Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1024-30-000
St. Croix County Planning and Zoning Friday, May 04, 200' at 11:40:09 AM Detail Sanitary Information Page 1 of 1 Computer #: 004 - 1024 -30 -000 Sub /Plat: NA Section: 11 Parcel #: 11.28.15.164B Lot: TN /RNG: T28N R15W Municipality: Cady, Town of CSM: 114 114: NW 1/4 NE 1/4 Owner: Danielson, Beverly 3169 50th Avenue Knapp, WI 54749 State Permit: 353296 Issued: 01/21/2000 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 04/14/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: Yes POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined Yes Hubbell, Darrell received as -built 4/3/01 $0.00 Kevin Grabau Sic€ e C eft Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 4/14/2003 4/18/2005 04/01/2005 4/18/2008 St. Croix County Planning and Zoning Thursday, December 20, 2007 at 9: 46: fJ2 AM Detail Sanitary Information Page /ref I Computer #: 004 - 1024 -30 -000 SublPlat: metes & bounds Section: 11 Parcel #: 11.28.15.164B Lot: TN /RNG: T28N R15W Municipality: Cady, Town of CSM: 1/4 114: NW 1/4 NE 1/4 Owner: Danielson, Beverly 3169 50th Avenue Knapp, W 1 54749 State Permit: 353296 Issued: 01/21/2000 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement County Permit: 0 Installed: 04/14/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: Yes POWTS Pretreatment: NA Issuer;'In As Built Plumber Otte?. Requirements Additional Notes Money Ow Kevin Grabau Yes Hubbell, Darrell received as -built 4/3/01 - see red WI Fund file - $0.00 Kevin Grabau Signed Yes WI Fund grant $3822 for 1000/650 combo tank to 8'x 47' mound Scheduled Purn Date Pump Notification .._..._ _.. 4/14/2003 4/18/2005 04/01/2005 4/18/2008 Owner: Litzel, David 3169 50th Avenue Knapp, WI 54749 State Permit: 16606 Issued: 04/28/1971 POWTS Dispersal: Non - Pressurized In- ground Permit: New County Permit: 0 Installed: 05/04/1971 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA IssueOn spector As Built Plumber Other R equirements Additional Note Money Owed Harold Barber No Boldt, Everett 1200 gal. septic tank to 2' x 100' seepage bed per $0.00 Not determined S c ne d No application. No inspection reports for these permits filed with replacement permit ST. CROIX COU11T'1'Y ZONING DEPARTMENT AS BUH.T SANITARY REPORT ' owner 6 e veer- / ,D h t *e,-S6h DECEI p Property Address 6 ef '.Qb 7`h v r city/State KH 4 e w i S - g 744 sr cr o 16 01 C w �►ary Legal Description: , � ' °F R C Lot — Block ; Subdivision/CSM # " _i ,w%, �kL-'/4, Sec. ,(I . TAN RAW, Town of C PIN # SEEM TANK — DOSE CHAMBER — HQLDIIYG TANK INFORMATION P c Tank mam&cturer A1,'JuetAW" Size ST/P0000 Gsv Setback fiom: House qO Well s ' P/L 100 t PUMP 1 G o0Ld I Model 3 rr? r L:'Pol -I Alarm location h *+ecs.a.+ t, ronrh 13b5 e rw*1r or- ycjvt� (HOLDING TANKS ONLY) - Setbacks: Service road Vent to fresh air intake Waxer Line Meter location Alarm location SOM ABSORPTION &YMM Type of system: M 0 V nd Width G Length G 8 Number of Trenches l Setback from: House 16o' Well 17S' P2 I o' Vent to fresh air intake I GS' E y+ A ,� NS Description of benchmark 5P.' ke • h /to by Elevation 10 Description of alternate benchmark ToP o t= w-e c Elevation 10 Building Sewer swn Inlet - O L ST ,Outlet — PC Inlet PC Bottom , Header/Manifold Top of ST/PC Manhole Cover 9 0 • R ad!`4 ,y Fly Distrifttion Lines () ��� 7 () �l � � () k ARe c Gv► Bottom of System Final Grade O G • O ( ) Date of installation S/ -2 /eU Permit number 3 3 6 State plan number Plumber's signature -Donw w� License number 02 3 Date 3 /1 2 / -01 Inspector V ew CWV,ft plot pta • I 40 ari M 2 ScC t e �S x c eAt w h t rt +t 3 fl � a Q p aC Well aM A+ w t�;S�;nt r'AnKt to b� Rc►rh•rcd ' w' G� ��, 1dhK Wp �► P S Sir &A ON, 0+ r r16 Z d " i3 vro v sa, of U r��d�d AREA 0 q� b' S ysre w, t q4.3 G RC4 Page 7 08 7 w "n Department'of Commerce PRIVATE SEWAGE SYSTEM y: alld Buildings Division Count INSPECTION REPORT St. Croix #;ENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353296 Permit Holder's Name: ❑ City []Village ❑ Town of: State Plan ID No.: Danielson Beverl Cady Township ag 3 CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: /V-a (,' 6 004- 1024 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic gAA V gpa ( Benchmark 3 • *0 j ofl, -D Dosing Alt. BM -ter DT 99, /p Aeration Bldg. Sewer Q S Holding St /Ht Inlet /aa,y' (`p,32 I3, oB TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake A . Septic %> CD � (' NA Dt ti gS '0 13 S 39 . Dosing IL ' NA Header/ Man. 9 Aeration NA Dist. Pipe Ks 94 Holding Bot. Syste PUMP/ SIPHON INFORMATION Final Grade Manufacturer 61 Demand St cover D U Model Number �i'p �{ � '� GPM (� yA TDH Lift 4.1, Friction, 4I Systems TDHq,D6 Ft Read oss Forcemain Length 33 Dia. - 7 Dist. To Well yy ' SOIL ABSORPTION SYSTEM .f•. z I BE / Width Q i Length . t / f T PIT No. Of Pits Inside Dia. Liquid Depth WIM [! DIMEN SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manu acturer: INFORMATION Type of CHAMBER r Moe Number: System: 3 r w IO D - _ OR UNIT DISTRIBUTION SYSTEM Ila Header / M �i old Z u Distribution Pipe x Ho Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. (' 2� 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/Tr nch Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes , E I N o COMMENTS: (Include code discrepancies, persons present, etc.) Ins - ection #1: 4 / 13 / Inspection #2: Y / Location: 3169 50th Avenue, Knapp, V1 54579 (NW 1/4 NE 1/4 11 T28N R15W) - 11.28.15.164B 1.) Alt BM Description = des -I ` 2.) Bldg sewer length = � ('' 4 g - amount of cove= 3. ) conto ` 6 . ems. R - /f /� - ,7) t5 ,,,J Y r A - , 6, a4 1 T " cnre rock, bR eQ vwttcy , Go / U °`'''LJ .!(- Plan revision required? ❑ Yes (( No r 5 •2 6 Use other side for additional information. SBD -6710 (A.3/97) Date Inspectors Signature Cert. No. SANITARY PERMIT APP Safety and Builgt Division 11 � 201 W. Washington Avenue 19 P O Box 7302 Department of Commerce In accord with Comm 83.05, (► a `, ! Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst pap L• unt} ��r than 8 v2 x 11 inches in size. - ,.,�♦,' � � . lGo i � • See reverse side for instructions for completing this a lic i , P 1`1 / re �, State -S itary Permit Number p 9 pp 9 353�q(Q Personal information you provide may be used for secondary purposes 1 ST CrRcq ❑Cheek if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �'`. COUNT � ate an I.D. Number 1 ZOAt1NGCc � SZ I. APPLICATION INFORMATION - PLEASE PRINT ALL I ATIOI� Proper Owner Name a i$� rJC(/G / 0A r eLS G6! 1 4 t C e T a g , N, R d,S (or W Property Owner's Mailing Address t Number Block Number I � S'o r/, /-� v Z -3/ — City, St4 I Zip Code Phorte Number Subdivision Name or CSM Number . TY E B ILDI G: (check one) ❑ State Owned ❑ it n �, Nearest Ro T ° v Public 1 or 2 Family Dwelling - No. of bedrooms 3 Tow o ��, OF SD �I 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 0 1 4 -;Jo w �' 6 -*4 2. ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Rec ational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. pq Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [MMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , / ► 42 ❑ Pit Privy 13 ❑ Seepage Pit )C 'C 5��1 43 ❑ Vault Privy 14 ❑ System -ln -Fill 3.3 0 V ABSORP SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade / Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q Elevation "1 .SD 1 3 TS 37{ �' — 1 �r 3 d Feet g�� 7 Feet Ca acit VII. TANK in allons Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete C on - Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 1000 100 r I "qi Uwesrek ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 6.5-0 ( 19 1 ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI ber's Signature: (No Of C Stamps) MP /MPRSW No.: Business Phone Number: e I p/ RR l� 11 I�I vi3t�� ���� � / I.1` w P,;z i�a ( o2 ) Plumber's Address (Street, City, State, Zip Code): A/ 7 9 a v f h 5J-- IR I 'vely FQ c r s w r IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) t 1,1 A pp roved ❑ Owner Given Initial < Surcharge Fee) - Adverse Determination o2$� cv – 2l` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �o _Q — _ c_ /I /� SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 4' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new 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.ovvn,6�Np-,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 when "ever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Nvisconsin ,nww commerce.state wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary January 04, 2000 CUST ID No.221073 ATTIC• POWTS INSPECTOR ZONING OFFICE DARRELL K HUBBELL ST CROIX COUNTY SPIA N6490 USH 63 ST 1101 CARMICHAEL RD BELDENVILLE WI 54003 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 01/04/2002 Identification Numbers Transaction ID No. 287152 Site ID No. 185545 SITE: Please refer to both identification numbers, Site ID: 185545 above, in all correspondence with the agency. St. Croix County, Town of Cady NW1 /4, NE1 /4, S11, T28N, R15W Facility: Beverly Danielson Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 642326 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. 