HomeMy WebLinkAbout004-1035-10-100 (2)a
St. Croix Count Pl annin and Zoniny9 Tltui-sdiq, January 12, 2006 at 2:23:46 PAI
Detail Sanitary Information Page I of I
Computer #:
004-1035-10-100
Sub/Plat: NA
Section: 15
Parcel #:
15.28.15.234c
Lot: 1
TNIRNG: T28N R15W
Municipality:
Cady, Town of
CSM: Vol. 11 Pg. 3092
1/4 1/4: SE 1/4 NW 1/4
Owner:
Brandvold, Barry 3050 County Rd N Wilson, WI 54027
State Permit:
262432 Issued:
05/09/1996 POWTS Dispersal: Mound
Permit: New
County Permit:
0 Installed:
07/11/1996 POWTS Detail: NA
Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/inspector As Built
Not determined Yes
Jim Thompson Signed Off: Yes
Maintenance
Scheduled Pump Date Pumped
7/4/2002
Plumber Other Requirements
Pelke, Herb
1 st Notification 2nd Notification 3rd Notification
Additional Notes
Money Owed
The current owners, Holtz, bought the 40 acres $0.00
adjacent to this lot from Soldiers of J.Christ, which
had an illegal holding tank/drainage system
installed by Pastor Sortedahl, with documentation
in emergency permit #259440 on parcel #004-
1034-30-000/.229 This may not have been
abandoned by previous owner
Parcel #: 004-1034-30-000
01/12/2006 02:16 PM
PAGE I OF 1
Alt. Parcel #: 15.28.15.229
004 - TOWN OF CAD7
Current X
ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map #
Sales
Area Application # Permit #
Permit Type
00
0
Tax Address:
Owner(s): 0 = Current Owner, C = Current Co -Owner
0 - HOLTZ, MICHAEL W & BONNIE J
MICHAEL W & BONNIE J HOLTZ
3050 CTY RD N
WILSON W1 54027
Districts: SC = School SIP = Special
Property Address(es):
Primary
Type Dist # Description
3050 CTY RD N
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
40.000
Plat: N/A -NOT AVAILABLE
SEC 15 T28N R1 5W 40A SW NE EZ-U-1 181/523
Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
15-28N-1 5W
Notes:
Parcel History:
Date Doc #
Vol/Page <e
,I yp
11/29/2001 6 6,35 FA 6
->
J 7.7 A -I? Q 7- - WD
07123/1-997
1179/393 WD
07/23/1997
1135/179 LC
07/23/1997
945/259
2005 SUMMARY Bill #:
Fair Market Value: Assessed with:
106566
Use Value Assessment
Valuations:
Last Changed: 09/07/2005
Description Class
Acres
Land Improve
Total State Reason
RESIDENTIAL G1
1.000
14,000 86,000
100,000 NO
AGRICULTURAL G4
38.000
4,000 0
4,000 NO
UNDEVELOPED G5
1.000
100 0
100 NO
Totals for 2005:
General Property
40.000
18,100 86,000
1041100
Woodland
0.000
0
0
Totals for 2004:
General Property
40.000
6,500 45,200
51,700
Woodland
0.000
0
0
Lottery Credit: Claim Count:
0
Certification Date: 04/17/2001
Batch #: PRGRM
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
-
r
Y7
Owner yl
ts LAS
Property Address 6 t I 1I-A A
City/State
Tly
C�O(JN
Legal Description: OPFIC�c
Lot Block Subdivision/CSM #
'/4 '/4, Sec. , T � q N-R ) -Wl, Town of
cG
PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer fil,J o,,c 1"1"e, eo,'� �- Size ST/PC 14SOI A-50Setback from: House t� Well 75 P/L
Pump manufacturer efe Model
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: Moq*i d Width � _Length � Number of Trenches
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS:
Elevation
Description of benchmark N c< i C, Elevation Z
Description of alternate benchmark �
� � r � �
Building Sewer 6)& 1 Lo, ST/HT Inlet � S11, � ' ) ' ) ST Outlet. �1 k"'o, - PC Inlet I5�1 / G
PC Bottom Header/Manifold
Distribution Lines ( )
Bottom of System ( ) q i - 4'11 ( )
Final Grade ( ) - 9 y , i :2, ( )
Top of ST/PC Manhole Cover / 6261
Date of installation P /10 Permit number 3 �fq�,) ",?State plan number
5 �J Date orl
Plumber's signature dzo-foe 2yiCiL I. r License number
Inspector. vi vN
Complete plot plan or
1 ) �
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.
AW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety Gnd_ Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Dnrc-nnm1 infnrm_qtjnn wr%i i nrnvire mav he ij,,;P.d for s-econdary ntjrnn,;P.q [Privnry I Aw q 1 r-; n4 t 1 wrni
I T-1 a..7%a I I LA4 J I I I W 11 4 J U- F-
Per mit Holder's Name: ❑F1 City Village Town of
SOLDIERS OF JESUS CHRIST CADY
CST BM Elev.-.. Insp. BM Elev.: BM Doscription: Q-0
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
_"__
(9 D
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P / L
WELL
BLDG.
Vent to
Air Intake
ROAD
Septic
f
Sly
NA
Dosing
t"L
NA
Aeration
NA
Holding
PUMP SIPHON INFORMATION
Manufacturer Demand
Model Number t PM
TDH Lift Friction System�j TDH \0;Ft
Loa- 1,acl
Forcemain Length w---n Dia. It Dist. To Well
12
5C)IL AtS5UKP 1 !UN 5 Y!Io I It M
ELEVATION DATA
County -
Sanitary Permit No ST, CR
344513
State Plan ID No.:
- - co 5-
Parcel Tax No.:
004-1034-30-000
ix
STATION
BS
HI
FS
ELEV.
Benchmark
C)
0/. ly
Bldg. Sewer
3
-o6
St/ Ht Inlet
St / Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
(,(
Bot. System
Final Grade
2-lio
(B\ED TANWcH
Width
Len th
ren�cg
PIT
No. Of Pis
Inside Dia.
Liquid Depth
EN�IIQNS
DIMENSI
SYSTEM TO
P L
BLDG
WELL
LAKE/STREAM
LEACHII 4
,Parrb�a c t u r e r:
SETBACK
INFORMATION
C H A F%A WrRR
Type Of
)p 9D
odel Number:
System:
cro
OR NIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size X Hole Spacing Vent To Air Intake
Dia. Length <9
Length Dia Spacing
-qK _-
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil El Yes / No ❑ Yes E] No
COMMENTS: (include code discrepancies, persons present, etc.)
LOCATION: CADY 15,28.15.229,sw,NE 3073 COUNTY ROAD N
1�- �`
Plan revision required? El Yes El No
Use other side for additional information.
SBD-6710 (R.3/97)
1� 0 4W ct Ov (t6� a 'Ir_a4l
Date Inspector's Signature Cert. No
isconsin
Department of Commerce
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302
Madison, WI 53707-7302
• Attach complete plans (to the county copy only) for thesystem,'on paper not less
County
S
than 8 112 x 11 inches in size.
