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040-1091-10-110
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT l�17y0 3 187 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jensen, Jeanette Troy, Town of 040-1091-10-100 CST BM Elev: Insp.BM Elev: BM Description: Sectionrrown/Range/Map No: /C/J►�'f'I/ �kk_2) 23.28.19.367E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,'A CAPACITY STATION BS HI FS ELEV. Septic / .�� Benchmark 77 16V-7-1 L M - GD,nn, 6, Alt BM t3 3.&4 /6 �� � /�� Bldg.Sewer g 9J • Z 4/ Holdin �a � z St/Ht Inlet c� 3 �-,/ J 2 St/Ht Outlet 'ddT TANK SETBACK INFORMATION �' / TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet e t, /� t Dt Bottom Dosing ot Header/Man. 103 t 17-!56 3 /ap S /S 7 Aeration Dist.Pipe 63 Holding Bot.System • 3 d2 - 4 Final Grade / q PUMP/SIPHON INFORMATION '1� Z• J Manufacturer Demand St Cover 6,1 9_-s- GPM d L1 �• /D� ' Model Number L-�a 3 / L TDH Lift Friction Los Syste He a TDH F Forcemain Length I Dia.2 ,( Dist.to Well Z_LA SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. ren s PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS C SETBACK SYSTEM T BLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION A CHAMBER OR Type stem: 7� / } i 1 UNIT Model Number: D J / /�- DISTRIBUTION SYSTEM Header/Manifold Distribution Z i/ x Hole Size' Hole Spacing Ve^to Air Intake Pipe( )s ,J— Ix �z Length Dia L Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 7 Bed/Trench Edge$ \ Topsoil ' � g Yes gs No F&I Yes Q No r / COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: �o / z Inspe ion#2: Location: 228 Highway 35N River Falls,WI X4022(E 1/2 SE 1/ 23 T28N R1 9W) NA Lot 2 Parcel No: 23.28.19.367E /� 1.)Alt BM Description= V j44� ��� 2.)Bldg sewer length= 6:5 � ��� -�S C4- -amount of cover= // (sue S� (3�(j��� (/���"i WE Plan revision Required? ❑ s No Q" / se other side for additional infor ation. Z1D Date Ins ctor's S' ture Cart.No. SBD-6710 eVa� TO, County Safety and Buildings Division `T Cr8/ y V flrr 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) ryo Madison,WI 53707-7162 it Permit Application s State Transactions JNumber In accordance with S 8 . 1(2 is.Adm.Code,submission of this form to the appropriate governmental u Art is required prior to ob�t itg itary Permit Note:Application forms for state-owned POWTS azej}}itd to dress(if different than mailing address) the Department of Safe and Professional Servies. Personal information you provide may be used for 5 o Shy purposes in accordance with the Privacy Law,s. 15.04 1 (m),Stats. V ,,�`�Q W S I. Application Information-Please Print All Information �T Property Owner's Name CON Parcel# 'Ta e*e, '-n n ✓� Property Owner's Mailing Address Property Location / 2 5 j�lJ Govt.Lot v • v �� �� City,State Zip Code Phone Number / �/� �j(.� �/, Section 2� !� (circle one) ?i T Z� N; R��—E or W 11.Type of Building(check all that apply) Lot# ❑1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name Block# ❑Public/Commercial-Describe Use G 1 ti.S �' -�" W fa.Y 6 ❑ City of El State Owned-Describe Use i ❑Village CSM Number ag e of S k�� • J-;`� a, '7( ►717 own of III.Type of Permit: (Check only one box onJline A. Complete line B if applicable) A' ❑New System ❑Replacement System Treatment/Ho g Tank Replacement Only ❑ Other Modification to Existing System(explain) Y P B. El Permit Renewal El Permit Revision El change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 7 L i3 IV.Type of POWTS S stem/Com onent/Device: Check all that a 1 1 D Z l 9 7 ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation 5�q(p 4 7 16196 /OZ y 7 VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units L o cC v U v i w New Tanks Existing Tanks L o a R, U 'vs rq [rw C7 0. Septic or Holding Tank J V d(; Dosing Chamber f ) fG VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) PI ber's Signature MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Code) VIII.Coun /De artment Use Only Approved Disapproved Permi Fee {Date Issued Issuin gent Signature Given Reas Denial $ 1)4 'i L5 DL CondiVIVOT6M1f11WOE"easons for Disapproval is Seplic tank,effluent filter and ,� + a dispersal 0"'Must all¢e services l main i f000/ as per management plan provided )y plumber. 1 -A� ,� y�pv e v 2. AD sefl*ck requirements must be maintalr*d 1 1 r / up or m*lcable code J ordinances: �^a,.,,-tL �,�„� �c �c. r cJY7�><t. �a!`,M-:l— t�J Attach to complete plans for the system and sub quit to the Coun only on paper not less than 6 121 1 inchestz SBD-6398(R. 11/11) W PLA Y P 1 GplS� i r> i 1 1 ��•——Y c o"C ---------- _ _ r i �i a Ct 4 ' Ta be r�l�c�-fe O z z �1 i Po t An_ .. I l� Yis l i»cJ We�s•r Sa t« 1"k / /R 50 e�41 pua.�p tank tobc �ns�al�eA1 I i IFY y,: •�CO. j Al V J _� I O way po,+ �,ga rlfr lot C0 AC w 4 ca._ _— 3____ ► trot vert,� Tod of C«IyPrIrPP` 98>3' IN °c Groa.