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004-1041-10-100
St. Croix County Planning and Zonin Tuesday, February I5, 2005 at 9: 06:26 AM Detail Sanitary Information Page 1 of 4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TNIRNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 114 1/4: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 12/16/2004 POWTS Dispersal: Mound Permit: Change of Plumber County Permit: 83 Installed: 12/21/2004 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA --~ Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Knudtson, Keith Owner signed affidavit needs to be recorded Signed Off: Yes for >3BR house connected to 3 BR system - supplied to owner on 12/21/04 ~~ ~~s~~ Ad ~tional Notes Money Owed chan a of plumber from Dale Hudson. Submitted $0.00 with 'gned application form and plot plan. Obta ed elevations on mound system. Confirmed ne ouse location with regard to tank and und, plus disconnection of house trailer from fhe system. The new building sewer line is insulated 28' out of house + 20 feet to tank. Old building sewer was 3034 pipe that had bellied and was collecting water and needed to be replaced anyway. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 12/21 /2007 S't. Croix County ~'lanniing and Zoning W'ednesdav, Ja~ruarp 02, 2008 at 4:01:33 PM Detail Sanitary 1 nformation Page 3 of 3 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Gady, Town of CSM: Vol. 16 Pg. 4378 114 114: NE 1/4 NE 1/4 _. S't. Croix County Planning and Zonin Tuesday, February 1 S, 2005 at 9:06:26 AM Detail Sanitary Information Page 3 oj4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 1!41/4: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 05/21/2004 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 75 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Reauirements Pam Quinn NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. Pam Quinn Notes Inspector Pam Quinn Pam Quinn NA Knudtson, Keith Signed Off: No As Built Plumber Other Reauirements NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. NA Knudtson, Keith Signed Off: No Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owners must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number St. Croix County Planning and Zaning N%eduesduy~, Jauuarp 02, 2008 at 4:01:33 PM Detail Sanitary Information Page 2 of 3 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 1/4 1/4: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 05/21/2004 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 75 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuer/Inspector As Built Plumber Other Requirements Addition~l_Notes Money Owed Pam Quinn NA Hudson, Dale Removal of house trailer with construction of new $0.00 Not determined No home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Obtained mound measurements and elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculated lift and documented existing pump model, etc. and distances of tank and system to setbacks from house, etc. Changing from Dale Hudson to Keith Knudtson to do reconnection. Will require the information be • obtained for mound elevations, etc. Will issue a new county permit number Owner: Lamb, Dennis 2791 40th Avenue Wilson, WI 54027 State Permit: 193469 Issued: 06/15/1993 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07/23/1993 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA eat Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson Yes Pelke, Herb Original permit is on file with reconnection -was $0.00 Jim Thompson No not signed by inspector - no record of a final inspection to show elevation of sand, pipes, or final grade of mound!! Pumped 3113/03 St. Croix County Planning and Zonin Tuesday, February I5, 2005 at 9: 06:26 AM Detail Sanitary Information Page 2 oj4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 1/41/4: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 05!21!2004 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 75 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. Pam Quinn Notes Inspector Pam Quinn Pam Quinn NA Knudtson, Keith Signed Off: No As Built Plumber Other Requirements NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. NA Knudtson, Keith Signed Off: No Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to Goset) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number St. Croix County Planning and Zoning Detail Sanitary Information Page 1 q/'3 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parce! #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 114 114: NE 1i4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 12/16/2004 POWTS Dispersal: Mound 24" or more suitable sot Permit: Revision -Change of Plumber County Permit: 83 Installed: 12/21/2004 POWTS Oetaii: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Issuzr'~nspector As Built Pam Quinn >4/1/00 -Not Required Pam Quinn P3i'u€3 " Yes Plumber Other Requirements Knudtson, Keith system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Wednes~lc{v, January 02, 2008 at 4:01:33 PM Additionai Notes Maney Ovred change of plumber from Dale Hudson. Submitted $0.00 with signed application form and plot plan. Owner- signed affidavit needs to be recorded for >3BR house connected to 3BR system -form given to owner 12/21/04. Obtained elevations onexisting mound system. Confirmed new house location with regard to tank and mound, plus disconnection of house trailer from the system. The new building sewer line is insulated 28' out of house + 20 feet to tank. Old building sewer was 3034 pipe that had bellied and was collecting water and needed to be replaced anyway. Scheduled.Pump Date Pumped 12121 /2007 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gallatin, Scott & Shannon Cad Townshi CS7 BM Elev: Ins . BM Elev: BM Description: /Ci~t~t- ~yi,. (~ ` 77.3 /~I 13 TANK INFORMATION ELEVATION DATA TYPE MArNUFj4C.jTURER ..~~--~?'' j~ CAPACITY Septic t ~~ /, I v Dosing Aeration __ Holding _ _ -~-~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~,~t Dosing ~ ~t~ Aeration Holding PUMP/SIPHON INFORMATION Q b --SC N ~b Manufacturer n Demand ~~ ~ ~ S GPM i MOpel Number ~i TDH Lif~ ~ ~ Friction Loss System Head Forcemain Len th ~ Dia. ~ a Dist. to Well ~,~ ~ Cf111 ARC(1RPT1~1N CVCTFM Ft County: $t. CCDIX Sanitary Permit No: 83 State Plan ID No: Parcel Tax No: 004-1041-10-100 Section/Town/Range/Map No: 18.28.15.275A10 STATION HI FS ELEV. B ncg hmark,~-~ / ~ ~ ~ ~ ~r ~ `~ Alt. BM U G -L Bldg. S~ >Q%~dta ~+¢ ~ L4 r SUHt Inlet ~ / ~0 ~,~C7 a SUHt Outlet ._-- Dt Inlet ~` • Dt Bo~ttom!_ ~` `~ Header/Man. Disc Pie„! °~ ~" d t! Bot. System ~ // G" . /J Off" 3 ~~ ~ (J"J Final Grade ~y I ~ ,s /~ (Jw (~ St Cover Z.