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Parcel 010-1060-10-000 03/22/2005 11:58 AM
PAGE 1OF 1
Alt. Parcel 25.30.16.380 010 - TOWN OF EMERALD
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* CLANCY, JAMES R & TRUDIE A
JAMES R & TRUDIE A CLANCY
1322 CTY RD D
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1322 CTY RD D
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 5.008 Plat: 0519-CSM 12/3281
SEC 25 T30N R16W PT SE SE BEING LOT 1 Block/Condo Bldg: LOT 1
CSM 12/3281 WD-1209/499
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-30N-16W
Notes: Parcel History: 9Q_ 40 UaAvcz~
Date Doc # Vol/Page T e
07/03/2003 728650 2300/215 WD
02/18/2003 710090 2145/279 SD
09/08/1997 1262/429 WD
1209/499 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
24734 199,700
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 30,000 167,200 197,200 NO
Totals for 2004:
General Property 5.000 30,000 167,200 197,2000
Woodland 0.000 0
Totals for 2003:
General Property 5.000 15,000 127,300 142,3000
Woodland 0.000 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 135
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 30.00
Special Assessments Special Charges Delinquent Charges
Total 30.00 0.00 0.00
t' or1soDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page l of
y . and Human Relations
l;K Division of Safety & Buildings in aCC ritlrti-83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less thap(,81 x 11 inches in site ;Av must include, but
PARCEL I.D. #
not limited to vertical and horizontal reference po nC(BM I nd 1To of,,krgpe, scale or
dimensioned, north arrow, and location and i- , ce to r~'fb21d. A Ole Ole
Rl(NT I R TJON~I , REVI E l X19 TI DATE
APPLICANT INFORMATION-PLEASE f,"
PROPERTY OWNER: ST C -PROPERTY LOCATION
S. COUNTY = 4G0VT. LOT s'~F 114 ,SE 114,S;63 T 30 N,R 1,4 .for) W
PROPERTY OWNER':S MAILING ADDRESS OT BLOCK # SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHO E OCITY OVILLAGE I N NEAREST ROAD
G e w p 7" 3 a 93 eq /4 /7 d G'o, 0~ C~
(j(] New Construction Use JX J Residential ! Number of bedrooms [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow - - gpd Recommended design loading rate ; .2 bed, gpd/ft2 3 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2_trench, gpd/ft2
Recommended infiltration surface elevation(s) T4(1 -~5" ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material GL A e i A 144 Flood plain elevation, if applicable /~!A ft
S = Suitab:for systeCONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitfors stem ❑ ❑ S 2 U 14S ❑ U ❑ S O U ❑ S W U ❑ S RU ❑ S PoU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouxlaty Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
i4tii:•:
,...i.....v a .
A4 ;2 M -5- 4
Ground 2~ J .3r /Q S 6 M VrR -6W V -,2 1,-
elev.
Depth to
limiting
fact
A
Remarks:
e 2
Boring # i O ^ /e V'K &Z
le Y&
, .3Q S~ 2 Sf i~~ ✓FR Cw vF ,;2,
Ground
elev. 2042 S6 3c! A it N/ v F" NA NfI
ft.
Depth to
limiting
factor ~
Remarks:
CST Name:-Please Print Phone: 71
Address: C ~G ra JJ' D~3
Signature: Date: '6„ CST Number:/ 6
ae
PROPERTYOWNER `',eg SOIL DESCRIPTION REPORT Page g"OLZ
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
i4ii;•ti~:•i:•ii •
.1.o vR 141 7/
C7 s i r ~,s
Ground 7a✓~" S C! ~Ni S6 r M ir~i~? w J vF o;2
elev.
q392 ft.