-F
• See reverse side for instructions for completing this application
State Sanitary Permit Number
3Ll,� / 3
Personal information you provide may be used for secondary purposes
❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. NiLmber
I. APPLICATION INFORMATION PLEASE PRINT ALL INFORMATION
Propert Owner Name
Property Location ion
4, 1/4(1 - 1/4, S T No R i) -XK(or) W
r
Property Owner's mailing Address
Lot Number
Block Number
3o 7 3
Cit State
Zip Code
Phone Number
Subdivision, Name or CSM Number
I. TYPE OF BOIL DING: (check one) El State Owned
q
❑D Cit
f-1 Village
Nearest Road
Public 1 or 2 Fami_ly DwellinQ - No. of bedrooms
y Town OF
Ill. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Numbers)
1 Apartment/ Condo '54e /C)
E] v9fP.' 47
2 E] Assembly Hall 6 E] Medical Fa&i/t^yv/ ursing H
Home 10 [-� Outdoor Recreational""Facility
3 E] Campground 7 0 Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 E Church School 8 El Mobile Home Park 12 E] Service Station / Car Wash
5 0 Hotel Motel 9 Office/Factory 13 E] Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B. if applicable)
A) 1. New 2. R Replacement 3. [:] Replacement of 4. 0 Reconnection of 5. E] 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 E] Seepage Bed 21 g] Mound 30 L] Specify Type 41 ❑ Holding Tank
12 E] Seepage Trench 22 [:] In -Ground Pressure 42 ❑ Pit Privy
13 n Seepage Pit 43 ❑ Vault Privy
14 E]'System-In-Fill
V1. 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
Arl t_Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
50 n,3 — —
-'±7= 5 Feet, Feet
VI I. TANK
INFORMATION
Capacity
in gallons
Total
Gallons
# of
Tanks
Manufacturer's Name
Prefab.
concrete
Site
Con -
Steel
Fiber-
glass
Plastic
Exper.
App-
New
Existin
structed
Tanks
Tanks I
Septic Tank or Holding Tank
9"'0
F1
®
El
Q
El
Lift Pump Tank /Siphon Chamber
j 4, s -(,,)
0__�
El
I EIT
El
El
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installa 'on of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print)
Plum is Signatu!r o, Stamps)
MP/MPRSW No.:
Business Phone Number:
L e- S �_ 6%
Plumber's Address (StrepA, City, State, Zip Code);
zc
IX. COUNTY / DEPARTMENT USE ONLY
ID Disapproved
Sanitary Permit Fee (includes Groundwater
Surcharge Fee)
—ro
ate
FIssued
Issuin;Vgent Signature (No Stamps)
U�Approved
Owner Given Initial
L
(A
Adverse Determination
X. CONDITIONS OF APPROVAL REASONS FOR DISAPPROVAL:
7
SBD- 6398 (R. 11197)
DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
r t
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years. I .
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system i s to be i nsta I I ed .
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County / Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Mir ff
isconsirn
Department of Commerce
May 19, 1999
CUST ID No.267341
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 05/19/2001
SITE:
Site ID: 166160
St. Croix County, Town of Cady
Facility: Penial Christian Home
CC%
FOR:
Description: Mound Revision
Object Type: POWT System Regul
1(%0
n
Safety and Buildings
2226 ROSE ST
LACROSSE WI 54603-1905
TDD #: (608) 264-8777
www.commerce,state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
A TTN.- PO WTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
I IUDSON WI 54016
Identificati ers
Transaction ID
22�005
Site ID No. 166a
0\ �- __Please refef to both identification numbers,
above, in all correspondence with the agency.
Y9
COIJ
.: 44655k-.&)
The submittal described above has been reviewedfbrkAin ` Ee with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The approved changes will become an addendum to the plans previously approved. All other portions of
the installation shall confon-n to the original approval.
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,
Gerard M. Swini
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
j swim@commerce. state. wi.us
DATE RECEIVED 05/05/1999
FEE REQUIRED $ 60.00
FEE RECEIVED $ 60.00
BALANCE DUE $ 0.00
WISMART code: 7633
4
MOUND SYSTEM
FOR
Page � Of I
LOCATED IN THE -S 1.13 1/4 OF THE 1/4 OF SECTION ) S , T Z% N, R \-S W,
TOWN OF c S-7. COUNTY, WISCONSIN.
PAGE
1
of
7
TITLE SHEET
PAGE
2
of
7
PROJECT DATA
PAGE
3
of
7
PLOT PLAN
PAGE
4
of
7
PLAN VIEW- CROS'.'.,'- SECTION
PAGE
5
of
7
DISTRIBUTION PIPE LAYOUT
PAGE
6
of
7
DOSE CHAMBER
PAGE
7
of
7
PUMP PERFORMANCE CURVE
PREPARED FOR
OT-- O-Nmlks-r
°�—%� Pc--)-J�L
Z-C-t q s e��jK;ry " ►�
�\- I
P•c�go .n-0
0a
Coj,Jittov�0 � RECEIVED
O
��ppRjMsp�-MAY - 5 1999
SSE GUR PREPARED BY
SAFETY & 13'L
Uije ut'v-
E-= CE; E-=- F=<- Uz- F:Z S C3 T L- -Y- E= fE3 -I- I ts%.l (�r
AND
ID E= � 1E C3 t%A :E-3 F-= F:;: qN/ 1E � I-=
P.O. E01 74 421 K. KAIN ST.
RIVER FALLS. Wl 54022
715 - 421 A 165
ZZQUS'0)\j OF T�+��r PL4\'�\j
" w
o/v
*� 16 00 00"00"601,446 *1 -ip
ARTHUR L
wF,3EREA
D-3 P
&*Lee** #0
I G 1;'V'
's
JOB NO_ 9 6) ()
r
• 1 f
�
1 0
Page 2 of " 7
This mound system will serve a 4 bedroom building providing
sleeping rooms for 6 children, 2 caretakers and 1 floor drain.
There will be no meals served and no showers taken in this
building by the children. The caretakers will likely shower
at this building.
The main dining hall, showers and laundry are located in the
existing facilities located approximately 1 mile West of this
site.
ANTICIPATED WASTEWATER
The most logical sizing is Camps -no meals served-15 gal/person.
6 persons at 15 gpd =----------------- 90 gpd
2 employees at 20 gpd =---------------- 40 gpd
2 showers at 15 gal each =------------- 30 gpd
1 floor drain at 50 gpd -------------- 50 gpd
Total = 210 gpd
The system is designed for 750 gpd to fully utilize the available
suitable area and to provide for additional loading if it should
occur.
TANKS
750 + 750 = 1500 gal minimum capacity required.
A 1650 gal Midwestern Precast, Inc. septic tank will be installed
with a 1650 gal Midwestern Precast pump tank.
PLOT PLAN
Scale 1 "= \4 W
Page --�S of ^�
i/
w
01
NOTES:
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( required)
3. Install 4" observation pipes with approved caps, ( Z required)
4 . - Septic tank to be 16 Sp gallon capacity manufactured by
5. Bench Mark S S Pr L)VL~'
6. Divert surface water around system to. prevent - pond ing at the uphill side .
y
Place lst hole Zq from center of manifold with succeeding -- cceeding holes
at Wr intervals. Last hole to be next to t ----- h e end cap
Of
LLJ
M
LL_
1
8
2
---a-3 7/8--sm...0 6 1/4
HEAD CAPACITY CURVE
MODEL 499811 A C In
0
U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS
80 160 240
FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOWPER MINUTE
EFFLUENT AND DEWATERING
CAPACITY
HEAD
UNITStMIN
FEET METERS
GALS LTRS
5 1,52
72 273
10 3.05
61 231
15 4.57
45 170
20 6.10
25 95
Lock Valve 23'
/8
1 16
1 112-11 112 NPT
12
4 3/16
SK1 102
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and 0 Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with 0 Double piggyback variable level float switches are available
or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - I.- H.P? Sin le ni hnri< variable level flnit switch or rback"hip 1 hnrvariable IPvPI
98 Series Control Selection
Model
Volts -Ph
Mode
Amps
Simplex
Duplex
M98
115 1
Auto
9.4
1 or I & 7
N98
115 1
Non
9-4
2or2&6
3or4&5
D98
230 1
Auto
4-7
1 or &7
E98
1230 1
Non
1 -.4.7
1 2 or 2 &
3 or 4 & 5
:j zi to J t, 9 t% .7
teat switch. Refer to F_ W47 7.