~ ~/j/tfir~ c~ !7 ~' ~ ~ '' // 7~ ~~ir1n 'f1nA/I. h.~" iA.r.~//J ~~~ _ ~ ~ f.- !7~ ~.T'~`.r- v i BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f System: UNIT Model Number: 1 g g DISTRIBUTION SYSTEM - Header anifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlfrench Center Bed/Trench Edges Topsoil [~] Yes ~ No ~ Yes ~ No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~Y ~ /~ ~ Inspection #2: 1 i Location: 2791 40th Avenue Wilson, WI 54027 (NE 1/4 NE 1!418 T28N R15W) NA 1 ~ ~~ Parcel No: 18.28.15.275A10 1.) Alt BM Description = ~~ ~/tP~/ ~~UYtiYt~~ 1 2.) Bldg sewer length =~S U /Q..~ t av~~ ~ 7t ~ ~ ~ wJ l~![d ~ ,.7~~ f~ -amount of cover = P ~" dJ~~ d V I/7-~/j'T /,~~ 3. Contour = ! ~cJ (,~G~t~t~ `f"n- LR.t~_ End ~2 Pian revision Required? [Yes ~ o ,~ / Use other side for additional Information. ~ ~" l _ u ~ ~ -_ _ 6 -~ SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. / s ~ p ~J ~• ~ `^~ V ~~.. {~ ~s~~ ~~~~b ~' \ `~ o ~~~~. J V ~ ~ ~ ~ . 4 ,~ ~~ ~ ~~~ " ~ --~~ a~nii\\ ~ ~ ~. ~ ~ ~~ `,~ ~ ` 2$' ~~r"~s~t(n~-~ spy c fa .~,- ~' Sc F.l~a ~ n~ --.- Z ~ `~~~~~ ~~ V ~ iL ZJ ~~~h LD n c%~ ~~ ~oo Jz ~~~ z~~~~ U n v fl v ~ ~. `~ vt ~ .~ ~` a ~ ~. ~ ~ ~ ~ ~ 3 rjy OC`, [(~,~ VJ ~~ n ~~ 4 ~i ST. CROIX COUNTY No.sTC- o o e' 3. SANITA ~~ ~ OWNER s~o~r Y >uan~J RMIT REPAIR ^ RECONNECTION NON-PLUMBINf3 ^ SANITATION REJWENATION ^ purpose of the sanitary permit is to allow repair, recorx~ec n, or installation of non-plumbing sanitation as described in for permit. PLUMBER xEI T~ /W~I ~T.jO/" LIC. # Wp ~,iy3 TOWN OF ~ LOCATED ~ ~N~ SEC ~~ T Z ~ N;R IS W AND/OR LOT r~,~, ~~ THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE TWO YEARS FRt~GI ORIGIN DATE OF ISSUANCE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION BLOCK ~~' /r ~/67,SUBDIVISION The approval of the santtary permit is based on regulations in force on date of Issue. The sanitary permit is valid for 2 years from original date of fasuanoe r be renewed for similar periods thereafter. Application for renearal shall j through the county and shall comply with regulations in effect at the ti (d) Changed regulations will not impair the validity of a sanitary permft unfit the time of renewal. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought. Changed regulations may impede renewal. (f) The sanitary permit b transferable. A sanitary perrnR transfer shalt be obtained from the St. Croix County Zoning Department. " If you wish to renew the permit, or transfer ownership of the permit, please contact the St. Croix County Zoning Department. • ~ AUTHORIZED ISSUING OFFICER -DATE County San ry ermit Application sT. cROlx couNnrwlscoNSIN M acbwd with 15.04 St. Croix County Sanitary Ordinarae ZONING OFFICE Personal infam~ation you ptoWde maybe used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy ~• S.15.04(1xm)J 1101 Camnir:hael Road Hudson, WI 54016-7710 (715 680 Fax 15 666 Attach ete ns for the s on rat less than 8-1/2 x 11 irx~es M size. Count Pemnit # Q vision to previous ication ra ' t ,( ~ . L~ ~s . ~~~a- io tcation Inforrnadon -Please Print all Information l.ocaNon: Owner Name 1 ./ /v ~ 114 !V 114 Sec , S ~ O G / ~ ~~1 T N, R ~j~ E W Property Owners Mailing Address t.ot Number Black Number ", 9, O ,,,~ /-~, ST. CROIX COUNTY ~ . r'i Z ,State Zip Code on Subdivision ame or M lumber T of Building: (check one) /~d~1~ ~~ ~ s~„~ ~ w 1 or 2 Famil Owepin 3 - No f B d ~y ^vl~ ~ y g . o e rooms: . ~ D ^ (describe use): O Sib-owned Nean~t Road ~ , n Type of Permit: (Check only one box on fine A Check box on line B if applicable) ~D ~J ~"`-- Paroei Tax Number(s) 1.p Repair 2. Reconnection 3.^Non~lumbing . ^ReJuvenation N OOS~ /0~~--/v /Ot> sanitation Peimit Number Q B) ~ ~ ~ ~ 3 Date Issued ~O /S~ y ~ ~ ry P was preVausly issuer Q~ 1 Z l Q . Type of POINT System: (Check all that apply) ~/i ~ O Non-presstuized In~round Mound 7 x 9~ ^ Sand Friter ^ Constructed Wetland O Pressurized In-ground O Holding Tank ^ Single Pass O Drip Line ~ 11t•9rade Treatment Unit ^ Recirculating ^ Other . OlspersaUTreatmentAreo Information: ~ 1. Design Fbw (gpd) 2. Dispersal Area "s 4. Seri Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required (GalsJday/sq.ft.) (Min~nch} Elevation Tarok Information Capaicty in Gaikttu Total # of Manufacturer Prefab Site Con- Steel Fiber Plastic New Facisting Gallons Tanks Concrete stnicted glass Tanks Tanks ~~ l fv~s ^ ^ ^ ^ J~ CSI o ^ O ^ . Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnerx:tioNrejuvenationfinstallation of ran-plumbing for the POWTS shown on the attached plans. A is not required for terraliit repair or the ins 1 'on ing 'lotion system. Pkxrrbers Name (print) PI r e mps • MP/MPRS No. Business Phone Number ~l r o ,3 ~/- 5r7d f 3' Pkrrmber's Address (Street, City, Sjtate, ) dam/ .. ~~ ,~ o~~ ii. Coun Use Only Disapproved MProv~ Owner Given Initial Adverse Sanitary Permit Fee C~/ 0 !~'~~ .~1thn °~ (/ C Date Issued ! Z/ nt 1 ng A g S~ignatu o stamps) Oetennination t:/ ~ 7 ~ ~ ~ , l~i~ `t-rr~c ~ UC. Conditions of Approval/Reasons for Disapproval: n ~ ~ ^ ~~G~ / ( ((./v r ` ~~ ~~G~rrN v~ ~T I~~ ~~ r (~'l ~ ~20-~~~Ci~l~ f~~ J U 7 S' D ~¢-e, C,o~~ ~ d'4.C ~~yvr. ~ ».~ SG~~=e~LO7-. ~G~-i~-'. --~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 JUL 1 5 2004 S ~ . Ci~UIh 000N ;_ AFFIDAVIT OF RE-CONNECTION BONING Or=F;CL Property Owner : SCO"L7-'- f~ J~K~/y l~ ~~'(~C..R?7N Address: ~7g~ ~©7N • GU~~~ w.~ Day time phone : (~) ~p 9~ -~oZ~ Parcel S.D.# ~- ~a'~/ ~ (~ "~~ l/~. ZP./~. eZ"']~i~ ~!)~ Legal Description of property: ~1/, ~~, Sec., T. Z~ N., R. t`~ W. , Tn. of C.f'~D y , St. Croix County, WI As owner of the above described property, I acknowledge that the septic system serving this proposed _~ bedroom residence is undersized by current code standards, but otherwise meets all requirements of State Statutes, Wisconsin Administrative Code and St. Croix County Zoning Ordinances. I understand that the issuance of a sanitary permit to allow the re-connection of the existing system does not imply that the system will function properly after it is placed in service. I also acknowledge that I will inform any future parties interested in purchasing this property that this permit was issued for the re- connection of an existing septic system and not forme installation of anew system. Signature: ~ ~Q,;1~t~~7`~/y~ GU~,~j~~ Date: (D°f•Q ®~~`y J. SKF~~,o2 IdOTAAY ~ - • - ~r `~~ ~lJ~I.IC z ~~ T~T~ OF W 1sC'~~ ~~~,~ _o v fl v ~ ~ \ V J . .~ V-i f ' (J R F `y~ 9~ ~ ynfh ~§- O ,~ }i 4 ~e t~ ~ \ ~ " eM1 ~7 ~ '~3 .~ '. 1-t. . s ~' ~. ~ ~ '~„ i : `.k ~; r ~ ~ ~ w r .R `~ ~; ~ `~. _ ._ f `~;~ ~ ~ ~ 1 q { } ~..,~-~.m-.+.... ~..,~_.~....__.._._ ..._.. ... _... ,. .. ... ..... _ _,_,.. ~ ^. ~~ _ "_"°..` ~ y:s S ~ d ~_ ~ S ~ E a, ;~(~ ~ ,y j ^~ ; ~ Z~Y t L , (~ y ..