YA? 111,q G'.W 2 3° S, A M v S /1i,4 N~
Depth to
limiting
factor
Remarks:
Boring #
ititi;i:•
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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BENCHMARK: v C J J O O, D IG c^
ALTERNATE BM: ~r1 C Cie) 1/-4r2 -0021
SEPTIC TANK / PUMP CHAMBER /,IfOLDING TANK INFORMATION
Manufacturer: /,'~L' 1 uid capacity:
!q Setback from: Wel1L2-yb House Ird Other
Pump: Manufacturer ll/ Iit Model# 2,S Size
Float seperation Gallons/cycle:
t l-! -2
tiG
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length_ Number of trenches
Distance & Direction to nearest prop. line: 1;-44M4 ,~Oax .~~oPr
Setback from: well: I -L-00 House ]$D Other
ELEVATIONS
Building Sewer ST Inlet: 73 ST outlet:
PC inlet - PC bottom Pump Off
Header/Manifold /~P,49& Bottom of system
Existing Grade *J Final grade l
DATE OF INSTALLATION:
PLUMBER ON JOB: /DV'bo s/NZ
LICENSE NUMBER: q&2,
INSPECTOR: KDL-) /"Ij d-z-
3/93:jt
ro
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER-
ADDRESS
SUBDIVISION / CSM# LOT
el,
SECTION 2
T 34) N_R- W, Town of CGt-t~C6-t
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
i
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
Wise-or%inDepartment of industry, PRIVATE SEWAGE SYSTEM County:
` Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety And Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No
GENERAL INFORMATION 299158
Town of: State Plan ID No.:
Permit Holder's Name. City El Village HORNE, KEN EMERALD
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
IOC 100' 010-1060-10-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic MIc6e~,`>I PrP(e.(51 ~ 1000 Benchmaf~ 3 5 3q' (os. /60
/ p
Dosing L' orv~ 1Do Co Sp ~ ~ ~ .5 7 j~6S3 ) O
Aeration Bldg. Sewer 5.7;5 16t/1-s'
Holding St Inlet 10.70~3r
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. Airlnta to ke ROAD Dt Inlet
rl
Septic fU4i ~~p~ l (obi NA Dt Bottom 17S7
IOC . D
Dosing (op~ NA Header/Man. -741
Aeration NA Dist. Pipe 7 Obz
Holding Bot. System 8 l Sr /o l ,38
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 1fOl aii cr Demand ? wlav~~no~e (A 7 O (0a (17
Model Number Shl GPM
System TDHR_(,~Ft
TDH Lift 5I Friction 0
1 Head
Forcemai n Length 5`I Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length 1 ri No. Of trenches PIT No. Of P' s Inside Dia. Liqui epth
DIMENSIONS 11 DIMENSIONS
LEACH Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
I
INFORMATION TypeO CHAMBER' 'Model Number:
System:VYID0'j l2 ~D o~(7Oa" OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
++rr
Length$1~OM/ Dia- Z Length 0101 Dia. a Spacing ► h ~ d
-
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.) 7,0 --ar~
I °l q
LOCATION: EMERALD 25.30.16.380,SE,SE 1322 COUNTY ROAD D
1~ ~n s. 0 q ~I Do 105.3°1' ,
-to • ~',1 ' a-0-15'q7 a o6t vAIM o ~ 1 u ~ C 6v eco l y
{v1 ~t w~C~ an r t l ! : ' n,Q W /vl T C,( ~ / 4V ✓ jU,4,tr G
Q d p,, fA a ~rl le:rjt<C.A,t 2., 5
Lji
Plan revision required? ❑ Yes ❑No
Use other side for additional information.
SBD-6710(R 05/91) Date Inspector ignature ert No.
ADDITIONAL COMMENTS AND SKETCH a 4
SANITARY PERMIT NUMBER: •
Q ej U F I b~~vice v, c► ec, , i o o-+S 70-F+)-rraviq ' l eo o, c
e~-
vtct 'JWonn awe rica K tylr• V-1CA15
G~~ l5 ~cc,- o!_t>Y) o""C lnovsc (Zt~'~
Safety and Buildings Division
lam.■I`Itnltn SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Count ~n
than 8 1/2 x 11 inches in size. 7- 02 1
• See reverse side for instructions for completing this application State Sanitary Permit Number
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 INF RMATION - PLEASE PRINT ALL INFORMATION
Property O r Name Property Location
f~ 1/4 _ 1/4, S Z~ T 3(~ , N, R Ilp E (or
D
AProperty Ow r' Mai g Addr r Lot Number Block Number
City, St zip Coe Phon Number Subdivision Name or C M hwnber
Road
II. TYPE F BUILDING: (check one) ❑ State Owned V" ±t -
( L) . Near st~a W
E] Public 1 or 2 Family Dwellin - No. of bedrooms Town
III. BUILDING USE: (If building type is public, check all thatapply) Parcel Tax Number(s) aS`/,~Q ?ego
1 ❑ Apartment / Condo v 4 /
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 0 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 130 Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11E] Seepage Bed 21,91VIound 30E] Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy
13E] Seepage Pit 43E] Vault Privy
14E] System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
LIS-0 ] Re 'red (sq. ft.) Pro s (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation
V06 101. J Feet O ~ Z-Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank ~k /jW " ❑ ❑ ❑ ❑ ❑
Lift Pump Tank fiber APO 1v4A<- • kwA ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibilit for i io f the onsite sewage system shown on the attached plans.
