10. Fora Main: Use s. ILHR 83.15 (3) (c) Minimum poslrlg Rate • � Dlantepr ` ire Adel. Code and PROVIDE A DETAILED 11 • Total Dynamic Head: LIST OF SIZING ON PLANS. System Head ■ 2.1 ft, 2. Depth to Limiting Factor ■ fL Vertical Lift • ft 1. bNt�anu Dose Chamber N 0 00 TDH■ Friction Lou • IL 2y' fL Distribution System • ft. S. Elevation Difference Net woM 2 � <�rJ 12. Pump Selec 2' wo Pump and Distributlea System - ... A. Perm� w w�k , o �ls ft. tl ot at Mast O 6. Absorption Area Siting: at a�fG.Bi� ��ny�1 k � a a "J'd u Area Required ■ � M• fL Pump model And KN Bed or Trench Length (0) fL 13 p� Volume: Bed or Trench Width (A) • ft. SO Trench Spacing (C) ■ IL 10 Times Veil Volume Of 7 7. Moved Height: Distribution Lkses a Dally Wastewaerr Volume FIII pepM (D) • 4 Ooses b 24 hn. • 43 gar. FIB tMPth Downslope (E1- h• t7� Bed or Trench Depth (F) • fL . 9. Bac mum Doi ■ o SAL and Top" Depth (G) ■ ft. . Cap and Topsoil Depth (N) ■ ' h•� N goo. .., 1. Mound Length: fe{ ?a End Slope (K) ■ RRIV SEWAGE SYSTEM Total Mound Length (L) ■ 7.S fL " old Daily Flow • W 9. Mound Width ,S sP 83.15 (3) (c) , Win. Upslops Correction factor • C.IM and PROVIDE DETAILED Downslope Correctlon Factor • F SIZING ON PLANS - 4>� uired Septic Tank C Oownsbpe Width U) Capacity • ga Total Mound Width (W) - -r.N c(fr`, _ f Percolation ■ - -- m� 4. Absorption Ana Sid 10. Basal Ana: e Refer to Table 2 in ILHR 83 Inflltradw cApacfty of , and PROVIDE A DETAILE LIS'( OF Natural Sol! ■ p tg3�l�+Y SIZING ON PLANS. Basal Ares Required • p• 9310. Required Area • Basal Area Available • N' ft. Length ■ ft. 11. If Standard Tables from Chapter ILHR 83 ..._� Width ■ ft. are : used, Indicate Table N Number of T nches • IL For the ion Distribut Netwwk, Uss Numben S•14 M Sectl►,11, , Trench SP r I ■ ft It. IN-GROUND PRESSURE SYSTEM 3 3 I but I on : .a.t - IL .1. Depth to Limiting Factor ■ tuber of Laterals ■ 2. Landslo" - Lateral Spadng - In. j. Percolation Rate • min./In. 4. Proposed System Elevation • fL Distance from Sfdewail W la Pipe ■ -- S. Wastewater Load, Total Dal Flow: W s gal. System Elevation ■ ft. Use B. ILHR 83 .15 (3) (c) , 1 Z.SIYSTEM4N-FLL Adm. Cade and PROVIDE A DETAILED Fill in All Itam from Section III LIST OF SIZING ON'PLANS. _ pac Required Sepik Tank Caity • f D0 0 g'r• V. SEPTIC TANK 6. Absorption Area Siting: Y O mire /in. 1. Capacity ■ O g Percolation Rats W � E ( / S � Area Required ■ sq. ft 2. Manufacturer. System Length ■ ft. 3. Show Site Constructed Tank Detalle eN Flan System Width - 7 ft. VI. DOSING TANK 7. Distribution Pipe SIZING: 1, Capacity ` ga Hole Sire • W. (,0 E (S F Hole SpaelnR ■ ,_a�. ft. 2. Manufacturer: jk Id Lateral Length • ft. 3. Pump Manulacturer: _ Lateral Sire In. 2 u 4. Pump Mode ft n6 '44 S. Operating Head Lateral Spacing �.� fl. Z ill t/. flow Rate+ U ibu i ia !rile 5111rw Ice 1r: 7. Show Slic Constructed Tank Details on Plans R. Ulstrlhullort ripe olsdtarGe Rale: i 9 Number of Ruin n ref Pipe low Pow Pyle • ItpIN. 2 Z• r 3 J VII. IIOI.UING TANK Y. Manifold piing: I. Capacity , venter or eml) art n 2. Manuiaclunr type ( Length ■ It. w to Constructed T Wtalls 0r1 /IaM Diameter ■ �aZ.. iN. _SHOW ALL INFORMATION ON PLANS- Page. -3. Of 4 Straw, Marsh Hay, Or Synthetic Covering - Distribution Pipe Medium Sand G Topsoil F D 3 E % Slope ( Force Main Plowed grik mas Layer D �� Ft. �A gG n dY.�y stem e m U s in E �� Z- Ft . Croy-V" con ��, g F V� Ft. - ®��:,`Fw�` het Ak4D4t on Area g Ft. A �_ Ft. H L Ft. Signed: B ,S'S It. License Number: .S K 1 63 Ft. - 7 — / 7 -86 L �� Ft. Date: - j _ Ft. Alternate Position I //__ Ft. of W Ft. Force Main L ' Observation Pipe -,, A ' ~---- -_ -__- -- -------- - - - - -- ------------------ - - --• Force Main ■ / r Distribution Bed Of Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area t( / po 7 Carves Pumps "n" fEET — - 1 0DEL JVVd 25 —�- - i �° — - - -- -: ��E 1 /4" Solids WE1S11 70 —}-- --i - -- 0 WE07M 50 J W EOSM _ 10 30 WEOJhA PWE03L - 20 i 10 0 0 10 20 90 40 50 60 70 Fro 60 ICQ 110 120 GPM i 0 10 ?D 50 m'/h CAPACITY " PUh1P5• INC. MMAS FEET - 120 � �— �N10 D E L 3885 - SIZE 3 /4 Solids Ito WEISMM — loo — -- -- — i -- 90 2S — j -- — 0 60 ~ is so WEOSMM -- � -- - , -- - i - -, -- -- r- r -� - - - T t o - 10 0 0 0 10 40 SO 60 70 W W 110 t i0 aPM 20 10 :J 90 m'/h 0 CAPACI f Y Eft"H�h• lf� • 1 W6 Ovuw ►Wnps. Ina. C364, i I � V _ �.�. LN f ` : b y i I . ^ � « " ' State =� . �� n_��^� | �,l 8bOr and ��UM12O��8�ons . PRIVATE APPROVAL. SAFETY & BUILDINGS o|vm|om Bureau of P1un/biny ^ � 201 [aut Washington Avenue ` P O. Box 7960 Madioun, Wisconsin 53707 GARY STEEL RE: Plan Number: 86-04437-S \ ! Galluno Per Uay: 450 98` NORM SHORE DRIVE Date Approved: Hugu^t 1 1986 , NEW RICHMOND WI 54017 Dace Received: 7/24/86 �- ' Proje-ct,A1.4ma: BRYSE CHARLES - RESIDENC� ^ �p�at 0,19W . ' Town of S«�ERS�T `' � ' ^ C6unt ^ ` The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145 Wisconsin Statutes and the Wisconsin Administrative Code, The plans are o 'conditionally approved'. This appro is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. ' All permits required by he city, village, 'township or ununty``u-al1 be iqed prior to conotructiun. The licensed plumber responsible for this installation shall keep one net of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ` - This approval will expire two years from the date approved or if a sanitary permit in ob�in�� will m�i�� d� �a initial sanitary �rmit�xpi�u. .~- . ~°. .�/� The Bureau of Plumbing has reviewed these plans for private sewage system code , requirements only. These plans have not been reviewed for the code requirement.- net forth in Section ILHR 82 for general plumbing or in Chapters 58-64 of the Wisconsin Administrative code. This approval is for the 'following components only: . " l~' NEW ; M�U�D i- NOTE: For any future plans, if the standard drawing, un the forms provided by the Bureau do not fit the proposed system 6esign, please provide separate draw- ingm. Cromuing out portions of the standard drawings will n*t he acoepted. Inquiries concerning this approval may be made by calling (608) 260-6952. R AN M A. KAMINISKI 'T ip" of Plumbing afety and Buildings Division PP026y0000w/11 cc: ___Private Sewage Consultant County _ _UW-SSWnP _ ..... _Piuh nmultan|. ___Owner __Plumber ___Envirvnmental Healt/ U) a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d '/ a OWNER /BUYER V-S� ROUTE /BOX NUMBER 4 Z- Fire Number CITY /STATE �)'�'(tis ZIP 3v PROPERTY LOCATION:_'�, �, Section O T �3C) N, R Town of e 7� 3 �T S St. Croix County, Subdivision jk o4- Lot number 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 I ` the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their 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. o E I /WE, the undersigned, have read the above requirements and agree z „ to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. p SIGNED DATE S ^` ,e 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. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. A,,y ivaaequaul,o ,:'l1 only result l:, aPlays of the permit issuance. Should this development be intended for resale by owner /contractQK,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property V '-L �� k, Section �� , T L) N - R j — � W Township 0=,.sQ S r ,5 t Mailing Address b Subdivision Name 4_ Lot Number F- Previous Owner of Property � l�14 � �(Y1 d Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? -- Yes No Is this property being developed for resale (spec house) ? Yes -�— No Volume 2 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings'filed with the Register of Deeds Office In addition, a certified survey, if available, would be'halpful 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. -------------------------------------------- PROPERTV OWNER CERTIFICATION I (We) eeAti6y that aU atatementa on .tlti z 6orm ate tAue to the be6.t o6 my (our) knowZedge; that 1 (we) am (a)Le) the owne 1 o6 the pnopenty ductLibed in .thz in6o4mation 6orm, by viAtue o6 a warranty eed recorded in the 066ice o6 the County Register o6 Deeds as Document No. L-O DD 5 -7 : and that I (we) preaentZy wn the proposed site 6m the sewage dispob-tem loa 1 (we) have obtained an easement, to run with the above de6cAibed pnopeucty, 4or the r , DOCUMENT NO WARRANTY DEED THIS SPACE RESERVED Pon RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 400577 V% 708 PKE164 PAGMEN ors Cecilia ST. CROIX . H. Malutlood, a/k /a Cecelia H. f Ferris S. , Re indiv... - CO., W{g ua - ly . and as. uxyiyinq joint ! _ _ _. cd. for Record this 25th Mahmood Grantor day of Mar ch A.D. 19 ... . .. ... ........... . . .