3. Mechanical alternator 10-0072 or 10-0075.
4. See FM0712. for correct model of Electrical Alternator, E-Pak.
5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4)
float system.
6. Four (4) hole J-Pak, Junction box, for watertight connection or wired -in
simplex or duplex operation, 10-0002.
7. Two (2) hole J-Pak, for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514 ' Piggyback All installation of controls, protection devices and wiring should be done by a qualified
Variable Level Switches, FM0477, Electrical Alternator, FMO486', Mechanical Alternator, F&10495, Sump/ licensed electrician. All electrical and safety codes should be followed Including the most
Sewage Basins, 171101048T. and Single Phase Simplex Pump Control/Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
Louisville, KY 40256-0347 Manufacturers of
L7 SHIP TO: 3649 Cane Run Road
Louisville, KY 40211-1961
02) 778-2731 - 1 (800) 928-PUMP
FAX (502) 774 -3624
% Wmcc; min Department of Industry, SOIL AND SITE EVALUATION REPORT
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road,
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION
Page "',\ of
PARCEL I.D.
o��{ _ 1 o3y_ 3�
REVIEWED "Y DATE
- f ,er June.,1
PROPERTY OWNER: S off, S 01-' Z-t-1-SQS PROPERTY LOCATION IF U
C. C) rz_ J Q, tAZ t n A vk-�Y' GEWF. S �Q 1/4 W �,� 1/4,S \ S T 7A) N, R E
1Z — 0)
PROPERTY OWNER'-S MAILING'ADDRESS BLOCK # SUBD. NAME OR GSM #
-L IS, 01 S I of LOT # I ---
CITY, STATE ZIP CODE PHONE NUMBER []CITY EIVILLAGE MTOWN NEAREST ROAD
I t�j (S 1^j I S Q �) 0 (1 LS) -�I-z - ":� I -I 1 (2- fitNL)t-j 0'vl� I - ""I j
New Construction Use j Residential / Number of bedrooms J Additiqn to existing building
Replacement Vj Public or commercial describe k5vi- is �, Ee� i rJ 6 V�_' w" S _R�l \J3 � Ea__'s
Code derived daily flow ZZ Recommended design loading rate - bed, gpd/ft2 7�)
gP6�f<) 60 K_ 4 � -trench, gpd/ft2
Absorption area required ft2 S bed, trench, ft2 Maximum design loading rate S bed, gpd/ft2 trench, gpd/ft2
(::C_
Recommended infiltration surface elevation(s) � ---) . ft (as referred to site plan benchmark)
Additional design / site considerations S -Fyz_�nJc lf UH \- ' C F S`i� F) L�.
Parent material 1._Oe5 S �\J E!<:S Flood plain elevation, if applicable ft
S = Suitable for systern CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
I I
U = Unsuitable for system El S OU ZS E1U EIS OU El S RU EIS NU El S IRU
Boring #
Ground
elev.
ft
Depth to
limiting
factof
Boring #
Ground
elev.
Cl; 1-7 ft
Depth to
limiting
factor
31
SOIL DESCRIPTION REPORT
F�
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Bai"
Roots
GPD/ft2
Bed
Trees
A
Remarks:
m4v
A
3) - S �
'S L-1 rz- 31
A, 4 Y
1 7 lm�
ST Name--Flease Print Arthur L. Wegerer Phone: 7 15 -4 2 5 -04-65-
rJie
-ess: ergrer Soil- Testing & Design Service-P,-Q,. Box 74 River Falls WI 54022
Date: CST Number:
oi�;natur 2 5 4
Fi
SO L t)\ ZTr- S OF
PROPERTYOWNER.- vS cvmtsl SOIL DESCRIPTION REPORT
PARCEL I.D. # 0 C) q - 3*4 - 3 (Z)
Boring #
Ground
elev.
cI %4 �Nt.
Depth to
limiting
factor
Z6.%
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Ground
elev.
f t.
Depth to
limiting
factor
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
41
Page of
Horizon Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence Boundary Roots
GP
Bed Tron
-zL
10 %-1 V- 3) f.
`'
si 1
Z b
S,
cl^j
-Sal
&Wool
Remarks:
Remarks:
Remarks:
Remarks:
• PLOT PLAN
SCALE lit= Y t
01-Z
vt t� tn-t-
"14
Er-L ci uL 13
," r i
V6
L
Page � of
°tip
-TV
r�i °
V" VL-43 Nn'
L
7 15 429-0I h5 1400576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations
Division' 1)'f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
go # COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (13M), direction` and % of' slope, scale or PARCEL I.D. #
OLINT
C
FAR PARCEL
dimensioned, north arrow, and location and distance tag, nearest road. 0 C)H t) 1\4
REVIEWED BY DATE
APPLICANT INFO RMATION-PLEASE Pilkf ALL: INFORMATION
PROPERTY OWNER: L S
PROPERTY LOCATION
SV&3 1/4 tQ 1/4,S 1 S T -Zb N IR 1 S E (ooW
-GQ�4. LOT
PROPERTY OWNER':S MAILING ADDRESSi LOT # BLOCK# SURD. NAME ORCSM#
CITY, STATE ZIP dODE- PHONt
RU ]CITY E]VILLAGE MOWN NEAREST ROAD
0
kj New Constuction Use[ Residen .1 S� AdditiQn to existing building
II Replacement Public orCOMMe6;111���t�\__��
Code derived daily flow \-4 0."Dd Ct� \-G�J P�*r 4S(� Recommended design loading rate bed, gpd/ft2 • I trench, gpd/ft2
Absorption area required S bed, ft2 5 trench, ft2 Maximum design loading rate bed, gpd/ft2 1z, trench, gpd/ft2
Recommended infiltration surface elevation(s) 0". S ft (as referred to site plan benchmark)
Additional wMM C)F:-
design / site considerations MUuy-jz� W / S� 'y- -1 S t *%T)-Zp ,C.0 MI rJ� USft`� L L_ F,1
Parent material Lows C_-�uat �vft-L "-m-L Flood plain elevation, if applicable t---% )% , It
S = Suitable for system CONVENTIONAL MOUND I IN -GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK
U = Unsuitable for system I El S KU 0S E1U EIS OU EIS ZU I El S WU El S Q'U
Boring #
Ground
elev.
Depth to
limiting
factor
Boring #
... . fi....»-
Ground
elev.
f t.