Plumbe " me: (Pr Ct) Plu a "s i a : (N tamps) MP/MP W No.: Business Phone Number:
o ~ I Plu r' ddress (Street, City, State, Zip
de): 5i Orz 17
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater L te Issue Issuing Agent Signature (No Stamps)
Approved E] Owner Given Initial Surcharge Fee)
Adverse Determination
~Jln Cj
X. CONDITIONS OF APPROVAL/ REASO S FOR DISAPPROVAL:
SRD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber
t i
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permi't' issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of -
Wisconsin, Safety and Buildings Division, 608-266-3815-
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide'the legal description and parcel tax number(s) of where the
system is to be installed.
IL 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; Q 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; L=) 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.
I
SAFETY AND BUILDINGS DIVISION
dw 2226 Rose Street
Nytisconsin La Crosse, WI 54603
Deptartr ent of Commerce Tommy G. Thompson, Governor
05-Nov-97 William J. McCoshen, Secretary
TL SINZ PLUMBING KEN HORNE
TODD SINZ
E 5612 708TH AVE
MENOMONIE WI 54751
KEN HORNE Plan ID 9720720
SE,SE,25,30,16W
Municipality of Emerald Inspector: Leroy G. Jansky
County of St Croix (715) 726-2544
Private Sewage plans including the following element(s):
MOUND 450 GPD
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for
compliance with all code requirements.
This plan action is subject to the conditions listed on the following page(s).
A copy of the approved plans, specifications and this letter shall be on-site during construction and ope
to inspection by authorized representatives of the Department. All permits required by the state or local
municipality shall be obtained prior to commencement of construction/installation/operation.
This project is under the supervision of a state inspector. As inspection concerns arise feel free to
contact the state inspector at the number listed. The inspector for this project is listed above.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when
making an inquiry or submitting additional information.
Sincerely,
Gerard M. Swim
POWTS Plan Reviewer
(608) 785-9348
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
LaCrosse, Wisconsin 54603
isconsin
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
Page 2
97 20720
- 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, prior to installation.
- Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
SBD-5524-E (R.07/96) File Ref:
Ken Horne - Mound
97-20720
Location: SE 1/4, SE 1/4, Sec. 25, T 30 N, R 16 W
Town: Emerald
County: St. Croix
Date: November 4, 1997
Owner: Ken Horne
Address: 1549 CTHW D
Emerald, WI 54012
Plumber: Todd Sinz.
Signature:
License # MP 139462
Attachments: 6748-Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan REC
4: system cross section. E1VED
5: plan view, lateral detail NOV- 6: pump tank exit detail 3 1997
7: pump curve SAFETY &
LU jS• DIV.
page 1 of 7
P.4 •W •T'S'
Conditionally
1)??R0XjEj)
ENT OF COMMERCE
~EPAR
ETY U BUILDINGS
SAF
OIVISI f NCE
DF
SEE GOR PONDF
Syst" Calculations
One family residence bedrooms
Loading rate 3 gallons/sq ft per day
Depth to ground water in
Depth to bedrock g in
Cross slope $
Force main length 1,g ft of in
Manifold/header length N ft of in
Drainback ~`k '6' gallons
Lateral length l @ Ct `o'ff ft of 2 in
Lateral elevation cl'w ft (bottom of pipe)
Lateral hole size in @ 0 in ( 5' ° f t) spacing
\ c~ holes/lateral, ~C~' holes total
Lateral volume 1 ~'•~b gallons
Total lateral discharge rate 22.2 gpm @ 2 ft head
Elevation difference ft
i
Friction loss ft @ Z gpm
Total dynamic head ft
Pump/si~on ~'3 gpm @ 1 ' ft of head
Manufacturer Model # S w 2j
Dose volume gallons
Lift/si'Plon tank gallons
Septic tank gallons
Measurement pump on & off in
Height alarm from tank bottom in
Reserve capacity ~~Y3 } gallons
talcs page Z of
N41~
7~ g w0 SO: CT W
mss' ~►~3` 2,`' Qvc ceQ 40 {3ti
3 • 13 n ..Q,.Q ~ ~ s ~
~ Q"` i ~+4). S i+~►~¢C1 At>.u ~ •+O. 21 w.:\ ~
~t > loop 7'~+ ~l ~l° 4VX ,{a(v.~(`a~ :r ~(~0+~~~tC\ ol.}~ ~ ~J~~A~
boo l~. ~ ~ o ~S 3. I o S c ~ ~ w..k
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WEAT1IERPQOOF
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LOCKING COVER 8ppt
QUICK W-corldsGT--N,
4" c.t. INr/ii W'Ov "
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SaL. 24" t.D. VkNT
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PIK 4 2" _ Iwc T%=.