• -- ............ — conveys and warrants to ...Charles. M BZ}!Se a O_ L iann T.-_ a 2 .15 P g .13Lyse,..husband.. and. £ e..as..ioint..ten*t;a-- ......................... .................... . .. --- - ----- -- -- ........... ..................... ......-- --- -............ . ------------ - - - - -- -- ------ ----- -- ------ - - - --- - .................... . -- .... - ----- -- --- _. _.. ................................. ....................... . . . . .. ------ ...... -.... RETURN TD Eric J. Lundell .................................. - . .. ....._.... ............... -- --.... New Richmond, DTI 54017 __ .. . .. ... .. .. . -- .- - .. -------------- _ -------------- I........ . the following described real estate in ...... ... ; c ................... .County, State of Wisconsin: Tax Parcel No: .............................. A parcel of land located in the NF; of the NFi; of Section 7, and in the NA of the NW; of Section 8, Township 30 North, Range 19 West, Town of Somerset, more fully described as follows: Lot 3 of a Certified Survey Map filed November 4, 1975 in Volume 1, Certified Surveys, pages 190 and 191, as Document #330085, as amended by an Affidavit filed May 17, 1976, at Volume 537, page 207, Document #332994, all in the Office of the Register of Deeds of St. Croix County, Wisconsin, together with the right of ingress and egress over the roadway described in the above Certified Survey. Subject to utility and roadway easements, and Protective Covenants of record. r This deed is given in satisfaction of a Land Contract Between Ferris S. Mahmood and Cecilia H. Mahn a/k/a Cecelia H. Mahmood, his wife, by her attorney in fact, Hugh H. Owin, as Vendors, and Charles M. Bryse and Liliann T. Bryse, husband and wife as joint tenants, purchasers, dated March 1, 1979, recorded March 2, 1979, in Vol. 590, on page 379 as Document #355456, in the Office of the Register of Deeds for St. Croix County, Wisconsin. This ----- is..Mt........... homestead property. � (is) (is not) L LF Exception to warranties: none Dated this - -... - .............. 51; --- -------- --- day of ----------- - I -`."A ---- -- -- -- .. ... .... -- -- ..... -- -------- --- -- -- ----- -- - - -- - . ......(SEAL) <� � - VAtr • -- Cecilia - H-- -Mahmood- - - - -- - - - - -- -- - -- -- ....- _ -°-------- --- ----------- --- --------- --- ------ (SEAL) - -- ... ... ....... • --------- - - - - -- ---------------- - - - - -- ----------- - - - - -- • . = w .. ---�1 '' r AUTHENTICATION ACHNOWLEDOME&TPIP' -wt Signature (a) - STATE OF MSHINGPON -------------------------------- --- authe nticated "..........�••'_ _ �',, authenticated this -------- day of_____________________ County. 19 Personally a before me this -__._ day of r •------••------------------------ •-- •----- ----••---- -----• - - --- ................ •... `+� ...... 19.8 the above named Cecilia H. Mahmood a -- -•-•- •- •-• - -- -- - - ----------------------------•-----•-----•----- -- ----- ---- ----- - -- -•- ------------------------------------------ ------------ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ------------------------------------------------------------ ............... -p - ....................... to me known to be the authorized by 708.06. Wis. State.) erson ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -- Attorney Hugh ... (livin, - (WIlV-- &-- C3VIN... .. .. ... .. .......... .. •- --- --- -- ....... I 430 2nd St., Hudson, 54016 -- -- - . ................ No a Commiss c .. y � ..../ (...... County. TOM r (Signatures ma y -.... ... _ be authenticated or acknowledged. Both is perman t. (if not, state expiration are not necessary.) date: C!� ---------- ------- 19_d -Q - -•) I ! Naar of persons alrulne in any mPwftr should be typed or printed below their signatures. BTAT3 B AB Or wtBOONSrN c M rL Ne. 1 2OA2 330035 330035 9 , FILED T NOV 4 1975 CD A"Ei O' CONNE(L ' . bplshr of Dseds ti • . SL Croix c o niv * TV Isconnsin a , ..... •N 040214 rn 8.1 I ROAD • • 1,30.79'7, 80 • . N. N 3 2e • ' • ar (D w O CD ° •U o u► o \0 :3 rn � sv " M 0 0 W o n C+ CD li (D �D W CD 0 O (D Cn (n H �o Z�� O��O Ma CD MO v v coo y� o ��•fl /' v N 9 to F-'• c+ p N O O� z � ° S� �o o., , O N W N : 3 8 O N N cct • - - --' v S O a c+ o (D o 0 (D c+ v r O �' • D wg l�Jt✓ � tzjr)r• ti NaM G w r OD .� ti o W (D O\ ' Qti1 o o - + z (D H 0 r x is o 0 oa O � „ c t�� p •U • (- Po o, ire; su v► o z ► - � c+ {n-•c+ a su _ C D 0\ m m su U) CD c+ :8, N ( .• r 0 .0 t y'' • " N• H ''i of O 'F Ca (A !v (4 \.n i C+ 11 z z 414.4 8' D c+ c+ • • c+ M z . m v' C rn CD D TO a (� p, N 0 O vi ( O " �S O N r - v 4 1 c+ (D n .. 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Z 640.52 TO �, °D o c+ CD o v• " O O En '-i O a H w I to Sz � n Q Q�q : CD :C O = cct 0 PI `C C �-+ CD C N �j r CD N 0 CDd (" m (D o 0 ° -_CD 0\V O wa� 0 O O " O , 5£S()oz 91 W l y :q txi Z W (D O 04s c+ O " _ �1 �• N to c0 D 0 to 0 40-60 N a m F h F rIN e", Form - S T C - 104 AS BUILT-SANITARY SYSTEM REPORT OWNER `� TOWNSHIP atS 6'3�— SEC. _- T 30N -R 9 W ADDRESS ST. CROIX COUNTY, WISCONSIN S SUBDIVISION LOT LOT SIZE �! " PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTT 4 \ \�fo \ ag INDICATE NO TH ARROW BENCHMARK: Describe the vertical reference point used PUMP CHAMBER Manufacturer: - ko r 2 Liquid Capacity Pump Model: p Siphon Manufacturer: Pump Sizey Elevation of inlet: _ Bottom of tank elevation: 5 Pump off switch elevation: O Gallons per cycle: ` Alarm Manufacturer: Alarm Switch Type: _ Number of feet from nearest property line: Front, Side, O Rear, 6 Ft Number of feet from well: — Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: : ( Lenith: J� r Number of Lines: o-2 Area Built: $� sG Fill depth to top of pipe: r Number of feet from nearest property line: Front, Side, O Rear,0 It Number of feet from well: �(�p T Number of feet from building: an (Include distances on plot plan). SEEPAGE PIT Size: Num r of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built- Has eithe drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used• Elevation of bottom of tank: Elevation of in t: Number of f et from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: �' Number of feet from nearest road: r , )EI OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS .O. BOX 7969 DIVISION AAOISON, WI 53707 BU AU 0 P 4 ING ❑CONVENTIONAL {ALTERNATIVE SIM PIa.1.D.N„mN�., O Holding Tank ❑ In Ground Pressure Mmound I1 8104437_� VAME OF PERMIT HOLDER q— ADDRESS OF PERMIT HOLDER ] iNsPEEMON DA'. I, Charles Br se Rt. 2 Somerset WI 54025 3ENCH MARK IPa•maot'f ,t1t•Mre pomO DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV. : CSI HFI Pr ELEV NE NE, Section 7, T30N —R19W, Town of Somerset Iw„r nl Plu„d,rr. MPIMPRSW No, C.—I, Sa Pr. m,l Numinr. Gary Steel 3254 St. Croix 83837 ;EPTIC TANK /HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUT LET CLEV WARNING LAB L LOCKING COVER PR r{� O O!