~ T. ~ O J ~ ~ o. ~~~ U 4y °'''S ?.l i ~s~ 1 ~" ,~~. At 4'' ~?t i ~F ;roe ~, ~, ~. ~~~ r~ y. ~ \~ t Fi ~ `~. ~y ~~ St. Croix County Zoning Detail Sanitary Information Thursday, December 16, 2004 at 11:38:09 AM Page 2 of 4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady Township CSM: Vol. 16 Pg. 4378 1/4 114: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 05!21/2004 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 75 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes lnsaector As Built Plumber Other Requirements Pam Quinn NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. Pam Quinn NA Knudtson, Keith Signed Off: No Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. Pam Quinn NA Knudtson, Keith Signed Off: No Additional Notes Money Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to Goset) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since system is undersized compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of reconnection on their deed. Changing from Dale Hudson to Keith Knudtson to $0.00 do reconnection. Will require the information be obtained for mound elevations, etc. Will issue a new county permit number St. Croix County Zoning Thursday, December 16, 2004 at 11:38:09 AM Detail Sanitary Information Page 4 of 4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady Township CSM: Vol. 16 Pg. 4378 1/4 1/4: NE 1/4 NE 1/4 Owner: Lamb, Dennis 2791 40th Avenue W!Ison, WI 54027 State Permit: 193469 Issued: 06/15/1993 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07/23/1993 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Jim Thompson NA Pelke, Herb obtain system elevations at time of Original permit is on file with reconnection -was $0.00 Signed Off: No reconnection inspection!!! not signed by inspector - no record of a final inspection to show elevation of sand, pipes, or final grade of mound!! Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/4/2002 3/13/2003 3/13/2006 7/23!1996 SB CredentialDetail eorn~nerce.v,~.gav` ~~~~w Cs~,~r~~acr,t a~ Coror Credentials listed for KNUDTSON, KEITH E Black=Approved Yello~~~= n Rcncrval Process Red=Expired or Not Valid CE CE Credential Hours Needed Type Expiration Needed By Journeyman Plumber-Restricted 03/31/04 ~ 12/3!/03 Service Master Plumber-Restricted Service 03/3l/OS ~ 12/30!04 POWTS MAINTAINER 11/29/08 12 08/30/08 Plumbing Learner-Restricted Service 10/22/00 ~ 07/23/00 Page 1 of 1 12/20/2004 Wisconsin Department of Commerce Safety and Building Division ..~ PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Gallatin, Scott & Shannon City Village X Township Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM l9 g S ~ Z-,v~ ~C..2Ci~ ~ -- dP.~ ~ BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. T f S tem: yp~'tgi~ ~ UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 SeededlSodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil [~ Yes 0 No ~, Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2791 40th Avenue Wilson, WI 54027 (NE 114 NE 1/4 18 T28N R15W) NA Lot 1 Parcel No: 18.28.15.275A10 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = ELEVATION DATA County: St. CfOiX Sanitary Permit No: 75 Stat Plan ID No: Parcel Tax No: 004-1041-10-100 Section/Town/Range/Map No: 18.28.15.275A10 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover 1 r Plan revision Required? I"' Yes [~j No ~~ -- III Use other side for additional information. ~~ j.__ J ~__ _____ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. 04/26/04 MON 10:48 FA$ 715 386 4686 ST CRX CO ZONING 1002 County Sanitary Permit Applica~on ., sT. cROlx couN~rir wlscoNSIN In accord wph 15.04 SL Croix County 3anttary Ordinance ZONING OFFICE Rersorral irrtprrnation you pnovlda maybe used for 58oonda<Y purpese5 ST. CRO C«1NTY GOVERNMENT CENYER jPrivacy Law. S. i 5.04(1 xm)] 1101 Camrirhaei Read Hudson, WI 540157710 15)386.4680 Feat 15 Attach complete plans tar the system an paper trot less than 8.1/2 x 11 I in size. ^ on to previous app~aii«t sty Sanitary Pemtlt / 8 - ~~g ~ . d ~ 5 A ~ a ~ . 1. Icatiort Information -Please Print all Information Locado : ~a~ ~ owner Name ~ 3 ..~ 1 . ~~lF~ t/4 1/4.3ec N / . ~ Q T N. R Owners Ma~ngpAddress ~ ~ ~~ ~~ 1 g 2 d O ~ Number Block Nrxnber ' Zip Code Phor~r,Ntj I X i; U U PS ~ ~ . , Subdivision Name or CS Number , 1~1~d r~ l ,~, ~~ ~ ~ ~ b~ ~ 70 ~ I T of Suit ing: (c sdc one of Bed ~/~~~`-~~ ~ ~ " " fs 1 or 2 Farnity Dwelling - No i~ ^YrAage own of ~~ `~ . ~ S r ~ _ bay N ~~ ^ 3tate~owrted (~~ ~ - Nearest Road ~ -~ ~ licable) ~ l B' ' ine app 1. Type of Permit: (Cliadc oNy boot on line A. x on umbe s) N ~ 7.^ Repair' 2. R~ uectba 3.L7 umbing .1] ReIW~ ~ ~fQ 7 ~' /~ ! r "' /a ~ O !~ L, ~ Permit N ~ ~ Q B) Mate Sanitary Permit was previously Issued _ 1 Date Issu S .'f~ry>'e pf POVYt' System: (Check ail that apply) © Nan•pressuriZed In.ground Mound ~f Y~ ^ Ilter WeU ^ PreesUtlZed in-ground Q Holding TaNc ^ Si Pas ^ Aerobic Tree ^ ^ At~rade ~ reatmettt Araa information: i R m E S 6 t . laeslgrt Fiovr (gpd) 2. Dispersal Area ~ 3. Dis al 4. Sal Rorie - ~n 5 orie on 5- Perr~lai Inlnehj ys e . S-7 Required s Proposed -4- (Gals) y/Sq- s ~~ ~, 3 ~- 3 . 2 . .lank Information Capaicly in Total # of Ma faau Prefab Site Con- d U t Steel New Sdsting ons 7at>Ics Concre e stru e TaiikS T Tt D ~ S ~ ~ vation 7: Final Grade ~ Elevation Fiher- Plastic 9~ ^ ^ a le ~ ~ 1. R6Sponstbility Statement . 1, the undersigned. assume responsibility for repairJrecorrrrertctiord rratiaMnstallation of non-plumbs for the POWfS shown on the attached plans• A 6S not required for terralift repair or tits installation of ing sanitation system. MPIMP $usirtess PMane Number s Name ? S'4 Plumber - lure cn~o~sta ): ~ ~ 'i5~- ~~~'°' -~~~ i I G , G. Plumbers Address (Street. .State, Zrp Gods t ~ J ' n. Cooney Ilse Onl D•~ Pemtit Fee / e Issued I nt Signor ~~~ Approved Owner Galen initial Adverse ~' df S~~ / D Determination / ~ ~` aUReasons for DlSapprovai: ~~ ~' ~ ~1 Se ~£bR'~" /i ~~y,..~~, v d ~Griy QjL~ L7-F nPrs^l air ~St ail be ervlc , ~ ®d ~' ~ /~A~C~-~ as_ermaua~ent plan provided by plu er. ~:~T.~~eJ ~~~~ Zip ~~,,~~p 2. All setback requirements must be maintai d S~ ~ ~/~ ~ ~G`'° D~~r!~.. , v as per applicable codelordinances. ~/S~~ ~ ~ 3 ~l // Z o~ ~~ c~c~ r~~n~d ~~--ru~:c, 900 ~ ~~r.~.~~ ~' ~.