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ST. CROIX COUNTY ZON�Nq` *tt RTMENT t,
' AS BUILT SANIT� , 19E J�
Owner �
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n
Property Address Z 3 z 4,y�r S' '' 9$
City /State D • v�So•J S'. S �/ sr
ccwNry
ZONING Ic
Legal Description:
Lot io7 Block Subdivision/CSM #
Sec. � , T I I N -R W, T-ewr"f G o PIN # 3 2
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: ,
1V1PWESraA 0 >i00 >SSo
/Di
Tank manufacturer ee tS �
T vL Size ST/PC I / (�5 Setback from: House � Well P/L
Pump manufacturer Model 9 %s �i %��U
Alarm location <,vsi .�! — �/ Gv v
(HOLDING TANKS ONLY)
Setbacks: Service z Vent to_�esh air intake Water Lime
Meter location
Alarm location
Z D!� o��fj -Gi �`� /�v%i•GTXiP 7'�EN�C.S
SOIL ABSORPTION SYSTEM " 5/� J �1� 5 ' @ 3/ Of> s4
Type of system: Width 3 Length 7 S Number of Trenches Z
Setback from: House (o 3 Well !/ P/L IP' Vent to fresh air intake
ELEVATIONS 3 Sf � � �
e57 /y /OV � 7
Description of benchmark e0u — Elevation ,
Description of alternate benchmark 6r X4 G ``E oT Elevation !o S
Building Sewer ST/HT Inlet �S, 2 Z ST Outlet '� S 679 PC Inlet 9 -5 � tia
q7 8� �� D '"�O
PC Bottom ' Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( ) g 7 -SV Ti
G /
Bottom of System ( ) 96 � d
Final Grade
OC(•Z'2- Z3 t
3
Date of installation / / Permit number State plan number
��63 D
Plumber's signature License number Date / /
Inspector kCIp L 6 1 , 1 0 GfiL�
Ulbricht &Associates
Complete plot plan
private sewage consultants
66s O'Neil Rd.
H„dcntj, Wis. 64016
•
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
Air 21-/ur
irotr"
Cesscire ��
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INDICATE NORTH ARROW
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division INSPECTION REPORT • CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) SanitarjYArW6.:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)].
Permit Holder's Name: f-1 City_ ft [] Town of: State Plan ID No.:
PENFIELD , ALLEN P. ZV til7ll
CST BM Elev.: Insp. BM Ele�v.: BM DgScription: � � Parcel ia�YW1062 -60 -100
TANK INFORMATION ELEVATION DATA A9800507
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic -o�. -oe, Benc pSk sv� lDsa�I /ov
Dosi ng O�Ab' - r— (o iii C(&A 9.2i `7 5.7 3
Aerati Bldg. Sewer
Hol I s *Inlet �5-
TANK SETBACK INFORMATION St/ Ht Outlet
I ntake
TANKTO P/L WELL BLDG. Air to ROAD Dt Inlet
ir
NA Dt Bottom
osing r� 2_? NA Header /Man.
Aeration NA Dist. Pipe �,� G- y
Holding Bot. System 9 ' C 3 q `, 4
PUMP/ SIPHON INFORMATION Final Grade - 7 7
Manufacturer De 3
em mand (O�
Model Number �J GPM
TDH Lifta.gf Friction c System, TDW,-71 Ft
oss Forcemain Length q 57 1 Dia. 2�� Dist. To Well
SOIL ABSORPTION SYSTEM
BE Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 7 S DIMENSION
SYSTEM TO P / L BLDG WELL LAKE /STREAM
LEAC G Manu acturer:
SETBACK
INFORMATION Type OR R Mod Num
Sy e �� (03� + 1(O� OR UNIT
DISTRIBUTION SYSTEM
+eede
P istribution Pipe(s), '�r/ R x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length 7S Dia. 3 7 Spacing O' r I ;2 ck&" n .�1 r�CN
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodd xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes C] N( ❑Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: NORTH HUDSON 13.29.20,NW,NW 232 SOMMERS LANDING NORTH
�wkcv� 16123 jq,�>
Plan revision require ❑ Yes No f
Use other side for additional infor ation. c
Cert. No.