� VIDED PROVIDED BEDDING VENT DIA ` VENT MATL 111H WAT H ' IJYES NO OYES ��NO NUMBER OF ROAD PROPERTY WELL BUILDING VENT OTHf $11 C_ ( j J AL ' A RKI FEET FROM uNE ARE INLET �SNCO ❑YES C�JN0 NEAREST 30ER: MANUF AC I LIFE E II of UUING LIOUID CAPACI I PUMPMOUEL PUMP SIPHON MANUI AC TALLER FW LABEL NO C J LOCKING YES COVER [EN ❑YES ONO O ES U ODED PROVIDED J = GALLONS PER CYCLE: PUMP AND CON TROLSOPERATTONAL NUMBER OF PRUPIH HURU IY LI INI. I VENFt" 111S.. (DIFFERENCE BETWEEN j '� PUMP ON AND OFF) FEET FROM LINE AIR TNT F T ' ✓ 301 ABSORPTION SYSTEM. Check the YES ONO NEAREST 10 _ Soil moisture at the depth of plowing nt T E N .IH IIIAMI 11 11 ' ,IAT 1141AI ANII MAI x excavation. (If soil can be rolled into a wire, construction shall cease uil FORCE :he soil is dry enough to continue.) MAIN CJ U CONVENTIONAL SYSTEM: BED /TRENCH WIOTH LENGTH NO Of 1151H PIPE SPACINI; COVEN - --- T IRENC / /f5 " INS,,,1 DIA z. % DIMENSIONS ANTE HIAL' 1 „)(Itlt PIT 'It PUl L V! L HE L PIPES DEPTH TILL DEP111 PI IIISIII 1'11'1 UISTR {•F DISTR. PIPE MAT RIAL O IS R 1 <f AHUVE COVER 111V INIII ELEV [NO —� NUMBER OF PROPERLY WCII HURUING VENT In IR1 bn PIP FEET FROM LINE Al// INII r ST MOUND SYSTEM: NEAREST- 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. YES ONO meets the criteria for medium sand. TIONS MEASURED. '.SOIL COVER j r + TO IIIHf ' =RTIANI IK{ RS H,N WI I I ti UEPTRnVEH IHENCII HEU O(PI11 OVlH IRENf., /BED Uf VI,1 qF IUPSDIL SUI,DI 11 ❑NO OYES LINO CF EH EIN:ES I SE f OF MIl11.11f I1 ❑YES ONO OYES f OYES �JNO _INO PRESSURIZED DISTRIBUTION SYSTEM: J BED /TRENCH WIOIN LE NO, j S,. TEIIAL SPACING IiHAVC UEP7,11(1 LOW PII'I , II L 0FPI11 AHUVI I: 1/ DIMENSIONS – _ ELEV UIU PUMP �.' IS1R PIPE MANI/11lD MAft HIAL NO, UIS111 I,IS 111 I'IPI ELEVATION AND EiE EL EV PIPES Dl DISTRIBUTION INFORMATION /COLE SIZE HOLE SPACING I COV (H MA f F NIAI 1:,11 /Nt SP INOS 111 APPRI ryl 1) PT ANS COMMENTS- fERMAF,ENTMAR ❑NO DY ES LINO OBSERVAT)ON WELLS NUMBER OF P {TOPER iY WELL BUILDING FEET FROM LINE DYES ONO OYES ONO N —y�_ Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE Illlf DILHR SBD 6710 (R. 01/82) J a SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code � STATE SANITARY P MIT #- -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. _ S -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORM - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PRO E TY OWNER PROPERTY LOCATION /4 ' /4, S T N, R E (or) W PROPERTY OWNER'S MAILING ADUFRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME JY, TATS ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE : .,W 4e 2 1 S1 R TOWN 11. TYPE OF BUILDING OR USE SERVED: /- 4tc, 114. 03.;1 — p?CI�G� — X -00 Number of Bedrooms if 1 or 2 Family - OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1. a. D544ew 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. Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. KlMound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ee a e 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): .71 p 37S 37 Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in g allons Total ## of Prefab. Fiber- Exper. strutted INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks G r Septic Tank or Holding Tank v to S� ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber L`S El 1:1 1:1 El ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber' gnature: (No Sta ps) k4P.4 tIPRSW No.: Business Phone Number: CO A-44 YAk QO PI 4er's Add ss (Street, City, State, e): Name of Desi ner: , " I Vlll. SOIL TEST INFORMATION Certifie I Tester (CST) Na e CST # & p_ 1 z 9� CST's ROMESS (Streft , City, State, Zip Cod w�, Phone Number: i (� W ( Z ` IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature M(NStam p s) Approved ❑ Owner Given Initial Surc arge Fee Adverse Determination �900 X. COMMENTS /REASONS FOR DISAPPROVAL: i SRI_)-6398 (formerly Plh - (R. 03/86) DISTRIRI I !ON: Orict,nal to County, One Copy To Bureau of Plumbing, Owner, Plumber State of WiscWin. 4slry,�,abor and Human Relations jrj=nt,.p,f Ind V ,,Qep_ PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION bureau of Plumbinq Z01. Last Washinq[,on AverILW P 0. Box 7969 m4disun, Wisconsin 5370? GARY STEEL RE: P11 Numbor: 86-04437—S ".511 [oris Per Day: 45o 986 IYOR'1'H SHORE DRIVE Approved: Atj( 1, 198b NEW R16HMOND WI 54017 Di�ite Re( (-j ved: 7/24/86 Pro j e-ct.,.M4me:. , BRYSE,, CJAARLES RESlPENCF� Lycc4t�� 4U,19W Town of SOMERSL4T' Uurttyl�� The plumbing plans and specifications for- this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans, All items that are noted must be corrected. the 'city, village,'township or cbupty�`s be obtairl9d All permits required by prior to construction. The licensed plumber responsible for this in�'tallation shall keep one set of plans with the department's approval stamp at the constructign site. The installer shall notify the appropriate inspector when inspections can be made. This approval will.expire two years from the date approved or if a sanitary pe . rmit is obtained, will expir .,the.,.d`_ the initial sanitary permitzexpires. The Bureau of Plumbing has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 64 of the Wisconsin Administrative code. This approval is for the'following components only: _7 1 NEW MOUND NOTE: For any future plans, if the standard drawincI5 on the forms provided by the Bureau do riot fit the proposed system design, please provide separate draw- - ard ings. Cros out portions of the standc . drawings will. not, be accepted. Inquiries concerning this approval may be made by calliri(3 (608) 266-6952. sir�pKely, RTAN A KAMINISKI / B. _eau of Plumbing fety and Buildings Division pP026/0009w/11 cc: Private Sewage Consultant UW _ nsu ltAn 1. -- Owner Healt! 1 1 /CC s Vs6 �-S - e:D . � �7 s �� L� rds'S 5�� 8604437 ��- ,dC)Sln-7 C:J -.74 r � � OPTIONAL WORKSHEET 1. MOUNQ SYSTEM 11. IN-GROUND PRESSURE SYSTEM- C"Unued- 1. Wastewater Load. Total Daily Flow ■ gat. 10. Fora Main: Use a. ILHR 83.15 (3) (c) Minimum Dosing Rau ■ � Adm. Code and PROVIDE A DETAILED Diamewr ■ in. LIST OF SIZING ON PLANS. .37 11. Total Dynamic H+ad: 2. Depth to Limiting Factw - 3. -�.� ft System Head ■ 2.5 fL 2. Lan lslw - -3 x Vertical Lift ■ tt. 4. Distance from Does Chamber M Friction Lou - / Is. Distribution System ■ c;? 0 � tt TDH ■ 2 Y. it. S. Elevation Difference Iletwen 12. " Selection: Pump and Distribution System ■ `� ft. Pump wN�AisdWse at leaet fpm 6. Absorption Area Siting: ii;; at _30 F3 7 n, total dynamic Mad. Area Required - N• tt pum model and ( aewnn Bed or Trench Length (B) ft. y.l F' e S N Bed or Trench Width (A) ■ ft. 13. Does Volume: Trench Spacing (C) ■ ft. 10 Times VOW Volume of SO 7. Moues/ "slot: Distribution Lines a "t Fill Dep1A (0) • is. Dally Wastewater Volume ♦ /3 Fite Depth Downslope (E) - Z ft. 4 Dotes In 24 hm - tae• Bed w Trench Depth (F) • R. • 83 Backflow ■ W. Cap and TopaN Depth (G) - tt. mum Does gal- - Cap and Topsoil Depth (H) - n! b ..L.LLGSL gal. t. Mound Length: End Slope (K) RRIV SEWAGE SYSTEM Total Mound Length (L) - 9. Mound width. ``. • IL*HRY,81�3r. otal Dally Flow - JIM Upsiope Correction Factor • ` 15 (3) (e) , Wi n. Upebl» WWat (1) - ,°C.rd. and PROVIDE DETAILED Downsiope Cometlon Factor - F SIZING ON PLANS. Downsbpe Width (1) ■ % ,6uirod Sepik Tank Capacity ■ W. Total Mound Width (W) - `y r(1:,'. Percolation Rate ■ m4% 10. Basal Ana: 4. Absorption Area Sizing: InflllrathK Capaclty of Refer to Table 2 in ILHR 83 Natural Sole ■ pXtJday and PROVIDE A DETAILE LIST OF Basal Ana Reetofnd ■ O p, � SIZING ON PLANS. Basal Area Available - ,4, tt. 436. Z Required Area - p• 11. If Standard Tables from Chapter ILHR 83 Length ■ ft. `_� ft. are: used, Indicate Table # - ---. Width ■ 12. For the Distribution Netwwk Use Numben S•14 M ches SUW -11, Number of T n ■ .