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. e Sincerely, DATE RECEIVED 12/27/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 MOUND SYSTEM DESIGN Residential Application � A INDEX AND TITLE SHEET Project BEVERLY DANIELSON Owner BEVERLY DANIELSON y� Address 3169 50 TH AVE -- s KNAPP WI 54749 715 - 722 -3145 Legal Description NW 1/4 NE 1/4 S l l T28 N. R15 W F•_0 , 1f�d.T. S Township CADY County ST CROIX Conditionally Subdivision Name Lot No. AJ NT OF COMMERCE DE FE y p Sk1tLDING� Parcel ID Number OlVlsi F Plan Transaction Number SE CORRE P NDENCE Index and title sheet Pagel Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump curve chart Page 6 Plot Plan Page 7 Designer DARRELL HU License Number 221073 Signature J w - v , � — V vae e Phone No. 1- 715 -425 -6517 Date 11/9/99 Notice: 1'ampering will) this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinaty action under s. 145.10, Wis. 5tats. Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1 )(m)]. SBD- 10462 -E (R.05l98) Pagel of 7 MOUND SYSTEM DESIGN C.:omplete red bones as necessary. li'(? l,,i ?I:1 ilt;i ai'+'LIr'i; iatj ?ill +I'I tlii +i Inch - pounds Metric Residential or commercial? R (r or c) (y or n) Y Replacement system? Creviced bedrock site? N�,(y or n) Slope 5� -„ ;% Wastewater flow rate p 4 gpd 1703 Lpd Depth to limiting factor 26 in 66.0 cm In situ soil infiltration rate 0.5 gpd /ft' 20.4 Lpd /m' Contour line elevation 93.3 ft 28.44 m Use standard fill depths? x OR Design depth? � din cm Place X in box te. use i;l;mdald dEJ h 'd aWt1 A -4 4 mclusf' f t ?R sipeaify design fill depOl Center or end manifold C (c or e) Hole diameter �0 25 in Lateral spacing F __-_ o 0 ft i-isp t'I lateral spacing for trenches. Estimated hole space 3.50 ft t•lot a fnri �:a: ::u'''Oictt. Number of laterals 4 Pump tank elevation 87 ft teat de t att tt t a +• "3ak. Forcemain length 120 ft Forcemain diameter 2.0 in I > � t n ::I 2%067 in Actual LD fil.)Lf= DIAMETER ccar+lt,;rr�sla�rl4 118 = 0.125 114 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5132 = 0.156 9132 = 0.281 Estimated daily flow 450 Igpd 1703 JLpd 3/16 = 0.188 5/16 = 0.313 7132 = 0.219 Absorption cell Design load rate & area 1.2 ] gpdW 375.0 ft` 34.84 m' Linear loading rate (LLR) 9.57 gpd /ft 118.7 Lpd /m Design width (A) 8. ft 2.44 m Cell length (B) 47.0 Ift 14.33 m Depth of cell (F) lin 23.6 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 16.8 in 427 cm Basal area required (gpd /infiltration rate) 900.0 ft` 83.61 m' Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.43 ft 3.18 m Up slope toe length (J) 7.20 ft 2.19 m Down slope toe length (1) 11.20 ft 3.41 m Total mound length (L) 67.86 ft 20.68 rrn Total mound width (W) 26.40 ft 8.05 In Project: BEVERLY DANIELSON Transaction Number: Page 2 of 7 4 MOUND PLAN VIEW observation pipes (typical) J - 26.4 ft A A = 8.00 ft 2.44 m 8.05 m t:: <:o: ":•;: >. B = 47.0 ft 14.33 m W ---- B J- 7.20 ft 2.19 m 1 K I= 11.20 ft 3.41m K F1 0.43ft -3.18 m _ 67.86 ft L 20.68 m typ, obs. pipe (anchored securely) I = down slope dimension C' = absorption cell (AxB) J = up slope dimension C = plowed area (LxW) K = end slope dimension 6" (152 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm lateral topsoil H subsoil cap E = 16.8 in 42.7 cm invert 94.80 ft - -- -- ' F = 9.3 in 23.6 cm 28.90 m - - - -- G = 12.0 in 30.5 cm elev. - - --- -- ASTM C33 H = 18.0 in 45.? cm D Sand Fill y Sys. F 94.30 ft elev. 28.74 m 93.30 ft contour 28.44 m elev. 5 % ---� slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absmpticin cell rne: -diva '0011 rar .ira F = absorption cell depth (,r agAregate .;n(I pipe kvilh iate als G = subsoil + topsoil depth at cell wall centered across A >B wedia. The coil H = subsoil + topsoil depth at cell center media is .:o °.er+ d with geotext;le rabf;::. Designer notes: The upslope of the mound to be graded to prevent pondin of surfa water SEPTI TAN _ ,1 __ 0 _ 0 6/ PRECAST - 2 b 3 8 3. The a P C omm 3 area '25 ft below the soil asor sys tem to be undiGturbe.d -_.-r _.�)�_)____� _.__. _ Perm markers to be installed at end of each lateral needed _ Obse pipes as shown on drawing 2 needed _ BENCH MARKS ARE, #1 SPIKE IN POWER POLE 10 INC A BOVE GROUND EL 100.0 # TOP OF WELL CAP EL 100.0 EXISTING TANKS TO BE REMOVED AS PER CODE DESIGNER EXCAVATED BORINGS AND ESTABLISHED CONTO LOCATION AND ELEVATION AT TH Project: BEVERLY DANIELSON Transaction Number: Page 3 of 7 ` .�..' . . . . , PRESSURE DISTRIBUTION CALCULATIONS ' Absorption cell | M etric Width KQ 8 ft m Length (E) 47,0 ft i_�4��1 |n« Lateral specifications Number laterals Holes/lateral 6 holes Lateral length (P) ft m ' Hole diameter 0.250 in 6.35 nonn LoL dis rate 6.99 nn Lis Sys. dis rate gprn Us Hole spacing (>() 48 in Lateral diameter Pipe diameter Des. ' ^ Designer must F`iucoXirra� 'X" one choic;e box - If ohoseo from the options dipnoek�, provided. Manifold diameter Pipe diameter De o Designer must ` 'X" one choice Place Xio/od from the options box of chosen provided. d�;meter Diutr|hu|ion system oon1uonm� 4 Lateral(s) LATERAL ��K�d����K� ~ ������77���� ����������o�7FU���� "�"�"�~"���~~ ��v��==o���uno ~~u~o�o�~o� ~=~="="�=~��",~�"" P|aoe correct /atem!diagre/nhyc|i('*ing III one right and draggmq t|n'��/aUram|n1o|h|smee Latwalg are idontir-;1 typical LASI hVilp drill�rl Flew to p(ld u�p 4 Inch -pounds Metric Lateral length (F) 22.00 fl 6.71 m Lateral spacing (B) 4.00 ft 1.22 nn Hole spacing (X) 48 in 121.9 onn Manifold length 4.00 It 1,22 nn Hole diameter 0.250 in 6.4 mm Lmhmnai diameter in 32 Imm Fmncennain diameter 2.0 in 50 mm Project: BEVERLYOAN(ELS(}N Transaction Number: Page 4of 7 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 6.90 ft 2.10 m Are laterals the highest point in the Friction loss 1.63 ft 0.50 m system? Yes "X" here. Total dynamic head FE t 3.36 m if no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 6.8 gal 25.7 L back to tank? ( "x" one) Minimum dose 112.5 gal 425.9 L Yes Drain back 20.9 gal 79.1 L No Dose volume Jigal 505.0 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with 7►� weather proof warning label and locking device disconnect grade Levels junction box ��' grade levels y alternate 4" vent pipe electric as per NEC 300 and E-- outlet Comm 16.28 WAC location 18" (46 cm) min. wall of pump approved I chamber or outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 87.9 ft C pump tank manhole = 4" (10 cm) off efev. 26.8 m minimum above finished grade D vent = 12" (30.5 cm) minimum above finished grade 87.