SBD -6710 (R.3/97) Date Inspecto Sig ture
Vi sconsin 01 E Wen�6^gtonAv ngevision
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box
' Department of Commerce Madison, WI WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County. % , y
than 8 v2 x 11 inches in size. `�/�/ k
• See reverse side for instructions for completing this application State Sanitary Permit Number
6
The information you provide may be used by other government agency programs ❑ Check r siOn c / I us application
lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbe �/�
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Nam �j Property Location �I
M ew �' • � ! Jc %�`Z- (fJ v4 Ajw 1/4, S �-3 T O , N, R 0 E (or)
Property Owner's Mailing Address Lot Number Ti� Number
23 07
Cily State Zip Code Phon umber Su ivision Name or CSM Number
9f o� �v /. � z y 6s�-r ss os Val. �/ /' • 3Z
II. IL ING: (check one) ❑ State Owned ❑ !t Nearest Roadd
village
Public 1 or 2 Family Dwelling - No_ of bedrooms 11 Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo NCO / /C6 Z G
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (CW my one box on line A. Check box on line B, if applicable)
A) 1. ❑New 2 acement 3 ❑Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
_____System ________System __ Tank Only__ ____________ Existing System _ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM (Check only one) 1b F & C /C/ S j j 1= __W1 >P&_?C frGT
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Se age Bed 3/ ,546.4 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 eepage Trench 7 1 i O S/yfL 22 ❑ In- Ground Pressure 1 t/ f_� fD f�� 42 ❑ Pit Privy
13 ❑ Seepage Pit C" sly -�� ., 43 ❑ Vault Privy
14 ❑ System -In -Fill � L�.dL je/1'a 3 ' X 7 S
VI. ABSORPTION SYSTEM INFORMATION: F(,,0
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
//50 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inc - Elevation
75 0 3 ySZS Feetj !`f 50 Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex p er.
INFORMATION New Existin Gallons Tanks Manufacturer s Name Concrete Con Steel glass Plastic A p p
Tanks Tanks s
�j�� ?- strutted
'�
Septic Tank @IddR9Tai%k /azo 0 !tf' ❑
LiftPumpTank*iphan- ehvn -rb C O 650 1 LW r - ❑ ❑ ❑ ❑ ❑
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 Signat e: (No Stamps) MPRSW No.: Business Phone Number:
'Rog�P_ T' U&,,Vi�i7' 2 z (e 3 �S x/5.38( • S� 8S
Plumber's Address (Street, City, State, Zip Code): &5_5 h v � i L 9 � O n (,� 0i
IX. COUNTY / DEPARTMENT USE ONLY C/ �J "iJ
❑Disapproved Sanitary Per t Fee (i ^cludesGroundwater ate ssue Issuing en (No Stamps)
Surcharge Fee)
Adverse Determination � �`
`W Approved []Owner Given Initial j�i� � .,1 `!'f"1Al`
` V / (U�/
X. CONQITI�ONS OF APPROVAL / REASONS FOR DISAPPROVAL:
3BD-SM (R 11/96) DISTRIBUTION: Original to County, One copy To: Safety R Buildings Division, Owner, f8ue�ber
ULBRICHT & ASSOCIATES CO.
' 655 O'Neil Road . Hudson, WI 54016 Reg Designers of Engineering Systems
7 i 5- 386 -8185 Private Sewage Co Uments
.
PROJECT INDEX
DILHR Plan I.D. # N /A Date Oct. 19, 1998
Owner Allen Penfield Phone 715 386 - 5246
Site Address 232 Sommers Landing Rd. N. North Hudson, Wis. 54016
Legal Description PIN 161-1062-60. Lot 107 CSM 554051, Vol -11, Pg.32
NE, NW, Sect. 13, T29N, R20W
Villa of North Hudson County St Croix
C.S.T. Robert Ulbriicht CST226375 Installer Robert Ulbricht
MPRS 2 26175
Local Authority/ Supervision
St. Croix County Zoning Dep
PROJECT DESCRIPTION
Replacement System. For an existing 3 bedroom home. Daily
wasteflow: 450 gals.
Soils are sandy and permiable: .6GPD /Ft.2 for trenches.