~~ a~ ST. CROIX COUNTY r+o.src- o o k S SANITARY`PERMIT OWNER ~"1+Tr~A'T~N PLUMBER ~ ~tJp S0~ LIC. # Z2oPS3 TOWN OF 2~1 °~ ( ~D~ ~Q SEC ~_ T Z S N;R f ~~ AND/OR LOT ~_ BLOCK ~~9 (moo ~ ' ~/~L~-j THIS PERMIT EXPI TWO YEARS SUBDIVISION REPAIR ^ RECONNECTION NON-PLUMBING [,] SANITATION REJWENATION ^ purpose of the sanitary permit is to allow repair, reoonnec n, or installation of non-plumbing sanitation as described irr for permit. The approval of the santiary permit is based on regulations in force on date of issue. (c) The sanitary permit is valid for 2 years from original date of lasuanoe a may be renewed for similar periods thereafter. Apptlcation for renewal shall made through the county and shall comply with regulations in effect at the ti (d) Changed regulations wilt not impair the validity of a sanitary permit until the time of renewal. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought. Changed regulations may Impede renewal. The sanitary permit is transferable. A santary permit transfer shall be ned from the St. Croix County Zoning Department. AUTHORIZED ISSUING OFFICER - DATE i~ UNLESS RENEWED BEFORE OFISSUANCE POST I N P LAI N VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION ~s~ LOCATED ,T DATE VIEW PLUT PLAN PROJECT NAME: f~E,~„~if 1,~~.i8 PROJECT LOCATION: F ~ p„~ S . of ly~ Sr. L'd/X Lo. M. P . LICENSE 4~ : .3,? - ~,e ~~~ SIGNATURE : ~,~„~ ,_,.~ ~~ ,' - .J DATE: sy_93 ti t` / ~., T mar. ?~ y ~, A~ _ `S'o a ~^ °„ (_ Cry OL` r ti ~`z ~G Go~S ~- `:~a ~~ ~~ ~'~' ~ '~~ ~~_ - ti '~ ~ ~ ~ ~ _° `~• ~ `o -~ ~~~~ • C • v~ i! ~ V ~O / ~= yo ~ p ao' sro ~ LBO = /.1 /1 ~ ~ /DU ya® o~ Gam` dl.~s- 18(= ~/J L - /at ~ tv~ of /sr S t~dc F!~/c~ ~~ ~ sV F rr~ ~ 00 o Fa s r ('Fos r it .S,..P'~~oeed~ ~aa.../o) yo ,¢c.e~ D.~~tc~t~i~dss~oa it/o OTNf~t NOUd~ p.c a/ALL N~ rv~,/ moo ' d ~ y ~ o~ ~tsr,., ~~~~ w ~~ d mod(, /OOL~ !SO ~ Go~tfo ds ~S ~ / Ao~btr0 i 3 - /~~. ,~ /~ ayu Qao~esrr ~ u166~ d ~,~ss Dili •4 °'`~s S } mil fs F" ~°`'~/4 ~_ /d'` y L lurk. r"o ~ o/otro ~~ io~r S,~lo `6~ 5~ D~ ~V 46 0 ~ 1i f f 0 09•° ~ ~ ~ i M ~~s~ b ~Ea~~ P°5~ F G ~a~~ ~s~o, ,p NA r v~ y Z ~a Q - - ~ R ~/ / ~r«~ SAO ~y~ ~~~F~ St. Croix County Zoning Detail Sanitary Information Friday, May 21, 2004 at 4:00:27 PM Page 1 of 1 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.375A10 Lot: 1 TN/RNG: T28N R15W Municipality: Cady Township CSM: Vol. 16 Pg. 4378 1/4 1/4: NE 1/4 NE 1/4 Owner: Gallatin, Scott & Shannon 2791 40th Avenue Wilson, WI 54027 State Permit: Issued: 05/21/2004 POWTS Dispersal: Mound 24" or more suitable soi Permit: Reconnection County Permit: 75 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Hudson, Dale Absolutely get mound measurements and Signed Off: No obtain elevations at observation pipes for system bed to tie into dose tank bottom elevation. Calculate lift and document existing pump model, etc. and distances of tank and system to setbacks from house, etc. Additional Notes Monev Owed Removal of house trailer with construction of new $0.00 home on-site. Plans show 3 bedrooms plus a "sewing room" with shelves (could be converted to closet) and office with no closet. Existing family is 4 persons and they knew house plan had to meet 3 BR limitation. Since svstem is ~mdersi~ert ~---- compared to today's code (376 ft2 instead of 450 ft2), the owner's must record an affidavit of nnec ion on their deed. Owner: Lamb, Dennis 2791 40th Avenue Wilson, WI 54027 State Permit: 193469 Issued: 06/15!1993 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07/23/1993 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Jim Thompson NA Pelke, Herb obtain system elevations at time of not signed by inspector - no record of a final $0.00 Signed Off: No reconnection inspection!!! inspection to show elevation of sand, pipes, or final grade of mound!! Maintenance Scheduled Puma Date Pumged 1st Notification 2nd Notification 3rd Notification 7/4/2002 3/13/2003 3/13/2006 7/23/1996 ~~. ~~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 5401&7710 (715) 386-4680 AFFIDAVIT OF RE-CONNECTION ~ SKA~i~Ja~ C Address: ~7g/ ~Q~ ~• GU~~nJ . wz Day time phone : (~ ~ 9~ -~aZ~ Parcel I.D.#~7 - ~~y~ "~~ "'~Uy l/~. ZP./r, e~-~~i4 ~D~ Legal Descriptioin of property: l~'/ ~~. Sec., T. Z~ N., R. ~~ W., Tn. of l.~l'~V y , St. Croix County, WI As owner of the above described property, I acknowledge that the septic system serving this proposed _~ bedroom residence is undersized by current code standards, but otherwise meets all requirements of State Statutes, Wisconsin Administrative Code and St. Croix County Zoning Ordinances. I understand that the issuance of a sanitary permit to allow the re-connection of the existing system does not imply that the system will function properly after it is placed in service. I also acknowledge that I will inform any future parties interested in purchasing this property that this permit was issued for the re- connection of an existing septic system and not for the installation of a new system. Signature: Property Owner: S Date: ~r -~- ~n ST CROIX COUNTY SEPTIC TANK MAINT (~E At3REEMENT OWI~IERSHIP CERTiFICATI4N-.FORM Owncr/Buyer ~( Mailing Address ~ S~~r~ ~"~ 6 ~~~ -~ Y~./ !~ Property Address ('T/~' ~J ©?/~--- ~ ~'~- (Vcrificatioa required frc(m Piaaaing Dcpattauat for acw` City/State ~ .~ O ~ ~ . Parcel Identification Number 00 ~ `~~~ f~ - ~ Q ~ X,EGAL DESCRxP"ITON Property Location /V~ %, ~~%,, Sec. ~ T~ ~ N-R~W, Subdivision a~s~ ~o Town of Lot # ~. Certified Survey Map # ~ 9 ~ ' / t~~ Volume ~ P e # ~ ~ Warranty Deed # ~~~' ~~~ Volume ~~~ Page # d ~ ~- . Spoc ~oase ^ yes L7 no t Lines idea " le CI~'yes ^. no ~-~ a~a~~ sYST>~r~~rAn~rrArreE ~3 8~~ sys~--~-Y, -i ~-3 c~ - - Imgmpcruscaadmaint~caaagcofyemrscgticsystcmcoaldn~Itmi~sp~atui~.fa~cuttohandlcwastcs.PmpernzainLcaan~ae ooasists of pumping oat the septic tank evrry~throc ycass or soak if nondod by a : what y,ar ~ i~ ~ canaffoet.~e'oa of tb~e septiuc tanlc-as.a stage ia~e ~rastefii_sposalsystcm, . _ Tom. Y~ o~ to ~tA St t~+onc Zaaiag Dcpartazcax i _oatificahon faun, signed by the ewzu~ and fir. a • pip ratactodplrnnbcrot•i Ii~ocasodpumpcrraifying that (1) hie oa~ito Rnstcanterfirsposal system is in pnapcr operating cvtyditioa and/or (2) after won sad pumping-(if noocssary), the ccptictank-is Less .than 1/3 ~tuII of nudge. - ~ the uadersignod have ncad the above roquirm~ and agroe too maimtaia the private sewage disposal system wi$r the standards . set faro;, .'as set by the Dcpatimcat of Commcmc and the Dcpartmamt of I~Iataral R,csourres; State of Wise sin.. C.utificat?on that Y~ ~c systaa has Boca maintanoed must be oompktod and returned to the St Qroix.Couaty Zoning Office wi8ua 30 days~of IIae throe year 'era date. SIGNATURE OF APPLICANT DATE OWNER CER77T~'XCATTON I (we) oatify that all its on this form are true to the best of my (our) l~aow[edge. I (we) am (arc) the owner(s) of ~ t~«cy above, by virtue of a warranty flood rcoordcd in Register of Dads Of'ficc. / ~ ._-- TUBE OF APPLICANT ATE «ss«ss ~y infotmatioa that is mis-c~r~sentodmay result is the sanitary permit bCing evoked by the Zoning Department 4sssss `• Include hrlth this application: a starnpod warranty docd from the Regina of Dcods oflicc a copy of the. cutified survey map if refcrwce is made in rho wacrnnty decd U 2251P 052 STATE BAR OF WISCONSIN FORM 2 - 2000 Document Number WARRANTY DEED This Deed, made between Dennis A. Lamb and Rozanne Lamb, husband and wife Grantor, and Scott R Gallatin and Shannon M. Gallatin, husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:; Part of the Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) of Section Eighteen (18), Township Twenty-eight (28) North, Range Fifteen (15) West, To isconsin, more uarticularl as follows: Lot One (1) of Certified Survey Map filed September 25, 2002, in Volume 16 of Certified Survey Maps, at Page 4378, as Document No. 691705, otI•ice of the Register of Deeds for St. Croix County, Wiscons Exceptions to warranties: Easements and restrictions of record. Dated this ~ ~~ day of (/.