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 26.5 m bottom of tank Tank manufacturer MIDWESTERN PRECAST INC Pump tank capacity 17 gal /in Pump tank volume 650 gal 7 Pump manufacturer JGoulds Inches Gallons Pump model number 13871 EPO4 c A 20.4 346.6 B 2 34.0 Alarm manufacturer ITANKMATE C 7.8 133.4 Alarm model number [SEP TM1 o D 8 136.0 Project: BEVERLY DANIELSON Transaction Number: Page 5 of 7 MODEL 3871 Su bmersible Effluent Pump «L: saw F130 ' m S rs a � ° � �• so � a ns o s i i n i2 •!M alscrrr p.,. Pitt V Spat M f'NBlim fl W Bettef 'h and % NP EPO4 impeller: semi -open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Obeharge size i'y NPT •EP05 impeller enclose performance. design Sol � Solids- 3 9 maximum improved + Rugged glass -filled thermoplastic A motors feature ball Ong and base design provides bearing construction. wpenorstrength and corrosion • Single phase: 115V reststanoe. - fiAble<Itb Of Con�tloe •Cast iron motor housing for Cast iron and heat transfer, strength, Thermoplastic and durab&y. • Corrosion resistant threaded Stainless sleet - stainless steel shaft +Available for automatic and manual operation. �) •CSA listed models available. AN Models are dewgned for operation arm feature star bw step! haakvare . L4ld 7 J Q ZZ — a G 'A' X0 ✓ Ot, 0 JSJAJ t3r od U, 0 0 0-5 Wisconsin Department of Industry SOIL AND SITE E V A L UA TJONA t F 0 R T Page—Ldf Labor and Human Relations Division of Safety & auild,ngs in accord with 1LHR 83.05,r� ;-Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizes: PL&n m St mcl6dy '*Pt79 PARCEL I x not limited to vertical and horizontal relerence point (BM), direction and �o=W sb *e le or i dimensioned, nosh arrow, and location and distance to nearest road r F R IE + ED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMAT1�N Cp -Z( PFl4PER }�N PROPERTY OWNER: 4 y N �"jI �• y3/4,S 1 � T 2 N,R 16 >0 W BC- 09 ADDRESS PERTY OWIVER':S MAIL LO PRO 9tK r t S, NAME OR CSM r i4V AIL 31b 5C}r` NEAREST ROAD CITY, STATE tIP CODE PHONE NUMBER QCITY []viLUGE 7W OWN 50r, SUE L 541 7y (715) CA New Construction Use (� Residential 1 Number of bedrooms () Addition to existing building Replacement (I Public a commeraal de scribe Recommended design loading rate bed. gpdm2 trench, gpdtft Code derived daily flow � gf� bed, gPdrff2 trench, gp(yff Absorption area required - 3 - 1:5 bed, 11 -? S trench, tt Maximum design ft (a referred to site plan benchmark) .g rate �_ Recommended infiltration surtace elevations) _ 9'1 2 tt ( Additional design 1 site considerations Flood plain elevation, it applicable NA ft Parent matesia! U IN-GROUND PRESSURE AT-GRADE SYSTFI+1 W Flll HOLDING TANK LU = Suitable system CONVENTIONAL U [] S �Z1 U ❑ S �3 U ❑ S ,� U • Unsu'slors stem (] S ICI U S U S DESCRIPTION REPORT Structure Roots GPD /tt Depth Dominant Color Mottles Texture Consistence Bed Trelrtdl Boring # Horizon in Mansell Qu. Sz: Cont. Color Gr. Sz. .; 3 Z 5 t ) ( 2 m�,b 4 I r mS C5 Ground 3 ?2 -Z` 10 3 elev. I s wob Q15 O,Z. 0 i1 q�`t5 ft. 9 Depth to limiting tact r rr Remarks U k� M rJ s : zo+.l I s - D.S o.l. Boring M I -- 2 .� s rn� Z-' Z -t3 10\1 13 b ivoa i`:y Ground I rhsb Mir O, Z- 10Z elev. y 2t -2 10NK -3 qtt. 0,2- q,3 2 -3 10 1 4 7.5Y 4 Depth to limiting b t -33 t o Y K tact Remarks: phone: ( Nome: —Please Print 01I i 1Z6 -11 ? S toss: CST Number: W g15 tog0't` E. Rau FA r c 5 -Date J , '()EC.Ob to19Q .r PROPEITNOWNER �� SOIL DESCRIPTION REPORT Page z- of PARCEL ).D. 8 Depth Dominant Color Mottles Texture Structure Consistence �Y Rood GPD /tt Boring # Horizon in Munseli Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trerxtt 3 > ? I O-lo si 1 Z rn �. C5 a• O.b to « s Z b_t 3 to ' -- �r Z ms M - Er C 5 0.5 Qb Ground 3 13 -21 �� R 5 ►l 2 w S'b rn�r CS O.S to elev. quit. `t 21 -31 10v — 2csb m(r Depth to S ak 1(nm a- 1, 5 +�'-+ ;% C, m m � 0-2- limiting fac tor. c Remarks: , DAIUA 4 was x z CO Boring # Ground elev. it. Depth to limiting factor I A- Remarks: Boring # �1 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: SBO.8330(R.05 /92) ` Page 3 of 3 PLOT PLAN Property Owner CAA)MU3 B� nr5zl- iLegend : yO/EXCEPr Ef Legal Description k PA RCEL lsxh - mD /gM = ®#! -SPIKE INE�RIC POLE M� /0 f/ GO-O"D S u , Z FACE - T.+a Twe +JW`I4 OF THE �y� �Iw, S - . EC. 11, TB'n), /� � Top op WELL C AS W& \ ,,J , TovJA3 oFCADV ST.c.. MCO. WS Do No DIs7uP-8 1 [] = soil boring w /backhoe / (o ACRE fi PPKOK• ZO() - M 50 AA- /Jo COMM %3 5ET'6AtK PRua/r.s 131A Lztu- a 0 w (� ���ZsefTC 3 SL c1 X � p ,h Q � Q�.�. a NE s��e wc,�l ion • ;� FFAXE LANE.- Sp PK.O PQel y uNE T ro+Y.g4T So zrr Aye U . Signed CST DQLI 111j .410 3'707 Date ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND Q�� A yW— (6z- C&X1 OWNERSHIP CERTIFICATION FORM Owner/Buyer 17F7t/&�C L y Mailing Address 3/ 41 5 - i,- Property Address ' (Verification required from Planning Department for new construction) / City/State �i h f _ t� 5Y f g Parcel Identification Number Fb4 —1 - 3 � ll• LEGAL DESCRIPTION Property Location fiW %4, PE %4, Sec. 1 r , T N -R L�::W, Town of CAA Subdivision 9 Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 3t4' 916 , Volume 5 Page # SD 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 mastorplumber, journeyman plumber, restrictedplumber 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 dar,ofi the three year a iration date. r / /C F 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 ;erty described a above, by virtue of a warranty deed recorded in Register of Deeds Office. l2lvl 0,Q NA 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 ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 'j5X L A rW ( S &A/ Mailing Address 3/61 5 - t ,• Property Address (Verification required from Planning Department for new construction) City/State &APP c'-c ✓' '��f R Parcel Identification Number Q' 4 —1 - 02 4 32 — M LEGAL DESCRIPTION property Location 1A( % ME - - V4, Sec. 1 / , T D N -R Town of Subdivision 9 Lot # Certified Survey Map # Volume _ . Page # Warranty Deed # 3lSS�� . Volume Page # �0 Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM 1VI — HW v"' - Improper use a Q.. e� n could result in its premature failure to handle wastes. Proper maintenance consists of pumping our N - sooner, if needed by a licensed pumper. What you put into the system can affect the function o 41 8 (_ _ � e in the waste disposal system. w U v ,�'' The property ow: � � / r oning Department a certification form, signed by the owner and by a masterplumber, joumeynu f �(��_ ucensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condi N ..,sptction and pumping (if necessary), the septic tank is less than 113 full of sludge. Ilwe, 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. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE *** *** A Formation that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" ** Include with this applicatlon: 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 I� a DOCUMtNT NO. I � rw- /— WAIIRAXW DMW (!1'f fail OVATE OF W18CM01N sse —Fo t 418876 WIS OPACa ttaaaRwo roe 0111sIOAYUS. IIIATA i THIS MWENCfJRE, Made this..._.._.._..... dal of......... .......... A. D. 19.7 .., j REGISTERS OFFICE i � between ,_. David B .__ Litzell and Barbara J. Litzell husband_, ST. CROIX CO., Wis. .. ._......_ ...................... _.._ d- is a7`kra�David, Litsall and Barbara L . _......... - •---_......_.._.........._ ......................_....-----...._......_.._.............._..... ._..........:.:.._.._.._....... art..�r.4.0... of the first part, and dSy -° O -- A.D.19?3 James E. Danielson and Bova ly E. _Danielson,_ _ _ (l w- ►Qi49 —,_ M. _ ........... .... ••• .......... ..._......_......_......_...... Dan .......... . .... ........... - .._.._.....his aifa� _ ...._......._......_ .................._...... ......_.._.._.........._....... ....._.........._ .................................._...._._......---....._........_......_........_ ...._.................._....... it ... ...._.. ....... _ ...... ... ........... ................. _.._... ........:._...part.....,...... of the second part, Witnessetb, That the said art... iea.. of the first psrt, for'and in consideration of the sum of.. One _ . Dol_ • ar_ _ and - other_�oo__ „an..._valuable con - RETURN To sideration ----------------------------------------- to...them •,__. in hand paid bq the said part..__._._._. of *' h he second part, the receipt . whereof is hereby confessed and acknowledged, ha ... 31e.. given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do .... ..... give, grant, bargain, sell, remise, release, alien, convey, and confirm unto the said part._._-.__.. of the second part ............................ _............. heirs and assigns forever, the following described real estate, situated in the County . y _ . and State of Wisconsin, to -wit: The East 600 feet of the North 490 feet of the Northwest Quarter (NW'k) of the Northeast Quarter (NEk) in Section 11, Township 28, Range 15, St. Croix County, Wisconsin. TRANSFER FEE (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part.!) S... of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto the said part ... _....... of the second part, and to ... _ .............................. heirs and assigns FOREVER. And the said ........David B,__Litzell.and a ... g.) _...