750 sq.ft. trenches required. Proposes, install 2 high capacity
- sidewinder "INFILTRATOR" trenches, each trench 3
with drop box distribution.
A lift pump station is required. A new combo septic/
pump chamber will be installed (Midwestern Precast Inc.).
ALL NON - CONFORMING
TREATMENT TANKS SHALL
BE ABANDONED PROPERLY
FOR t"M 83.03(2).
��� • s
U1bticht 3 Associate
s
Pdvats . Consultants
Sswsp
n sWS� 54016
Pg.1 PLOT PLAN VIEWS p6`,
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS 2,Z Ce 3 S
o�
1 DOSING CHAMBER CROSS SECTION
P � PUMP PERFORMANCE SPECS
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SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN . ABOVE GRADE & 1WEATHER PROOF
>_ ' FROM DOOR , WINDOW OR JUNCTION BOX APPROVED
qnP, FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
//`` W/ PADLOCK 6
FINISHr'D GRADE 4" CI RISER
r WARNING LABEL
6 " MIN .
yG.75 . ABOVE G ADE �V , z r��-4" MIN .
I- ti
3� 6" MAX . `�, r4-1--
- �t�t
INLET r- �` �\`�1
j �1 �`"' -
5 LEI I
.. -�
��1 / b WATER TIGHT SEALS GAS- , 4
T , TIGHT1
4 JjOrbm 1 BAFFLE A I SEAL t 1APPROVED
-� JOINTS W/ CI
CI PIPE �-��� , �� ALM
3 ' ONTO Of , ` , B " 1 ON PIPE 3 ' ONTO
SOLID qo.q5 ifdi� (33 ) LL qo 1 .,- SOLID SOIL
SOIL �_ PUMP OFF ELEV . I �✓FT . - - — -- I ►'DOFF *"* RISER EXIT
f L PERMITTED ONLY
I/�� I I IF TANK
MANUFACTURER
HAS APPROVAL
0D/^02 Nf 3" APPROVED BEDDING UNDER TANK
�/E im Ti0~' CONCRETE PAD
SPECIFICATIONS ,
'SEPTIC / DOSE
Mfglyt57-
TANK MANUFACTURER : A.er4-5 7- 4e • NUMBER DOSES PER DAY : 7/ .
//,I•5 ,
TANK SIZES : SEPTIC &Iry GAL. DOSE VOLUME INCLUDING
DOSE 6,50 GAL. FLOWBACK: �Zd GAL.
ALARM MANUFACTURER: 1J61- 4(/0/44 4 . CAPACITIES: A = /S7'5 INCHES = -3619 GAS,.
MODEL NUMBER : (j. L •
SWITCH TYPE: .Afe,eU'a 7 F/O/fr B = 2 INCHES = 32 .5 GAL.
PUMP 'MANUFACTURER : ;?0E//V2 4 . C = /4 INCHES = /20 GAL.
MODEL NUMBER : IT yltttF lis t/
SWITCH TYPE: pe5yyAMK iii tO,Qy r/04r— ' D = /2• 1 INCHES = 11'75 GAL .
REQUIRED DISCHARGE RATE 25 GPM PUMP & ALARM WIRING AS PER ILHR 16 . 23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . 6 'gd • FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . N/4 FEET
+ 35 FEET FORCEMAIN X liu FT/100 FT. FRICTION FACTOR . . , 394 FEET
TOTAL DYNAMIC HEAD = 77. z. FEET
I, , :.
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ;:o ; WIDTH 70 ; DIAMETER„.....------ .
LIQUID DEPTH 70 I'
SIGNED: f LICENSE NUMBER: 21/375 •
DATE: . `� 1.,
1/88
ItVteu T /D/ice i of s/frE 7 (ziff4 -7- To P40/
80xY ��) Z 5- 7 7•4.z. valid /./Fi , .
diP Vary 35 of
, if /)126 /1(E /44/ti c:-Py ems, Y , _ /6 S s
•. 1&o5, ,,5 Or Co-e-f60 /2'2-. ' aC� 10 " 4'f:P = y i/O J.eD .