�l Etrd, 10.2.3' GOULDS PUMPS Submersible Effluent Pump so . . WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■Shaft:Corrosion-resistant, Single phase(60 Hz): can be operated continuously Specifically designed for the stainless steel.Threaded •Capacitor start motors for without damage when fully y g design.Locknut on all models maximum starting torque. submerged. following uses: to guard against component •Built-in overload with ■Bearings:Upper and •Homes damage on accidental reverse automatic reset. lower heavy duty ball bearing •Farms rotation. •SJTOW or STOW severe duty construction. •Trailer courts oil and water resistant power •Motels ■Fasteners:. series P ■Power Cable:Severe duty stainless steel. cords. •Schools •'/3 and 1/2 HP models have rated,oil and water resistant. •Hospitals N Capable of running dry NEMA three prong Epoxy seal on motor end •Industry without damage to grounding plugs. provides secondary moisture •Effluent systems components. •%HP and larger units have barrier in case of outer jacket ■Designed for continuous bare lead cord ends. damage and to prevent oil operation when full wicking.Standard cord is 201. SPECIFICATIONS P y Three phase(60 Hz): Optional lengths are available. submerged. P 9t Pump •Class 10 overload protection P ■O-ring:Assures positive •Solids handling capabilities: MOTORS must be provided in 9 P sealing against contaminants 3/a"maximum. separately ordered starter e aks il l d oe •Discharge size:2"NPT. ■Fully submerged in high- unit. an g •Capacities:up to 140 GPM. grade turbine oil for lubrication •STOW power cords all have AGENCY LISTINGS •Total heads:u to 128 feet and efficient heat transfer. bare lead cord ends. P Tested to UL 778 and TDH. ■Class B insulation on ■Designed for Continuous CSA 22.2 108 Standards •Temperature: '/3-1'/z HP models. Operation:Pump ratings are CM® By Canadian standards 104°F(40°C)continuous ■Class F insulation on 2 HP within the motor manufacturer's us 549 File 140°F(60°C)intermittent. models. recommended working limits, Goulds Pumps is I50 9001 Registered. •See order numbers on reverse side for specific HP, METERS FEET voltage,phase and RPM's 40 130 available. 120 - -- —- SERIES: 35 -- - __ ___—_ RPM:3500& 110- 175 FEATURES - — - -- -- _ -- 5GPM _ ___ ___ _- 30 100 __ __ ___ _ _ ______ __ _______ ___ __ _ ___ ■Impeller:Cast iron,semi- 90 -_ ___ __ ___ __.___ __-- ______---------_ open,non-cog with pump-out W 25 80 vanes for mechanical seal _ ______________ _______----- _.F___ ___ ___ __ __ _______ -___________ protection.Balanced for 2 20 70 n i1 __ ____ _______ __ _ __ ._ ___ ___ smooth operation.Silicon 60 _-- _ ___ ___ _-_ -_ _ _______ ___ _ _____-_-_-____------ _-- -__ ___ ------ _ bronze impeller available as a 15- 50 _ _- _-- _ _ _____________- ------ __--__ ------- -__ --- __ ._ ........ ----- _-------------- an option. _40 . _------- ____ __ ___ ■Casing:Cast iron volute type 10 .__._- for maximum efficiency. 30 _____________ __ ___ __ __ ___ ___ 2"NPT discharge. 5 2 _------------------- --- --- --- --- --- -__i_-- ■Mechanical Seal:SILICON 10 CARBIDE V5.SILICON 0- 00 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. I , , , , Stainless steel metal parts, 0 5 10 15 20 25 30 35 m3/hr BUNA-N elastomers. CAPACITY Goulds Pumps ©2003 Goulds Pumps ITT Industries Effective July,2003 vvvvw.goulds.com 83885 <& Jun-13-2013 10:33 AM St. Croix County Plan/Zoning 715-386-4686 1/3 County Sanitary Permit App Cdt tan ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 SL Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for seconoary purposes ST. CROiX COUNTY GOVERNMENT CENTER 8r (Priveoy Law. S. 15.04(1)(m)) 1101 Carmichael Flood Hudson, WI fr 1 54016-7710 Fax 15)3984566 Attach oom eta plans for the system on paper not Is •112 x 11 inches in size. County Boni e ❑ Ch If revlslon~o,preAous ion 1. Application Infornla nt all 1 ation oca Property Omer Name Vft C,QOi I3 - r~2 1/4 ;5-1/4 See jq_ J N.anclt ~nse~ '';~'0 N, R E(oi1Q Properly Ownefs Mailing Address Lot Number Block Number City, S to k Zip Code Phone Numer ubdiAsioonnNName or CBM Number ~tver 1-,(I~ 1 46z z ✓e(~ , I`ll II Typo of Building: (cheek one Mlly Ovillaae XlTown of O 1 or 2 Fa Dwel0np-11o. al drooms: T J3- Publi mmsrt:iel (describe use): 1 Af lit y-t1 t) u 5 -e- r0 ❑ State•owna wrest R ad Type it: (Check only one box on line A Check box on line B N applicable) packet Tax Number(s) A) 'kRepalr O Reconnection ONon-plumbing I.Z Re)uvenstlon 10 RI _ 10 ! 0 0 367 Sanitation is) pp ermit Number Date issued n -7 State Smitery Permit was previously iseuad l p 83 q& IV, Type of POWT system: (Check all that apply) 13 Non•pressurtzed In-ground und k 24 in, suitable a Ci Mound s 24 In. sukabio sell p Mound A+0 ❑ Sand Filter 1~zn O Peat Filter G Drip Une © Pressurized In-ground O Holding Tank O Single Pass O Other O At-grade O Aerobic Treatment Unit O Recirculating V. Dis sairrreetment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Sall Application hate 5. Percolation Rate 5. System Elevation 7. Final Grade Required Proposed (GalsJday/aq ft.) (Min.Anah) E1evallon I. Tank Information sparkly In Gallons Total ff of an cturer Prafalb to n• tae er• o Nov,, Existing Gallons Tanks 4711 57k (C Concrete strutted glass Tanks Tar ills q9 BD 0~ m D O ❑ ❑ II. Responel Iitymmment 1, the undersigned, assume responsibility tot repair/ramnnonodoNro)uvenatlonAnstalledon of non-plumbing for the POWTS shown on the attached piers. A Dense Is not required for terdifl re r or the Installation of n lumbin sanitation s stem. Plunk era Namo(cufnt) Plum a 61g stamps); MP/MPRS No. 15usinen Phone Number ~rl ✓ cis 0-'9 Z' 3"/ 49'V OP?4 Plumbers Address (Street, City, te, Code) O S 7 G t/t Kite' Fa J' S 1l. 0owity Use Only Disapproved Sanitary Permit Fee • _Doe Issued Pig Ag I Signs (N pa) 3 Approved Owner Given Initial Advarsa ZZ~'. Q 7/2/1 Deterrninedon / IX. Conditions of Apptoval/Reaeona for Disapproval: 4U STi~ 3~ SYSTEM OWNER: ~e~ , 1. Septic tank, effluent filter and yr- &4L A dispersalcell must tp s9 vi d I maintained (~,f OL • as per management plan provided by plumber. 