04 . pup
mm ECTIOMi
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p ~N
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ore Irf'r
SEPTIC
DOSE M F
TAWK MAIJUFACTUR.&R. ~y " IJUMOER OF DOSES: PER DAy
TAWK SIZE OALLONi DOSE VOLUME
ALAR PWIUiACTLIII:ER: S S Z« `1~ INCLUDING GACK/LOW: ' GALLONS
AOOLL AIUMbER: `D~ ~ w CAPACITIES: A= 7- WCHE5 OR GALLOWS
SWITCH Tupt: INCHES OR 34 GALLOWS
PUMP MAWUFACTURCP: C INCHES OR GALLOWS
MODEL WUMOCR: Sw Z1"~ D INCHES OR ko Z GALLOWS
SWITCH T»PE: MOTE: PUMP AIJD ALARM ARE TO pE
MINIMUM OISGNARGE RAT Z 3 GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWCCY PUMP OFF ANO OISTRIoUTIOW PIPC.. FEET
+ MINIMUM NETWORK SUPPLU PRESSURE 2.5 FEET
+ 11 g FEET OF FORCC MAIN Y. !Aoo*nFltICT10Q FACTOR. - /CET Z~ y~•r.
TOTAL 0SUAMIC, HEAD s ~S FEET
10TERNAL. DIMEW610NS OF TANK: LENGTH ,i~~;WIDTH b ;LIQUID DEPTH
N 0110--
L I Z! 14 4,11 Z! 1q DIV
d I
- Performance Data
32
Pump Characteristics
Pump/Motor Unit Submersible
24
Manual Models SW25M1 SW33M1 U.
Q 1/3 HP
Automatic Models SW25A1 SW33A1 W
x
Horsepower 1 /4 1 /3 216
Full Load Amps 8.0 10.0 ; 1/4 HP
J
Motor Type Shaded Pole (4 pole)
f
R.P.M. 1550 o a
Phase 0 1
Voltage 115 0
Hertz 60 0 10 20 30 ao 50 60
CAPACITY-U.S. G.P.M.
Operation Intermittent
Temperature 1204 F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 NP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 NP- 47 45 43 40 37 34 30 26 22 16 10
Discharge Sire 1-1/2" NPT
Solids Handling 1/2" Dimensional Data
Unit Weight 30 lbs. 1. All dimensions in inches
Power Cord 18/3, SJTW, 10' std. 3-1/2 5-7/8 - 2 Component dimensionsmay
a-1/2 vary ± 1/8 inch
(20~ Optional) T 3. Not for construction purpose
1-1 2 NPT unless certified
3-1/2 DISCHARGE 4 Dimensions and wephtsnit
Materials of Construction approximate
S Oo/Olf level adjustable
Handle Steel 6 We reserve the right to
3.1/2 make revniom to our
lubricating Oil Dielectric 011 I products and them
Motor Housing Castilian ! specif caoom without notice
Pump Casing Cast Iron I / -
I( '
Shaft Steel
Mechanical Seal Faces: Carbon/Cermak
Shaft Seal Seal Body: Anodized Steel
Staedess Steel t►.r =fr t 1- t, a
Yellows: Bum-N PON P
10.1/8 9-1,2
Impeller Ther stk
Upper Bearing Bronze Shreve Bowing DISCHARGE
HEIGHT
+Lower Bearing Single Row BaN Bearing ----T
3-,/2
Strainer/Base Plastic 3 PUMP
OFF
Fasteners Stuialess Steel
AURORA/HYDROMATIC Pumps, Inc. e_ 3- , s
1840 Blaney Road, Ashland, Ohio 44805.
(419) 289.3042
WisconsinDepartment ofCommerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in .05, Wis. Adm. Code
Attach complete site plan on paper not less than 8% x 11 i' County
include, but not limited to: vertical and horizontal reference point (BM), dir on St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.#
010-1060-10
APPLICANT INFORMATION - Pleas rmation. Reviewed By Date
Personal information you provide may be used!? n 19 Law, s. 15.04 (1) (m)).