1":: ' '
NEAb CApACI
ry cunvE
MODEL "9t) 7/1 1/1
11 4 6/6 ii
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S
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•mugBo
-- --- --50 e0 IO
a0
e Igo240
now PEP MINUTE
•
Mailpy
IONS DYM/Wro rrunertoks PIR la„url • •—
Ir rt',41 ruro MVO?l POO
t1
latall tAPAcrts
IIN1taMiN
��- ----_._ 1 1
/III YSt[RS r►Ate Safe
mint
I I e! it 9r7
II Ie1 e1 vo •
20 t 1e I2S Ds
t 1�
Lock Vahylaill an•
t
-__I
CONSULT FACTORY FOR SPECIAL APPLICATIONS
6 Etscirlcal ehernelors, for duplex systems, are evallable end itipplgd with en therm. • Mercury phase switches are available for controlling single and
•
Mschanlcd SMemetlxe, Idr duplex systems, ere available with or • three Systems,
Double piggyback mercury float switches are available for
without Nerm InvMcF»N,
vSllable level long cycle controls.
•
811lnderd all o SELECTION GUIDE
models - Wel hl 90 !be, - I. Inlegrallkwe •
N tarl — �___ r/� I�.p_ parted 2 pots rnach.+Jcd switch,no'Marna!
Modal V hp a.pl, Mks Am , Conlral-Selection
2. @Ingle 009014 mercury tloy switch or double r cut .control I float d.
-- elm bx ---- such.nsler to Fk1o111, PiOY k ms►cury,Noel
•
- al �� 1 ulo 0 6 e* Du (aN 3. Mechanical ahsrnalor 10 0072 o1 0.
.6_, —1 pill L-- — 4. Rso FM0I 12,la correct 1 �1S
DU 241-----1_ -� fl— _9, ---Z 1._Q_. ___� 5. Memory modal d Electrka)Alternator, E Pak".
f0@Aut / 1 a 1 /1I� ry sensor Moat switch IO0225.tom as a control acUvalor
!JO I Non /! —t- — du lla*(3)or(l)Ibt swam. .pecih•
.2 � .. 2 w 1 It 1 .N►hpte 'JPak".lurtcllorj
pi.*er duplex oMradm t000 tonneNbrl a w41d In elm
P. Two R)fools-J►s ',lot w11aN1/41111 own..__..at apNce
/er k�"'+(rl M w1[.w Pot so Yrrdurtl Wet b cu
tAlr ►� 1ab1111 EI.c6kY A11.inua en bt�rNon Htloetl; AN M.I.N.IIon CAU11oN
Inb/12 �� 17 /'^Na....p.@..ty Flbut; n.ta, N eanlrob.irdseUon 4.110ee enA*idol
am 11�mrLt Cast @ox, In* Ne.n..N .110.14 tan• AN a1../14; .M e.l ito oikl(oc pa Nona ►y a twit
' Me IFa �.I r.e.nl N.ibn.i[I.ebie C '11 reoN.a e1( M Iallow.J tn.luN.
• H..MA Ad (OSHA), °� (N[c) .nN Oho C eeu
RESERVE POWEPEDp.tlen.l..r.ltr .,,N
For unusual conditions a reserve DESIGN
.safety factor Is(inginee►ed into the design of oiery Zoeller pump.
•� ,• MAIt IQli
•Of°4132:4133
11
O •
fizz` ECd i t�%'k%r9Yi Manulaclurers ol.,.
L ,r LJ .... to;30 � m tape
l oclh, e,KY Il),^16
__ _ (SU2)lls•2131 MY 1502)114 3624 el/.4I/IY 109.f%ver/9.Z9 4'
Wisccnsin Department of Industry, SOIL AND SITE EVALUATION / of 3
Labor and Human Relations Page
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizer•PIa6 mutt' .__"'-4, County
include,but not limited to: vertical and horizontal reference point(BM),.dtebtion and „ S/• Cjt-C,/�
percent slope,scale or dimensions,north arrow,and location and dist nce: near •rvadrEO Parcel I.D.#
I,f-�'3�L ,/ /— /D6 2 - �o o
APPLICANT INFORMATION - Please print all informat' n. or T 19 Ii � Reviewed
by Date
Personal information you provide may be used for secondary purposes(PrivacyLaw s.15.04(1)(m)) ,OIX >�y, ,i,'� I I/r"i l��
Property Owner \, Pra \Th 'Ca
4-L PENF,ELl7 / Gout.Lot /v ` 1/4�t& 1/4,S/3 T 27 ,N,R 2 6) E(orA�
Property Owners Mailing Address �'\'Loot# Block# •Subd.Name or CSM#
2 3 2 ,s'o pies z/'140/v6-- /V. A/. 10.._.. _C s/1 ss y4.5/ U4/ //• /' . 2 Z
City „ State Zip Code Phone Number 7/S'— Nearest Road /GO .