Depth to
limiting
factor
SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Motes
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
BoLitary
Roots
GPD/ft2
Bed
Trench
cl_
LEE--
Q)E SOIL L-3
I A.) 6:
C>'N.J
Y —019
C R.1 '
tip - -�3I`
l=
-
LS -S
1 "1
(,A' `�D
L
tN
L
IQ
�� ,,) �— NAt.-Sk_L
i
c'�C� 1�1_�'�'
ri
L)
Remarks:
M=14
LVJ 61 11
MMU-
A
�POMWIIUMIMPASWW
%own,
N®R
MOEN
mm
Remarks:
;ST Name: —Please Print Arthur L. Wtgerer Phone: 7 15 -4 2 5 -0 16 5
egeSerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
signature:, Date: F 9CSTNumbev
,,V, c,
k_x_� 220254
Wisconsin Deparumnt ot Indusby, SOIL AND SITE EVALUATION REPORT
Labor'ind Human Relations
DwIsion 6f Safety & Buildrxjs
in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but,
not limited to vertical and horizontal reference point (13M), direction and % o ' f slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION 'PLEASE PRINT ALL INFORMATION
Page \ of I
COUNTY
S-r_
PARCEL I.D.
oay_ �o3y_ 30
REVIEWED BY DATE
PROPERTY OWNER: u_s CVr;i?__LS-r PROPERTY LOCATION
C-hfi GGVT. LG�T SW 1/4 t\) IE 1/49S 1 S T 1,b IN,R l S E W
PROPERTY OWNER:S MAILING ADDRESS LOT # BLOCK# SUBD.NAME ORGSM
#
Z, 01 C11L S 16 " 11
VILLAGE MOWN
CITY, STATE ZIP CODE PHONE NUMBER E]CITY [❑] NEAREST ROAD
C-) is) C. �
New Construction Use Residential / Number of bedrooms AdditJQn to existing buikfing
j j Replacement j Public or commercial describe
Code derived da4 flow q QDd 0��WW Prr 4&� Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2
Absorption area required ':S_1 S bed, ft2 1 -1 -5 tench, ft2 Maximum design loading rate i-S bed, gpd/ft2
trench, gpdM2
Recommended infiltration surface elevation(s) 0171.s ft (as referred to site plan benchmark)
Additional design / site considerations. M(sLtj,-� w / S ')c- —1 S " *7�-ZZ_ry 0 . M I N I MU M kj� c)F:- SfrF-1 LL.
Parent material 1--k:5 k`_'M S (:NU kat Gs-LAQ L kL "-n L-L Flood Main elevation, if applicable f%a A ft
S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL RXDWG TANK
U-= "Unsuitable for system Ds KU 0S E1U I EIS OU EIS OU I El S OU El S C�'U I
Boring #
ti
Ground
elev.
ft
Depth to
limiting
factor
Boring #
Ground
elev.
ft
Depth to
limiting
factor
SOIL DESCRIPTION REPORT
Depth
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Struc tu re
Gr. Sz. Sh .
W,
ape I or 7_.V�ffla 91
was
Ms
k4l, I it
twl 4
P�Nslm'
MM14♦
-,
m
tMW
MW
M10
mm
W1411.
-
M
will
mot.
a
-N, a IRV
11-1 qtmw�%
Remarks:
b
w6rall
OEM
Remarks:
ST Name: --Please Print Arthur L. Wegerer Phone: 7 15 —4 2 5 —016 5
'eeSerer Soiq Testing & Design Service—P.O. Box 74 River Falls WI 54022
signature: Date:
c79 CST Number:
A_111� - 2202 54
Wmolisin Departnent cff Musty, SOIL AND SITE EVALUATION REPORT P Hof
Laborearod Human Relations
•bi.An of Safety & Buildings in accord with IL R 83.05, Wis. AdmCode
C7 COUNTY
Attach complete site plan on paper not les than 8 1/2 x 11 in6' esin' i M gh Ida im it
-Z
PARCEL Fn
not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D.
dimensioned, north arrow, and location and distance to nearest road. o�� - � -so
a REVIEWED BY DATE
APPLICANT INFORMATION -PLEASE PRINT ALL . IMFORMATTj N Ltw 1d;
PROPERTY OWNER: S oL. ti of-' :Yt?_-s\js Cam" -[3_r PROPERTY LOCATION 0
C. / C) \' Q, vrvus-p � 60VT. i F, " 1/4 W 1�,� 1/4,S 1 S T 7,� N,R l S E (0(cw)
PROPERTY OWNER:S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM
CITY, STATE ZIP CODE PHONE NUMBER []CITY [:]VILLAGE RTOWN NEAREST ROAD
CITY,
O-N
New Construction Use Residental / Number of bedrooms AddibQn to existing building
Replacement Vj Public or commercial describe
Code derived daily flow gp160 P�1_ 1-1 so Recommended design loading rate bed, gpd/ft2 7�) trench, gpd/ft2
cz�
Absorption area required _�� S bed, ft2 8 trench, ft2 Maximum design loading rate -S bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/ site considerations Y__'IS'71Lc� ml"Imum \-Z"l p F Sfv\jb Fj uL
Parent material '__C)e53 Wi k2Vt 6 fv-L -r) 1r Flood plain elevation, if applicable It
S = Suitable for system I CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system El S OU 2S OU [IS NU El S LKU EIS NU El S LRU I
Ground
elev.
C�--) . "'L ft
Depth to
limiting
factor
Z__ ) 11
Boring #
Ground
elev.
L ft
Depth to
limiting
factor
- 3 \
SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Baxilary
Roots
/f t 2
GPD/ft2
Bed
Tmnch
Qb G
'_S
?n -S -Z
-).s wL
Remarks: 0
0..10
1,b`1 R-- 3 l "t
S l �
Z`�' S�1�
�n'�'h
(° S
1�
' S
-Is �-,.��ty
—
s `
� m s�
h�v'f�-
e�.�
,y .S
+�-iCQ
SKR S /�,
Sci
t o�
Yy►'�1-
-
ti�� • ?
Remarks:
;ST Name ---Please Print Phone:
Arthur L. Wegerer 715-425-0165
eeSerergSoil-Testing & Design Service-P.O. Box 74 River Falls WI 54022
>�nature: - ";Date: CST Number:
220254
SoL- ntkzTz-S 0V=
PROPERTY OWNER us C tS SOIL DESCRIPTION. REPORT
PARCEL i.D. # ooq — 1o3\4 -30
Boring #
3
Ground
elev.
0, Wit.
Depth to
limiting
factor
Z 6 ''
Ground
elev.
ft.
Depth to
limiting
factor
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Ground
elev.
ft.
Depth to
limiting
factor
Page Z of
Horizon
Depth
in.
Dominant Color
Munsell
ry
Mottles
Color
Qu. Sz. Cont0-1
Texture
Structure
Gr. Sz. Sh.
Consistence Roots
G P Dlf#
�'-i � 3) Z
-.
`�
t i
Z�s�1R
w,� � 1�
Bed a
'I�E A
to %-t 12,- 3) L
s ti
.10
S �
S 11 D. 3 � y
n .s��.�s1 �3
s
oti,�,
*-V�-
y
�•S�[R- ��
se ]
p
Z
Remarks:
l .
Remarks:
• - l
Remarks:
nemarKs:
�nr) 0,)nn1rw eNf* In %
CST Signature
PLOT PLAN
SCALE 1"= 40 ' gAer�y
I
a
Ulz
f
C' V6
Ira
Page Hof '---)
O
Orj
`v
. V
Date Signed
99- DZ
i 71 425' --01 6-L 1400576
Telephone No. CST #
Safety and Buildings
2226 ROSE ST
_0 LACROSSE WI 54603-1905
Tommy G. Thompson, Governor
isconsin Brenda J. Blanchard, Secretary
Department of Commerce
January 20, 1999
CUST ID No.267341
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS W1 54022
RE CONDITIONAL APPROVAL
APPROVAL EXPIRES: 01/20/200
"000
ATTN.- PO WTS INSPECTOR
ZONING OFFICE
qT CROIX COUNTY
SITE:
, ?'