Property Owner % Property Location
R Govt. Lot SE 1 4 SE 1/4 S 25 T 30 N,R 16 W
CO An
Horne Ken
Property Owner's Mailing Address Lot# Block # Subd. Name or CSM#
1549 CTHW D
City State p Code eVkWber ❑ City ❑ Village ®Town Nearest Road
Emerald WI 012 dd6t"5-710 Emerald CTHW G/D
❑ New Construction Use: i,ntial / Numb a ooms 3 ❑Addition to existing building
❑ Replacement El IiC'o~ r ►i ibe
Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpolfts .6 trench, gpd/fF
Absorption area required 900 bed, fF 750 trench, ft' Maximum design loading rate .5 bed, gpolft2 .6 trench, gpdtW
Recommended infiltration surface elevation(s) 101.3 ft (as referred to site plan benchmark)
Additional design / site consideration sinstall 4'x 95' rock bed mound on 100.3 as upslope edge of rock w/ V sand fill
Parent material loess over till Flood plain elevation, if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system ❑ S® U ® S❑ U ❑ S N U ❑ S E ❑ S ®U ❑ S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ff
Horizon
ch
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed !Trench
l 1 '0-4 10YR 3/3 - sil 2 f sbk mvfr CS 211m .5 .6
2 4-14 10YR 3/3 - sil 2 m sbk mvfr CS lm .5 .6
Ground 3 14-20 10YR 5/4 - sl 2 m sbk mfr gs lm .5 .6
elev
99.7 It 4 20-28 7.5YR 4/4 - sl 1 m sbk mvfr gs 1 f .4 .5
Depth to 5 28-36 7.5YR 4/4 f2d 5YR 4/6 sl 0 m mfr - - .3 .4
limiting
factor
28"
Remarks: occasional gr, cob & st below 14" -
.,..,_2.. 1 0-3 lOYR 3/3 - sil 2 f sbk mvfr Cs 2flm .5 .6
2 3-10 lOYR 3/3 - sil 2 m sbk mvfr Cs lm .5 .6
Ground 3 10-14 10YR 5/4 - A 2 m sbk mfr gs if .5 .6
elev
100.3 It 4 14-24 7.5YR 4/4 - sl 1 m sbk mvfr Cs 1 f .4 .5
Depth to 5 24-35 7.5YR 4/4 fad 5YR 4/6 A 0 m mfr - - .3 .4
limiting
factor
24"
Remarks: occasional r & cob below 12"
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref #
10/9/97 222774 182
PROPERTY OWNER: Home, Ken SOIL DESCRIPTION REPORT ~s2 Page 2 of 3
PARCEL I.D.# 010-1060-10
Horizon Depth Dominant Color Mottles Structure GPDlitz
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots
Bed :Trench
3 1 0-4 10YR 3/3 - sil 2 f sbk mvfr cs lf/m .5 .6
2 4-13 10YR 3/3 - sil 2 m sbk mvfr es lm .5 .6
Ground
elev 3 13-20 10YR 5/4 - sl 2 m sbk mfr gs if .5 .6
100.3 ft 4 20-24 7.5YR 4/4 - sl 1 m sbk mvfr cs if .4 .5
Depth to 5 24-28 7.5YR 4/4 f2d 5YR 4/6 sl 1 m sbk mvfr cs - 4 5
limiting
factor 6 28-38 5YR 4/4 f2d 5YR 4/6 sl 0 m mfr
- - 3 4
24"
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
I _7
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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u
Wisconsin Department of Commerce TE EVALUATION Page I of 3
Division of Safety and Buildings i Ciess it PIR. Wis. Adm. Code
Attach complete site plan on paper not less than 8% x 1l e. Ian m County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, an nd distance to nearest road. Parcel I.D.#
010
APPLICANT INFORMATION - P o tion. -1060-10
. 15.04 1 m Reviewed By Date
purposes (
Personal information you provide may be use f ndary s
Property owner c--/' K CNEI► Property Location
Horne Ken Govt Lot SE 14 SE 1/4 S 25 T 30 N,R 16 W
Property Owner's Mailing Address O C T } G 1997 Lot # Block # Subd. Name or CSM#
1549 CTHW D Lo ax
city State Code Yn El City ❑ Village ®Town Nearest Road
Emerald WI 2 zof,~m~~ Emerald CTHW G/D
® New Construction Use: ® id~rt ' 6V-'pe o edrooms 3 ❑Addition to existing building
Replacement ❑ Public al describe
Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/fF .6 trench, gpd/ft'
Absorption area required 900 bed, T 750 trench, fts Maximum design loading rate .5 bed, gpd/ff .6 trench, gpd/ft'
Recommended infiltration surface elevation(s) 101.3 ft (as referred to site plan benchmark)
Additional design / site consideration sinstall 4'x 95' rock bed mound on 100.3 as upslope edge of rock w/ 1' sand fill
Parent material loess over till Flood plain elevation, if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system ❑ S ®U ® S ❑ U ❑ S ®U ❑ S ®u ❑ S ® U ❑ S ® u
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots _ GPD/f?