2. All setback requirements must be maintained as erapplicable code/ordinances. ~v 0 7777,d/' U`L,(~ S 122 4~ VhGvvW n L5T PLA p~ 1~P i5~ 1 1 Y~ ~1 tJ (R N d a / Or 71-n 7-6 bit rc~GC~~e ~u' a 57a~e ~11V. Jun-13-2013 10:33 AM St. Croix County Plan/Zoning 715-386.4686 2/3 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to cert that I have inspected the septic tank presently serving the LOAXY, 1 e- o maklenee located at: /A, 5E '/4, Section d Town,24!~LN, Range_Lj__W, Town of d St. Croix County Wisconsin. Upon inspecti , I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service r.u•l~ er, rrn vu tc Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: 1aS0 Construction: Prefab Con rete Steel O r Manufacturer (if kmwn)• ' C 0 "7 C- - , - - s _7 Age of Tank (if known): q616 t,717 & j f Ai'o - ~Gr1 -2 ~i'Z1S p (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS 6 ) 3 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Jun-13-2013 10:33 AM St. Croix County Plan/Zoning 715-386.4686 C_3 L.V ST. CROXX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNBRS142 CERTIFICATION FORM Owner/Buyer l J e 4) Mailing Address / Z- 7 % 7LI 3,5- /lV Property Address All (Verification required from Planning & Zoning Department for new construction.) City/State J' ~ ~ ~ Parcel Identification Number U 4Q ~ I0~l -10f l ~ CAL D SCRIPTION Property Location , Sec. 2.3 T,=~-LN K I W, Town of l ra Lot # Subdivision Plat; Certified Survey Map # I fo Volume , Page -7/ -7. 1-~Vrazty Deed # (before 2007)Volume -7 o Page # Spec house p yes plno Lot litres identifiablekyes C no SYSIK MAINTENANCE AND OWNER CE T-MCATXON Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tm * as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge, 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,, herein, as set by the Department of Safbty And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/am the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. N b f bedrooms SIGNATURE APPLICANT(S) DATE "*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04112) MOUND SYSTEM FOR Jensen Di ti t-ributi ng Company 29R Hiogbizay 35 River Falls, WT 54022 I Ca ~ . Z 2 ' O p INDEX j L z a z Q ~ as O Q co PLage 1 of 7 ...........................Index ;,a = ge 2 of 7. ........Calculations C* z I- W cc 1- p Luu age 3 of 7 ...........................Plot Plan z 2 ~ jage 4 of 7 ...........................Lateral Layout o z gage 5 of 7 ...........................Cross Section CC U) Seage.5 of 7.............. .Plan View cc ? w a Q age 6 of 7-i i .......Pump.Chamber. Q O z O oC r Q OR &age 7 of 7 ...........................Pump Curve o Q O Q V Located in the SE a of the SF Sec: 23 T 28 N, R 19 W, Town of Troy St crnix_ Co• r ally Wisconsin. Q0. d Cari L................ Prepared by Paul ..C:0.......Steiner. ~~P D~Q N°MSA~~ ~NG~ Steiner Plumbing and Electric, Inc. p`V~s~o ENO • G~RR N8230 945th Street i Rawer Falls, Wisconsin 54022 Master Plumber: #6780 Date: September 19, 1997 PAGE 2 of 7 CALCULATIONS ANTICIPATED WASTEWATER 2 Floor Drains at 50 gpd = -------------100 gpd 20 Employees at 20 gpd - ----------------400 gpd TOTAL - 500 gpd SEPTIC TANK 500 gpd + 750 = 1,250 gallons minimum capacity required and exAst%pg.U~ " c"I M co t MOUND SYSTEM, 500 gpd f 1.2 = 417 square feet of absorption area required. '22 r4' f` A 5' x 84' trench will be used providing 420 Square Feet..; `z `~.aa Yr - - I I I ~ rz~.//.x~slin<~ Wa~sw Sa~♦w lark I /t50 ~4l ~uw~~ 'fohk tobc ~as~a((tdl I i BCLI~d/..°~ I .zj gm tl /oo,o' toy z dt BIa•k i wr„/. Br ~u,•~ iHOe~s ' ti ~os~ G•go. rh~lol WaA k a .t plc o~Culpordiy,pt 9.43 _ d° Farce /Ua~n Elev 99.0 ~ \ I ell ` W7 / st Synthetic Covering ASH C33 Distribution Pipe i Medium Sand N G SYS. ELEV. 10 6" Topsoil s--= - b r Slope Bei d 0f z~- 2 %z (Force Main Plowed Aggregate Layer (G" Be low Pipe) 0 1.0 Ft. E 1.2 Ft. I Cross Section. Of A Mound System Using F 0.8 Ft. A Bed For The Absorption Area G 1.0 I A 5 Ft.- N 1.5 Ft. B 84 Ft. K 10 Ft. L 104 Ft. J 8 Ft. I 15 Ft. W 28 Ft. Observation Pipe A t-----=- Force Main ~d . _ - - - - Distribution Bed Of z 2 %Z+ Pipe ...................-Aygregole Observation Pipe Permanent Markers 4 Plan View of Mound Using A Bed For The Absorption Area L u~~ 5 7/ • LATERAL LAYOUT Perforated Pipe Detail 70 III Perforated Grid View PVC Pipe Holes located on bottom, End Cap are equally spaced. Variable--Y" Distance 4 t PVC Force. ~ Main From Pwnp Install permanent markersy;'/ , at end of each late Distribution Pipe Last Hole Should be next to end cap. i I P 40.3 Ft. X 42 Inches Y 42 Inches Hole Diameter 1/4 Inch Lateral 1Z Inch(es) ( Manifold Inches Force Main 2 Inches Invert Elevation of laterals 104.00 Ft. 12 x 117 = 14.04x 2= 28.08 GPM/Total Place 1st Hole 21" from tee with succeeding holes at 42" intervals. Last hole to be next to the end cap. PUMP CHAMBF.11 CROSS SYCT1011 AND SPF:C-F-F-I-CATIONS--..