Site ID: 166160 C
St. Croix County, Town of Cady
'00t4v
Facility: Peniel Christian Home 2ot4lt4cc*r
1101 CARMICHAEL RD
HUDSON WI 54016
Descri�'' ___
ption: Mound
Object Type: POWT System Regulated 0 ec o.: 446558
Identification Numbers
'transaction ID No. 207716
Site ID No. 166160
Please refer to both identification numbers,
above, in all correspondence with the agency.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• This approval does not include plans for the general plumbing systems or sewer piping leading to the
septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to
determine if plan submittal and approval is required.
A copy of the approved plans, specifications and this letter shall be on -site during consiruction 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,
I -A
card M. Swim
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim@commerce.state.wi.us
DATE RECEIVED 01/20/1999
FEE REQUIRED $ 180-00
FEE RECEIVED $ 180-00
BALANCE DUE 0.00
WiSMART code: 7633
• MOUND SYSTEM Page N Of
FOR
j
V-) � S-Tlfl\
LOCATED IN THE S 1/4 OF THE 1/4 OF SECTION ) S , T Z% N, R \S W
TOWN OF c tl sl- - COUNTY, WISCONSIN.
T&TnVV
PAGE 1 of 7 TITLE SHEET
PAGE 2 of 7 PROJECT DATA
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE IA 0n�LllyPAGE 6 of 7 DOSE CHAMBER Aitt0
PAGE 7 of 7 PUMP PERFORMANCE McmP�pF���EN �� VO
PREPARED FOR
s�����zS o� ���s cm:.>>r Go��,ESPo
RECEIVED
JAN 1 9 199q
SAFETY & BLUbS DIV
I ml
40�sc 0 NIT
AND
APTHUR L.
WEGEREA
D-915 P
P.O. HI 74 421 K. KAIK ST_ ELLSWORI-K
WS&
RIVER FALLS. WI 54022
C4 ����,. fi
104pom P, a
46 0
JOB NO.
PROJECT DATA Page 2 of 7
This mound system will serve a building sleeping rooms for 16 to 18
children, one floor drain and a maximum of five employees. The
employees are comprised of caretakers, office staff, etc..
There will be no meals served and no shower or laundary facilities
in this building. The main dining hall, showers and laundary are
located in the existing facilities located approximately 1 mile
West of this site,
ANTICIPATED WASTEWATER
The most logical sizing is Camps -no meals served-15 gal.person.
18 persons at 15 gpd =-------------------- 270 gpd
5 employees at 20 gpd =-------------------- 100 gpd
1 floor drain at 50 gpd ------------------ 50 gpd
TOTAL = 420 gpd
The system is designed for 450 gpd.
SEPTIC TANK
450 + 750 = 1200 gal minimum capacity required.
A 1200/800 Midwestern Precast, Inc. combination tank will be
installed.
• PLOT' PLAN
• Page of
Scale 1"=\4rj
r
U
0
r�
UtZ —�
low
ass
51
,� �' •boo-o' o S kE ZoY %,*E v �
5 �- q 6,
tee.
00 1-� Del jo
G
bS'
�� Z -• LbZ-0' Vri --UQ of
,,-, rLO P cis ev.-s
Vz ► w G
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. Z required)
3. Install 4 " observation pipes with approved caps. Z required)
40 - Septic tank to be N7Wu /bu,3 gallon capacity manufactured by
5. Bench Mark S S CI`1 Pr% v V L.=_
ti
6 . Divert sur f ace wa ter around s y s t ein to. prevent- . pond ing at the uph i 11 s ide .
Page 1"10 f,
Approved Synthetic Covering
Medium Sand
H
Topsoil
E
/0 slope
Trench of --2 22
Aggregate
(undisturbed
Soil
Plowed
Layer
D Ft.
E Ft.
Cross Section Of A Mound System Using F 0 -'b Ft.
I Trench For The Absorption Area G � -� Ft.
A Ft. H I- S Ft.
B Ft.
I Ft.
Linear Loading Rate= 1---)-a)GPD/LN FT
J Ft.
Design Loading Rate— 0--�) GPD/SQ FT
K Ft.
L 7 Ft.
Position of Force Main----.-. W Ft.
L
Fore
B K
A
W
\,.,Trench Of
i _ 2
Distribution
Pipe Aggregate
Observation Permanent
Pipes Markers
(Anchor Securely)
Distribution
Dist ribut ion Pipe
G
Elev'. S
D
Force Main
From Pump
Mound Using I Trench For Absorption Area
Page _S Of -7
Perforated Pip6 Detoll
0
End View
End Cop )Perforated
--
PVC Pipe
Pipe
Lost Hole Should Be
Next To End Cop
Distribution Pipe, Layout
Install permanent -marker
at end of each lateral
Holes Located On Bottom,
Are Equally SPoced
End Cop
P Ft.
X 31, Inches
y3b Inches
Hole Diameter )19 Inch
Lateral Inch(es)
Manifold Inches
Force Main " '2- inches
# of hol es/pi Pe VZ,,
Invert Elevation of Laterals 98.00Ft .
bq )c -z-
Place 1st hole from tee with succeeding holes at �C intervals.
Last hole to be next to the end cap.
Combination Sep-tac;Tank and
PUMP CHAMBER Goss SECTIOU AMD SPECIFICATIOMS PAGE 6 OF 7
VCUT CAP WCATHEK FK00fr
jukJCTIOU box
4 r C.I. v[MT PIPE APPROVED LOCKIMG
10 1 F R 0 M - D00i, Mk Q 110 L E COVE K wt
'.dlMD0W OR t KLbn
Ajj� i U TA K E
APPKOVF-D JOINT
W/C.T. FIKOF_Plx
"01*.
APPROVED JOIIJTI-
W/C.I. PIPEORPic
1 3 d
RISER EXIT PERMFULD C)QL!J IF TAwK MAQUFACTURZIR
HAS SUCH A,PPRDVAL
• 5PCClFlCATlDKJS
SEPTIC
DOSE: IQUI'AbElk OF DOSES: P F_ K DA�
T,A, W K ,MA UUFACT URZ
TAWK SIZE : G A LL 0 Q S DOSE
VOLUME ���, �
ALARM M%AW U FACT U R. �_ R :iS WC-L-IJOING
15ACKFLOW: GALLDWS
/'�DDLL WUMBLR: CA.PACITIES:
A IMC14cs OR CALLOLJ5
5wiTCH T�PC:_
WCHES %. OR t�-{Z�G� LLDW�
PUMP t'%AWU FACT URC •K:
Cz -WEIACS DR 4,ALL0kJ5
MODEL WIJK5F-F,*.
D INCHES OR 2)"q GXLLD�JS
SWITCH TtIPFLO. kJOTE"
PUMP AND ALAKM ARE TO bE
M11JIMUM DISCKAR&E P%ATE
INSTALLED OW 5EPARA%T[ CIRCUITS
V�KDCArL WFEEKEKICC bETWL[IJ PWAP OFF AiJD.C)I5TIZIbUTI0Q PIPE..