�- Trench Sp ng ` tL It. IN- GROUND PRESSURE SYSTEM 33 � /SYSTEM4N Sy Vim: 1. Depth to Limiting Factor - .ai -_ ` it_ �2. Land,$*" • _ _ % of Laterals �. Percolation Rate - min./itt. pacing ■ I"• 4. Proposed System Elevation ■ ft. from Sidewad to Pipe - in. S. Wastewater Load. Total Dal Flow: gal. levation • ft. Use a. ILHR 83.15 (3) (c) , Win. Adm. Celle and PROVIDE A DETAILED i LIST OF SIZING ON'PLANS. /A,� n Fill In All Ron* from Section III Required Septic Tank Capacity ■ /DO O Pl • 6. Absorption Area Siting: �/ V. SEPTIC TANK r . o „o Percolation Raw • 1. Capacity - lJP �,., / P ,�f,L E S�- to Area Required • sq, ft. 2. Manufacturer. 1 � System Length - 5 fL 3. Show Site Constructed Tank Detaik en plan System Width ■ '7 n• 7. DisI WAl" Pipe Siting: VI. DOSING TANK ` O tea+ Hole slie ■ ._ \ 1 1 4 In. 1. Capacity W 4 E { S t% Hole Spacing' .._ate_ ft. 2 MAnUfaCIUM : Lateral LeMtth - ft. 3. Pump Manufacturcr: - Lalrral SO* in. 2 u' 4. Pump Mmict: I.�ril spacing fl. S. OperallnN Head ■ r � il I)WAnce fawn Skirwall•lo Pipe ' In, b. Flaw Rate. u N. Distribution Pip+ DlschArits Rile: 7. Show Site Constructed Tank Details on Plans Number of i kolas Per Plpr i 9 I low Per PlIK N pm• 7 Z•t3J VII. 1101.1)ING IANK 9. Manifold suktt: 1. Capacity Type (waster or oal) . n 2. . Length ■ 1 t, w t+ Conm ucted Tank Details on Plans Diameter ■ _a1-- in. -SHOW ALL INFORMATION ON PLANS- a Y Page,..2. Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand N G Topsoil F J � 3 E D % Slope • BI$ %2 ( Force Main Plowed Layer Ft. Cro. - crx0 10 A�` aArl �'ystem Using E 42- Ft. �8��d:,`F�cc�s``The� A � 4 - fi i on Area F + Ft.• G Ft. A _7 Ft. H Ft. Signed: - B ,S"-5 .Ft. J License Number: 4= K f e3 Ft. Date: — / x-86 L Z Ft. J Ft. Alternate Position I Ft. of Force Main W D Z Ft. L J Observation Pipe A I «• -- -- - - - - -- -- - - - - -- ----------------- - - -•-� Force Main W ' ---- 7 - ------------------ - - --•I Distribution Bed Of z 2 Pipe Aggregate Observation Pipe Permanent Markers Nan View Of Mound Using A Bed For The Absorption Area Page Of Perforated Pipe Delop Per /aoteaL End Co PVC Pipe ic e r p►s� ` :.oles Located On oottonn, Are Equally Spaced S c- 1� PVC Force Main .7 PVC Manifold Pip* - •' P' Alternate Position Of OislPipe Force Main 3 Lest tteie Should Be +sr ... Nast To EM Cep End Cap Distribution Pipe Layout P Ft. R .3 S 3 X 3& Inches Y Inches Signed: Hole Diameter Inch Lateral "�, Inch(L License Number: 3 Z S"4 Manifold Inches: Date: 9- 17 ` (P a Force Main " 3 Inches # of holes/pipe ! al Invert Elevation of Laterals 00 ''t. 0 0/off � 3 0 � 3 SE�' rs GOP - � l 5 lbl �t 3h w. Vag s rr6 , boo � <— 10 23 ' �s PAGI CF PUMP CHAMBER CROSS SECTION ANG SPECIFICATIONS VENT CAP 4 "C.I. VEMT PIPE WEATHER PROOF APPROVED LOCKING J JUNCTIOIJ BOX MAWHOL COVER a 23 FROM DOOR. ��►pp �� WIWDOW OR FRESH IL'MIU. ( qr,•� 1 +5� �l} AIR IWTAKE GRADE I I Y MIN. � � I e• rctu. E COUOUIT -- miLT @�'��voll1 f U y 1 � ` P � ROVIDE L yS d, 0 �,� APPROVED JOIUT A C , `r`� P I I I APPROVED JOIN* W /C.X. PIPE CXTCNOfpG 3' ALARM E OIJTO SOLD W O UTO SOLID SOIL I�p. �.► `� SaF of �� I f � i I o1J . ELEV. FT. O��A�� G� PUMP J rr 0 CONCRETE OLOCK RISER EXIT PCRMIlrED OULy If TA MANUFACTURER HAS SUCH APPROVAL SEPTIC E _ 3PCCIFI *CAf1 4487 7 0013E w �5 m7lQll L4; UMBE IJR OF R OD / 6' 3: PER DAM MA�IUFACTURCR. TANK SIZE: (goo 6�LLOIJS DOSE VOLUME LAR MAIJUFACTURCR: Ems` IMCLUDIUG GACKFLOW: ' y GAI.I.OWS MODEL UUNIOCR: CAPACITIES: A= //&,✓ MIGgES OR GALLONS SWITCH TAPE: u "' / Bu 4 INCWCS OR 6A �LLOUS PUMP MAUUFACTURCR: C=�IWCIIES OR I-BO GALLONS MODEL UUMBER: O D- INCHES OR ZG 7 GALLO SWITCH 'rVPC: Yh L- V v NOTE: PUMP AMC ALARM ARC TO BE, MIWIMUM DISCHARGE RATE cpm INSTALLED OW 3EPARATE CIRCUITS VERTICAL DIFFER G= BETWEEN PUMP OFF AND DISTRIBUTION MPE.. FEET � IY + MINIMUM NETWORK SUPPLY PKt%SUKE ......... ..� FEET �C z + FEET OF FORCE MAIN X .1.Y FACTOR. FEET x x 9 / ,y l TOTAL 0SUAMIC. HEAD : FEET X3 1 • z� ,32 �� IWTERUAL DIME IOW% OF TAUK.: LEU&TH L W IDTH 9 , ;LIQUID DEPTH RIG1.lEf�t LICEMSE UUMOER! • • d ■ ■ ■ ■ ■ ■ ■ ■ ■ ■e ■ ■ ■■ ■■■■■ 11 ■■■■■■ee■■■■ ■e■■■■■ MIN UMMEMEMMENIMMEME ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■e ■ ■ ■■ a ■■ .►:�� -�� ■■■ ■ ■ \ ■ ■► ■►gee ■ ■■ G • ■�� ■e ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■w M ODEL '.. "wwe■ew■w■■■w■■w ., ■e ■ ■� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ,iiM ■■ww ■■■w■e■■■■■■■■■■■ . ■■■w■■■M■e■■■■■■e■■■■ ■ ■■■■\m■■■■■mu® ■w■■■■■■oe■ ■ ■we■■►■w■■■■Mw■■■■■■■■■■■ ,■■ ■we■■►e■■■eev■■ee■ ■e■■■■ ■ee■■i■■►�■e■e■ee■■e■■■eae■ ■e■■■■■■■O■■■O■M■e■■■■■ ■■e STATE OF WISCONSIN - DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: I Townshio/a" 4mu" NE k1 NE 'X 7 IT 30 N/R W St. cu ix Street Address: Subdivision: County: Landowners Name: Mailing Address: Chah.W & y4e Rt. 1, Somemet, W1 54025 I (We), the undersigned, hereby make application for an alternative system on the above - described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I a ree _to have t he. system installed itt-- conformance with the Bureau's approval of.plans and specifications. .I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. 8604437 I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF L This day of 19 0. Notary Public, State of Wisconsin My Commission Expires: r A 1 ST. CROIX COUNTY WISCONSIN ZONING OFFICE � 798 -2239 (HAMMOND) 425 -8383 (RIVER FALLS) HAMMOND, WI 54015 June 26, 1986 Divi.6ion o6 Sa6e ty and Buitding Bureau o Ptumb.i ng P. 0. Box 7969 Ma.di6on, Wl 53707 Dean Sit: An on site inve tigati.on bon the Ch mte.6 Bny6 e pnopen ty, toca ted at th.e.Nt=% o6 the NB% o Section 7, T30N -R19W, Town o SomeAAe-t, St. Croix County, neveat.ed 6ui table 6oit.6 at a depth. o6 3.33 6z., below which 6easonabte high ground water was noted. This bite 6houtd be 6u,i tabte bon a mound 6 y6 Zem. Shoutd you have any queation6, pteabe beet 6nee to contact thi.6 o66 ice. Sinc ety, u t) �4 9 . Thomas C. Nees on A66.i. Cant Zoning Adm.iru. t4 ton -� TCN /mJ WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS M. DIVISION OF SAFETY b BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. cuix Location N_ 1/49 NE 1/4, Sec. _ 7 T 30 N, R 19 A uXW4 W Town )V jy SomeU Street Address Lot No. Block , Subdivision Landowner's Name: _ Cha4tea Bea e The application for this site is for: Q new construction use. ❑ replacement system use. r If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Ll to have one of the first five approvals guaranteed for this year. This is numher - - of those applications. (Use one of the first five quota num ers- ssueTo you. ) one of the applications needing a quota number. The quota number assigned to this application is _ 07 _ 7 . 4 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Ofor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. IJ for an application on file prior to February 1, 1980. 0 4 L]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: E] a failing conventional soil absorption system. El a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Ne,6 on S i unty c a Title _A , 6.6i6tant Zoning Admi-niztAaten Date June 26, 1986 nTl NR- SRn -f,15R (R. 17/R9) STATE OF WISCONSIN DILHR � DIL.HR PRIVATE SEWAGE SYSTEMS DIVISION OF LUMBINa BUILDINGS BUREAU O 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969 Madison, WI 63707 606 - 2663816 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The bark side of this fofm describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266 -3358. 1. PROJECT INF RMATI N Type or print clearly Revision To Plan Number: Spy 4 Name bmitting Party (Plans retur ad to came) Project Name v4� l-. 'S L /no d St re & No. or Ruhl Route Project Location - Street & No. or Legal Description Ili , S h ov (-: r . G- G I fdviv. /Z J9 City or Village State zip City ❑ County Village � 11 13 OF: n �� 1 �� >n dYl � (.CJ ; . S ¢O/7 Town S o rin u r S Telephone No. (Include area code) 5- Designer Telephone No. (Include area code) Owners ame Telephone No. (Include area code) Street o. S �S� 2 ' • 3 Street & No r L I W . City or VI age State Zip City or Village State , zip e-"S a: -� sr 0 2. APPLICATION FOR: New Mound System (3a) ❑ Groundwater Monitoring (7) ❑ Conventional System - Public Building (1) ❑ Replacement Mound (4a) ❑ Holding Tank (2) ❑., Replacement Pressurized System (4b) El System in Fill (1) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5) 3.. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50.00 4a. _ 00 3b. 1,501 - 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 - 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 . 9,000 gallon septic tank -100.00 4d. 3e. 9,001 - 15,000 gallon septic tank -150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500 - 1,000 gallon dose chamber - 30.00 4g. Co. Od 3h. 1,001 • 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001. • 4,000 gallon dose chamber - 70.00 4i, 3i. 4,001 8,000 gallon dose chamber - 90.00 4j. 3k. 8,001 - 12,000.9allon dose chamber - 110.00 4k. 31. Over 12, 000 gallon dose chamber -150.00 41. 3m. 500 • 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal r_:o 3r. Priority plan review: walk through) 4r. Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee - 4 • O O Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 - -...._ ...mac.... •....1,..•,,..w,.,,.11y I P•SiTP9CENTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDU DIVISION LABOR AND P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /MWA4Q49I�ITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: G '/ Cr T.30 N/R A (or) W SO -n s C O NT : OWNER'S UYER'S NAME: MAILING ADDRESS: 3 - S �. USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PR FI D NS: A TESTS: Residence �PJew ❑Replace A- �P° RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) []S U DU ❑S 1E1SZ1J1EJS9U1 ` - � 2w If Percolation Tests are NOT required DESIG R TE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: !Y1 A (/ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND EPT NUMBER BEGIN, ELEVATION OBSERVED EST. HET TO BEDROCK IF OBSERVED (SE ON BACK.) �� (p co 511 , 3 Ct7 100 A) B- 0 7L 3 3 01 3 .$ S � jj S ,L. B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER WVeME AFTER SWELLING INTERVAL -MIN. I PER PER1002 PERIOO 3 PER INCH P- 0:) 7 �8 P. 2 2 3 2.-. P- 0 30 7 (i 3 O P- 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 9 �� d =P -4 Oin - B mid. )4+100/ - tN to, LZ L 33 — Fi3n0 — (Z8 /ZO'>•i) 56MOSS uu •aalsal !!oS pue aaumo Aiaadoad'A}!aoylny !eoo of Adoo auo pue !eu!6!a0 :N unelulsla ' 91me irm ` mos anS 3 0U5 eu � .FILED. s� NOV 4 1975 Co LAMES O, CONNELL ' . Roolator of Deeds w • St. Crolx Coon ' • 3 CWIS4) �� O N o) N 04 W ROAD °;...... 08.11 35;, '0 130.79 ti o $ • . so a 8s Sq ,� . N. N 343 SO% ti • •. co ct ' N CA) ct • o o c�D o b L M(D wo :z n•o -o Vol o FS. N-0 0. • a\� 0 A) K (D . 0 0. W on ct N I cn N (D \O W (D 0 O (D CO N H ry o U y� oy °a �9 W z..:�(,a 01-t o u► \) 00 O �� ° • O ° (D 0 -t ct v, O (D O 0 cm ct to ca K ct o N 00 ( ct v N• 0 :3' o �' �.n �� CO f�D FA w" '�`flc a o v o z t- ° o w t z co n) r a m :j to r N -N 'o. �� • = ct 4*lct P. w rn m oa tv cn (D ct :1� cn O\ .O : 4 -P- C', W ct ct 0 K (D (D Cn » o » W . t-y 1 ''• H 4 Qq r o i• d v . I✓ .p- ... W N 0 O (D Z Z W� O_ (n • -%J m \.n Il ct " ,'J' 1\) 1.1 414.4 8 OD ct ct • » cil oa z o w (D rn _ TO m cD' a � o . �•m Cr -4 Q\Fi D o a N N OWN 0 I O N. v r _0 , � w ct (D c .0 0 ; � � �' 0 t � oo � 'i P. m z 0 " .4 "g 0 m I�V - m ^' . (n N El (D IV W ct ct J-t tr• 0 cn (n (nom 0 11 N (D oa 0 " -3 (D 1 -4 W *64 ct ct T -1 o o • N) ' N OO O �p Of 0 0 m v Cn cn (Dw(D •1 _ � — -a 0 CD a ct o (D • 00 0 N " o Fi p O p cn N -.7 `n (D 1- 1 i n N (D o y o 0 v � 11 z 0\--j -0\--j cn 0 v c a a �, o a o ». a m _. % c 0) 0) N) 54 •• P1 t. to 0 m ,,,( ngprl£oZ81 % 4 a v) m O m 00 ct n S1 N. rn n > . _ O i�7 -PA . n �, � 0 (D o h o a ct' i -0 A 0 S 05 °11'05" w Cn °D.a c t o w = 0" ct ct K 0) to a (n o • H O ct N• :I ct (D t7 < 46 0.80 1 TO Z _ _� o 0 oats o o 1 • Woaw-4 V M N co w rn m w O o h: cD c o TT \` L i W oo O v 0 ,F0 0 -. W m ct z w N ct O co .0 (1) N ct (1) (D ILA • cn r - ct » 4— CD o. W 00 P. w "i p w m v, o' �' O O m ►-ti :3 (D y Gl • 0 00 OJ 0 Ct (D n ct ct 0 cC 'U A D _ ct 0 z O (D (D a s , y ° • (� ct ct n O m ct z F-+'tY N ''i �\,•� vi O ct (D mw w m ct ' cow (b . o N "J 41 Fi N. �� • . O`� pti CD Z (D O (n H O o a n ct ►ii • ,� � t h H WO W o (D Oj t D z o S 02. 14`00' W y r� o.. � o .o 11 CQ FJ (D .. 640.52 TO co 0 ct m o " rs o cn ~i o a H , .. 4o� _ - aq Oct = ct 0 (D G " W' W Form -STC- 104 AS BUILT - SANITARY SYSTEM REPORT l ,9•r,n S r SEC. T 3 N -R�W OWNER TOWNSHIP S � - ADDRESS ��_. ST. CROIX COUNTY, WISCONSIN SUBDIVISION �.� LOT A LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTE� 4 5 may ag INDICATE NO TH ARROW EPARTMENT INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BU AU OING ADISON, WI 53707 ❑CONVENTIONAL XXIALTERNATIVE ) sl.I PNn LD. NuIr1ImC (If eH IlII14(/f ❑ Holding Tank ❑ In- Ground Pressure MiMound , 8604437 AME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECrION DA: E Charles Br se Rt. 2 Somerset WI 54025 [ ENCH MARK 1Permanem reference pomA DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. ELEV NE NE Section 7, T30N -R19W, Town of Somerset ,m of Plumlrr. 1 7RSW No.. County - Sa nndry P..,-.t Numlur: - Gar Steel 3254 St. Croix 83837 EPTIC TANK /HOLDING TAN MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LA L LDCKINIiCOVEH P�R PROVIDED W YES ONO ❑YES ONO BEDDING V VEN ENT DIA. T MATL. HIGFI WAT Fi NUMBER OF ROAD. P [UILDIN(; I VIN T OfNf SH ALARM LINE AllINLE DYES NO C DYES NO NEAREST < V IJ OSING C AMBER: I MANUf ACTUREH I SFO13ING I LIOUID CAPACITY PUM19'M)UEL jPUMPSIPHPNMANUtACTLJOj[H WARNING LABEL TPR:DE1 NG COVER 1 PRO IDEU DYES "NO �lllJ �.�. r R; YES UNO YES CJNO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF P/IOPI HIV 1 1 1 11 O L( Hun DINT, VENT T 1111 SU (DIFFERENCE BETWEEN / FEET FROM LINE , AIR )NLFT PUMP ON AND OFF) V YES ONO NEAREST — �► OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Lt N6 111 MIAMI n 14 - vAII In A) ANIIMA/1KIN1. r excavation. (If soil can be rolled into a wire, construction shall cease until FORCE IhtONVENTIONAL e soil is dry enough to continue.) MAIN L 0 J SYSTEM: BED /TRENCH WIDTH LENGTH I NO OF UIST PIPE SVACIN6 COVE J INS101 M7 aPIIS I.10tlll) i14ENCHFS M TE IAU PIT UFP114 DIMENSIONS ; ;1AVFLOt PFH FILL 11 PIII UI" 011 UISTR PIPE DISTR. PIP. MAT RIAL U I- REAREST UMBER OF PHUPEHTY WLLI. HUILDING VF NT 10#14IN1I HF LOW PIPES AHOVE COVER f I f V INI f I ELEV ENU PIP S EET FROM , LINE AIR INL[ 1 —► M OUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES El NO meets the criteria for medium sand. TIONS MEASURED. 15 01L . COVER IT x"IRE VF I4NIAN1 NI MA14KI I4S I113M 14VA 114 IN WI 1 I S D tH[NCN HHE[) Uf PIII VFR INCNCH HEU UEP114 OF InVSOII SODUF II CENTE EDGES (� 1 YES ONO DfYES DNO /l -V I OYES r3N0 '* CJ NO AYES DNO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH 1 1-tN(011 . NO.OF I.ATERAL G SPACIN rrWAVE L Uf PTH Hf LOW VIII I It L DEPTH AH41V1 (a)VI H TRENCHES DIMENSIONS MANIF ULD PUM MANII UL I) UISTR PIPE M NCI UIti 111111 I:ISNI ni-%Mi HT) MP. 04IAI /L MAI4KIN4, ELEV T ELEV SJ DIA ,j ELEV. 44VFS UTA ,.) PI ELEVATION AND I C)u DISTRIBUTION �- J INFORMATION ROLE SIIF 140LE SPACING Ufil= .Mim ITV COVFH MATERIAL VI H I ILA1111 I (;ORHf SO" INDS 11) APPHIIVI I) n PLANS ,,....