------------ Vent cap. Hea ther Proof Approved Locking T Junction Box (HL inh ole Covcr 41, C.I. 12 2tin vane Pipe Final F b" 11in Grade I r----7--'_' , 18" Min Conduit ' 18" Min Approved In1eC i Joints w/ C.I. Pipe ' Gxtendinl; Approved 3' Onto Joint x/ Solid 1 , C. 1... Pipe .Ex t e n4 111 g Ground '.1 3' Onto Alarm Solid Cround Qn^ C .Pump Off Concrete Block D SPECTFICATIANS TANK PUMP _ manufacturer: WiP,gpr fnnr-rptfP Manufacturer: tt=s Tank Material:_ ggncgete Mod a 1 14 u 1111; u r : ME40' 9'ank Siza 1.250 Gallons SN.i tch• Tyra M. Mat Total Dyoain ic lie ad 17.80 Ft. CAPACITIF,S 11 ump Din chis rl;c Rate: 2,98. (R- GPM Total Daily Effluent: 500 Gallons Il 19,._g " or 520__1 Callons 14umhar of Uoses : 3.2_ Per Day U » 2 " or 53.3 Callons Dose Volume;' 213.4 Gallons C N or Callons NO tcs: 1. See Puml) curve for - _ D 1.g..._ o r a sS.il_i_t_i a n a c e . Total Tank inIor inn tion Capacity Required 1266.9 Cnllona 2. Pump and alarm are to be inatn1led on ueparate! circuit ALAIIM au per ILIM 16.19 HAC. linnssf ncturert, Level Alarm 11ad e l 1lumbe r : D f.u i 1 e is Type. Mercury Float page 6 of 7 • ME40 PERFORMANCE _ CAPACITY: LITERS PER MINUTE 0 50 100 150 200 250 '300 350 40 12 35 10 30 co) a. W U-' 25 20 6 p -j T O 15 4 Q ' 10. 5 2 0 0 0 10 20 30. 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 23833A275 Parcel 040-1091-10-100 07/02/2013 12:15 PM PAGE 1 OF 1 Alt. Parcel 23.28.19.367E 040 - TOWN OF TROY Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - JENSEN, JEANETTE JEANETTEJENSEN 212 HWY 35 RIVER FALLS WI 54022 Districts: SC =School SP =Special Pr erty Address(es): ' =Primary Type Dist # Description 21 HWY 35 SC 4893 SCH DIST RIVER FALLS ~7 SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.240 Plat: 1717-CSM 06-1717 040-86 SEC 23 T28 R19W PT E1/2 SE 4AC LOT 2 CSM Block/Condo Bldg: LOT 02 6/1717 INC P364E EXC PT TO HWY PROJECT 7200-04-21 HWY 35 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/06/2004 781745 2709/085 TI 07/23/1997 1157/41 WD 09/30/1972 312744 490/146 WD 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 3.240 134,800 588,600 723,400 NO Totals for 2013: General Property 3.240 134,800 588,600 723,400 Woodland 0.000 0 0 Totals for 2012: General Property 3.240 134,800 588,600 723,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 k t.. 417f-~_' a FILED =2 ~98G 00 CERTIFIIM SURVEY MAP R K Of j DONALD AND JEAIVLTI',TE JE[VSIIJ wboomb omk ~r - Part of the Northeast 1/4 of the Southeast 1/4 and the Southeast 1/4 of the Southeast 1/4 of Section yo ~2A 23, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. ~N, LANDS _DESC_IN V04. by ° + '4 °o 396, PAGE 574, 10 y~' / 99 r Q R (FAST 140'1 0 Op0 M1 q~. s `0 • r Ne9.50,46"E 142.,04' olh LOT/ o 0.307 ACRES 0 Jp yyF 1j"35.- SO.~ FT. 6 Q ~ ~ LOT 2 I O / 5 ` qyo 4. 000 ACRES 174,240 $0. FT. p p~ NET = 3. 439 ACRES 0 /49, 820 SO. FT. a y APPPOVEID y COT 02 1986 X10 N A~ ~ , vo W w ~Noo ST. CRUX C'.iv 'I Qi / Z 2 \~o lro COMPREHENSIVE PARKS PLAN,•:!yG 0 V 0 ° ~ o AND ZONING COMMITTEE % ° try J i do 5, P ~s' Qom/ ti \,a0J~1 v b c, ~ SCALE /00' yu ~ 2 N N 0 50' /00' 150' 200' 300' z to U N N 0 V • I W m i k. ro a ° • Indicates 1" iron pipe found. £ N m o CIndicates 1" x 24" iron pipe weighing ° a 1.13 lbs./lin. ft. set. N °o i a Dated: September 2, 1986 ~ 11 SE COR. SEC. 23, T 28N, R19 W,I ~GNsl Oo,/ COUNTY SURVEYOR'S MON.) I r Note: Lot 1 of this Certified Survey Nap is not LAUREN a buildable lot. Lot 1 is to be attached to these M W M HY p lands as described irk Vol. 596, Page 574, Doc.# % W 358107 of St. Croix County Records. ,r• J vER FALLS, • , WISC..•' JQ ~ %~.~9F~ • LAND S.~'~•► Vol. 6 Page 1717 Laurence W. Murphy Certified Survey Maps Registered Land Surveyor St. Croix County, Wisconsin SHEET / OF 2 i T 4 o (a 0 0 CO) O' i 3-0 n tz O C-1 f C d p a 3 (D CD (D F), M -0 •D (D (D ((D (D 3 - - - n{ o Cn Z - O N E -I 2 I n O 00 C- -1 N O 1 O CD O N v% C,J CD W A 00 (O 7 C N N O , 7 0 0 a< ~ C ~ m ° rn (D CL m I~ ° z n ° C) o w N O W !O O O O! O N N Q. m O O 3 (D 7 CD (D O O m O O O CD N C) m 3 d CD Z O ? N 7 N Qo O O 7 tll N CO CA C L w m d CD CD Z~ CD 7 ~ ~ N ~ Z7 C O C N O O I C` N ~y ~O_ 3 Z (D (O N o OD = n r U> ° w rn rn cn o a Ul .a !r Z w N O O O O O O Z cn E o c T < N Z fA N fA UJ !n D 3 CD N U -0 v v v v q o cQ I N S N T O (,D cQ N m ('D -T (D o (D w m w 3 CD to 3 m o rD Ln J N ~ A O Z Z Z m °Z N 0 D D c D a° ~y !w l CD a 3 (D D CD CD - ch (D 3. c C (D C. 0 a / m 3 D CD C6 • 0 .3 N j N M 1 D. A Z 3 ~ -i N =r OD S W (D (D m ` `D m m z `N° ° 3 c 3 o - p O 4 N ~7 N Z O ? O O p7 (D 3 3 0 Q CD C O (D O O Q 3 a CD - CL v 3 a 3 (OO C 3 ~D O C ( CD ( D CD CD T d w A =1 cL 3 w C7. 0) 00) C W (D j CL Z =3 r. N N. CD Cl ID 'n Vs m 3 X 3 3 o` c oW~ v 6 CO r c,. r LCl=3 O n N (D O O 0)~`- N N 3 t 01 a N a n O a s CD (D CD O N 2k w O I N N (D A OD _ Q 0 N T ?o CD (D v O (v (fl G O v (D (D ST. CROIX COUNTY WISCONSIN ZONING OFFICE 11111111 ° u ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 28, 1994 Mr. Art Wegerer WEGERER SOIL TESTING & DESIGN SERVICE 421 North Main Street River Falls, Wisconsin 54022 RE: Septic System for Don Jensen Dear Art: Per your request this date, enclosed is a copy of materials within our file regarding Don Jensen's septic system. This property is located in the SE, of the SE h of Section 23, T28N-R19W, Town of Troy, St. Croix County, Wisconsin. If there is anything else that you need, please do not hesitate in contacting our office. Very sincerely, Marilyn K. Zais Administrative Secretary mz Enclosures U `~`~L' Form-STC- 104 AS BUILD' SANITARY SYSTEM REPORT Sys /y S~ OWNER TOWNSHIP Tll~?6 I/ SEC. 2-3 T 24 N-R W ADDRESS y. 3 5 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE 30' PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW Top O V ~L j wk ~~E sT47c hf%SS w,* y ' 1b PUMP CHAMBER Manufacturer: Liqui apacity: Pump Model: Pump/Siph Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevat' n: Gallons per cycle: Alarm Manufacture . Alarm Switch Type: Number of fe from nearest property line: Front, O Side, O Rear, 0 Ft. . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 1 e Trench: ~i^Qz p Width: Length: `53 Number of Lines: -3 Area Built: 3 Fill depth to top of pipe: L&JEST 5"~, % yoZ - 64Sr S"Or' `3 Number of feet from nearest property line: Front, ~O Side, O Rear, O P't. 70 Number of feet from well: Number of feet from building: tea" . (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: D eter: Liquid depth: Bottom of epage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of th~abee-soil absorbtion syt ? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of et: Number o6f feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: r ~ CIS ~ o ~ ~ G v1 O1 °o b t R~ 1 ' L `C ~C-s To I-N r~ > c ~yRv r ono ~ et L~ cli, n w g L~ T C o X. bt'a b~ b Ny ~ M c~+ ~G EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ' SAFETY & BUILDINGS ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BUREAU OF PLUMBING ADISON, WI 53707 (~y,, ZYCONVENTIONAL ❑ALTERNATIVE SletePlenl.D.Numhel IIf A5.0ntdl ❑ Holding Tank El In-Ground Pressure El Mound COMMERCIAL NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE 7F AP~ Don Jensen 250 Summit, River Falls, WI 54022 JBENCH MARK (Permanent refe,emepomU DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST FIEF PT. ELEV SE SE, Section 23, T28N-R19W, Town of Troy mr nl Plundm'. MP/MPgSW No.. County- S-.wv Pelmn Numhm. Robert Ulbricht 3307 St. Croix 83846 EPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV JWARNING LABEL LOCKING COVER 1 PROVIDED PROVIDED L. S L, DYES ❑NO DYES CJ NO BEDDING VENT DIA. VENT MAIL 1141(iH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING VENT TOF14FS14 ALARM FEET FROM LINE AIR INLET DYES ONO DYES 1:1 NO NEAREST OSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MUUEL Pl1MP. SIPHON MANUI ACTURtR WARNING; LABEL LOCKING COVER PROVIDED PROVIDED DYES ❑NO DYES ONO DYES C1NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PHIH't I4 1v 1011 L1 If" 111DINI, IVENT TUFHISII (DIFFERENCE BETWEEN FEET FROM LINE AIH 1NlE T PUMP ON AND OFF) DYES ❑NO NEAREST-i OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I f NGI IF 111111111 11 I1 IIIAIIIIIAI AND MARKINt, r excavation. (If soil can be rolled into a wire, construction shall cease unfit FORCE IONVENTIONAL e soil is dry enough to continue.) MAIN S YSTEM: BED/TRENCH WIDTH LENGTH NO OF UISTR PIPE SPACING COVER INSIDI IA apjls 1IOUID THE NCHFS NIATE141AL: PIT UFP1n DIMENSIONS G IAV L DEV H FILL )EP 14 U1. 111 1'l$'I UISTR PIPE DISTR. PI-P MATERIAL NO UIS1H NUMBER OF PfFOVEif Iy WELI HUILUING VENITNILIE) IF 141 SI HE LOW PIPES AN(1VE COVER 11 f V INI f 1 ELEV END ► M _ PIPES FEET FROM 'LINE R NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it . ON REVERSE SIDE. SHOW ELEVA- DYES ❑ NO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TtxTUHF Pt HMANINIMA14KI44S 111SSIIIVAIRINWIIIS UFPT H OVER THE N(Af Of[) DE VT II OV( H IH ENCI BED IDEPTF; OF TOPSOIL IsImI)f II DYES Ist(Of ❑NO DYES LINO I) - MUl C14U CFNIEH EDGES DYES ONO DYES ONO DYES F_JNO RESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH ILIN(Oll NO.OF LATERAL SPACING ,HAVEL U(P711 HI LOW VIPI F It L OF PI If AROV( COP! H TRENCHES DIMENSIONS MANIFUI.U PUMP MANI 10 tD. 01STR PIPE MANII OLD MA tHIAL Not UIS 111 I:IS111 PI'1 5ISII5hU1R7NP1P1 K1A 11111AI ARIAHKINI, ELEV ELEV UTA ELEV. PIPES UTA ELEVATION AND DISTRIBUTION INFORMATION ROLE SIZF HOLE SPACING UIOLLLI) f mil11 C11 Y COVFH MATERIAL V11111CAI I It I CORHFSPIINUS IO APPIMVI I) PL ANS DYES ONO COMMENTS: Y- PERMANENT MARKS D YES ❑ NO OBSERVATION W1__ I ELLS. NUMBER OF P LIRNEOPERTY WELL BUILDING FEET FROM DYES ❑No DYES ❑NO NEAREST- Sketch System on S U Reverse Side. Retain in county file for audit. 1 SIGNA TUNE I1T LE DILHR SBD 6710 (R. 01/82) EZ DI R SANITARY PERMIT APPLICATION Tom. In accord with ILHR 83.05, Wis. Adm. Code ,,^'~,,,,,,o~„•,~„~,,,o~ STATE SANITARY PERMIT # g3 y4 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. - OS 3 Z / -See reverse side for instructions for completing this application. PETITION M71 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES 1nS1 NO PROPERTY OWNER PROPERTY LOCATION jAFAfS46 AJ 5 C 5:6" %,S23 T29, N, R E (o W OAr PROPERTY OWNER'S MAILING ADDRESS L=AT I VJUaE1 AMBER 8WHOV18t91J NAME 2,5 D ~'uwi~ci' pvt,Ie r- o 3 ACS -ANDUARK CITY, STATE ZIP CODE ` P7~7 N~`K q Wz. CITY NEAREST ROAD. VILLAGE : ?}PD 3 II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR KI Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspectedand soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ❑ seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): RQUIRED (Square Feet): PROPOSED (Square Feet): y N -Private / -2- Feet N-Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X Z O &J t ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undRO WSf WW111114(I69 4bility for installation of the private sewage system shown on the attached plans. Plumbed Plumber's Signature: (No Stamps) W/MPRSW No.: Business Phone Number: Q OBE T ULBRINO. .33 0~ ~~f ~ j Q 4 U~ WIS. MASTER PLUMBER lIC. N0.3307 M.P..3 Nam of Designer: Plu 3 w~~O~J ovs S cI v~R i c h 1~ VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name HONESITE SEFIIC PLUMBING CO, CST # RT. 3 O'NEIL RID.: HUDSON, WIS. 54014 2- CST's ADDRESS (Street, City, State, Zip Code) ROBERT 1ABRIGH4 Phone Number: WIS. MASTER PLUMBER LIC. NO. 3307 MAR 1 MINN. INSTALLER & DESIGNER LIC. NO. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date ZZ Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee ~~OEJ ¢ Adverse Determination V J Q° (o X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT' APPLICATION TO THE APPLICANT: 1. This 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 must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow 'number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (;)BD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be property maintained. The septic tank(s) should be pumpod by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private, sewage syster contact your Iccal coc'e t0mirr,;strator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: Property owrer`s name and mailing address Provide_ the legal description where the S)Str 'TT is to be installed; 1. Type of building or use served: It public i checked, indicate type of use (i.e. 10 unit apa;?rnen7 , 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; Vi. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 110 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ` result of over 2 years of steady negotiation and public debate. The groundwater bi l Gro,-,r cl'..,ater included the creation of surcharges (fees) for a number o'' regulated practices which V't;s L;o can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that bur~~! ~reaSUro is used ie your building is returned tc: the groundwater though your soil absorption system or the disposal site used by your holding tank pumper. ' The monies collected through these surcharges are credi'ed to the groundwater fond admini!: tere(by the Department of Natural Resource:,. These funds are used for mon for rg grour d- t~#F ate , groundwater contamination in.estigations and est~.blishment of standards arc; ndwal,-,r 's worth protecting. SBD-6398 +;R.03/86) .b State of Wisconsin ` Department of Industry, Labor and Human Relations 7 ISioN PRIVATE SE .~At- ~tSrA1rF~E~TY~ &E$tUIf LpI lI.sNitGSl,DraIiVa s~~ c9 l+ -l:~i,.. t~~lutiiClC~Sl~r1 tTIfEtFt'iY.tct ' . ~~V rltlr ifi ti> W1.sccins.in 5,;70 liOi'13b i It. 1'I UMt3S1i<.; CO 1 a~13. »i, PQr' Day: ~ 340 RC)13F h i' L1t..EiRxC>iT 1^Itli1WIV WT 5,401.6 to4F1,S c,'.c ~>1Y"acwity Roview): 1.30 00 Dat.i i<c~cea.v'ed z6/:J0/86 pr`i i j(, c t Name : ~TvN'G'i::.itj EtiEE i? I~i~i t llt)ti; I i>c:, ( O")rl : r , af z (28 IV. R :l~~ln! trswra of : FROY(F. We'J PAKT The ).iaialC .i 53~~ pd_ anti ,:ar@d ;t t:ti k'f":k~ clf :l,Clli : ('u tI'?:f. i7~'fJ.l r I2tai~t1 i;2~`C~r1 1"(}vlewed 'for" <.(1mp r i anco 1"Jith rah; p scab) c r.4)Cit- r ,-jq d l row r i , . I l:l. ar,rxS 11 i i has od on ("h apter tr~~:), ih16"fC.:LSFI.;t..l '(?ttsElit_ mild t'.t'li! t'~?ti t,Yla~.r~ h~d~f;ti9t7~.~.i<~1 t~di ( S,~h7 IriE ):>1.iir.~is are :11+.1;1 tioctFal L / 'rA);?{" i r}iJecl E 111:, Fitq,r'ova i_ , ccwf` i rvjeviL i,l2Jon c.orRph ainc:p wjAh E ~^any t t lsa.t;l.ont, ~;f+ U0 )'1011 ).)tu13'?ii , f'1~t i~t'r~ must be COi YC C tt d AJJ per-111it.3 e-equirod 6:j thtt i_itV, itrI4:aa~:~. r;tt;y Shall be.., f))Uaj.ned for this Jt1,15io lation (7r kilt Ir; rttfiiS('.rklC,Lztfl lr) .tlft'rfsE'21 )d9J. I ) C C:. ? cm1 o-t t k l`~t) with the ilf+CS tF i ru~titi ' (t,r :sir 1 i. -S~ ctG7}1 'iL the^ 1 ~y e fhc! inst•kj (xr-, *1 ti iS~e1 .Li' 7 i~lp5 cajo~;ll,l~,r' L~~E,I iCtC.pE3Ctor LU{ c1 n is o:,n o e ltlk a)) tlris0<4 1, i,Jt f,l Ki).t.Ys° ~Entu y r"'S lli','i 1llFti ~t,ars.' t~I'CFu or if wa pev.'mi(- 1.oi,) t:2 i k-:!d, It C?,x(}.!i(! ..,,?ita ry i;H?1,11i e x P re, t t'44' t3l r" ':'til tiT I' li.it$1I«t k tit 1'li f°k it i . Iatr!t 1 . Y o, i .l.1 krU1 if 1(. 5 4 :i t E11T1 (.C]t~ C-4 11~,i 0 tN ~ Cili. Cocle equirciywnt5 St~tYi )I lt}i C)f).I it rieid( ii l<, l_ i"i t t,' ti 0 .._ty^4 of the 1 t ,ie(,-t ort c.IC?(IQfL61.,L y i,,consin 0)(i lir)a.5tr'atikie i:cst;ie This ,Approval. i 8 for ~Oic! following i;larataf,'lnonts on tit : Iii117w (;X)iiIVE61i11Ot1AL, . 1'li;1Ua..r'a.Ery (::i;3rit::sct.Y"rY".kr1Gl 4; i'1J: t -,ir.wr''i)1ic. l m,4-y b, I)1+:ark-:, -t:?1/ +.{?i) I lnc) (.608') 266-82,30, Y aZZ'I t:4/ ,zalid ('21.,31 ).d'l.r?)! i_ ,i.tr I > ).t>t"f cc.:: ft~ •x 1> 1tJrlltar~c~ i e>r1 ai,l1 Lcal'tt J. r ortil)er) i.-a 1. t h DILHR-SBD-6423 (N. 04/81) PROJECT INDEX SHEET OWNER : ,00A,) ADDRESS: SITE LOCATION: 3 J0 A~ h'1'XGI.Q 5c * Sec. 23 ~ r2PN elf 4-,) Tot w of lWoV (E~tsr P`~'~r~ St, Ci~°o!X ~ouUry PROJECT DESCRIPTION: 41410 OWS Tti°vcri o v~ A 4.2 'X /7✓r " 0,V 54413 /,3EE`p, Dot T,PlJY& 7'i;w Cvg,P~/fov.SF r~,'dt.. a F/ooe ~~P~4i~vS 74D/1G oic 12-•y//4DYj5js3 3 y~ fx6 . ~rD-1A G xlee O vireo r9/3Jo rh T,f r~ff,,vT 9~Pt~j : ;5S SQ FT iPoj~G2SEI~: 9,~ /p ~3 Gov vf,-VriAPA,,44v fitz~ w~dl~ ~1' /sj"l~ f'~L , St~O fi G ~'~9.~~ • PAGE 1. PLOT PLAN VIEWS PikGE 2. CROSS SI CT-rnrT & SYSTEM Pi.,AN VIEWS -T27, 7TT)~ T M1 fT14 f A T 1-1 14 J . •r PER F ORI-ViN(l I , SP`CS O ry -r PLUMBER: HOMESITE SIT-r.; 11;V~1T,UATF~ or DESIGNER RT. 3 O'NEIL RD., HiC NUMBING CO HUDSON ROBERT . WIS. 54616 WI4- MASTER PLUMBER LLB RICH~T MiNN.iNgTgLLER N0.3307M HOMESITE SEPTIC PLUMBING CO. & DESIGNER L'C' 07 .p P •RS " AT. I O'NEIL RD., HUD60N, WIS. 51016 00663 ROBERT ULBRICHT VAS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 0060 DATE: SIGNATURE ~o O h O U \ 64 \b u %4. 