FEET
+ miwtALIM METWOKK SUPPL'� PRESSURE
2_50 FLV_T
+ FEET O\,\U\ FTF FORCE: MIM X Y,0() FT.FRICTIOW VXCTOR,
3-31FECT
TOTAL OtWAMIC HEAD
FLET
DIAMETER
Pump chamber
� �, d,
IIJTF-RLIAL DItALWSIMJOF TAQK: I.-F-M&TH ;WIDTH
—..,;LIQUID OUTH
BOTTOM AREA 231
GAL/INCH
AS PER MANUFACTURER
GAL/INCH
3 15/1 fi 6 5/32 P� �7 0 `7
4 5/8
I � 1 112 —11 112 NPT
25
HEAD CAPACITY CURVE
"53 - 57" - "55 - 59" SERIES
Z$
08
0
U.S. GALLONS 10 20 30 40 50
LITERS
O 80 160
FLOW PER MINUTE
SK2W
IViI TOTAL DYNAC HEAD/CAPACITY`
PER MINUTE
EFFLUENT AND DEWATERING
50 SERIES .
Ft.
Deters
Gat.
Ltrs.
3
1.52
43
163
10
3.05
34
129
15
4.57
1s
72
Loch vcnm: 1 e.25'
10
3 15/16
_4
4 1/16
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Variable level Float Switches available. •Available with special cord lengths of
• Variable level long cycle systems available. 150, 25', 35' and 50'.
• Alarm systems available.
• Duplex systems available.
Standard cord length - automatic 9 ft.
0tanr�nrrt rnrr� lonnth _ nnnal itnma#sr 1 !#
MW5 31 S
an 371 9 Control Selection
Model
Volts Ph
Mode
A
Simplex
Duplex
M53155 & M57159
115 1
Auto
8.0
1 or 1 & 7
-----
N
6
5
or 4 &D53155
& 05MB '2N
1
Aub
1 7
-----
E 53155 & E57159
230 1
Non
4.0
:::4
2 or 2 & 6
3 or 4 & 5
53 Series - WL 22 lbs. 57 Series - Wt. 27 lbs.
55 Series - WL 24 lbs. 59 Series - WL 30 lbs.
e32
1
• sKas4
SELECTION GUIDE
1. Integral float operated mechanical switch, no external control required.
2. Single piggyback variable level float switch or double piggyback variable level float
switch. Refer to FM0447.
3. Mechanical alternator `M-Pak' 10-0072 or 10-0075.
4. See FM0712 for correct model of Electrical Altemator, E-Pak.
5. Variable level control switch 10-0225 used as a control activator, with E-Pak (3) or
(4) float system.
6. Four (4) hole J-Pak, junction box, for watertight connection or wired -in simplex or 2
pump operation, PM 10-0002.
7. Two (2) hole J-Pak, junction box for watertight connection or splice,
PIN 10-0003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination starter, FM0514, All installation of controls, protection devices and wiring shc�u!d be done ty a qualified
Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be fDilowed including the most
rn Alteator,FM0495;SumplSewageBasins, FM0487;andSinglePhaseSimplexPumpControl!Alarm recent National Electric Code (NEC) and the Occupational Safe,,y in d Health Act (OSHA)
r Systems, FM0732.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. sox 16347
Louisville, KY 40256-0347 Manufacturers of .
SHIP TO: 3649 Cane Run Road
0
Louisville, KY 40211-1961 Qusiirr PirAWAS SacE /9179
(502) 778-2731.1(800) 928-PUMP
FAX (502) 774-3624
F � j
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Bur``f ' c (l' 's c , d �- c,►
yer ►_50/p,(ff r_5 O�C je t� 5, 5
Mailing Address Lj Ile -
Property Address
( � AJ I /
(Verification required from Planning Department for new construction)
City/State oe "7 !� t/ Wq
&i Parcel Identification Number _ ! .3 � � c`� .
LEGAL DESCRIPTION
Property Location '/4, '/,44, Sec. T N-R
S/41/ W, Town of
Subdivision Lot #
Certified Survey Map # 9 Volume . Page #
-2� � 3
Warranty Deed # 6 / c_� e" �' �� Volume Page #
Spec house EJ yes EJ no
SYSTEM MAINTENANCE
Lot lines identifiable 0 yes El no
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
IGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Off -ice.
All
c NATURE OF APPLICANT DATE
* * * * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.******
Include with this application- a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
Wisconsin Department of Industry,
Labor arvd Human Relations
,Safety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Permit Holder's Name: ❑ City ❑ Village Town of:
SOLDIERS OF JESUS CHR ST I -X
aacbx
CST BM Elev_: Insp. BM Elev.: BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/ L
WELL
BLDG.
ventto
Air Intake
ROAD
Septic
NA
Dosing
NA
Aeration
NA
Holding
PUMP/ SIPHON INFORMATION
Manufacturer Demand
Model Number GPM
TDH Lift Friction System --[TDH Ft
Loss H
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County:
ST, CROIX
Sanitary Permit No.:
State Plan o.:
Parcel Tax No.:
STATION
BS
HI
FS
ELEV.
Benchmark
Bldg. Sewer
St / Ht Inlet
St / Ht Outlet
Dt Inlet
Dt Bottom
Header/ Man.
Dist. Pipe
Bot. System
Final Grade
BED/TRENCH
Width
Length
No. Of Trenches
PIT
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS-_
SETBACK
SYSTEM TO
P 1 L
BLDG
WELL
LAKE /STREAM
LEACHING
manufacturer:
INFORMATION
CHAMBER
Type Of
Moe Num er:
System:
OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold
Distribution Pipe(s)
x Hole Size
x Hole Spacing
Vent To Air Intake
Length Dia_
length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth Of
xx Seeded / Sodded
xx Mulched
Bed / Trench Center
Bed / Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Cady.15.28.15W, SW, NE, County Road N
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
I;
r
wfsjcuwsm
N PAP rME"I OF
"'Cl
TMV LABOR AND
AN PtLArI0015 Safety and Buildings Division
MMON N EW% Bureau of Building Water System
SANITARY PERMIT APPLICATION 201 E . Wam-
sh i ngton Ave.
9 In accord with ILHR 83 05, Wis. Adm. Code P O. Box 7969
I I Madison, W1 53707-7969
0 Attach complete plans (to the county copy only) for the system, on paper not less
County...,-
than 8 112 x 11 inches in size.
0 See reverse side for instructions for completing this application
State �anitary Permit Number
"2�FeA/0
The information you provide may be used by other government agency programs
❑ Check it revision to previous application
[Privacy Law, s. 15-04 (1) (m)],
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name vp
PLoperty Loption 0-0000W
&A�/4 1/4's T N, R E (o
AJ
Property Owner's Mailing Addresp
Lot Number
Block Number
C, +..r.
ity, S t
Zip Cod
Phone Number
Subdivision Name or CSM Number
El Ct Nearest Road
11. TYPE BUILDING: (check one) ❑ State Owned
ub Iri c 0 1 or 2 Family Dwellin2 - No- of bedrooms
171 Village
Zerrw n OF ALL—_ 91
171. BUILDING USE: (If building type is public, check all that apply) Parcel Tax
1 F] Apartment/ Condo A
2 F] Assembly Hall 6 Ej Medical Facility/ Nursing Home 10 El Outdoor Recreation cflity
3 E] C mpground 7 0 Merchandise: Sales/ Repairs fining
�Church
4 / School 8 F1 Mobile Home Park 12 E] Service Station / Car Wash
5 E] Hotel / Motel 9 Ej Office/Factory 13 E] Other: specify
IV. TYPE OF RMIT: (Chet my one box on line A. Check box on line B, if applicable)
A) 1 ew 2. eplacement . F� Repair of an
I E:] Replacement of 4 ❑ Reconnection of 5
System System Tank Only Existing System Existing System
B) E] A Sanitary Permit was previously issued- Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
110 Seepage Bed 21 ❑ Mound 30 [-] Specify Type 41 E] Holding Tank
12 E] Seepage Trench 22 ❑ In -Ground Pressure 42 [] Pit ivy
13 n Seepage Pit 43 ault Privy
14 E] System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
'1. Gallons Per Day 2. Absorp. Area I Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) Elevation
Feet Feet
V11. TANK
Capacity
I
INFORMATION
in gallons
Total
Gallons
of
Tanks
Manufacturer's Name
Prefab
Concrete
Site
Con-
Steel
Fiber-
glass
plastic
Exper
App.