Citu4/0 •T7 UAP,So� I a)/ I S9o/lv I ( 396)S27 9//7 Owl a44e, - of fo.J, .SO.,/,fi S GgvP/e,(,-
r❑ New Construction Use: Residential/Number of bedrooms 3Addition to existing building
li Replacement "'Public or commercial-Describe: /Vie_ /0 o T
Code derived daily flow �,/� gpd Recommended design loading rateA/ie bed,gpd/ft2 ' trench,gpd/ft2
Absorption area required //a bed,ft2 7-Se) trench,ft2 Maximum design loading rate//' bed,gpd/ft2 • 6 trench,gpd/ft2
Recommended infiltration surface elevation(s) S-e-c P 3 ft(as referred to site plan benchmark)
Additional design/site considerations s-- ' -' '16- -D(to w t•/J G----
- material G`S Flood plain elevation,if applicable /V/2/ ft
S = Suitable for system Es--
Mound In Ground Pressure AST Grade System in Fill Holding Tank
U = Unsuitable for system L�S ❑ U L�S ❑ U L k i U R- ❑ U ❑ s L-I- 11 ❑ S -
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
I.
y G /7 /o //e3)i 4.5 /f'I, aS.1L- G'S /f' es- : . c.
Ground 3 /747 / 1//e // __ -5/L /'$4/� Gl h C S — . a : . 3
(.ll�V ft. 1 �7•qi 7•S'�/R yl4 6,038 L/ �Cs- /f�/` 1' _ _ S, .
Depth to - . -
limiting
fa1' or
> In. arm
Remarks:
Boring #
/ D•$ /o v',Q 2/3 - L s / fA #s es 3 f. -2 ; .8
2_ 2 5. 27-- /or?3/ GS -/v.f7, Is4 Cs /7 ' .s ; '6'
-
3/ /orn W-(
3 2Z- 6_/ /I s ' di eS r . Z , - 2
Ground y 5S 7. S yip V/ Co/16 L/ - G7Cs /,fM d _ _ . s : .
eev. 'L/ fAa4a.r�
ff ft. - ,
/ Depth to
limiting if
f_a/tor
<G'v�( in. Remarks:
CST Name (Please Print) 'PO/3L-/er 2r/hi ;Signature - Telephone No.
7/5"• 386 .8/8 s
Address Date CST Number
Ulbricht 8 Associates £G7- 7, / ',7 Z 2 3 7 S
P,►vate Cewage Consultants
865 O'Neil Rd.
Hudson,Wis. 54018 AkRG,C --,0,5-2) 54%0i7-4IQ(/ 'J /p„ -
eir/'sr//vt PX/yw 6- /i 744.16'/A .
(d Z'flaw/XI`) Q 6X/''T/u G.-.
I G\ IN I... 5'6,P ,-tc 7 /t>t , s P�_
cow G/ A-Al------/ -- A.s 5'E-c-- tis .
0 Vim)
/r • �.,Qwt'%t LG7 SOIL DESCRIPTION REPORT 2 3 •
PROPERTY OWNER Page of
PARCEL I.D.# /&/ ' /06 Z 6 (�
Boring # Horizon Depth Dominant Color Mottles Texture Structure G D/ft2
Consistence Boundary Roots P
rriin. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed .Trench
:43 ir / o•�/ /oY/2713 Z$ /nix ds cS 3-1 : • e
G/' / Yfi r/Gq $i 1- /-fs k -. 2- ; .3
Ground 3 2,6 'ff 7 SYie 7/6 L/ /fS /-1 dA _ - . : .