__._. ......................................... a /k /a David Litzell and Barbara Litzell •-•-- . .................................... .............................. .............................................. ......._..................................-........-- •--- ..........--- ............ for ... _ ...... hemselves, their heirs, executors and administrators, do.......... covenant, grant, bargain, and agree to and with the said part ............ of the second part, ....... .................... heirs and assigns, that at the time of the ensealing and delivery of these presents....... thty__are ....... _.._... well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, ....... _ ...... ....... _ ...................... .......................................................... _.. ... .... ............ .............. ....•-------'-•------"-----..........._._--••---••-- -- "-- -- -•• °-..- .._.- .._.- ...... ........ -- - -- ------- .................................. ....... ----- -•- ----- • -- ---- -- - - - --- - - - - --- °---"--'-----'-'-•-----• ................_........._._.............._...........--•---.........._........................_........._..... ....- ....._....._.._......_.... and that the above bargained premises in the quiet and peaceable possession of the said part............ of the second part . ........................ heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, ........... _........... will forever WARRANT AND DEFEND. In Witness Whereof, the said part.40a.. of the first part ha ... Ya.... hereunto set ... their .... _....... hand._&.. and / seal ...... this.. .... . .,1 ....... day of.-- --'./ ---------------- A. D., Za - -•-'- °- - --- -- -...(SEAL) SIGNED AND SEALED IN PRESENCE OF "'"""'""-" •- -'------ Litze /k /a D v , t 1 _ .........- - - AL) AAtonia C. Recu rt_ Barbara J. Litzel /k /a Ba a Litzell - ` C p C. .S.r i ----- - - ........--- .....-------- .... ............ (SEAL) - -.1 -- - (% - _ _- - _ - MidoQr Lorrie Ol iver ......--"-"--._ ......... _ ...... .................. --- ----- -- -- --- ..__ .......... _ ... (SEAL) P A Al f (] f � ` idavit No. 666 Xf1MiY 1 --- ---- Sa- n.._Juan ------- ... County. personally came before me, this .... _9.1=.11. day of._-- . ..... ,J ])- L1'....._... -_, A. D., 19-x.3 - -, the above named _.__..Dad a - -_.,. T..t a .1..AT)S1.B &xbar &...J..._.7�1Z alb,.. husband-, ar}d - - -. ........... ------- - ......... •--- .........g jk rs -_ Dayi _.irit_sel1--- and. .Hafbara.- Li-tsnll._huahand.•and..w fe....._..._......_...... to me known to be the person-B. a*&%aat%R* the foregoing instrument and acknowle d the same. �a .. ..--•--------' ....... ............................... THIS INSTRUMENT WAS DRAFTED I `�. Puerto R ��� �D No ublic, ..._.._.._.�,aI1 ....17.8,11 ................... County, VRXX v aim My commission ()Mk 4K) (is)... Qx ....11E �._. _.. ......... NINNEAf OLIS, EDWIN a M t(N. 55402 Gau,DT 3q' (Section 5931 (1) of the Wiscorvio Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grant , witnesses and notary. Section 39.513 similarly requires that the name of the person who, of govern- mental agency which, "drafted : instrument, shall be printed, typewritten, stamped at wtittea thereon in a legible m aMtr.) STATE OF WISCONSIN Wisconsin Legal Blank Company WARRANTY DEED - FORM No. 1 Inlwauk" Wis. (job assos J mutv ev Wisconsin Department of Health and Social Services Plh. #67 3/70 Division of Health SEPTIC TANK' PERMIT APPLICATION TY ?E or USE BLACK IN.{ A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) B. LMATION OF PROPERTY WHrRE SYSTEM WILL BE CONSTRUCTED ALTERED O EXTENDED COUN?Y Check One: CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? / YES NO _ �� ' f� PERMIT NUMBER D. SEPTIC TANK CAPACITY f' !; Gallons NEW INSTALLATION REPI:ACEMENT ADDITION MATERIALSs Prefab Concrete k� Poured in Place Steel Other 11 MBER OF TANKS 70 BE IUSTALLEDs E. TYPE OF OCCUPANCY Cheek Ones One or Two Family Residence X Commercial Industrial Other 1, Specify Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer x YES NO Dishwasher YES NO Automatic Potato Peeler YES_ NO Other (Specify) G. MASTER PLUMBER ?TAKING INSTALLATION Names A ddress: / License Numbers c -� �� x � ? '' �t r� ter;/ MP Signature of Applicant: �. , ��. �/� / � � HP RSW ' Addresss C., H. (To be Completed by Issuing Agent) Date of Application ' /— Fee Paid / r ' Permit Issued (date) Permit Number � Agent (Name) , /.. �� /t �.i" }. - 1 Fors r m s s Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing,antil all of the above questions are answered and the fee paid. Agents will fomard application, the fee of ;1.OG for each septic tanK and the third copy of the permit (canary) :o the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below — FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED by RETURNED (Initials) (Date) See Car *es.) FEE RECEIVED VALID. No. � PERMIT NO. I - Yes or No - REVIEWED BY APPROVED DATE (Initials) - ,. Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT N0. R E P O R T ON SOIL P E R C O L A T I O N TEST AND SOIL BORINGS TO DIVISION OF HEALTH - PLUMBING SECTI-611 ��'� -D P.O.Box 309„ Madison, Wis. 53701 4 a`;� Psarsuant to H 62.20, Wis. Administrative Code 6 PBRC0LATI ON TEST EA1; �G T est Depth Character Soil Hours Hater Rest Timo D i n Water Level Inches utes I Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall Example 1st Wetted Overnight in Minutes Last Period Last Period.. period Qns<Inch P - 0 36 Top Soil 1G'! Cla 2611 25 Yes or No 30 1 2 2/2 1/2 60 LL 2 5 C r RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B 0 R I N G S- Minimum 36 Below Pro osed Abso Lion S sous Boring Total Depth De th to Ground Wate Depth to Bedrock Number Inches Cbserved I Estimated Oboerved Estimated Character of Soil with Thickness in Inches Examtple B - 0 72" 7211 Black Top Soil 12"j C12Z i8"A Sand 18 Gravel 24 RECORD DATA FROM MINIMUM OF 3 BOU HOLES YPE OF OCCUPANCY: RESIDMICEs Number of Bedrooms _ OTHER= (Specify) _ Number of Persons i �OO WASTE GRINDERS Yes - No „ Dishwasher: Yes No r Automatic Clothes Washer: Yes No i FFWENT DISPOSAL SYSTEM: NEW t EXTENSION ADDITION � REPLANT Tile Size No.Lin.Feet Trench Width �- Depth Number of Lines Seepage Bed: Length _- Width_ Depth Tile Size �=� No. Lines Seepage Pits Inside Di'=.aeter Liquid Depth tt t Is the undersigned, hereby certify that,the percolation tests reported on this form were made by me or under my super- vision in ,accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of tort holes are correct to the best of my knowledge and belief. NAME r `/ TITLE Type or Print)_ REGISTRATION NO. or MASTER PLUf�ER LICENSE NO. ADDRESS t DATE e SIGNATURE i ST. CROIX COUNTY WISCONSIN '"" '� `~_✓` �_ ZONING OFFICE N r N N 0 ■ _ - „ + i ST. CROIX COUNTY GOVERNMENT CENTER -- _ -- 1101 Carmichael Road Hudson, WI 54016 -7710 s (715) 386 -4680 Fax (715) 386 -4686 August 31, 2000 Beverly Danielson 3169 50 ' Avenue Knapp, WI 54749 RE: WISCONSIN FUND GRANT AWARD Dear Ms. Danielson: Enclosed is your Wisconsin Fund Grant Award check. This is the amount you have been awarded for the replacement/rehabilitation of your septic system. If you have any questions, please feel free to contact our office. Sincerely, e e'VU * 11- Y• Kevin Grabau Zoning Technician s Enclosure -j COUNTY OF ST . CROIX NORWEST BANK OF HUDSON, N.A. `,.... STATE OF WISCONSIN ....: VOID : AFTER SIX MONTHS Ck�k D ate .Glick N4, 01 00 Q 510098 $3,822.00 PAY THREE THOUSAND EIGHT HUNDRED. TWENTY TWO DOLLARS AND 00 'CENTS DANIELSON, BEVERLY TO THE 3169 5 0TH AVENUE ORDER OF KNAPP WI 54749 Authorized Signatures ii'005 L0098li' x:0 L$ L L80 ©�:.< 000 LO LO 230 COUNTY OF ST. CROIX STATE OF WISCONSIN Vk�ttOR VENDOR: DANIELSON BEVERLY 1 08 31 00 00510098 999999 INV 3l.CE . DESCRfPTION VOUCHER MQ AMOCJNT PAtL ..... 