(/~ , 2003 * AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 54002 (Signatures may be authenticated or aclmowledged Both aze not necessary.) ' Names of persons signing in any capacity must be type WARRANTY DEED ~~~~s` KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , M1I RECEIVED FOR RECORD 05/22/2003 09:30A1i MARRANTY DEED ElfEMPt # REC FEE: 11.00 TRANS FEE: 318.00 COPY FEE: CC FEE: PAGES: 1 Area Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin, WI 54002 L 004-1041-10 Pazcel Identification Number (PIN) This is not homestead property. (itSl (is not) 1~~:-, A - ~~~ * Dennis A. Lamb s Roxanne Lamb ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croia County ) Personally came before me this ~ Vi day of ~` rd~r 2003 a above named rDennis Lamb and Ro. ,.,Lamb to me lmo ':~o be s n who ex cuted the foregoing insttum a e. ~..__~ Notary Public, State of V1-'ISCONSIN My Commisston }~ pfr>~aitent. (I:'not, state expiration date: INFO-PRO (800)6552021 www.infoprofom~s.com !~ d or printed below their stgnatl STATE BAR OF WISCONSIN FORM No. 2 - 2000 APPR~~~~ ST. CRO1X COUNTY Planning lnni~~ enf! Pahe (r,rvlmifleP, Sip 2 5 ZOOZ `may 6 9 1 74_15 VOL 7 6 PAGE 4378 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD If not recoraeU wrtnm 3U days ni 09-25-2002 1:45 PTI a~Q~pvai date approval shall be "t,li ~~d yr REC FEE: 13.00 CER T 1 F 1 ED SURVEY MAP pAGESFEE: 2.00 LOCATED 1 N THE NE i /4 OF THE NE 1 /4 OF SECTION 18, T28N, R 15W, TOWN OF CADY, ST. CR01 X COUNTY, WI SCONS 1 N. PREPARED FOR: NOTE: BEAF21 NGS ARE DENN 1 S LAMB REFERENCED TD THE NORTH LINE OF THE NE 1 i4. (ST. CRO 1 X COUNTY COORDINATE SYSTEM). N I i4 CORNER OF UNPL ATTED LANDS NE CORNER OF ........................... SECTION I8. (FOUND SECTION 18. (SET ALUMINUM CAP P. K. NA 1 L FROM MONUMENT ). NORTH L 1 NE OF THE NE 1 i4 EXIST 1 NG CORNER T 1 ES. 2640. 07' w ~.4.Q.T.H.. w ___ N89°21' 33"E `"- N89°21' 33"E 356. 00' °! __ S89°21' 33"W¢_ r~'~-~-~- ^ 335. 0I' 1949.06' ~„~ w w . . . . . ~ . w o - - j~N89°21' 33"E 356.00' ~ _o - - - I ~ DRIVEI M • LOT I o :Z ;a p r N H 1 GHWAY 2. 62 ACRES ,SETBACK, .L,l NE ~ :~ n M ............ .~ .................. .......... D :y 1 13, 916 S0. FT. :y ~ . 2.35 AC. EXC. RiW ~ 3 ~ :O N ~ GARAGE °102, 168 S0. FT. ^ O :v O :r ~ N ~ SE N h 'r ~2 M ~ ° ~2 ° N ~u°, Z SEP71C° y :c°n 21' 33"W 356. 00' UNPL A_TTED..L.ANDS O - SET 1 " (0. D) X 24" 1 RON P 1 PE ~+JE i?!-I!!dr !. 13LHS .°=Fi _.INE:•.i:' F~~~T, 1""JOO' O 50 100 250 2002057 TH1S INSTRUMENT D:?AFTED BY JIM WEBER ~~a~ ~~~~ s - ~ fioa 3PRlP1G VALLEY was. ~~ ~ ~ ,'~,~ _ . G~ s~ SHEET 1 OF 2 JAMES 'i~~,~SfJ`10'b4 LANDMARK 'ING DA TEDJJ"~Z`k . ~ 2- :~ Vol. ~ 6 Page 4378 5t. Croix County Planning and Zonin Tuesday, February I5, 2005 at 9:06:26 AM Detail Sanitary Information Page 4 oj4 Computer #: 004-1041-10-100 Sub/Plat: NA Section: 18 Parcel #: 18.28.15.275A10 lot: 1 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 16 Pg. 4378 1/4 114: NE 1/4 NE 1/4 Owner: Lamb, Dennis 2791 40th Avenue Wilson, WI 54027 State Permit: 193469 Issued: 06/15/1993 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07!23!1993 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed Jim Thompson NA Pelke, Herb obtain system elevations at time of Original permit is on file with reconnection -was $0.00 Signed Off: No reconnection inspection!!! not signed by inspector - no record of a final inspection to show elevation of sand, pipes, or final grade of mound!! Maintenance Scheduled Puma Date Pumped 1st Notification 2nd Notification 3rd Notification 7/412002 3/13/2003 3/13/2006 7/23/1996 artrr~e~~t~nd~rs~ry,28.15.275~ ~'~F~,~C~]jS4 AVE. L~ uman Relations Safety and Buildings Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ^xTown of: lev.: Gds . ~ ~ Insp. BM Elev.: t~ • c~ ' BM Description: as ~ ~. ~.~.- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing /' e~~®~ ~ ~v Aer Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction Syetem TDH Ft Forcemain Length Dia. Fii Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Bench m ark /3,/3' ,G~ r ~~ [ Bldg. Sewer St/}~ Inlet ~/S ' d , 9~~ St/ ~f. Outlet Dt Inlet Dt Bottom ~ p/, /7 ~ H~ef/Man. Dist. Pipe Bot. System Final Grade BED /TRENCH DIMEN I N Width Length No. Of Trenches PIT DIMEN I N No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anufacturer: SETBACK INFORMATION Type O CHAMBER Model Nu 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 COMMENTS: (Include code discrepancies, persons present, etc.) Np ~a,Q rw- ~/~l LOCATION: CADY 18.28.15 275A,NE,-~rE,PIONEER 40TH VE. /Z„ ~ ~,L Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R OS/91) Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No Date Inspector's Signature Cert. No. County: Sanitary Permit No.: State Plan ID No.: S93 60 Parcel Tax No.: 4- 04 -10-000 A9300135 °`~S ~-= _ _ SONITeRY PERMIT APPLICATION - - -- - - - -- ----- - - -- - -- - - - - - - - - •~ In accord with ILHR 83.05, Wis. Adm. Code couNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ ~~ y~ 8~ x 11 inches in size. ^ Check if revision to previous application -tiSe@ reVerSe Side for If1StrUCtIOf1S for Completing thlS applicat)On. STACIE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. J -- ( (' PROPERTY OWN R PROPERTY LOCATION ,~,~~ tea- 'la '/a, S T,?g , N, R S $(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PRONE NUMBER 8~1894lflst~tifr~ OR CSM NUMBER L NO/~wA ~ISJD / 7.7- d 93 11. TYPE OF BUILDING: (Check one) ^ State Owned NEA ST ROAD O fN rlr ^ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms ~ ~~ III. BUILDING USE: (If building type is public, check all that apply) ~ Q y- ! Q ~~ ' ~O 1 ^ Apt/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestauranUBar/Dining 4 ^ ChurchlSchool 8 ^ Mobile Home Park 12 ^ Service StationlCar Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TY P E OF PERMIT: (Check only one in line A. Check line B if applicable) f ~ A) 1. 