Boring# Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 1 '0-4 10YR 3/3 - sil 2 f sbk mvfr cs 2flm 5 6
2 4-14 10YR 3/3 - sil 2 m sbk mvfr Cs lm .5 .6
Ground 3 14-20 10YR 5/4 - sl 2 m sbk mfr gs lm .5 .6
elev
99.7 ft 4 20-28 7.5YR 4/4 - sl 1 m sbk mvfr gs if .4 .5
- - 3 4
Depth to 5 28-36 7.5YR 4/4 f2d 5YR 4/6 sl 0 m mfr
limiting
factor
28"
L
Remarks: occasional r cob & st below 14"
2 1 0-3 10YR 3/3 - sil 2 f sbk mvfr _ Cs 2fl m .5 .6
2 3-10 IOYR 3/3 - sil 2 m sbk mvfr Cs Im .5 .6
Ground 3 10-14 10YR 5/4 - A 2 m sbk mfr gs if .5 .6
elev
100.3 ft 4 14-24 7.5YR 4/4 - sl I m sbk mvfr Cs 1 f .4 .5
- - 3 4
Depth to 5 24-35 7.5YR 4/4 fad 5YR 4/6 A 0 m mfr
limiting
factor
24"
Remarks: occasional r & cob below 12"
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote AJ~ 715-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref#
10/9/97 222774 182
PROPERTY OWNER: Home, Ken SOIL DESCRIPTION REPORT Paz Page 2 of
PARCEL I.D.# 010-1060-10
Depth Dominant Color Mottles Structure GPD/ft2
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
3 1 0-4 IOYR 3/3 - sil 2 f sbk mvfr cs 1f/m 5 6
2 4-13 10YR 3/3 - sil 2 m sbk mvfr cs lm .5 .6
Ground
elev 3 13-20 10YR 5/4 - sl 2 m sbk mfr gs if .5 .6
100.3 ft 4 20-24 7.5YR 4/4 - sl 1 m sbk mvfr cs if .4 5
Depth to 5 24-28 7.5YR 4/4 f2d 5YR 4/6 sl 1 m sbk mvfr cs - 4 .5
limiting
factor 6 28-38 5YR 4/4 f2d 5YR 4/6 sl 0 m mfr - - .3 .4
24"
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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561443 ti
CERTIFIED SURVEY MAP
Ron and Elizabeth Forrest
The Southeast 1/4 of the Southeast 1/4 of Section 25, Township 30 North, Range 16 West, Town of
Emerald, St. Croix County, Wisconsin.
,~~Illllltlf/CAF,
3 K
LAURiEr,F
H
W MY °C
m
0
Dated:.June 2, 1997 •••IVER FALLS
Revised; June 12, 1997 Wisc.
Q
"Revised this 24th day of i 9FQ • SJ East Ouorter Corner
Section , June, 1997." ~ ANO\(8erntsenSNo% Found) W
OWNERS ADDRESS Laurence W. Murphy
116 PINE STREET Registered Land Surveyor
GLENWOOD CITY, W1. 54013 M
I
UNPLATTED LANDS 1
NOR TN L INC SE 114 - SE I14 SECT/ON 25
_ N8-9053'1-9".1 1318:57'--- - - '
X n-859.62' -T X X y X- 408.9, ~ I
- r-, 03 r:
EX/STING FENCE x, 5 i N
1 0 Ob' of
~a• LOT 0
W z1
218,160SO.Fr•O 1 N Jl
6.008 ACRES p,~ 1
V (INCL. R/W) h)
tql O a 19 4,B56SQFT. It a N N W~
p 1 N d 4.473 ACRES 2
Q I H (EXCL. R/W) I O W Q I
•~I N ~i S V -JI
00" tu Ch CL
408.70' \ I
I I I W O
S 870
581 '5
.70$ W
y ~ H
3 APPROVED LOT 2
WN RUINS OF
y 0 !,5/6,300 SOFT. OR 34.810 ACRES DWELLING W I -
_ N {aj 'i I•' 'C (INCLUDING R/W)
q tn W I
a .J 7 Q0
431,993 SO. FT. OR 32.874 ACRES l w , 2 LOT 1, C.S. M.