3,822.00 08-30-2000 PRIVATE SEWAGE SYSTEM REPLACEMT G0005067 ;r 17._ 9.q i Ile te " yvIsc6 Department of Commerce \ Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353296 Permit Holder's Name: ❑ City []Village ❑ Xwn of: State Plan ID No.: Danielson Beverl Cady Township oZS 3 CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: [ e , o' /U ( r►1 ewtl o e 004- 1024 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e) - �`Zj ro Benchmark 3 *p pp, ' Dosing Alt. BM -� �-�' j9, /O ' Aeration Bldg. Sewer Holding St /Ht Inlet �os.v (v,32- 93, o8 TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet A. Air I Septic ��p' �' ' ( �---z- NA Dt ~ !3 s 8'9•�a Dosing '` " L` S-Q' NA Header/ Man. 9 Aeration NA Dist. Pipe s -(3 Holding Bot. S y ste A (",r2- PUMP/ SIPHON INFORMATION Final Gradek 5 Manufacturer G Demand St cover 98 O 5 Model Number 2* GPM OvA TDH I Lift 4.1- Friction .gl System TDHq.VbFt Forcemain Length 1 331 Dia. H Z " Dist. To Well .4 ' SOIL ABSORPTION SYSTEM .t. Z . -f BE Width Q Length , / / Liq PIT No. Of Pits Inside Dia. uid Depth IME I N (� T f a&q DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of , I CHAMBER Moe Number: System: �3 ? r w rep OR UNIT DISTRIBUTION SYSTEM :ZZA 1 `f 5 Header / M fold Z u Distribution Pipe , x Ho Size x Hole Spacing Vent To Air Intake Length Dia_ Length Dia. (' ZS 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.) Inspection #1: y T3 /&D Inspection #2: Y Location: 3169 50th Avenue, Knapp, V1 54579 (NW 1/4 NE 1/4 11 T28N R15W) - 11.28.15.164B 1.) Alt BM Description = dos 2.) Bldg sewer length= !I -amount ofcove_ , IV vr) 3.),5 nto , Ik .4 rack. W Plan revision required? []Yes [( No `, f' 1 _57 1 _Z (o Use other side for additional information. A[ 1 (L3 1 0 , 0 1 SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ST. CROIX COUNTY WISCONSIN ZONING OFFICE Nov " " M ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road JA Hudson, Wl 54016 -7710 (715) 386 -4680 Fax (715) 386 -4686 NOTICE OF VIOLATION NUMBER 00 -v -01 BEVERLY DANIELSON 3169 50TH AVE. KNAPP, WI 54759 RE: Failing septic system at 3169 50th Ave. Town of Cady - St. Croix County, WI Computer # 004 - 1024 -30 -000 Parcel # 11.28.15.164B Dear Mr./Mrs. Danielson: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 12/21/99. The violation noted is sewage discharging into zones of saturation. An on -site inspection by this department on 12/21/99 revealed a depth of 20 inches of septic effluent in the vent pipe of the existing system starting approximately 30 inches below grade. A soil test submitted by Mary Jo Holhster(ID# 224832) dated December 9,1999 shows mottled soils at 26 -31 inches below grade approximately 15 feet from the end of the existing system. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 12/21/99 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: The soil evaluation will determine the type of septic system needed and its location. Contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than June 1, 2000. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. SinK erely,, Grabau Zoning Technician cc: file ST. CROIX COUNTY WISCONSIN ZONING OFFICE A A r n n A i1 n ■ -_ „���„ ST. CROIX COUNTY GOVERNMENT CENTER 1`101 Carmichael Road _ Hudson, WI 54016 -7710 >" (715) 386 -4680 Fax (715) 386 -4686 NOTICE OF VIOLATION 12/21/99 NUMBER 00 -v -01 BEVERLY DANIELSON 3169 50TH AVE. KNAPP, WI 54759 RE: Failing septic system at 3169 50th Ave. Town of Cady - St. Croix County, WI Computer # 004 - 1024 -30 -000 Parcel # 11.28.15.164B Dear Mr./Mrs. Danielson: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the def ition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 12/21/99. The violation noted is sewage discharging into zones of saturation. An on -site inspection by this department on 12/21/99 revealed a depth of 20 inches of septic effluent in the vent pipe of the existing system. starting approximately 30 inches below grade. A soil test submitted by Mary Jo Hollister(ID# 224832) dated December 9,1999 shows mottled soils at 26 -31 inches below grade approximately 15 feet from the end of the existing system. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 12/21/99 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: The soil evaluation will determine the type of septic system needed and its location. Contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than June 1, 2000. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sincerely, K Zoning Technician cc: file State of Wisconsin PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and Department of OR REHABILITATION GRANT PROGRAM Buildings Commerce Division OWNER'S APPLICATION Instructions For Property Owners: TO BE COMPLETED BY COMMERCE You may apply after you have received a determination of failure and obtained Application Number Date Received a sanitary permit. Complete Part A of this form, attach evidence of your annual Income, and send these items to the governmental unit listed below: PART A. TO BE COMPLETED BY THE PROPERTY OWNER Owner Name' S al Security No." Additional Owner Social Security No. " ' so � Additional Owneq Social Security No." Additional Owner Social Security No. " Street or Routs Attach documentation of additional owners if needed. 3169 -6"-) Avenue ft- city, State I Zip Code Telephone Number (include area code) 11a LtD �t� 9 s 77 - 3 'Grant awftd will be issued In the name of this owner. "Note: Your Social Security Number may be used to verify your Income and verify status of child support and maintenance payments. 1. Was the principal residence or small commercial establishment constructed prior to and occupied by July 1, 1978? X Yes ❑ No If your principal residence is a mobile home, was the current unit placed at this location by July 1, 1978? ❑ Yes ❑ No 2. This application is for (complete both If applicable): 19 Principal Residence Do you occupy this residence at least 51% of the year N Yes ❑ No ❑ Small Commercial Establishment Do you occupy this small commercial establishment at least 51 % of the year ❑ Yes ❑ No Small Commercial Establishment Name: Description tion of Small Commercial Establishment (farm, restaurant, etc.): 3. Was the private sewage system replaced as part of a real estate transaction or change of nership? VJ Yes ❑ No 1 ICY if , explain: 4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private sewage systems? ❑ Yes ® No 5. Will a portion of this system be funded by another source? ❑ Yes ]R No If yes, explain: 6. Evidence of income. Attach a copy of your Wisconsin income tax return for the year of or prior to the enforcement order or determination of failure If you are applying as a principal residence. If you are applying as a small commercial establishment, submit a copy of your federal tax forms, including all schedules for the year of or prior to the order or determination of failure. If you were married and filed on separate forms, you must also include your spouse's Wisconsin income tax return for the same year. You must include evidence of income for each owner (and for each ownees spouse) fisted above. Evidence of income wrfit be keptan file at the govemmental unit and is subject to verification by the Wisconsin Department of Revenue and by the Department of Commerce. If you or any owner listed above did not file a Wisconsin Income tax return or were a part-year residence in the year prior to the enforcement order or verification of failure, check this box= and contact your governmental unit for further instructions. 7. Property Owner's Certification. I certify that to the best of my knowledge and belief, the Information t have provided on this form and all attachments are true and correct. Owner's Signature Date Signed Co- Owner's Signature Date Signed f Personal Infofttion you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. SBD -9163 (R. 1/99) PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP Does the owner(s) name agree with the name(s) of the applicant on Part A of this application? ❑ Yes ❑ No What document was used Document or to verify ownership? Page Number If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property i Yes ❑ No when the order /verification of failure was issued or the system installed and incur the cost of replacement? 2. How wa a initial contact made regarding Wisconsin Fund eligibility for this applicant? 3. is this application for a replacement structure? ❑ Yes ■ No If yes, have the requirements outlined in Comm 87, Wis. Adm. Code, been met? ❑ Yes ❑ No 4. Is a public sewer available to this rope ❑ Yes t No 5. Hasa previous grant been awarded for this property under this program? ❑ Yes ■ No 6. Principal Residence evidence of income. Please indicate applicable annual income: $ 1 g a- Wisconsin income tax form Une 13 , Year / Affidavit of , Year Other form used Line , Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $ Profit & loss form used: Line , Year 7. Date of Order or Age of the �7 Determination of Failure: 1 exi sting failed system: Sepa rating Distance from the bottom of the existing failed system to a limiting factor: 8. Private sewage system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ................................................................................ ............................... ❑ Category A zone of saturation ............................................................................................. ............................... a A drain tile or zone of bedrock ............................................................................... ............................... ❑ Category 2 The surface of the ground ...................................................................................... ............................... ❑ Category 3 Back -up of sewage into the structure se: vcd ....................................................... ............................... ❑ 9. Replacement System Type: ❑ Conventional ❑ In -ground Pressure ❑ At -grade ■ Mound ❑ Holding Tank '❑ Experimental System and Monitoring 0 Other, explain Uniform Sanitary Permit Number ' ?� ?'? ( Date Issued )- 24-00 Plan Approval Number I'D+ 2-i l ) SZ Date Approved Experiment Approval Number Date Approved " 10. Eligible ■ or Ineligible ❑ Reason Ineligible: 11. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that they are true and correct to the best of ay knowledge and belief. Signature orized Governmental Unit Representative Title Date Signed �- -24W 3 v State of Wisconsin PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and Department of OR REHABILITATION GRANT PROGRAM Buildings Commerce Division GRANT WORKSHEET Owner's Name: r Governmental Unit: ' Dm t ei s ors Crvi X GRANT FUNDING TABLES A. Site evaluation and soil testing. Grant amount $250. $ B. Installation of a replacement or additional septic tank. Minimum Gallons Required Grant Amount 750 .......................................................... ............................... ...........................$500 975 .......................................................... ............................... ............................550 1 , 200 .......................................................... ............................... ............................650 1, 425 .......................................................... ............................... ............................725 1, 650 .......................................................... ............................... ............................750 1, 875 .......................................................... ............................... ............................875 2,100 or more .. .950 $ C. Installation of a pump chamber and lift pump or siphon: Number of Bedrooms Grant Amount 1 or2 ....................................................... ............................... .........................$1,100 3 or 4 ........................................................ ............................... ..........................1,200 5 or more ..... ................. .......................... . ................ ....................................... 1,250 $ 2ZO D. installation of a non - pressurized or in -ground pressure soil absorption area. 1. The following table shall be used for systems sized according to percolation tests. Grant amounts determined by number of bedrooms. Percolation Rate Design in When Properly Rate in Gallon Filed with County Per Square 3 4 5 Each Addl Before 7 -2 -94 Foot Per Day Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 800 $1,100 $1,400 $1,725 $150 10 to less than 30 0.60 900 1,175 1,400 00 1 250 30 to less than 45 0. to 0.59 1,050 1,450 1,650 1,95 1,975 300 45 to less than 60 0.49 or less 1,150 1,900 2,200 2,250 2,275 300 E. Installation of an at -grade or mound soil absorption area. Grant amounts determined by number of bedrooms. Type of Design 1 2 �3 4 5 Each Addl Bedroom: At -Grade $900 $1,300 $1,475 $1,825 $1,950 $250 High Groundwater Mound 2,250 2,325 2550 3,400 3,775 250 High Bedrock Mound 2,350 2,950 3,000 3,400 3,525 275 Slowly Permeable Mound 2,900 3,100 3,250 3,400 3,650 300 Mound with less than 24" of suitable soil or greater than 12% slope. 3,050 3,400 3,475 3,550 4,500 375 $ F. Installation of a holding tank. Addl Number of Bedrooms: 1, 2 or 3 4 5 6 7 8 Bedrooms Grant Amount: $2,250 2,925 3,100 4,000 4,200 4,750 $225 $ -0 G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250 -1,499 1,500 -1,749 1,750.1,999 2,000 or more ^^,, Grant Amount: $550 $650 $750 $800 $900 $ v Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)). SBD -9167 (R. 1199) ; PART, "1. GRANT FUNDING TABLES contl�ued H. Installation of an Experimental System. Amount Requested For Installation: The Department on a case -by -case basis reviews installations of experimental systems. If you are requesting funding for an experimental system not covered by the grant funding tables, $ please submit a copy of the plan approval letter and experiment approval letter with corresponding identification numbers signifying that the experiment has been accepted by the Amount Requested Department of Commerce. For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the rig Cop of paid invoices must be submitted with this request. $ 1. Installations not Covered by the Grant Funding Tables. The Department on a case -by -case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A -H, please explain your request here, attach a copy of the paid invoice, and request 60% of the cost of the installation at the right. $ — TOTAL PART 1. ` , .PART �� ±GRANT AM�3UNTCALGULATIONS A. Enter the total from Part 1. B. Is the applicant a licensed plumber or contractor who installs private sewage systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. $ _O C. Enter the smaller amount listed in sections A or B. If this application Is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, this is the total grant award. Cary this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is greater than $32,000, goes to section D. If this application is for an experimental system, carry this amount forward to section F. $ SSo D. Enter 30% of the amount by which the applicants annual family income exceeds $32,000. Annual Family Income Subtract - $32,000 Subtotal X .30 = $ Q . H. Subtract line D from line C. This Is the maximum gram amount for this applicant Carry this amount forward to section F. (The amount In section E must be at least $100 to be eligible for any grant award. If the amount calculated is less than $100, enter $0.00 in section F. ) $ ` F. Total grant award requested for this applicant $ "� SS *L con s i n SANITARY PERMIT APP sa fety and Bun gs Division 201 W. Washin on Avenue P O Bo 7302 Department of Commerce In accord with Comm 83.05, a / Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst n pap�� than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this applic r! Sta 'te� itary Permit Number ; .. L � _ 35 3ag� Personal information you provide may be used for secondary purposes ST CficG!X ❑ if revision to previous application [Privacy Law, s. 15.04 (1) (m)). � —, ZHNGQ,e UN7Y rI a►y an I.D. Number I. APPLICATION INF RMATI N -PLEASE PRINT ALL I TI I� SZ Propert Ow x . � ner Name at�iagft I,�Ei. J_L Y 0,41? r eLS 661 1 a i_ 1 1 T a g , N, R I,SSE (or W Property Owner's Mailing Address t Number Block Number 1 G 5'0 City, Uote Zip Code Pho Number ubdivision Name or CSM Number it/14P? w l 5`17K (715 )� II. TYPE B ILDI G: (check one) C] State Owned it (f NeaS�o o Tow T/I v Public 1 or 2 Family Dwelling - No. of bedrooms 3 nn OF vy III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 [] Apartment / Condo vv 1 , I b 2. F] Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Rect6ational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /, ar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ;R Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an S stem - - - - -- System ------- - - - - -- Tank Only ------- - -____ ExistinQSystem _- _ -____ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 JM Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , / t 42 ❑ Pit Privy 13 ❑ Seepage Pit I )C 't �e� 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 , VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q Elevation q,Sa 3 7S 376 . S' / y� 3 0 Feet Feet Ca acit VII. TANK in allon Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st acted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 1 41 1 'DL,.e 5*ervt ® ❑ ❑ 1 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 6 5 - 0 6,5 I Z usfi ( 000 G ® ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI er's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Ceti 01 =1 H u1313FL L 1 �� 1 Pa 107 4.