6 86-05321 Sr,cr,~r //wy 35 h ~J % 00 .1k ~ v v w O ~ i U's M %J o Q p cv A o- ~ o R46-C 2- of 2- - ~~v v/mow s c \cS 00 I I - - _-r. 5oliD Sc ~ X031 ~ I /~A,v%FoGD y.. I I ~ I I SEPT%G T~1v/l` M/Iv!/f~Ti~PE~ . .S3 1 I ~ I GUiESE~Q CavG,P~'7E ~'dDac7~ 3, ( R; r2. /few . /D I I S y~,~D \ 13~ I ED ~'o~tJGr,C7~t- U I pE!fi'l /2,6"o Ih/. 3OP41 5114?CR ~ ~ `h. ~ I ~ a X 9/ /y Ala"~Et p (f) 1o i ~ ~yq ~ I BElow w t eT ~ ~ I ( D,QSE~Ug~/o,✓ ~i~~ I I fl ~ I g6-0532 ~ w v`G~ . l~~ 9 ~E~PfFPA~ D .5 055 &567-10AJ sh Air Inlets And Observation Pipe Approved Vent Cap ti n rz~ Minimum 12° Above FiNidllE~ J~°~DE :o Final Grade M~XiM cr.H of Above PIDH 4" Cast Iron yL'- DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION. SECTION: TOWNSHI LOT NO.: BLK. NO.: SUBDIVISION NAME: sE 1/ 1/ 23 /T2-9 N/R/9 E W TRo d-46-7- Py9r!!!~ Ps1,eT o,~' rt 3<F 4CkZ-~ ~CEL.. COUNTY: OWNER'S S NAME: MAILING ADDRESS: -EUSO~J 1-3E~R S R~ Q LrroRS sr. ~RoiX J'E t N -R; V C Rk FA I IS W Is . S yon USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Re' &M. $eBR D!'S7R/,8• New ❑Replace f- w,~Ak 1 -'roa,t "hi-OT 3 /Z E,~p/ayt-~S 70~.~ L D.9rLy Gv~JTE ~Ga4v = 3 ~~b fif~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rE]S YSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) o S ❑u o S JS ❑u au ❑ S ©u ve-.j'*L 23&.2> If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CL~ S S Floodplain, indicate Floodplain elevation: S'C5. 2- tT£werr soils PROFILE DESCRIPTIONS /d BORING TOTAL DEPTH TO GROUNDWATER-IN. r CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPPTHr ELEVATION OBSERVED EST.. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O B- / O • J ' / O . J U ' Qs & 7 /3 BIIJ. / S tj 13,v. blew o ve're s B- Z D. D 1/00. O /0 , d v -~_o ~o ~IPIF C'" /S • 'N, 9S S ` Q • v 'R ~o v Je- /s ' /.7~~t/,~ s.e/', e 0PG'#pRSEo~- N S, /S G/•Ba. B- 7z > /0. q1 5 ' /s . ' -e Hv- G 7' J3/,I` S// _16A' s. G 7 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES c1 NUMBER IN AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER105 5 PER INCH P_ y~ Jre- Y 10 ,G „ ,i P_ i P_ 2- (0.0 Z ' P_ P_ -o~ 1- ro rG PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ' 1 -F E ! I i E ` I y f a _ _ . _ _ y_._ E E j INSTPI ICTIONS FOR COMPLETING FORM 115 - SRD - . To be a cornpl accurate soil test, your report MUSt include: I . Complete le I ion; 2. The use se( ly in( whether this sidence or commercial 1 3. MAXIMI-1V ,,ommercial use gunned; 4. Is this 5. !;in A SITE IS SU ,BLE FOR A Ht E T' JL Y IF ALL RULE_ T BASED O L CONDITIONS; B. ~ l is ~v here for tiff ofile description€s ~ ornpleting tis~~ Blot plan; ~r y locating y, _wrr 'est location. scale is `erred, A elevation , point , M), an( r° lent; dates, names, as esses, flood h': percola ;o~i s: t exemp- ~,i ,fraior7} does riot apply, r X; 11 . ~r and yon i~ di. luired- ALL SO_ ITH THE < THIN 3C OF COMPLETION. AT-'. OR CERTIFIED SOIL TESTERS x t, Other Syrtibols Other BR Bedrock Cob C SS - Sandstone gr - C '_S - Liine~ s - - H -Ih . j < - L Bn *siJ r Bi si toy Y --Y R - r mot ffl _ rill.. - d - P Ki HWL - H ; Sur' f IBM - Br VRP 1r xJ;rUR UN SOIL BORINGS & P- . OLATION TESTS 115 Project TEA15E.1 1~, E E12 l"7► S T l~ i (3 . ~th°t 0 ~S '~il/itl~S CU/.S . NOMESIIE SEPTIC PUMIWN6 m ' I, EG -11ND At i WAIEII NO., NUD M, VA& 5" • = Ba c kh o e i t s WIS. MASTER PRLUMBER C. Na 3307 AJRU MINN. WfALLER i DESIGNER UC. Na we X = Perc Locations Q = i;xisting Well ~ ~P-rr C.S.T. 2482 RbGI- Ze4i4", T of ~ 1 K ~ STfiyE vertical Reference Point POST' r,_.evation of Vertical Reference Point X00.0 • - Lot Line .a 9RRDE/Ertrieuf CALE : / 10.30 ~G~PcS ~ I I X70 fo No. PIPo~. (fly q~I° ~ cvlvER~ ► I ~ 100.5 oo ~v ~R v f J3 30 0 ~I H09ESITE SEPTIC PLUMBING CO. ti R1. 3 O'NEIL RD., HUDSON WIS. 54016 r S T C - 105 ROBERT ULBRICH4 r" 9 Wigs WSTER PLUMBER LIC. NO. 3307 M.P.R.S. SEPTIC TANK MAINTENANCE AGREEMENTT itJSTAILER&DESIGNERUC.NO 00663 C St. Croix County z c7 OWNER/BUYER 2>0,4) ROUTE/ BOX NUMBER Fire Numbyer R CITY/STATE/(~ ZIP 1 PROPERTY LOCATION Section , T 20P N, R W, C1 X61 ~ Town of, St. Croix County, vision Lot n er Improper use*and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of.60% of the eQst 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 systems properly .maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-Rite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. o E 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 Depart- 'b ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. HOMESITE SEPTIC PLUMBING CO. RT. 3O'NEIL RD.; HUDSON: WIS. 54016 ROBERT ULBRICH4 APPLICATION FOR SANITARY PERMIT 08. MASTER PLUMBER LIC. NO. 3307 M.P.&& WNN. INSTALLER & DESIGNER LIC. NO 00%3 STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - oDo~ J ~~v S,~ Owner of Property Location of Property SE 14 34, Section 2 , T 21? N-Ro W Township / _/4?®y Mailing Address v11 Address of Site ~"~,r►"~~ Subdivision Name Lot Number Previous Owner of Property Total Size of parcel If 714tJ, Ile- Date Parcel was Created ()5 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No Volume Z I-70 and Page Number &&0_ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTy OWNER CE=RTIFICATION I (We) eent%6y that att ~statement6 on thi.6 6o,cm ane tAue to the but of my (ouA) knowledge; that I (we) am (cute) the owne t (,s) o6 the pno pen ty dens cA bed in this WSRRANTY DEED.