/oa.34—ft. wig f EL
Depth to
limiting
factor 51
fO in. J _
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench
Boring #
Ground
elev.
ft. •
Depth to
limiting
factor
in. •
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330(R.08/95)
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•
. Wisconsin Department of Industry, SOIL AND SITE EVALUATION / of 3
Labor and Human Relations Page
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
�5 .;..r< f r County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size, Plan,
include,but not limited to: vertical and horizontal reference point(BM),directjon and 4, S/' C,Pd"'
percent slope,scale or dimensions,north arrow,and location and dist rice, near /Effl Parcel I.D.#
t,'i L ,/ /— /062 - 60
APPLICANT INFORMATION - Please print all informer ,n. OTT 1 1?(38 Revieewed/by Date Q
Personal information you provide may be used for secondary purposes(Privacy aw 1.15.04(1)(rn)):; :;QIX r/ (� f; s//k I I/9A j 1[�
Property Owner ��� . Pc ef: Wit, — �(/1 "j(v /�(
4-L PENE/EL)) '\,K/.: Govt.Lot /1.1 1/4/tv 1/4,S/3 T 27 ,N,R 20 E(o WT,
Property Owner's Mailing Address \',; Loot# ' Block# -Subd.Name or CSM#
2 3 2— .5-0 tVit fs IA/yaw- /ed. ,4/ `- 7__ e$/1 s5 yo5/ t/// //• /i • 2 Z
City /l State Zip Code Phone Number 7/5'— ❑ Nearest Road /f10 .
/f/D J7U�SO) I W/. I S�D/�o I ( 3�)S2yG I///�i4 orlla/ ,e, - U7bA)1 .Sort. io'j S G,q,(4O/.vG-
2
r❑ New Construction Use: Residential/Number of bedrooms `-� Addition to existing building
Replacement //��//�� ❑Public or commercial-Describe: ,7�_ ,0 T' "E-co,�yjKE,vP`ty
Code derived daily flow 4:0 gpd Recommended design loading rate///` bed,gpd/ft2 • trench,gpd/ft2
Absorption area required Pa bed,ft2 7So trench,ft2 Maximum design loading rate// bed,gpd/ft2 • 6 trench,gpd/ft2
Recommended infiltration surface elevation(s) 5-of P '3 ft(as referred to site plan benchmark)
Additional design/site considerations sue- ' E.'S -o((o c-&.' ( /J 6--
Parent material L 5 Flood plain elevation,if applicable ft1/% ft
S = Suitable for system S Conventional � ❑Mound_nd In-Ground Pressure AT-Grade System in Fill Holding Tank
U = unsuitable for system E ❑ U iF s u L S I1 u E ra❑ u ❑ S R-o ❑ s gir---J
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2
Consistence Boundary Roots
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench
. / 9-Co /d t/�2/3 s /40 fy 15' 2 f . "1 ; .g
2 6 ./7 0VIII( _ G5 / d k e s-s /f .s : . C.-
Ground 3 /747 /ePY,� //7 -_--- 5/L. //5% ' Gt /4 c5 — . Z ; . .3
•14/ ft. z7.9g 7.5yy ff God S 8LI G� /fv I S, .
6!
Depth to
limiting '
factor
> 6 g in. 40
Remarks:
Boring#
/ D•B /oV, 2/3 LS //Yf I, /S' es 3 f . 7 ' .8
Z 2 S• azioy/43/y GS /v.ff, IS4 Cs /f •s : -6-
3 2 1.-3 loyn W1( ,c/L /f'6de dA cs . z 3
Ground y 9‘i 7 5 Yie Y/6 co 4/3 Li _ z s /e y j? dii- -- . s , •
elev. 4'/ 9,1i9U.l�
-� ft.
Depth to -
limiting * ;
factor
!!-i,y in. Remarks:
CST Name (Please Print) Telephone No.6 Signature -
'C7j l3 2l �I?i i 7/5"• 386 •Mg s
Address Date CST Number
Ulbricht&Associates 067- 7• /1Y,F 2--2..4 3 7 5
Pavate Sewage Consultants
665 O'Neil Rd.
Hudson,Wis. 54018 Pa, G/C --i0,S6-. -5-4,0/7)1i4 j/ A'J j
/ —Ceru -S4,v%T7 T%O-rJ
CCi sr1/°7 izyw 6' L 74.1"
(o U r-lal v/,v ) Q;, &fs?-/,v G -
G\N P1-- 567177c 7 ' / ' 5 N°71 copes
L, A vti i -- 11(s sp s .