��{{ YES ONO ' _ L�YY ONO COMMENTS: PERMANENT ARK 11 : OBSERVAT ON WELLS NUMBER OF PROPERTY WELL 8UILUING U E_ � n YES 1:1 NO ES ❑NO N Sketch System on Retain in county file for audit. Reverse Side. ' SIfiNA TUNE TITLE DILHR SBD 6710 (R. 01/82) r� SANITARY PERMIT APPLICATION COUNTY ILHR I n accord with ILHR 83.05, Wis. Adm. Code '74 STATE SANITARY PLARMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8/z x 11 inches in size. S -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION PETITION PRO E TY OWNER PROPERTY LOCATION FOR VARIANCE ❑ YES NO %4, S P7 T N, R E (or) W PROPERTY OWNER'S MAILING ADIFFIESS LOT NUMBER 111LOCKNUMBER SUBDIVISION NAME C Y, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK GS VILLAGE : TOWN OR 4a_,_Qa II. TYPE OF BUILDING OR USE SERVED: #4tC11- /ZQ . Number of Bedrooms if 1 or 2 Family - OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1. a. D�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. ` Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy e. 9,Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ee a e Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA RPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feetqg ED (Square Feet): -71 o I? S 7 S F eet &Priva te - ]Joint ❑Public VI. TANK CAPACITY Site in alions Total ## of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank &�', -l ow (,� S Lift Pump Tank/Siphon Chamber �/ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber' gnature: (No St Pl er' a ps) MR/dAPRSW No.: Business Phone Number: � t et, Iat ,3z 5" WE) Z y �o� urr�s Add ss (Street, City, State, e): Name of Designer: at I RG I Vlll. SOIL TEST INFORMATION Certifie I Tester (CST) Name CST # k 1 z � CST's A E S (Str t, City, State, Zip Cod Phone Number: 40 �'Lc7 i Z 6 azyeo IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee I Groundwater Fate Issuing Agent Signature (N Stamps) Approved ❑Owner Given Initial Surc ar e Fee 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 State of Wiseppin Department of Industry, J-abor and Human Relations PR' ,IVATrr� e'°.WAGE� PLAN tiE'PP SAFETY & BUILDINGS DIVISION _t r' ic:ia 'J -� r � f�` t { ! ":- 1. � ! Y f? �:• r p p t.3P(.._, r. sCl .`q0 ! 1` S ki y . a v ( S d Ir ttll! t a �{ i t li`' isrka t�'-'• eF i ed s 1 r ° qyi .I,t I t. i 1/♦ kP_ 1 ,'f'- 1 i I Y i f.. ii � sej C it tit l t?! 0 ltS C" tf(r, t I rr 11 f , ! : Tit,. l�ltt it >s3tl , � {!.. ?f 1"'�;t;it (•114.', t. 1h ; �t - ^ iIS'.1 i 1 .artN t I f: i u i _ i - L i 6 � (3 ,a (. jj" L.?1F(3 r i:i_ ; t'P.41ca:�ta a:i,:! •li.j a15t.t s :ft 1`ni!'1 t niLHR- SBD-6423 (N. 04/81) y ��• °� s � �-i � rds 5��, � �� ••- �� STATE OF WISCONSIN DILHR DILHR PRIVATE SEWAGE SYSTEMS BU I E UN F OF FETY& PLUM ING BUILDINGS 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608- 2663615 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this fotm describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266 -3358. 1. PRMICT WFORMATION (Type or print clearly Revision To Plan Number: -56 4 !ter Name ub�m ittinp Party (Plans raur `to me) Project Name � et P7 0 N L. Str & No. or Rutal Route Project Location - Street & No. or Legal Description e h U v, A) G-" / E I --t W. R 19 City or Village State ,�Zi ^p City O l County W � 7 1 UJ � . - S7'-v/7 Village 10 OF: �0 MI97 rS Ir 7" • 'C/`.t. � �� Town Telephone No. (Include area code) Designer Telephone No. (Include area code) Owners Verne Telephone No. (include area code) street Street & No CRY or Village State Zip City or Village % State Zip 2. APPLICATION FOR: ew Mound System (3a) ❑ Groundwater Monitoring (7) ❑ Conventional System - Public Building (1) lJ Replacement Mound (4a) ❑ Holding Tank (2) ❑.,,Replacement Pressurized System (4b) ❑ System in Fill (1) ❑ Petition For Modification (6) D New Pressurized System (3b) ❑ System in Flo od Fringe (1) ❑ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50.00 4a. 4 , 00 3b. 1,501 - 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 - 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 - 9,000 gallon septic tank -100.00 4d. 3e. 9,001 - 15,000 gallon septic tank -150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500 - 1,000 gallon dose chamber - 30.00 49. c30 06 3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001, - ,4,000 gallon dose chamber - 70.00 4i. 3j. 4,001 8.000 gallon dose chamber - 90.00 4j. 3k. 8,001 - 12,000.9allon dose chamber -110.00 4k. 31. Over 12, 000 gallon dose chamber -160.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank -100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal Cl r r?© 3r. Priority plan review: walk through) 4r. Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 may be subject to chanp annuNlb DILHR4BD4746 (R. 03/84) - Effective July 1, 1984 / - OVER STATE OF WISCONSIN - DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township"AU UAMW NE hl NE kIS 7 IT 30 N/R W St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: ChaAt" atpe Rt. 1, Someuet, W1 54025 I (We), the undersigned, hereby make application for an alternative system on the above- desoribed premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I _ a ree _ have t he_ayztem- installed in- conformance with the Bureau's approval of.plans and specifications. .I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. 8 60 4 437 I understand that this application does not permit me (the applicant)or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. O Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF � This day of - Notary Public, State of Wisconsin My Commission Expires: Lt DIIER -SBD -6413 (N. 05/81) ST. CROIX COUNTY WISCONSIN .a ZONING OFFICE 798 -2239 (HAMMOND) 425 -8383 (RIVER FALLS) HAMMOND, WI 54015 June 26, 1986 V.iviA ion os Satiety and Building Bureau o j Ptumb.ing P. 0. Box 7969 Madi6on, Wl 53707 vean Siv An on 4 to .investigation jon the Cha4te6 B&y6e pnapexty, toeated at the NI=% of the NE% o6 Section 7, T30N -R19W, Town o6 Someuet, St. Uo.ix County, %eveated 6uitabte 6oits at a depth. o6 3.33 it., below which 6easonabte high ground water was noted. Thi.6 6 i,.te 6houtd be 6a tabte bon a mound 6 y6tem. Shoutd you have any question6, ptease beet 6nee to contact this o6jic.e. Sincetety, Thomas C. Net6on A66.istant Zoning Adm.in"tnaton 8604437 TCN /mi WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY b BUILDINGS, BUREAU OF PLUMBING AN P.O. BOX 7969 MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System r In the County of St. Cno.ix Location - NE 1/4, NE 1/4, Sec. 7 T 3o N, R 19 W Town Somez Street Address Lot No. , Block Subdivision Landowner's Name: ChWu Bnube The application for this site is for: Q new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: �.1 to have one of the first five approvals guaranteed for this year. This is number of those applications. (Use one of the first five quota rnn�ers ssueU - to — you .) L lone of the applications needing - a quota number. The quota number assigned to this application is 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. nfor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ( an application on file prior to February 1, 1980.�� r � r s [_.]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: [1a failing conventional soil absorption system. a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Now Thomas C. Neeaon Si re (County Official Title A64iA tan# Zoning Adm Date June 26, 1986 DILHR -SBO -6158 (R. 12/82) .'ARTIGIENT`oF REPORT ON SOIL BORINGS AND SAFETY b BUILDINGS i?USTRY, DIVISION MA P.O. BOX 7969 J MAN RE LATIONS PERCOLATION TESTS (115) MADISON, WI 53 07 (H63.09(1) & Chapter 145.045) )CAT CTION: T N .: BLK. NO: SUBO '/4 �/ 3 N R lore W S _ E f DINT W 'S UYE E: MAILINGADORESS: _A i -° E DATES OBSERVATIONS MADE QResidsna , 1 SNOW ❑ Replace / %TING: S• Site sukable for system Um Site unsuitable for system 1� MC OU Q Q - LL a OL S G TANK: RECOMMENDED SYSTEM:(optionsl) mewbod Percolation Tests are NOT required D SI R TE: if any portion of the tested area is in the _ der s.H63.OB(51(b1, indicate: Floodplain, Indicate Floodplain elevation: �.J / PROFILE DESCRIPTIONS ) tN6ER fifiPRiilN. ELEVATION N H A L 1 HI U , AND PT Q► T BEDR K IF OBSERVED EE ABBRV. ON BACK.) 0 `v r♦ . S. �., a z 7 -j- yo t a e a f l/7 j . s. 63 91 IF s ,L. PERCOLATION TESTS rEST DEPTH . TER IN HOL TEST TIME MINUT 1MBER AFTER SWELLING