131 New 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 # - Date Issued Y. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Qther 11 ^ Seepage Bed 21 ®Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE f3. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Galsidaylsq. ft.) (Min.Jinch) _ ~ y ELEVATION y.SO ~7.~ .37L ~ 2 -- /07 ~ Feet //G l Feet VII. TANK CAPACITY in allons Total # of ' Prefab. Site l Fiber- Pl i Exper. INFORMATION New istin Gallons Tanks Manufacturer s Name oncret Con- Stee glass ast c App Tanks Tanks structed Se tic Tank or /moo GNO l r ,/ .t ~rs~ Lift Pum Tank/ er LSo ~- L~ / n ~~ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Na a (Print): Plumber's Signature: ( o Stam ) N MPflAWi6W No.: Business Phone Number: / ~ Plumber's Address (Street City, State, Zip Code): AA IX. C UNTYlD PARTMENT USE ONLY ^ Disapproved Sa tary Permit Fee (Includes Groundwater a e ssue Issuing gent Sig No S ps) Approved ^ Owner Given Initial /~ / Surcharge Fee) ~~~ ~ ~S ~ ~ Adverse Det rmination v / ~ "" X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ,. 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit muss be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite,.sewage system, contact your local code administrator or the State of Wisconsin, Safety & Building"s Division, 60&266-3815. . 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. II. 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 in 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 in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/ septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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'~ x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. S8D-6398 (R.11/88) ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 30, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Dennis Lamb property, located in the NE ;NE ;, S.18, T.28N., R.15W., Town of Cady, St. Croix County, WI., has been conducted with the assistance of Mike Hassett, CSTM# 3266. This onsite revealed suitable soil for onsite sewage disposal to a depth of 24" while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system having 12" of sand fill. Should you have any questions, please feel free to contact me at this office. `Sincerely, mes K. Thompson Assistant Zoning Administrator cc: file ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 19, 1993 Pelke Plumbing, Heating & Well Drilling, Inc. HC 63, Box 32 Durand, WI 54736 Dear Mr. Pelke: We received the sanitary permit application and the check for Dennis Lamb. Before we can issue the permit card, we need the following information: 1) Form 100 (Enclosed) 2) Form 105 (Enclosed) 3) A copy of the "recorded " deed (you can get this from the Register of Deeds Office) 4) House Plans since its a new system Send us the information as soon as possible so we can review the information. We will send you the sanitary permit card as soon as possible, if there are no other problems. ackie Stohlberg Secretary Please feel free to contact our office, if you have any questions. Sincerely, Enclosurer s '--- a Wisconsin Department of Industry, $ O I L AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Division of Safety & Buildings ,,.,~ ,..:.~. ~~ uo ~~ ~C ~.~:,, w.~... ~..,~,. COUNTY ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but ~ ~/a/X . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWED BY DATE PROPERTY OW ER: PROPERTY LOCATION ~,~~ 1~,yB GOVT. LOT y~ 1/4~~ 1/4,SfB T ~8 ,N,R ~~ E (o~ PROPERTY OWNER':S MAILING AD DRESS LOT # BLOCK # ~ OR CSM # ~ CITY, STATE ZIP CODE PHONE NUMBER ~I~Y f-MOWN NE EST ROAD .o,/c .~ .~, ~ .moo b?/~ )d~J.7 - .Zr.~ ~ .o r .v ,~ yQ rv ,E.Yj New Construction Use (,Y] Residential / Number of bedrooms ~ ~ ]Addition to existing building (]Replacement [ ] Public or commercial describe ~.A.SAL A?~R- Code derived daily flow ~,~v gpd Recommended design loading rate . 2 bed, gpd/ft2~~trench, gpd/ft2 Absorption area required .~75 bed, ft2 .~75" trench, ft2 Maximum design loading rate _,~bed, gpd/ft2 , wrench, gpd/ft2 Recommended infiltration surface elevation(s) ~/ ~ ,o~Soa~ LA.f.O! - /o ~ ~ ~~ ft (aS referred to site plan benchmark) Additional design /site considerations ~c O.or/ ~~~~. EisY iOLG~fS To L/,o-lL,,o~ sii~f ,, ,S~ Xf'yAoa.r ~~si~/a.'/ ~ ~ Parent material _ GL.GGi.OC ~« Flood plain elevation, if applicable ~/,4 ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ^ S 8 U ®S ^ U ^ S ®U ^ S ®U D S ~~-U ^ S ® U SOIL DESCRIPTION REPORT Boring # .:.~:. Ground elev. ,~ /~' _ ft. Depth to limiting .factor „ 30 Boring # '~~ Ground elev.,, /oc'S ft. Depth to limiting fact Horizon Depth Dominant Color Mottles Texture Structure . Consistence BoL~ Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trer>ch D /2 oy~. 3 L - s~./ .l .n ~~ c ~ . ~ , C ~' AL ... 1 4I r/fL L/si~ili/ ~- ~ /Y /' ~./ p Y' .s ~ /oyt a~Lt ~a~ oY s~ .~~e d 3 - / ort s' B ,fawn /o rr fsz/ d /77/~rD'uAr s ~ G S - , ,f S'/ -Lo .v s•N Ar0 .~+'al isi/L r ao s t i ~ S ac Remarks: ~Lg~%v~ r~~~ is uNAtJo~r T6.o f" lxTi~~i /Bir !/./9ii.1L~ ~./ Oi1~ ,vi t',vr //dA/Zd./S / 4-7 oy'~ ~ Z - ~ d1 ~ r .~ ~ s 3 S G ~ ~~o is ~ - s c ~ coJ ~ ,7 y oTo 1 B ./ 7. Src /7' _ N/i~ao~c /S O ~ 7` ~ ° c i ~ S , . G .~~ ~L ?'Z y - u ~~ ~~ - s' ~ C 2-3'o a 2 ,nrR /1 r 75s'y~ sue/ ~ ~° -- 'r ~,~,~. FG Remarks: Name:-Please Print rte, _s~r~~S i= ~aaress: ~S`O~ ~ ~~/ Y -~S, C,®a G L~5 v~ .D- Signature: ~~~~ ~/~O/' ~_ ~~ 7 Date: CST Number: PROPERTY OWNER ~/~"•uNis LA.y~ SOIL DESCRIPTION REPORT PARCEL I.D. # Boring # 3 ~' Ground elev.~~ /ol /r ft. Depth to limiting factor Boring # tE4 .. {~:~\ Ground elev. ft. Depth to limiting factor Boring # p4}::~::ii: ii Vii:; •~:,4i vk~:>. iii: nM1. Ground elev. ft. Depth to limiting facror Boring # ti 4..:: %i~• :\: ~i~ is . iti\4vi;~::~:~iiii Ground elev. ft. Depth ro limiting factor 4 ^~ • Page _ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .? ~ o riC y 3 - / .y /` S ~ .S~ 3 8- arm _ s/~./ «~ ~~ c /~~ .~ s' s 3G 7, sr~c. e1 .t7a',ud r 6.o„r.91 /S O s r° W - S S ~-ys~ ~,s o~~ ,a..,~o~ to~as~ s D ~° - . y .~ C SO o S ! 7-s>'.t s'~~ /y? ~ ors - -' Remarks: /~ o~.ac.> ~ ,Y~1 . sda~~~~ ®.r,~,_r~ ~,h ~"~ J G~.®,/.os o L d /L l iJ//~T/a i G~On~ .On ~ ~ s' pNo r u s o /rid L n/ GGV /Oi/ ~/ A /l .B /L .4 T>YY~,i, A./ L 6 NS/ P7'~t7 •/ f ti o.~/ r o.J fN ~ r-s o.y//Jo./ Lit T•. Remarks: ~`//~ r>os r 6i~~cTiy~ o•N srr~ Disdos.so ,~ysr~M. Remarks: Remarks: SBD-8330(8.05/92) PROJECT NAI~'IE: ~E.~is L.>~i1 PROJECT LOCATION; ~~~~ /8 .78i/ /Ss/ ~~ ~. CST LICENSE ~` : ~~~ ~ _ ~ ~j ,isrJ~P-- SIGNATURE; DATE : _ f~ o?,~ - 93 PLOT PLAN -----~-- 78~i ,4dst' ~~~st /d~ fa~~ io` ~ T s% .