O UP)
ti . /g&, (/E LG7 SOIL DESCRIPTION REPORT 2_ 3 •
PROPERTY OWNER . Page of
PARCEL I.D.# /6P/ • /06 Z — G D
Boring # Horizon Depth Dominant Color Mottles Structure G D/ft2
Texture Consistence Boundary Roots f
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench
o•�/ /oY8 713 Ls /441 . Is C$ 3-f. s
/.2L, /0 wz Y/47 — 5 L /fs%% dX l's . Z ; .3
Ground 3 26. - 7 5Y, /! e ee& iy Lf$ !f f/e GL/b — S cP
elev.
/6°.341—ft.
Depth to
limiting ,
factor S►
fO in.
Remarks:
Boring #
Ground
elev. ;
ft.
Depth to •
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr. Sz.Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring#
.40
Ground
elev.
Depth to
limiting
factor
in.
Remarks:
SBDW-8330(R.08/95)
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ST CROIX COUNTY
• SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer L �GC.
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number AW 140601 Z
LEGAL DESCRIPTION vl` / `
Property Location N� ' /,, /0A /a, Sec/ 3 , T N -R � W, Town of
Subdivision , Lot #
Certified Survey Map # CS,/ — ,Volume �� , Page # 3 2 -
Warranty Deed # 3�6�GS , Volume [Id_ , Page # 21
Spec house ❑ yes no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the thre r expiration date.
131 S8
SIGNATURE OF PLIC NT s�L... DATE
\
OWNER CERTIFICATION 1
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property deed above, by virtue of a warranty deed recorded in Register of Deeds Office.
<a / / 3 / .98
SIGNATURE OF PPLICA T DATE
****** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
arSk'k .& 3
t}i?GUMRf? PtT HNC , .p MRG4noea+4�
nrri e►a¢t T
tf ..
REt Q
This D
. X aF.Tt !bA ! AMSl.. :..
All
�d hits ;
45 th That the saki Grater I
. r Maur "I► m Qtah the %mmbtd dewr%W tea! gtelte . '`{ .
8tpe of ri►ltapsla: t
a
F of hard located to t" wort3 t .t r s :
s 1�ft varths ua
est Qrter' of Secttoa s "
4 t
r amp 20 West, and In Gc,verawlixt Lot � :et t #
* t. %= 20 West, described as, Lot 3 of t* esia ,
Office of tUe Register of Deeds'
elli 'sif
+.8.1L I Pap 8 76, Document 360662. • , 4 vim y x
^�
� w xa � y
�
c
}
fi
t4
This ... _JA ... . hemastead Prover".
(is) (is not) tbsrennto belonging;
Together with all and sineulsr the bereditsmarb asd aFpr3rb►saaas
And- .. Giif ox #..�J._.koamere ..*Ad
simple and lsea and clear
warrants that the title is good. indefeasible in tee ear of eocnmbrancea =cot
x
ar.4 will warrant and defy - -rA the
pared thin ....__,...:22nd .......... . .. . ... ... ... duy of ... DCt+Obir�
......... Isl9.
(SBAL) -
r » -
_.-- - --•- --
(SEAL) - ---- .......... (SEAL)
AIITHgNTICATiON AC=NOWL>tDOXXXT
Signatures authenticated this ------ 27Ad_... dey os STATE OF WNCONSIN
October f _._ ..... 1878
- . -.
Coewt .
y ;
r Penonatly enure before ae.. -
ay of
_ -. f
_..... the above .. • --
nersea
JO D. HEYWOOD
TITLE: MF'IBER STATE BAR OF WISCONSIN
x t If not, -.. .
' s.uthorrzed by § ?06.06, Wia. Stets.) _.,_..
._.._.--- - .........
wn to be the person - wbo executed the
_.. .. ._.mot e..urut urea DRAFTED 1Y to age kt __ �� •V .•...a.