-To Husband and Wife as Joint Tenants FORM 399 (Revised) ni En cu M-%Ar, rr 312744 This Indenture, Nfade this 30th--------- day of .September--- in the year of our Lord, one thousand nine hundred and _seventy-tWO_.-._.-.-.--between William_ Jensen..and_Winifred Jensen, husband and wife, and Gerald C. Jensen and Ann Jensen, husband and wife, - Parties. of the first part, and--------- -Donald W. Jensen and Jeanette Jensen, M of River Falls, Wisconsin# _ _ husband and wife, as joint tenants, parties of the second part. Witnesseth, That the said part ie_s.of the tlrst Dart, for nncl in consideration of the sum of One ($1.00) Dollar and other good and valuable consideration XX4Aq( to _ them. ill hand paid by the said parties of the second part, the receipt vehereof is hereby confessed and ackno~c led ;ed, ha ve_ -giv'en, granted, barg;litted, sold, rcll&ed, released, aliened, conveyed and confirmed, and hN these presents do give, ,rant, bargain, sell, remise, release, alien, c•onveV and confirm unto the said p~rtic of the second part, it-, joint tenants, the following dcscrihed real estate, situated in the County of St. Croix and State of 1Visconsin, to-N\ it: A parcel. of land being pert of the E1 of the SE4 of Section 23 and the W' of the SW4 of Section 24, Township 28 North, Range 19 West, described as follows: All of the E',- of the SE';; of said Section 23 and W'; of the SW4 of said Section 24 lying SWly of and adjacent to the Sly right-of-way line of State Trunk Highway No. 35; EXCEPTING THEREFROM the following described previously conveyed parcels: Part of the 1'2 of the. SE4 of Section 23, T 28 N, R 19 W, described as follows: Commencing on the W line of said )z of the SE4 at the Sly right-of-way line of the C. St. P. M. & 0. Railway Co.; thence S 520 32' E on said Sly right-of-way line 293.80 feet; thence SWly at right angle to said right-of-way line 153.2 feet; thence West 140 feet to said West line of the E'z of the SE-14; thence North on said West line 300 feet to the place of beginning; together with a 100 feet wide parcel lying North of and adjacent to the above described exception, said 100 feet wide parcel being the same hereinabove referrenced right-of-way of the C.St.P. M. & 0. Railway Co.; and: A parcel of land containing 1.57 acres located in Sections 23 and 24, Township 28 North, Range 19 West, further described as follows: Beginning at the SE corner of said Section 23, thence West along the South line of said Section 23 a distance of 118,0 feet; thence North 150 10' West a distance of 160.8 feet; thence North 420 03' East a distance of 145.0 feet; thence South 520 44' East a distance of 432.8 feet to the South line of Section 24; thence West along the South line of said Section 24 a distance of 366.0 feet to point of beginning; together with an easement for an access road from the above described parcel Northerly to S.T.H. 35 as now opened and traveled. Subject to existing public roads, highways, any and all public or private utilities now located on the above described premises. Subject to all reservations as to minerals and the right to remove minerals reserved by the Chicago, Saint Paul, Minneapolis and Omaha Railway Company in their previous deed to grantor herein. (Actual consideration is less than $100,00.) And the said William Jensen and Winifred Jensen., husband and wife, and Gerald C Jensen and Ann Jensen, husband and wife t)l,"t ies (4 1 Ilk' !'IT -t 1, IT t. f(,;. their hcir;, c~, ru!+)~; an,i :nl;uini~ti at,~r5, do ct)%unant, grant, Iwi,1 aln, an+l a n t t,~ -ui(l with the ,:,A ixutics ,)f the pili, Ilid io :tort t".ith till. ;tir%-it,-oi ,lf thcm, hi: or hrr hi-ir- utll rt,;icn:, that it tilt, tilt, rif Ow (.11 u~ ;u1-1 they are a,11 >titr~l ,)f tilt' Pr,•,l;i-,,.- (h-crihcd, ;1; i,f a ,,tuul, inn , 1)t rf, ~"t. all,~,lut, ind in 11w I m . iu I,, nul tl:. I till smile :u-c fnc anal ,•'k"Ir fr(mt :,li in~'~o~lln ;Icv ~,hatc~"rr. and that lilt alu,tt• I~,u~;Iin,~,I I~r,nr-,~~ it ;L,~ ,iui~t al,l I,,,u",~.:I~l, Inr:,,,•~~i~il ,.I the ~;ti~l I)arti,~> ,,f tl,,=~r~~::,'. i ~ I,:trt thcrcof, they till Inr,~,r 1\:AI~I:.A\l -A\I) I)VI In AVitrless \V11ol-eof, Ihr ;.u;i I~.rt ies „f tht• Ilr>t I,ari- h.t Ve Ili rrunt~~ <t their s «Cal s thi: 30th .lx, 4 September 1. 1) . Io 72 ;i IIod, ;i :I1(.,] .11),1 1 it vIe,1 i❑ I rr~hncl ,,f Williani Jensen Winifred Jensen John _ DaviaoliL ell/ 7 Gerald C. Jcdsen Darlene J. Gilles till JCIk,,Cl.t STA'11? OF \V[S(.ONSIN, PIERCE (,ol,lit~ Pcts()nall, (Illw hcf,)re nn-, this 30th da)' of _ September A. 1O 72 the ahovc n.uliel William Jensen and Winifred Jensen, husband and wife, and Gerald C. Jensen and Ann Jensen, husband and wife to nun knlmn to Inc dic jwr~,m s %%110 t•.<t-ctitt(I the fore: t)in~ instrttmcnt anti M-htiowlcdl, ed the ,aloe. THIS INSTRUMENT WAS DRAFTED BY: John W. Davison JOHN W. DAVISON Attorney at Law River Falls Wisconsin Pierce \otar}i Public, P is .permanent. K X ('onimission t~cl9i lm- (section 59.51 (1) of the Wisconsin Statutes provides that all Instruments to be recorded shall have pistInly printed or type--!tten thereon the names of the grantors, p.rantees, wltne.s yes and notary) . O rl G Q ' 7 ~ W W? U o i L LJ U v) C': a _ 1 r Q cli