~~ ~.~ iN T cos T ' d sf /6~/D`I~ ~ N 3S ~ ~ T S~ ~~~ ~~/ ~~'fJ /6 O %c ~"~ /c6~/tN T `J9, •r Nd L er'v6t ,~yo ~ ,L 603 To - Go . /f/N r. ``j~/~/ ~ L.r a.rs /~isco /" s'o ' ~ moo, yon C7 = ,~.Icr~/oae firs ~'= Q mil, :iod ~ To~° vF Gu6d~~.t Lam= S r!, 2= /oso ~ row o~ /Srsra<ec fd~c~ l~asr ~FTd-.~ ~JOO Q dos r ~~'os f ~~ s-~ ~i AQd O~ si AO ud0~ yo ACa~ ~~ORGdG~~/l~OSSt"D ~ p.~9rty last'a~~o, ~vo aTH~.c /foals o,c w~~,G L//Tw~v Bap' of rtTr~ ,sitlA lJisto,~c< ,Srw, ~irJ /f 2 ~s ,vo p/~oas., rr L/,,,rs/SA' ~ SSt6~ o~Gb/ W/TiV/~/ ~ DP 0 yt~V oy.0 ~~ls, S~~D z. 1 s~ des"n s'~ 1 j `6a `{ `' !r'/~6Aos`o ~-~, /Ii/ P/~/BraLS~o d'6~ SH~B " >.Saa Ai,/~ r ~ ~ /~d ~~~5 - ~ ~~ ~~ ~ , - . ~ ~~ ~/~' ' /00 ~ y-o~ vF Gcitud4 ~ • F- Sao ~ T"o AU/J ~~ Lo . /~/l: PLOT PLAN PROJECT NAME: E~/„/~f ~,~,,y,a . PROJECT LOCATION : F ~ G~~„~; /S~ of ~,~or, Sr. G,raix Go. /~l M. P . LICENSE 4~ : .3.?7- 6 ~,~ ~ r / / ~ ' ~R - f ~ 1 SIGNATURE : ~..w.~ ....> ~~ F' _ ~ = y~ o ao~ yd i W/, DATE : S-y- 93 y ;. ?o c~ AT ~ ~o a _~ y ~~a, r ~ ~~ y ~.-P ~C COY p<< r v ~~z T /ar lV ~'- ~ ,~ ~ ~ ~~ .~., ~ ~ , ' J=4 0~' ~ ~ ~~ ~. ,` ~o~ ~~ ~ ~Q~~ <c ~' ~/j o ~its.4~ 4O ~ i V ~O .rs ~ d`is s } i~~ Ss ~ ya~N4 ~_ . ,d y` t cur[. / ~ Gols ro F- r~ i~ U A 6A~ls FiFi~ /oa ya o o ~ G a~ d~~~' ~ = ds/I L - /aS ~ tv~ DF /sr S tdd6 Fd-~~~ - ~ors' ~Frr.~ uoao Fasr~~osr' /r .s,~'',vsoa~ sAO.../D~ yo ,~~~~ OA/rC~L~/14SSl~a R/o O ~iVlR NOcif~ D.C s/!~L J ~ oio.rro iO6P ,f p~0 `6v rr 5~ ~r ~V 66P 46 ti ~ Pos P~s~ 4'0 ~ ~' " ~E X54 ~a ~ P ~ ~a~ ~ >s~ AAA r o~ ti ~ q .,/ ~t~ , G/~,~ (1 II (fj `~ I R // / E-- ~ ro !~ . ~ r. it/~fl /S./'!. ioo ~ ~ ~ o ~ G us dry P^ ~.~,~~ SAO ~yd `¢,~~F~ `~nA_ Y~ /Cs~ ~ ~o~so Gon4to as' ~oNojrO ~-/I... off. Qua Pes ro G~66~ PAGE OF ~'' PROJECT :TAME: ~E.v~/is 1,i,yB PROJECT LOCATION: ^/E /` i~ .~d~.i ice./ i4. P ..LICENSE ~~ : 1~ _ SIGNATURE: DATE: ~s ~ f1 A-_~/ Ft . B-~~lFt . I- //S Ft . J -~^F t . K-~Ft. L- //C Ft . lJ-a73.SFt. PLAN VIEW OF MOUND W a p~~ N ~ L ~ ~ ~~,~ ~ z Q .~ ~~y. 2 •~ ~-, .? ^ ~/( -~ ~ V ° W -"~° ~y ~ W -°' c ?~ W L_ L a o ~-~-. J I ~ . B k -- -- -- ~ '_ '_ _1 F~rn~c Manifold ,~90~ Q~~ Observation A Y X Pipe w ~ O ~--- ___, -- I ~-observation Pi e D' -' '-""~ P istrlbution Pipe Bed of i-22" aggregate I Permanent Markers (2)x 6p 40~ ~~ Force Main ~~~ adl PROJECT i1AME : ~~-,.,,,,~ s ~,s,,y,Q PROJEC)T`'`LOCATION:_ A/_ ~ ~T /~~ap~/S~ !~ e<' C..O,Or ~r Gam,, ~ ~ t4. P , LICENSE ff : ,~ _ SIGNATURE: I1ATE : s^_ yi 91 D- / Ft. E - /. z F~ . F- . ~ Ft . G- / Ft. ri- /.S Ft , S / Slope ~~ O ~V `~ ~~ 'CROSS SECTION OF MOUND SYNTHETIC COVERING; MEDIUM SAND ~~~~ TOP SOIL -r1. ~ T y ~Q~~ ~ W z= ac ~ w x~ is Q • ~ ~ 3.., 3 .~ c, a- ~ y '~ , w ~ ~ c.~ ~~ ~ O ~ y ~ O z~ ~ a ~ Z~. ~' ~. o a a ~ ~.~ PAGE OF f ~;_ , L~ G ,~ ELEV. 07~ ~~ PLOWED LAYER PROJECT NAME : QE,,,,,,,f ~,/,,,,s PROJECT LOCATION: „~ " i . mf M.P. LICENSE 4i: L~.t - SIGNATURE: DATE: f ~ ~1 Hole Diameter - ~In. Lateral " - ~_In. Manifold" - .? In. Force Main" - ~ In. P- 7,?Ft. X - ~-Ft . Y t y Ft. PIPE LATERAL LAYOUT v~ :; ~~ ~~~='~ A~ ~ Q ~~ to ~~~ Ca ;~ ~ ~ "` y ~r«~ Permanent -'--- Markers End Cap a p ~..op /s-/<.o~f C ~ ~ ~ ~. O End Cap ~ '-~ X i ~:aE PAGE OF --Permanent Y~ -Markers ~anifold - J"~9~) Force Main=,~~ soo~o ~s~ `~SEP~'IC TANK E: PUMP CHAMBER _:CROSS•SECTION AND SPECIFICATIONS . - .~ 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ aWEATHER PROOF y 25' FROM DOOR, WINDOW OR ~ JUNCTION BOX 'APPROVED FRESH AIR INTAKE " WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE CI RISER 4 WARNING LABEL 6" MIN. y ABOVE G~ADE r C~ l __--4" MIN. ~^ _ ~ 18" MIN. 6" MAX. ~ ~~~ .~ ` - `'1 • INLET - << . . ~ ! .' WATER TIGHT SEALS 'GAS- i• ~ ___./ ~ TIGHT ~ ~ • A SEAL ~ ~ APPROVED 4 ~~ BAFFLE ~_ ~ CI PIPE ~ ; ALM JOINTS 4]/ CI 3' ONTO ~ ~ ~ B l ~ ON PIPE 3' ONTO ~ ~ , SOLID SOIL SOLID C t . ' SOIL • PUMP OFF ELEV . /oo FT. F~kti4TE SEW '~~ RISER EXIT a PERMITTED ONLY O1Z~dl` • IF TANK • MANUFACTURER HAS APPROVAL ' 3" APPROVED BEDDING UND1 ~ ~ V • S ~ ~ '~ O nn pEPT. OF INDUSTRY, LAua~~ ~ HIQ~I(yNQAD ~ l/ O ~ SPECIFICATI~Y~ON ~ DF SAI=F'i f t~, BW INGS~. SE . ~ . ~ C /DO S ErTI __. ..~._ ~.~ ---- TANK MANUFACTURER: ~~~ES~,~. ~~'~•~sr NUMBE$$OSD$,r~ER``-DAY '~- ~ 8 . Sr~s ~ SEP.TIC TANK ~_ GAL. DOSE VOLUME INCLUDING X13+ 7socs= /70 OD0 , "DOSE ~ so GAL. FLOWBACK: 7o GAL. ALARM. MANUFACTURER: . s ,~, ~Llcr~ro. 'CAPACITIES: A _ ~_ INCHES = ~ ~ •3y0 . GAL.. ~ ~ MODEL NUMBER : ' _ ~ /o/ . SWITCH TYPE: f~~~~W,r B = • 2 INCHES = GAL. PUMP MANUFACTURER.: ,~ihey..~~~ ~7~it~,/a,v ~ C = ,lQ INCHES = /70 GAL. MODEL NUMBER: SWITCH .•TYPE: D = _~` INCHES = /p,2 GAL. REQUIRED DISCHARGE RATE ~ GPM PUMP ~~ ALARM WIRING AS''PER ILHR 16.23 WAC VERTICAL DIFFERENCE~. ,BETWEEN PUMP OFF AND DISTRIBUTION PIPE. 8.0• FEET + MINIMUM NETWO~2K SUPPLY PRESSURE 2.5 •FEET FEET FORCEMAIN X /,~/ FT/100 FT. FRICTION FACTOR .~. FEET + ~ _ '~ TOTAL DYNAMIC HEAD = j/ l FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ~; WIDTH `~ ~~ ; DIAMETER ~., ~` LIQUID DEPTH ° •3~'~ ~•~ SIGNED: _ ,LICENSE NUMBER: ~,T -,~,.a DATE: ~ =y yf ~H!! • ~./$II ws/DS25 WS25A1~" ~ ,~1~ z DS2~ • Completely submersible automatic sump/effluent pump. • Available with wide-angle "piggyback" float switch (WS25A1) or diaphragm type "piggyback" switch (DS25A1). • Cast iron constuction with non- corroding ABS volute/base. • 1 /4 HP. 115V ofl-11lled motor with thermal overload protection. • Anti-clog thermoplastic impeller. • Can be used without switch for portable dewatering pump. • 1 1 /4" NPT discharge with adaptor included for 1 1 /2" NPT discharge. • 10' replaceable power cord. • Weighs 141bs. UL listed sump pump. DS/WS25 - 114 HP -MAX. SOLIDS 112" - 3300 RPM 28 2a w 20 w LL ? 16 O Q W = 12 Q FU LL LOE F- O g AMPS AT 1A 115V. , 8.5 4 593-01009 SW SD25 33 SW/SD25 - 114 HP - MAl(. SOLIDS 112" - 1550 RPM sw2~ • For sump and effluent use. za • Automatic models available with wide-angle "piggyback" 2a float switch (SW models) or diaphragm type switch (SD ~ 20 W models). Also available in ' = s manual models. o • 1/4 HP (SW/SD25) or 1/3 HP = 72 (SW/SD33). heavy-duly, 115V oil-filled motor with thermal ~ a overload protection. • Rugged cast iron construction. 4 • Non-clog vortex impeller. • Long life lower ball' bearing. ° Sintered top sleeve bearing. • Carbon and ceramic mechanical shaft seal. • 1 1 /2" NPT discharge. za • 10' replaceable power cord. (20' z4 optional). • UL listed sump pump. W ~ W LL ? 16 O Q W J 12 o e 4 0 5 10 15 20 25 . 30 35 U.S. GALLONS PER MINUTE S 10 1S 20 2S 30 35 40 45 50 U.S. GALLONS PER MINUTE SW/SD33 - 113 HP -MAX. SOLIDS 112" - 7550 RPM L J J 0 5 10 15 20 25 30 35 d0 45 50 llS. ^, ~t.LptJS oFA 11R.`.uT~: ._-.. .. ;. .., : ~.. --; • MAY 19 ' 93 09 ~ 18 .. P . 2 .. ... __ . ~ . 