�s - Gsra �a(�ro21 Plumber's Address (Street, City, State, Zip Code): Al - 7 �( �s � 9 � �i >'• h S �'- R I' Vey (-c ( (S uL/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved j S n itary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Approved ❑ surcharge Fee) Owner Given Initial Adverse Determination oZS� X. CONDITIONS .� -- APPROVAL/ REASONS FOR DISAPPROVAL: l��KtS 5��;�u�., a;.�olorq,�d�t� �� • DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber R MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project BEVERLY DANIELSON Owner BEVERLY DANIELSON Address 3169 50 TH AVE KNAPP WI 54749 715 - 722 -3145 Legal Description NW 1/4 NE 1/4 S 11 T28 N. R15 W 1P_Q. - r•s• Township CADY County ST CROIX conditionally )PIKOVErU% Subdivision Name Lot No. NT OF COMMERCE DE F FEY D BUILDING$ Parcel ID Number ptVtsi Plan Transaction Number SE CO RE p NDENCE Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump curve chart Page 6 Plot Plan Page 7 Designer DARRELL HUBBELL // � License Number 221073 Signature /Yu�%6u/' Phone No. 1- 715 -425 -6517 Date 11 /9/99 Notice: Tampering with this file by unauthorized persons is probibil-ed. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Slats. Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (1)(m)]. SBD- 10462 -E (R.05/98) Pagel of 7 5071' AU i i n s 1 1 Q ; i u- 16y hp.ali Y well s - Itl�f ?0 df I�� /nabld NO c 1 fIV A _�.� 1 . / n4Y�tiflr „Y g2 1 P.I'� Wpvc�Ft� �t�rF� � , � �' c r� ►, , „ ��,< <^ c X13, 't? r Vn F l 11.1 7 47 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353296 Permit Holder's Name: ❑City ❑ Village [] 'Mwn of: State Plan 1 No.: Dani elson, Beverly 1-- Cady Township CST BM Elev. - - Insp. BM Elev.: BM Description: Parcel Tax No.: 004 - 1024 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH I Lift Friction System TDH Ft oss Fi Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENS DIMENSI SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O CHAMBER Model Number: 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 7 ❑ Yes ❑ No I ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 3169 50th Avenue, Knapp, WI 54579 (NW 1/4 NE 1/4 11 T28N R15W) - 11.28.15.164B 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = 3.) contour= Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.331997) Date Inspector's Signature Cert. No. WAItRANT1r DUM ,I DOCUMItNTNO I 8 �(ti/ fti(� uTAT oR WtttCON�IN -roltM 1 SS V V tjy •Jt J TNI/ /lAOti IlRtitRlltP !OA W006OI1141 DATA i REGISTERS OFFICE THIS DMENTURE, Made this ............. . day of ............................. . A D 1911", W1 David B Litzell and Barbara J. Litzell husband li ST. CROIX CO.- s. between _...._ __._........ A. ..... _.._.. _.._. .... ....... amd•w�,fe•••-- arkra_David Littall and Barbara - Recd for Record this__ tk- _._..:;: :::: ::�::.::�:._._... _ .....:::.:..._.__._... day of_. ��r__aD. 1923 art..�t_q. @ -.. of the first part, and j _.-_...._ ......_.._ ..................... - ............. ......_. ... _. i atw�?►4149 �_ M. James E. Daniela_on and Beve 1� E.. Danielson,_ _ _wife, •••••• ....... ........_....__..._ ........ .. ........ _ ........ .. ... ......_ ...... _ ... ...... ......................._._.._. __. ...___....__.......-_ ........ ......... .... ............. .._.._.... zkrof s ..... - .......... _ ...... _ .. . ._...part.....,_..... of the Second part, _ .._.._.. eth, That the said ...._.. .._.... ................. att ies.. . part, for and In consr - - - - - -- ''I Witness...e.8.. of the first deraGon ( • - -. ---= ----- - - - - -- _ ............... - - - - - -- 1 IQTLRN TO of the sum of........ - _..........__._. ---- - - - sideration-------- _ - e sum One Dot ar and other oo and valuable con - Lo.. them in hand paid by the said part ....... _... of the second part, the recelpt whereof is hereby confessed and acknowledged, ha.. -Ye... given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do .......... give, grant, bargain, sell, remise, release, alien, convey, and confirm unto the said part...____... of the second part ......................... - .._ ...... _..... heirs and assigns forever, the following described real estate, situated in the County of ... St._Croix _ •- ••.- ••••, - -•_- and State of Wisconsin, to -wit: The East 600 feet of the North 490 feet of the Northwest Quarter (NWk) of the Northeast Quarter (NE'k) in Section 11, Township 28, Range 15, St. Croix County, Wisconsin. TRANSFER 2,00 FEE (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE BIDE) - Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part-iee••• of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenance. To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto the said part --- -------- of the second part, and to .... .......................................... heirs and assigns FOREVER. And the said David B,_ Litzell- • and •• Barbaxa••j- .... Li.t. 7. g. 1l .... _.._ .................................. .. ...... _.._ ... _ a /k /a David Litzell and Barbara Litzell . ••-,•• .•- , ....... _................... ................._......... __....._..._.................._ .........._......_..._..._.. -_ for..._.. --- themselves, -- their • - - heirs, executors and administrators, do .......... covenant, grant bargain, and agree to and with the said part -------- _... of the second part, .............. _........... heirs and assigns, that at the time of the ensealing and delivery of these presents._....._theX are....... _•__... well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever ••••••.. -•- .•- "•• °•• - •----•-- •-••- •-------- -- --- -- _------- --- -- - ---- ....... _ ---- -- ..... - --- --- -• - - ---•- - ....... - ..-- --- -- --- ....... ......... .................... ........... ........... .................... .-.._.._.. .._-__ ......... -....... ...... ................. ................ .................. ......................... ....... ......................... and that the above bargained premises in the quiet and peaceable possession of the said part ------------ of the second part . ........................ heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, _..._...... ............ will forever WARRANT AND DEFEND. In Witness Whereof, the said part.. a•• of the first part ha ... VP_.... her set ...1~hc�.x.._ ••••• -• hand. -fl.. and seal ...... this ....... 1._ day of..._..� ..• .............� A. D., .7-a-.. ... _ .... ... _ .............. °- -......- .. --.-(SEAL) SIGNED AND SEALED IN PRESENCE OF i z - 11 /k /a. D V • t 1 .............. _ ............ Mtonia C. _Recurt Barbara J. Litzel /k /a Ba a Litze .._...._......_..... - ...(SEAL) .............. . .... . ...... __ Mid Lorrie Oliver —�, —_ ............. ..- .... ........... °-........_...(SEAL) Affidavit No. 666 faig � --- Sam ... Juan .......... County. Personally came before me, this ---- day of ... ....... JU.> Y ............. A. D., 191 the above named ..._._�vi .......--- T.. 1: Q1. 1_.# T)d.RAxb &a...1...._I,11.�1.�..- husband --az}d-- wife,..... _ ..... -•-- -•• --• .. ...... ..... . ..• - - jk (g -- Davy d..l,l�kze ll--- and..RalEbaza..I.�t ztel.l, _.buahamsl_. and ..Yife,--- __..._.---- •• -• -••- to me known to be the personas. v*&ja&N€1Cs*j the foregoing instrument and acknowle god the same. ..... ............................... Puerto THIS INSTRUMENT WAS DRAFTED --"" R 7� No ublic, .._...._.. Sr�11 ... .lUi1A .................. County, I r My commission 0=k00 1lie -.- MINNLAPOLIS, trt,ilN. 55402 (Section 59.51 (1) of the Wiscm4in Statutes provides that all imtrumeots to be recorded &hall have plainly printed or typewritten thereon the names of the grantors, granters, witnesses and notary. Section 59.SI3 s i m il ar l y re that the name of the ptrtoo who, a 1-10- mental s,gency which, drafted &ucb instrument, shall be printed, typewritten, stimptd Of written thereon in a legible manner -) STATH OF WISCONSIN Wisconsin Legal Blank COMP=l WARRANTY DEED � FORA/ N/. 