W O (EXCLUDING R/W) WELL' I I V0-- PAGE 1616
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
r
OWNER/BUYER ~ 2 lsJ i (1 V1'C~. 4 ~)'C~t r\ -cte-
MAILING ADDRESS l ~i~l V~ t- Y'h l2 K~ l~ 5`l-b 2
PROPERTY ADDRESS - S(y Z
(location of septic system Please obtain from the Planning Dept.
CITY/STATE Ej2Q 6 /1 '
PROPERTY LOCATION 1/4, 1/4, Sgction e , T 3C~N-R_~_ W
TOWN OF F- na~" (k9 ST. CROIK COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME, PAGE LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible.to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation+prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
" I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
4111-
SIGNED:
DATE: /C) 7:5 I
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
B T C - 100
This application form is to be completed in full and signed b
owner(s) of the property being developed. An inade 1' the
quacie
only result in delays of the permit issuance. quoind s will
development be intended for resale by owner/contractor, this
house), then a second form should be retained and completed (when spec
the property is sold and submitted to this office with
appropriate deed recording. the
owner of property
Location of property 1
cr-
~ Z1/4, Section ~
/4-- -R W
Townshi
PbCI
---Mailing address ~
Address of site
Subdivision name CS yam,
Other
other homes on property? P. Lot no .
A No
Previous owner of property
Total size of property _Jj
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable?
o
Is this property being developed for (spec house ?Yes N~~_
Volume and Page N )?Yes Yes umber as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DO
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS R' VOLUME AND PAGE
In ad, a
certified survey, if available, would be helpful so asdtol avoid
delays of the reviewing
references to a Certified Surve process. If the deed description
shall also be required. y , the Certified Survey Map
PROPERTY OWNER CERTIFICATION
I (We) certify that all statements on this form are true to the
best of my (our) knowledge that I
property described in this (We) am (are) the owner(s) of the
warrant information form, by virtue of a
y deed recorded in the office of the County Register of
Deeds as Document No.
own the proposed site for the sewage~disposaltsystem or I (we) and I obtained ( ) Presently
an easement, to run the above described property,
construction of said system, and the same has been duly recordedtin
the office of the County Register of Deeds as Document No.
431 gnatur Applicant
Co ppllcant
Date of signature
-31-7 7
• r
VOL '?6 PACE42-~
- r
564986 STATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUMENT NO. REGISTER'S ICE
ST. CRCIX Co., WI
RONALD FORREST AND ELIZABETH FORREST, HUSBAND AND WIFE Repo for Record
SEP 0 8 1997
10:00 q
cones and warrants to KENNETH W. HORNE AND JEAN A. ,
Register of Deeds
HUSBAND AND WIF PROPERTY R
TO SURVIVORSHIP
THIS SPACE RESERVED FOR RECORDING DATA
I
the following described real estate in ST CROIX County, NAME AND RETURN ADDRESS
FIRST NATIONAL BANK OF GLENWOOD
State of Wisconsin:
PO BOX 338
GLENWOOD CITY WI 54013
LOT 1 CSM
VOL 12, PAGE 3281, RECORDED 06-25-97, DOC #561443
IN SEC 25, T30N, R16W, ST CROIX COUNTY, WISCONSIN PARCEL IDENTIFICATION NUMBER
T t~SFER
FEE:
I This IS NOT homestead property.
(is) (is not)
Exception to warranties:
t
I
1
I, Dated this 20TH day of AUGUST , A.D., 19 97
(SEAL) / der (SEAL)
« RO LD FORK ST
(SEAL) (SEAL)
« « EL ZABETH FORREST
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
ST . CROIX County.
authenticated this day of , 19 Personally came before me this 201 H day of f%'7 11