INTERVAL-MIN. PERIOD I PER1002 PER INCH m T�8 JP JQA Z .30 s. 0 ;V 446 )T PLANt Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sale or distances. Describe what are the hori- al and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and parant ind slop`: / STEM ELEVATION _ Q- - i 4 ,gym mid i I 1 - i i - Nlb - - _ #3 } i f-to `D o 5� lk to sCF'�'c� EY* CO Pz , f_ Pr. v AAe 46 P4`� f 1023 -*f , OPTIONAL WORKSHEET 1. MOUNQ SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Continued- 1. Wastewater Load, Total Daily Flow • gat. 10. Fora Main: Use s. ILHR 83.15 (3) (c) Minimum Dosing Rate ■ Adm. Code and PROVIDE A DETAILED Dlam ew In. LIST OF SIZING ON PLANS. � 5 T 11. Total Dynamic Head: 2.. Depth to Limiting Factor • ft. System Head • 2.S h. 3. , Landskope • IS Vertical Lit ■ ft. 4. Oman" from Doss Chamber to a OO Friction LOU • 2 3 fL Distribution System • R. TON ft. S. Elevation Difference Mtweslt re f 12. Pump Selection: Pump and Distribution System ■ fL ►umm w dbdwp ant bete 6 ' gom i. Absorption Area Sizing: at fL total dynamic head. Area Required ■ sq. fL ►tart► model said Fl CA a &( lei W or Trench Length (8) ■ ft, \..I tr A S 1-1 Bed or Trench Width (A) ■ fL 13. Doss Volume Trench Spaci (C) • h. 10 Times Vold Volume of C,a 7. Mound Helghe Distributi" Lkses ■ �, 7 = i lls DOOM (D) • fL Daily Wastewater Volume +• FM Depth Downslops (E) ■ ft. 4 Dows In 24 hrL ■ gaL Bed or Trench Depth (F) • R. 83 Backflow • gal. Cap and TopesN Depth (G) ■ fL �1 0 t u .' mum Dow ■ ° 196, gal Cap and Topsoil Depth (H) ■ _ fLQ � � 00 W. 1. Mould Length: End Slope (K) ■ 3 Total Mound Length (L) • /t.`' U �D RRIV W SEWAGE SYSTEM !. Mound Width: Jam star oral Daily Flow ■ gal. Upslops Correction Factor • spa Nv Be 83.15 (3) (c) , Wis. Upslope width f 11 • � ` �( Code and PROVIDE DETAILED Downslops Correction Factor • J� �pF F SIZING ON PLANS. Dow Amp Width (1) • �� F wired Septic Tank Capacity • SAL Total Mound Width (W) •� �S Percolation Rate • mkn./In. 10. Basal Area ��QP� GOB 4' Absorption to Am Table 2 in ILHR 83 Infiltrative Capacity of Natural Soil ■ ' 7 and PROVIDE A DETAILE LISP OF Basel Area Required ■ eq. ft. SIZING ON PLANS. Basal Area Available • sq. It. 936. Z Required Area • sq. ft. 11. If Standard Tables from Chapter ILHR 83 .___� � Length ■ t6 are : used, Indicate Table 11 -._ Width ■ IL For the Distribution Network. Use Numbers S•141n Sect 1 Number of T aches ■ " /, 3 Trench S • ft. 11. IN-GROUND PRESSURE SYSTEM .3 `� S.` Distribut System: Depth to Limiting Factor /SYSTEML41N4F1LL I Length ■ .�� IL Landslope' % r of Laterals • .�.� . w 3. Percolation Rate ■ min./in. l Spacing' in. 4. Proposed System Elevation ■ fL ce from Sidewaq to Pipe ■ .�. I% S. Wastewater load Total Oai Flow: gal. Elevation ■ fL Use s . II,T#R 83.15 (3) (c) , w Adm.Cals and PROVIDE A DETAILED i LIST Of SIZING ON•PLAHS. Fill In All Items from Section 111, Required Sepik Tank Capacity ■ OD O gal. ' Absorption Area Suing: V. SEPTIC TAN K Percolation Rate • min./in. 1. Capacity ■ }�j' 00 gal. Area Required • sq. ft. 2. Manufacturer. System Length • ft. 3. Show Site Constructed Tank WtHls on Plan System Width ■ 1 7 h. 7. Distribution Pipe Slaft: VI. DOSING TANK Hole Sire • .�,�� in. 1. Capacity ■ { S E gal. Hole Spacing • ft. 2. Manufacturer: _ Lateral Length • fl. 3. Pump Manufacturer: Lateral Site • in. .2 04 `"' 4. Pump Momich _ Lateral spachrg It. S. Operatinit Heads ft. DIA."We from sMkwall 4n Pips h". G. Flow Rate = i m :.. M. Ulstributbn Pipe Dkekarps Rate: i 4 7. Show Site Constructed Tank Details on Plans Number of I toles Per Pipe I low Per Pilso r ttpm. 22.13 3 VII. NOLUING 'TANK q. Manifold Sfiho: 1. Capacity ' , Type ( antor or oml) •• E na 2. Manufacturer* Length a ft. w te Ceasl Zed Tank Details on Plan Diameter ■ �.� In. -SHOW ALL INFORMATION ON PLANS - OR MR S11041611R0342I K. Page Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil G F 3 � E D 7 J lk % Slope 8e o ' 2 For Main Plowed g °� ; Layer Al Cro ft' . ystem Using Z Ft. 83 F ion Area 4-70 Ft .° G / Ft G '_ Ft. H .� Ft. B S"_5 . Ft. " License Number; .S K 163 Ft. Date: - 7-1 7 —'s 6 L 7S Ft. j _• Ft. Alternate Position I Ft. of — , Force Main W �2 Ft .� L Observation Pipe --� I r 8 K 44 ---- - A ��'------------- - - - - -- - - - -�� Force Main Distribution Bed Of ?�— 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Ar..act Page _ Of _ Perforated Pipe Detail rA d i Perforated JV S End Cap ;1' PVC Pipe � Holes Located On Bottom, irk Are Equally spaced is PVC face M ain 1' P PVC Manifold Pipe Alternate Position Of Distribution Force Main 3 Lest. Mob should Be Iw To EM cap EM Cap Distribution Pipe Layout p rT Ft. o'4 c 2 �r ..: R 3 S 3 X 3& Inchon y J% Inches Signed: Hole Diameter Inch Lateral "2 Inches) License Number: in p"Q - a S' Manifold Inches Date: 9— 1 7 mot;' Force Main " 3 Inches # of holes /piped 1Q 6 s,2 Invert Elevation of Lateralt. lei PA&V or PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS fr VEUT CAP _T 4 VENT PIPE WEATHER PROOF APPROVED LOCKING ZS� FROM DOOR, _T JUNCTION SOX MAIJH L COVE � R 1 WIMI)OW OR rRCSN IL MIU. ( w4Mt l�se� r,� -n � AIK INTAKE I �/ `v GRADE 1 ( 't' MIN. ' COIJOUIT _ ___ A INLET �M�� 4 . PROVIDE ` I �� • .�: ev � � � APPROVE 1 � n L�s� � � • PEA �, I 1 � I via, tti V O J0 UT A (' ® :,, ' r+ v I I I APPROVED J0110TS w /c.z. tAPtr W /c. =. PIPE CXTCPJ0146 3' EXTEIJDIW6 3' OUTO SOLID SOIL ` �� I ALARM OM SOLID SOIL I I ON r2Q C r � �� P O • I I ELEV. FT. - -� PUMP —� Orr Li CONCRETE BLOCK 1 RISER ILX PERMIWED OULU IF TAUK MAUUFACTURCK HAS SUCH At�k11iQVAt.", SEPTIC 3PECIFI'CA'T t1 4 4? ` DOW �} !7 = J.�KS MAWUFACTURER: -wL ns &new -1S IJWNlsER OF Doses: PER DAla TANK SIZE: 6 L.LONS DOS[ VOLUME L ALARM , MAIVUFACTURER: ``�,�1 14 f d`� Ip1CLU01W�i BACK /LOWS..! �� ad GALLONS MODEL WUMOER: CAPACITIES: A a INCAES OR 8 CALLOUS SWITCH TAPE: �� u''� o n l ucues OR "LLOUS P41MP MANUFACTUR[R: C • � IUICMEi OR � 9 CALLOUS MODEL NUMBER: Da IMCNES OR Z 407 GALLOUS SWITCH Tli ►E: NOTE: PURP AND ALARM ARC TO eE MINIMUM DISCHARGE RATE GPM INSTALLEO OLI SEPARATE CIRCUITS VERTICAL DtrFERENCt pETW[[U PUMP OFF AND otBTRlsuTtou MP[.. 2 FEET z Z ZWo$,q�SYI. + M NETWORK SUPPLY PRCSSURE ... 6 FEET ♦ FEET OF FORCE MAIN X - s- 49 $_r ` 3r. KFRICTIOU FACTOR i- FEET X la Z x A p „(,3 TOTAL oUmAMic. HEAD : AltiM FEET co) A 2V.32 AV IIJTERIJAL. DIME: IONS Of TANKS LEAICrTH � ;WIDTH ;LIQUID DEPTH . .� m0nscJ �t41►1[ LICEWSE AIUMSERi JQ eZ- DATE: ` -OU • � w •�s�_,_�91�.:.�:. i' .� ■ice ■ ■►1 ■ ■, ■ \ \ ■ ■ ■ ■■ o ■■■■■■■■��■ ■■■ ■■■■■tee ■ ■■■■ err DEPARTMENT OF INDUSTRY, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS LABOR AND DIVISION HUMAN RELATIONS \ J PERCOLATION TESTS ( P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 53707 LOCATION: ' SECTION: p CZ;M id?�1C1r AI ZA,1�ITY: �LOTN. /41.° � (� N /11 ?A (or) c� O NT OWNER' S UYER - S NAME: L IN G ADDRESS: �- S 0 . USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE Residence r� PROFILE D IPTIONS: ] I S - AT ON TESTS: �, J A IC`TMew ❑ Replace I !d " /7 S RATING: S= Site suitable for system U= Site unsuitable for system CON�V � U U TIONAL: MOUND: IN_ - GROUND - PRESSURE: S Y STEM- IN- FILLHOLDIN G TANK: RECOMMENDED SYSTEM: (optional) ❑U D S S � S U [under Percolation Tests are NOT required DESIG R TE: If any portion of the tested area is in the s.H63.09(51(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS S !BORING TOTAL ION UMBER 0EPT"4N, ELEVAT D PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLO EPT OBSERVED EST IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BA B- B- B- .Si PERCOLATION TESTS TEST DEPTH PdE?