1 YLLwatakew Wis. ( Job 19909 ) Wisconsin Department of Health and Social Services Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. MINER OF PROPERTY Name Address (Street, City, Zip Code) B. LOCATION OF PROPERTY WN" RE SYSTEM WILL BE CONSTRUCTED ALTERED O EXTENDED COUNTY Check Ones CITY VILLAGE LEGAL DESCRIPTION _ TOWNSHIP / J C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? N/ YES NO `� ' PERMIT NUMBER D. SEPTIC TANK CAPACITY �� Gallons NEW INSTALLATION 1 , ,V REPI:ACEMENT ADDITION MATERIALS: Prefab Concrete ti� Poured in Place Steel + Other DUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY t Cheek Ones One or Two Family Residence X Commercial Industrial Other Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC.- Food Waste Grinder YES NO Automatic Clothes Washer x YES NO Dishwasher YES NO Automatio Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER 21AKING INSTALLATION Names Address / ' ; . �, ., a 'License Numbers L -1 <:% !P Signature of Applicant: MP RSW Address: �..• ; . �� , H. (To be Completed by IssuinC Agent) Date of Application - `- r� Fee Paid $ Permit Issued (date) f '•Y Permit Number Agent (Name) ' <' /Li s - ' / For: Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.OU for each septic tanx and the third copy of the permit (canary) .o the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED 1 (Initials) (Date) See Corres.) FEE RECEIVED VALID. No. �.i PERMIT N0. Yes or No) - REVIEWED BY APPROVED DATE (Initials) - Yes or No COMPLETR 07RFR SIns A .0 SEPTIC TANK PERMIT NO. 4" R Y P 0 R T O N S O I L P t R C 0 L A ? I O N ? 2 S T AND SOIL BORINGS TO n DIVISION OF HEALTH - PLU`MING SECTIt�T RECEIVr7 h P.O.Box 309, Madison, Wis. 53701 ' ^; ? P►uvuant to H 62.20, Wis. Administrativo Code MAY 14 G'^* -'r 6 PBRC 0LATI ON TEST EA►, Z !:5 Test Depth Character of Soil Hours Water Test Time Drop in k'stor Level In ches utes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last o Fall let Wetted Overni in Minutes Last Period Last Period Period C?, Inch Example P - 0 36" Top Soil 10" Cla 26 2S 2 Yes or No 30 2 1 1/2 60 1 l RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B O R I N G S- Minimum 36" Below Pro osed Abso tion S stem Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Cbserved I Estimated &servedl Estimated Character of Soil with Thickness in Inches &xaaple B - O J 72" 72" Black Toe Soil 12 C12Z ie"I Sand 18 Gravel RECORD DATA FROM MINIMUM OF 3 BORE HOLES LD E OF OCCUPANCY= RESIDEICEs Number of Bedrooms OTHERS (Specify) Number of Persohs WASTE GRINDERS Yes No Dishwashers Yes No Automatic Clothes Washer: Yes �� No FFLUENT DISPOSAL SYSTEM: NEW ` EXTENSION ADDITION REPLACEMENT Tile Size _ No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length _' Width Depth ' Tile Size No. Lines Seepage Pits Inside Diameter Liquid Depth�_ I, the undersigned, hereby certify thst.the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of to ^t holes are correct to the best of my knowledge and belief. NAME 1 /.`4- T 'TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ADDRESS DATE SIGNA?URE �"Z,' i I Dam DOCUM<NT NO, ` w►At IN—r TAT[ OF Wtt11CON�IN - t i MIS HPAOt pig[i[RYwD rOA =OOADIMD DATA i. - - - •.. , Made this ............. day of_.•- __........_.._.- •..••. REGISTERS OFFICE b A. D. 19 x I � i en ... David,B. Litzell and „Bar ara J. Litzell,,huaband_ �; ST. CROIX CO., WIS. _.._.._.. aAd•a�drfa a k)a _David Litsell and Barbara Litsell ••••• ; Recrd for Record this__ W_ _.._.._.._.:,:: :�::�::�::�: _ ....::..:..._.._..... da of__ 4QkQJ mW_ _A.D.1923 _.._.._.._...... _.._ ......................... .................._- ---... actJ er @... of the first part, and � &L--iftw-3 M. J ames 1!. Danielson and Beverly E. ,Danie lson, j (t _ _vife� - ._..... ...... _.........._ ................._.... .._...._.._.........._.._...... _.._.._ _ .. .............._........_..»..-....... ._...._.............._.._...... R�L'I ar of w .... .. ... _ ...... _......_.._..- ....... .._ ............ ...._.........._.. _ . part............ of the second part, Witnesseth, 'That the said part ... iaa.. of the first part, for*and in consideration ncruaw To -- _ - __ - -_ - — of the sum of ... a?e_ p r ... olla and .. other_7n and „valuable„ con -_,,,_ i _.. sideration-- - - - - -- -” - -- .. -. _.._ t0 . them . ..... in hand paid by the said part ....... _... of the second part, the receipt whereof is hereby confessed and acknowledged, ha ..Ye.. given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do ... _..... give, grant, bargain, sell, remise, release, alien, convey, and confirm unto the said part..._.._... of the second part ............................ _......_. heirs and assigns forever, the following described real estate, situated in the County of ... St._Croix _ and State of Wisconsin, to -wit: The East 600 feet of the North 490 feet of the Northwest Quarter (NW's) of the Northeast Quarter Mk) in Section 11, Township 28, Range 15, St. Croix County, Wisconsin. TRANSFER $ 32.0 0 FEE Or NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part- :Cea. -• of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto the said part ... _....... of the second part, and t .... .............................. _ ...... _.._. heirs and assigns FOREVER. And the said ........David B,_,Litzell and- Ba- rbaxa.. ......................................................... _ a/k/a David l Litzell and Barbara Litsel ... ... . for.......... Chemselves, - their_._ „_, heirs, executors and administrators, do.......... covenant, grant, bargain, and agree to and with the said part............ of the second part, .... ... ....... ........... heirs and assigns, that at the time of the ensealing and delivery of these presents....... thex_are - - -_ - _ -•_ - -- well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, ....... ........ ...... _ ................................................................................. "'-"”" ... . .......... -..... ... •- ........... ..-...... - ----- -.....- ........ _ ................................ ........... .......... I .,.............. ....................... ........................... .............. .............. ............ _ ............ ....................... ....... ................................................ _ ...... _ ... ,........... ....... and that the above bargained premises in the quiet and peaceable possession of the said part............ of the second part, .......•...........I.... heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, ........... .......... .. will forever WARRANT AND DEFEND. In Witness Whereof, the said part.. s •- of the first part ha... hereunto set ... their .... _....... hand.. &.. and seal...... this ....... /...5.------------- day of. - - - -- .................. A. D., 1a_.. _...._. � _/ ............. SIGNED AND HEALED IN PRESIiNCE OF i 11 /k /a D v tLitzall \ '1 ✓�-� �.�� .:- ..... ... ...... � =SEAL, _ .._ ........ - - -. ....... _ bAtonia C. Recu /� Barbara J. Litzel /k /a Ba a Litzell J L4Q� 6, , t ---- ......_.............. °.... - °° .............. ......... -...(SEAL) L Mid r Lorrie Oliver .. ......... Affida 666 -- �gn...�j�a}Z.-.. -. -... Count . Personally came before me, this---- 1.91h. day of ...------- JMIX ............. . A. D., MD. husband- ,aid • wife, • .- • - _ -...- the above named ... ...D.v � -• --... Jai t Z9 1. 1--- aMt- RaX'bara ... J.....Z.f.X�.�l.�,s. . a jk( Dax d..ltib�e ll...and..Ral!`baxa..l.itznl.l ._huahand... and ..life ....................... to me known to be the person.Z. a 4"W the foregoing instrument and acknowle d the same. � v - -w Puerto THIS INSTRUMENT WAS DRAFTED \ R Tom 0 No ublic. ... ..... ---., San ...JU.d-A ................... County, my commission ()=bC0() (is) .... £Ox- .... 1 -1 $•.-- NtfWQLjS, tziN 55402 (Secti(In 39.31 (1) of the wiscoryio Statutes provides that all instruments to be recoeded shall have plainly printed or typewritten thereon \ Vic names of the grantor a, grants: a, witnesua and noauT. Section 59.313 Similarly requires that the name of the person who, a, fern- mentai agency a gra drafted tuc16 ioatn shall he printed, typewritten, damped of written thereon in a legible manner.) lank CorriVILDT STATE FORSK N*. I Natty WARRANTY DEED MRw uttm Wls, $ ( Job asses )