0 tU m ! _ ! ~ ~ Lr~~:v ~ M hSi2 ~ ~ ~ ~ ~ ~ W ~ s ~a aoo«. .,~ a~~e~. r~~t,~.. ~. ~ 14r+G w ~~ rc,)c~•.. .. ~ ,.~, ~ IP p'.3' 4'. • • ~- 8" • • , ,MODEL8016382BACKRA OADER NO. Z1~8p2 , •... +~~ A3 ~ D S ~S~ 4+ Fto ^~f .. ~ r~ w , • • AS y ~•/3~ .~ SEWER l : FROM THE BACK OF HOMF. • /a I ~~`~ ~ `SF ~ ~~ • "~ - ~IN FROM SIDE - ~s WATER:~FROM ~jo'" ,n ~~~r ,aS CSrde THE BACK OF HOME ~ ~ IN FROM SIDE ~ S . ELECT:i ~-FROM THE BACK•OF HOME ~~ GAS: D FROM THE BACK OF HOME 4 ~ S ALL MEASUREMENTS ARE TAKEN FROM THE FORWARD • BACK OF THE HOME to G~. F'll~-e~--d-o~° /~"~l~-~P ~ , M.or~ ~o J4 5~ ~ ~ d- ro a ~ 4 q 3 ~d,.Q, , 5 % Zc, ~ t~ ~ X $~ ~o m ~. Pl.~'S ., STC-100 This application form is to be completed in full and signed by Ithe owner(s) of t}~e property being developed, Any inadequacies will only rESUlt in delsys of the pormit issuance. ,should this development be intended for resale by owner/contractor,(spec House), then~a second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------ owner of property Location of property~l/4 ,~_1/4, Section ,~_, T v~0 N-R 1S W Township Mailing address .'~~i(~q5 ~~2.n mQC~h70 .~ Address of site _ t' tiOYlee~[` v~~~.~ - Q~CY' ~ ~j (;r ~w~ " pJnJ" Subdivision name_ ~/~ Lot no. Other homes on property? yes ~ No Previous owner of property _ ~ Q ~~ ~ L(a YY. h Total size of parcel i-1 ~ ~ r Date parcel •was created ~~35`~ Ac_r~~.~c.L~„~-c ~ ~}~~dra~,x- Are all corners and lot lines identifiable? _____~yes No Is this property being developed for (spec house)? Yes ,,~No Volume ~~ and. Page Number 11 as recorded with the Register of Deeds. INCLUDE WITii THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & TIIE SEAL OF THE REGISTER OF DEEDS. ,In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my ( our ) knowledge that I ( we ) am ( are ) the owner (s ) of the property described in this information form, by virtue of a warranty deed recorded in he office of the County Register of Deeds as Document No . ~'7(~.3b , and that I ( we ) presently own the proposed site for the sewage disposal system or I (we) obtained are easement, to run -the above describacl property, for the construction of said system, and the same has been duly recorded in the o•Pfice oP County Register of deeds as Document No. . ,..~ I I Signature of applicant / .} ' Date of Signature G7~C~ini..t-~ ~W~-~ Co-applicant ~-~-1~ Date of signature S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUY ADDRESS- Sn ~ '~ ~ I~~ ~ 1~(~l ( FIRE NUMBER CITY/STATE ~ re~A n ~~r ~ /1! ZIP_`~~.53~~ PROPERTY LO//Cl!ATIlON : ~_1 f 4 ,~~1/4 , SECTION- r ~ , T~N-R~W TOWN OF_ (~[l~/ ~i , St. Croix County, ' SUBDIVISION 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 a 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/~~e, 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 Co. Zoning Officer within 30 days of the three year expiration ldate. ,~J SIGNED : _ / _~.r.~ ~/ cr DATE • ~/~ ~~~ St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 ' • :+- . } ~ - ~ _ ` - i. ~. i : I ~~ ^~ t.___ -__ ____._-__.____._ ___...__.. _. ______ • 'f it I i ~ - '- II - ~'', oocuMer~r No. WARRANTY- DEED- THIS SPACE, RESERVED FOR RECORDING DATA ~~ 476436 i STATE BAR OF WISCONSIN FORM 2 -1982 ii j ; vei ~25PAGE 2~0 .REGISTER'S OFFICE ST. CROIX CO. 1NI Paul Lamb a/k/a Paul Robert Lamb and Violet ~ ~•,. ` -------Lamb,-.-husharid:_arid-.-wife ..............•----.......---•------.....-•------•- '~ ReC'd for Record . ;~ ----------------------------------------------------------------------------------------------------------- DECO 41991 ~~ ....>------------------------------------------------------------------------------------------------------ ---- '~ ~ 8:30 A.-: M ~ -conveys and warrants to ...-Dennis•-A.---Lamb,.and_-Roxanne.--•.-__._ ~ .._-.--Lambs-..husband--and-_wife_~ •-as--Joint--tenants _•_ ~! ~ ~~~"~~~ R ist r p ;~!~= ,, ...-- -----------------------------...---------........ ..---------------------...........----....----------..---- j .................................... ........ . RETURN TO ,i i ----------------------------------------_._...----=------------------ it '( i i ;i - •,' the following described real estate in ._..:.St.....CzO.iX .....................County, ~~ ~I State of Wisconsin: Tax Parcel No------------------------------- Northeast Quarter of Northeast Quarter (NE4 of NE4) of Section Eighteen (18), Township Twenty-eight (28) North, Range Fifteen (15) West, EXCEPT that certain parcel of land and easement. to Wisconsin Telephone Company as recorded in Volume 349 of Records, at Page 45, as Document No. 254557. Grantors agree to pay 1991 real estate taxes when due. agree to pay all subsequent real estate taxes. Grantees . r. * .- ~. .Q V ~~ This .--..-i s n_ot (x)c (is not) --- r. homestead property. Exception to warranties: Easements and restrictions of record. Dated this ......... - ~ ~~ ............. 19..91.. ~~....----•-•--------------------- day of ....._..... Pl'111Q~P~ -•---•-• ......-•----•-• ...............................•----••-----•--....... {SEAL) 4 ....................................... .......................... --••---•-••---•-•-••---.....--••-----------•-------....-•---...----. (SEAL) AUTHENTICATION Signature(s) ---...-•-----------------------------•--------•_-_- authenticated this ____.___day of___________________________ 19____.. Paul Lamb ..................s....~......_................................... ----..~CI~..co-~•.o~c?~rr~ ........ .......(SEAL) Violet Lamb ACHNOWLEDGMENT STATE OF WISCONSIN ss. ~i .Sj'C ~G~jl1~-----°--------County. ~~ , Personally came before me this .__~~___day of '~ ~(l 1/Prst - - -- ---Q_-------~tl~--------------•-----, 1991--. the above roamed ..------•---------------------------------------------------•------------------- Paul Lamb, a/k/a Paul Robert;.. Lamb, and Violet Lamb ; - -;i..' ,~ ~' TITLE: MEMBER STATE BAR OF WISCONSIN I„ --------------------•------------•-•--------------------- - i~ (If not, .--•-•------------------------------------------------------ ----._......._._ p ...._.::_.:_:. `~H6.. authorized by § ?06.06, Wis. Stats.) '--'------'~ - -• to me known to he erson s foregoing inst n/t- aad ack :~,. THIS INSTRUMENT WA8 DRAleTED BY ~,/ `,~. ~ .. '~'~' Thomas A. McCormack ..............................................-..~._:./~.~._ ~~>. ~- __......-Baldwin, WI 54002------------------------------ •------------~~ovvt~c ~:_~!".~G>sfy!.?'!~ -~-f ;.`:` --- -. ':'_ I •------------------------------------------------------------------------------- Notary Public ----- ~'~ ~. o . ~ ~----------------•~,__ ,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration aze not necessary.) date: -•-•-------------------------------------_...---......, 19_....__ •) - --