}tE WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES NUMBER 'F'9 AFTER SWELLING INTERVAL -MIN. PERIOD 2 RATE MINUTES PERIOD 1 PER P- 7�8 PER INCH j P- 2 2 3 Z 9 Y4 o P- P- 3 0 P- P_ I —+_ 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 _ 9 71 i � .. A — E _ i 1� I mmv_ I .. .. . - E i : 4Z- DOCU MENT N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA " STATE BAR OF WISCONSIN FORM 2-19N 400577 MG4TO6 Offia , Cecilia H. Malgmod, a a Cecelia f individ- ST. CR01X CC %, WM ually arid as the surviving joint t..... 1 Ferris S _- Reed for Record this 25th Nlahm?ocl, cantor -- -- ....... r ............................. day of March A.D. 19 -- -------------------------------- ------------------- - --- - - ----------------------------- of 2:15 P . conveys and warrants to .. (arle5 M. Bryce • and Lilianl•1 T. s �, r Bryse ,- .husband -. and -Hti fe..as..iaint..tenct ............................ ------------------ r -- .--- .. ...... ----- -- - --- - - - - -- - ------- - - - - -- - - -- ------ .. - - - -. ------------ -- RETURN To Eric J. Lundell -------------- - - --- -- -•-- --- e Richmond, Id w 2 5401'j the following described real estate in ........St... ... x i. ...............County, State of Wisconsin: Tax Parcel No: ........................•----- A parcel of land located in the NE, of the NE's of Section 7, and in the M4 of the N110% of Section 8, Township 30 North, Range 19 West, Town of Somerset, more fully described as follows: Lot 3 of a Certified Survey Map filed November 4, 1975 in Volume 1, Certified Surveys, pages 190 and 191, as Document #330085, as amended by an Affidavit filed May 17, 1976, at Volume 537, page 207, Document #332994, all in the Office of the Register of Deeds of St. Croix County, Wisconsin, together with the right of ingress and egress over the roadway described in the above Certified Survey. Subject to utility and roadway easements, and protective Covenants of record. This deed is given in satisfaction of a Land Contract Between Ferris S. Mahmood and Cecilia H. Mahmood, aA /a Cecelia H. Mahmood, his wife, by her attorney in fact, Hugh H. Mn, as Vendors, and Charles M. Bryse and Liliann T. Bryse, husband and wife as joint tenants, purchasers, dated March 1, 1979, recorded March 2, 1979, in Vol. 590, on page 379 as Document #355456, in the Office of the Register of Deeds for St. Croix County, Wisconsin. This ----- is. - not .......... homestead property. ' -1 9 40- 0 (is) (is not) L� Exception to warranties: none Dated this ---- --- - - -- --�rJ - - -- -- ---- day of ------------ ------- ... ------------------------------------------ -- - -- ---(SEAL) " - -Cecilia H - - -- - - '$ M I -- --- (SEAL) - --- - - - ------------------- - _ AUTHENTICATION ACSNOWLEDOMEITj��w.p� Signatures) ........ ............... ...... ............. STATE OF InF�,SHINGPON '•,��r� / � as. ....County. / authenticated this -------- day of......._ .................. 19 .... __ Personally . e 1 - before me this _____7_day of ......`+��`ZLk <rx f!f� 19- 84 the above named ....................................................... Cecilia H. Ma the i - -- -- TITLE: MEMBER STATE BAR OF WISCONSIN --•----------••-----•-•----••-•-----------------•----•- not. ... . .. ...... ..... ..... --_.--- ------ -- --- --- -------- -- - ---- ------ — --------- -- - -——----- -- authorized b by § 706. 706.06, Wis. St ata.) - to nntrn b e instrument t h e p erson acknowledge the same uted the j . I THIS INSTRUMENT WAS DRAFTED BY 1 II Attorney Hugh H. GAin, CWIN & ( WIN . •... .................................... ......................... • - --•. ---- -- -- - - -- �{ 430 2nd St., Hudson, WI 54016 ------------- - - - --- • .......... ............................... Notary 1 c County, WA f l k (Signatures may be authenticated or acknowledged. Both My Commission is �� ffi - --- - ------------ •-- are not necessary.) Ferman t. (If not, state expiration date: ----------- I "Namaa of yawns aftnfog in any capacity should be typed or Printed below their aienatvtae. I ��:• 9TATS BAR Or WMCONSM FORK No. 2 — 1982 Stock No 13002 l z cn H . a ST C- 105 r" r a H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z OWNER /BUYER COY / /�� L�S' -�S � a H C+7 ROUTE /BOX NUMBER o Z Fire Number .CITY / STATE ZIP ge J � vd, PROPERTY LOCATION:_ '-g '�, Section © T R / W, Town of � Q� �': , St. Croix County, 'f Subdivision Lot number . T I 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 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. H 0 I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE - Z 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. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being develuped. Auy inaciequat-i,. , : only resc? 1 . d4-lays of the permit issuance. Should this development be intended for resale by owner /contrac WK ,( "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 yn Location of Property '3y, Section �� , T N - R W Township S S Mailing Address b i Subdivision Name Lot Number Previous Owner of Property v t Total Size of Parcel �� ;} 4 AAAL C Date Parcel was Created l� -- 9 _ el Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes -- Volume and Page Number 1 L� as :recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOW 1. Warranty Deed 2. Land Contract 3. Other recordings'filed with the Register of Deeds Office 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. -------------------------------------------- PROPERTV OWNER CERTIFICATION I (we) centtc;by that aU .6tatement6 on .this bonm ane tAue to the be.6t ob my (ouA) k.nowtedge; .that I (we) am (ane) the owneA1.6) ob the pnope&ty debcA bed in Chia in6o4mation 'bosun, by vi4tue ob a wak&anty eed neconded in the Obb�.ce ob the County Regi4 teA o Deedb " Document No. 't 0 05 7 ; and that 1 (we) pneaentty ou,n the pnapozed site bon the aewage dispozat 4y4tem (on 1 (we) have J� U � •� t . Y I i G' i _ i ✓ t F , f }4 t� /�� g • gP �P �, : If V , �Pv 51 ro �e0 .0 N O 4� o- r p ' Pol �, 0- ��O S P� Q o-� g �4 r , ST. CROIX COUNTY y . WISCONSIN 0 �'�o ZON ING OFFICE .. 796 -2239 (HAMMOND) 19' Pq 3F :. ' 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 June 26, 1986 Divizion ob Sasety and Bui.tding BuAeau ob Pttumbing P. U. Box 7969 Mad uson, Wl 53707 Dean Sit: An on z to invati.gation ban the Chantes Bnyse pupehty, tocated at the NB% ob the NB% ob Section 7, T30N -R19W, Town ob Someuet, St. Croix County, nevea.ted Tsu i tab,te zo.c z at a depth ob 3.33 6t., below which 6easonab.te high ground water was noted. Th.iz 6ite shoutd be su-i tab,te bon a mound system. Shou.td you have any questions, p.tease beet bn.ee to contact th" obbice. Sincae2y, (:/ k'"t) a U"./, - Thomas C. Netzon Az s i dta.nt Zoning Adminizt c.a ton TCN /mj STATE OF WISCONSIN - DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: i TownshipyWAMMMON NE 1 4 NE k 7 IT 30 N/R 19 J&XgXAW St. cuix Street Address: Subdivision: County: Landowners Name: Mailing Address: ChaAtes Btp e Rt. 1, Someu et, W1 54025 I (We), the undersigned, hereby make application for an alternative system on the above - described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR -SBD -6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Chaix Location _NE_ 1/4, NE 1/4, Sec. 7 T 30 N, R 19 1 F}C4xwo W Town 14xXkij4jgjRARAAAUX Same)uset Street Address Lot No. Block Subdivision Landowner's Name: Chahee/s Bt4e The application for this site is for: (.�.. new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: �.1to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers ssueTo you.) �. ]one of the applications needing a quota number. The quota number assigned to this application is 59 - 07 _ 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (....]for an application on file prior to February 1, 1980. (_for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. Fla holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here.F1 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Netzan - •�" — County Official Si m t re Title A-ssi6tan-t Zoning Adm nisi atot Date June 26, 1986 DILHR -SBD -6158 (R 12/82)