New
Existin
strutted
Tanks
Tanks
Septic Tank or Holding Tank
Ej
❑
❑
❑
�
❑
Lift Pump Tank /Siphon Chamber
El
El
El
F1
El
0
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name.- (Print)
Plumber's Signature.- (No Stamps)
P/MPRSW
Business Phone Number:
A'c 5,,,ti
Al
"Plumber's AcTdre!sv(Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
R Disapproved
Sa itary Permit Fee (includes Groundwater
Date rssued
Issuing Ag t Sig ture (No tam
Approved
F] Owner Given initial
Surcharge Fee)
Adverse Determination
C-P
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SHO-6398 (R. 05/94) DISTRIBUTION- original to) County. One copy To: Safety & Rtjildinijs Diva -,ion, Owner, Plumber
DESIGN COMPUTATIONS
log
STC - 106
t
PRIU INSTALLATION AGREEMENT
St. Croix County, Wisconsin
PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION
Property Owner(s): Reserved For Recording Data
45
)6k-f� 0 E'•o 0 �t
Mailing Address:
5-7
`7u,-7
)J 1/&
Location:
11 4. S T N, R E or W
City, Village, Township Of:
w A >
Parcel Tax Number:
Legal Description:
ytl
• F !� %Y
y
1. No plumbing will be installedin the privy.
2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or
holding tank exists, or a valid sanitary permit to install such a system has been issued.
3. A privy vault/ pit shall maintain minimum setbacks as specified in Table 1.
Table 1
Open Pit
Well
50 Ft
Building
25 Ft
Lake / Stream
Min. 75 Ft
Additional County Setbacks
Sealed Vault
25 Ft
25 Ft
Min. 7S Ft
d. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code.
5 Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and
other vermin. Doors should be self -closing and vault ventilators should terminate at least one foot above the roof.
6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall
comply the intent with ILHR 83.20, Wls. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes
and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code.
7 The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR
113, Wis. Adm. Code
8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the
register of deeds in a manner which allows its existence to be determined by reference to the property where the
privy is installed.
ranted Owner(s) Names)
-Alf
r� xl�
iwner s) Signature
Subscribed d swo n to befor on ate:
NO ary Pu V,s
l
M commission e "
o� Jf
'TV° �
NOTE: This document was drafted by the State Department of Industry, Labor and Human Relations.
Bureau of Building Water Systems.
kTH NI, 8f� DAHL R
NOTARY PLIEUC
-0 �- �,4,t � A et N-', C.."
• ... ---I . .
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Fv-oM 8u. I (A i'k5 �d
vaoC �P
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Q�rq�ho�P
ot C.4 o C. z 10
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wnOVAe�
Y0 Ck
c�.oo �
�a5� Cow.P`�S
D�a�h ate 1d
K e Y..\ S o h fe. q�
HOLDING TANK SERVICING CONTRACT
Contract Date
This contract is made between the
——-------------------------
Holding TAnk Owne"r(s) Name(s) ----_——and —
and I Pumpers Name ------------
9F
�-
:S 6*5u�5
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:)
1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement
required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of :5"'�
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and
to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or
drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the
pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper.
3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR
83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The
pumper further agrees to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
C. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local
governmental unit and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) (Print) Owners Signature(s) Subscribed and sworn to me on this date:
CV,
t Today's Date
/� . ,�,�,�,,r � ,fit � ,,..- 4e
Pumper's Name (Print) Pumper's Signature Of 14 SRO— W
101,10, Notary Public Signature
XMNM4 N. SORTEDAHL 11
NOTARY PUBUC
STATE OF WISCOISMIN
P-7 Y .,
Pumpers Registration Number C I S' piration
3
Drafted by 7E
47
Wisconsin Department of Industry, HOLDING TANK AGREEMENT Safety and Buildings Division
'Labor and Human Relations Bureau of Buildings and Water Systems
Document No. / Plan Identification No
Ag rm ent Date /,r a �, / ��
�
This agreement is made between the
governmental unit and holding tank
owner(s)
County or Local Governmerltal Unit Holding Tank Owner(s)
ceo! ' r vplefs or i6 e'5-f
We acknowledge that application is being made for the installation of (a) holding
tank(s) on the following property: (Provide legal land description)
r\ Y X 4 -77 VIJ /.
IIILC:YC 47'
A J/, 411, - 3 AJ -1
This space reserved for recording data
Return To
or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of prope n_tain nt of sewage.
Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm.
Code, or Ch. 145, Stats.
As an inducement to the County of to issue a sanitary permit for the above described property, we agree to do the following:
1 . Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fads to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59,
Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing
the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats,
2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by
the County and State- The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation,
maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis to read
and/or inspect the water meter.
3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the
holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank . The municipality shall notify the owner
of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within
thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of
a human health hazard, and the tax shall be collected as provided by law.
4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have
the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality. The owner further agrees to file a copy
of any changes to the service contract, or a copy of a new service contract, with the municipality within ten (10) business days from the date of
change to the service contract.
5_ The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a
report in accordance with s. ILHR 83.18 (4) (a) 2., Wis, Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3)
(d), Stats., the owner shall submit the report to the municipality_ The municipality may enter upon the property to investigate the condition of the
holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained.
6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the
property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the
existence of the certification to be determined by reference to the property.
7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the
register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be
determined by reference to the property where the holding tank is installed -...
OVner(s) Name(s) - Print
The information you provide mdy be used by other government agency programs (Privacy Law, s 15.04 (1)(m)]
cnn cI I7 10 nnKIn
St. Croix Count Planning and Zoning
y
Detail Sanitary Information
I
AfaudaY, Ju�y 16,2007 at 9:03:33.+11
Pa-roe1 of I
Computer #:
004-1034-30-000 Sub/Plat: 40 acres Section:
15
Parcel #:
15.28.15.229 Lot: 1 TN/RNG:
T28N R15W
Municipality:
Cady, Town of CSM: Vol. 20 Pg. 5020 1/4 1/4:
SW 1/4 NE 1/4
Owner:
Soldiers of Jesus Christ 3073 County Road N Wilson, WI 54027
State Permit:
259440 Issued: 12/26/1995 POWTS Dispersal: Holding Tank
Permit: New
County Permit:
0 Installed: 12/26/1995 POWTS Detail: Privy - Vault
Bedrooms: 0
W1 Fund:
POWTS Pretreatment: NA
N, 0 t C." S
Issuer/Inspector As Built Plumber Other Requirements
Additional Notes Money
Owed
Not determined Yes Sortedahl, Ken
Jim issued a vault/privy permit and had owners
$0.00
Jim Thompson No
complete a temporary holding tank agreement until
a system can be designed for this
dorm itory/house. Will file permit with mound
permit issued in 1999 - owner never completed
septic system and in 2005 is again having a new
tank installed with plans to have a mound system -
someday
No inspection report filled out. NO signature by
county on Holding Tank Agreement nor
documentation that it was recorded aqainst deed -
parcel now own .by Eoltz-.
installed
d by Pastor
stor
-12TI-9/95 an illegal non -system installed by Pastor
So rtedahl with 20' x 8' tank connected to dranage
r te d a ' to d ranage
Cbottoms
pipe and plastic 50-gallon drums with tops and
s 04 P r
bottoms removed and filled with 1 rock
Sortedahl's as -built.