•
\S<-C• CI e.56ie_A- •K �'/;. 7
/ i7- 4 ._-
554051 CERTIFIED SURVEY MAP
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 13 AND GOVERNMENT
LOT 2 OF SECTION 14 ALL IN T29N , R18W, VILLAGE OF NORTH HUDSON ,
LEGEND ST . CROIX COUNTY, W I SCONS I N.
ID COUNTY SECTION CORNER MONUMENT FOUND, TYPE SHOWN.
• 2" IRON PIPE , FOUND.
• 1 " IRON PIPE , FOUND. -1
c
0 1 " X 24" IRON PIPE WEIGHING 1 . 68 Ib . /LINEAL m
FOOT , SET . CO
m
D
jZ 1 " X 30" IRON PIPE WEIGHING 1 . 68 Ib . /LINEAL z
FOOT , SET . m=m 0
mom, NW CORNER
z* SECTION 13
SCALE IN FEET 2 T29N, R2OW
- , 71 BERNTSEN CAP, FOUND.
o
0' 50' 0' 200' LOT 2 0 POINT OF
1tr)
CSM BEGINNING 1�
VOL. 3_
PAGE_876_ z 1 33' \ 33 1 I�
DOC. 360463 0 0 11 6 INI1 1�
NJ I rn S 88°34' 00" E O 1 Ir
S 88°34' 00" E 317'± I oo 01 144.36' ' I .,
292.1 ' - o , 1r1 1 -37
1 C)
230.17' m o z IIN1 1�
=25I+ 80.00' • 91.40' 58.7 ' 62.01' I 0 , 1 ► 1
WATERS EDGE Z fn Z 'o 1 r 1
JUNE 11, 1996 dog LOT 106 5/ R°' Iw �o 0 1� 1
ELEVATION = 678.60 (Om 1.464 ACRES± 44 99, o� T. 1 I z 1
v� 63,768 S.F.±� u+ o 1
u' 68.48' -oi- 'o 0 \ \Q '
, • '
I'm BLUFFLINE 3.30' v • S6 ° 0� 2 •r*, 1
f— s r'IN 85°18' 10" E 2 •6.959 ,.75' 27•0' �,S 44, 38. N69°0� •�o (3 11
,+ 40' 156.20'SETBACK LINE WELL `�
1-11 = 50•.81 �/ 10.6' �� 52' / o I0 II
_25' _
LOT 3 I P. 6 '33,
C-SM G
VOL. 3 �, I GARAC 'Ac' yG 33' \
/ PAGE_876_ / 1 \__� OF ., ,NP
i m D_OC_. J360463 �,�N p�� I 1
o /2� o O� \& ' ' -EXISTING �N'CF-,1IxI 1•1
\ / c. 2 N N SEPTIC TANK HOUSE G Z-1 2- 1 1
o 2 LOT 107 1 X �' .Rio--z, m 2.827 ACRES± 1
/(O r- > 123,138 S.F.± 1 1
^i '1 BOUNDARY OF
= LOWER ST. CROIX I 5a �2 1
NATIONAL SCENIC \N d WELL 1
1
/ z RIVERWAY Ng2$06 00 z ' LOT 4 1
`� ° / SE. 1
s M S62 w I o VOL. 3_
EA.GE_876_
,0 _ ((D c• [loc. 352463
\X'L�s �2
room �OS 155 / \\ m o
o-ir)o � "o,\ \� ` ��
W%n m N ' _'/"�'9 4y \9j W 1/4 CORNER ••LD
z z m \- \ 2 SECTION 13 -
rn - �O-9�"9,�- \ \SQ T29N, R2OW FILED 12
m-z = �;\ \\� \\ \ \�9 PK NAIL, FOUND. 3 JAN 0 3 1997
>;o z �; KATHLEEN H.WALSH 1
o�-m •` 6k -543 '` \2� 9 Register of Deeds
=o \s St Croix Co.,Wf
rn N-I CO 0
N
(D
N
THIS INSTRUMENT DRAFTED BY DARN FLATER PAGE 1 OF 2
VOLUME 11 PAGE 3200