S ort a
Owner:
Soldiers of Jesus Christ 3073 County Road N Wilson, WI 54027
State Permit:
344513 Issued: 06/22/1999 POWTS Dispersal: Mound
Permit: New
County Permit:
0 Installed: 11/10/1999 POWTS Detail: NA
Bedrooms: 5
WI Fund: No
POWTS Pretreatment: NA
N -,)Ue s
Issuer/inspector As Built Plumber Other Requirements
Additional Notes Money
0 ed
Not determined >4/1/00 - Not Required Stang, Joe
Penial Christian Home - 4 BR building/dormitory
$0.
Kevin Grabau Sinned 'Off: Yes
with employees and floordrain calculated on state
approved plan - 750 gpd DWF
Midwest 1650 septic tank to 1650 gal. Dose
chamber to mound 8'x 79' cell
Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification
11/10/2002 12/6/2005
12/6/2008
Parcel #: 004-1034-30-000
07/16/2007 08-52 AM
PAGE 1 OF 1
Alt. Parcel #: 15-28-15.229 004 - TOWN OF CADY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Owner(s): 0 = Current Owner, C = Current Co -Owner
0 - HOLTZ, MICHAEL W & BONNIE J
MICHAEL W & BONNIE J HOLTZ
3050 CTY RD N
WILSON WI 54027
Districts: SC = School SP = Special
Property Address(es): Primary
Type Dist # Description
3050 CTY RD N
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
-41 301-3
Legal Description: Acres:
40.000
Plat: N/A -NOT AVAILABLE
SEC 15 T28N R1 5W 40A SW NE EZ-U-1 181/523
BlocklCondo Bldg:
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
15-28N-1 5W
Notes:
Parcel History:
Date Doc # Vol/Page
Type
11/29/2001 663586 1776/297
WD
07/23/1997 1179/393
WD
07/23/1997 1135/179
LC
07/23/1997 945/259
2007 SUMMARY
Bill #:
Fair Market Value: Assessed with:
Use Value Assessment
Valuations:
4
Last Changed: 04/09/2007
Description
Class
Acres
,n Improve
Land Improve
Total State Reason
RESIDENTIAL
G1
1.000
'0 86, 000
14,000 86,000
100,000 NO
AGRICULTURAL
G4
38.000
�0 0
4,400 0
4,400 NO
UNDEVELOPED
G5
1.000
00 0
100 0
100 NO
I
Vk
1�15
Totals for 2007:
General
Property
40.000
18,500 86,000
104,500
Woodland
0.000
0
0
Totals for 2006:
General
Property
40.000
18,300 86,000
104,300
Woodland
0.000
0
0
Lottery Credit:
Claim Count:
0
Certification Date: 04/17/2001
Batch #: PRGRM
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
/
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-- - ----------------------
£6T •
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- I 9£
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Parcel #: 004-1035-10-200
07/ 16/2007 09:19 AM
PAGE 1 OF 1
Alt. Parcel #: 15.28.15.234D 004 - TOWN OF CADY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
01/23/2006 00 0
Tax Address:
Owner(s): O = Current Owner, C = Current Co -Owner
MICHAEL &BONNIE HOLTZ
O - HOLTZ, MICHAEL &BONNIE
3050 CTY RD N
WILSON WI 54027
Districts: SC = School SP = Special
Property Address(es): * = Primary
Type Dist # Description
* 3050 CTY RD N
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
5.121
Plat: NIA -NOT AVAILABLE
SEC 15 T28N R15W PT NE NW & SE NW BEING
Block/Condo Bldg: LOT 01
LT 1 CSM 11/3092 5.00AC EZ-U-1181/525
NKA CSM 20-5020 LOT 01
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
15-28N-15W
Notes:
Parcel History:
Date Doc # Vol/Page
Type
07/13/2005 800214 20/5020
CSM
04/03/2003 715832 2194/139
WD
01 /30/2001 637673 1580/592
WD
07/23/1997 1175/570
WD
2007 SUMMARY
Bill #:
Fair Market Value:
Assessed with:
0
Valuations:
Last Changed: 04/17/2006
Description
Class
Acres
Land
Improve
Total State Reason
RESIDENTIAL
G1
2.000
28,000
1711100
199,100 NO
UNDEVELOPED
G5
3.121
2,000
0
2,000 NO
Totals for 2007:
General
Property
5.121
30,000
171,100
201,100
Woodland
0.000
0
0
Totals for 2006:
General
Property
5.121
30,000
171,100
201,100
Woodland
0.000
0
0
Lottery Credit:
Claim Count:
1
Certification Date:
Batch #:
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
VC.1
?97
STATE BAR OF WISCONSIN FORM I - 1999
Document Number WARRANTY DEED
This Deed, made between Soldiers_ of Jesus Christ, Inc. bv Its
President, Kenneth N. Sortedahl.- Grantor, and Michael W. Holtz and
Bonnie J. Holtz, as survivorship ma;J*wt-proWrty Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(the "Property") (if more space is needed, please attach addendum):
The Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4),
Section 15, Township 2,8 North, Range 15 West except that part lying
North of County Trunk "N", Town of Cady.
Kenneth N. Sortedahl joins in the execution of this deed for the sole
purpose of conveying any interest he may have in the property, and more
specifically any Interest by virtue or the Land Contract dated April 1,
1994 and recorded August 14, 1995 In Volume 1181 on Page 523, being
Document No. 532461.
Together with all appurtenant rights, title and interests.
Together
with all a, interests.
good, . co,
Gran arrants that the title to the Property is good, feasible in
subject to all easeme ,ry r
§trictions and rights -of -we record.
Dated this 7 t day of September , 2001.
ALMEENTIC ATION
Sienaturc(s)
authenticated this day of
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Kenneth N. Sortedahl 11
Spring_Valley, Wiscon-sin 54767
(Signatures may be authenticatcd or acknowledged. Both are not necessary.)
4E& 4ESm, :23t!!:-5 434EEw
1< F'I 'T H-; E' E N H . LJ A L S H
REGISTER OF DEEDS
CROIX Co. WI
RECEIVED FOR RECORD
. . 41-29-2001 2:30 PM
WARRPHTY DEED
:TXEIPT #
H-RT C0f1Y FEE:
COT,Y FEE:
TRANSFER FEE: 390-00
REr'ORDIHG FEE: 11.00
PAGES: I
Recording Area
Name and Return Addiess
Red Cedar Bank
P.O. Box 100
Boyeeville, W1 54725
' _�� ���.
004-19a4�-Q-
,��
Parcel Identification Numbe (PIN)
This Is no homestead p perty
(is) (is not)
e simple and free clear of encumbrances except
Soldiers of Jesus Christ, loc. by its President,
ACKNOWLEDGMENT
STATE OF WISCONSIN - )
) ss.
DUNK County
Personally came before me this day of
September 2001 the above named
Kenneth N. Sortedahl
to me known to be the peKWn(e),u410 executed the foregoing
instrument and ackn!$�t %% Wef ripe
C4
11 HABER
Notary Public, State Pate ni 1A
My Commission i,
Names of persons signing in any capacity must be typed or printed below their signature, information Professionals Co., Fond du Lac, W1
STATE BAR OF WISCONSIN 800-655-2021
WARRANTY DEED FORM No. I - 1999