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HomeMy WebLinkAbout042-1056-70-000 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284336 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BADLANDS GOLF CORPORATION WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax 0422- -1056-70-000 TANK INFORMATION ELEVATION DATA A9700177 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic `r Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION D I M E N I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER Moe Number: INFORMATION Type O OR UNIT System: 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 De th Over Depth Over I xx Depth Of xx Seeded / Sodded xx Mulched No p E] No E] Yes El BedlTrench Center Bed /Trench Edges Topsoil Yes ❑ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 20.29.18.315A,SW,SW 1018 80TH AVE ILA-v NUE ~,D rallki 0 Plan revision required? ❑ Yes ❑ No Use other side for additional information. Date ' Is tors Signature Cert No. SBD-6710 (R 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: - Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. Cro I • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs E] Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ,8 114 SW 1/4, S v TA? , N, R E (or Propert Owner's Mailing gU Address Lot Number Block Number hl~~ Cit State Zip Code Phone Number Subdivision Name or CSM Number Ofzo2 ~ W/. A 9 ( ) A II. TYPE F 6 ILDING: (check one) ❑ State Owned ❑ !ty Nearest Road ❑ Village 7* ' Public 1 or 2 Family Dwelling - No. of bedrooms Town OF GU 0 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 X Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. X Repair of an -----System System______----- __TankOnly Existing System _________ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [Ig Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation rZ~ ~ Feet Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Concrete strutted glass App- Tanks Tanks Septic Tank or Holding Tank Q / z ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 10 1 ❑ 1:1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum s Signature: (No Stamps) M MPRSW N Business Phone Number: CGS Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY C] Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing k ent Signat re (NOS m Approved ❑ Owner Given Initial`/ p~ p~6urchargeFee) Adverse Determination Q X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05(94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Dimaion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permi L may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system.. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if "required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations Utllttln111r,l• 199n 701 f nn 1: WnV4li 1 n1iLu11 Avnnuo P. 0. Box 7969 Madison. WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S96-04733 FEE RECEIVED: 160.00 BADLANDS GOLF COURSE / PERRY, GORDO SW,SW,20,29,18W TOWN OF WARREN COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any.stipulations i shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan i submittal and approval is required. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. i ~ C(OPY UUUA•89911 I R. I W94) SAFETY &c BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations III nf4lrllf A Agg0C1ATFC Page 2 December 6, 1996 PLAN S96-04733 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. 7mmes rely, ~ D n Quinlan Plan Reviewer Section of Private Sewage (608) 266-3937 E • dHUA •99ge Ilt. 101911 ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineoring Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S96-04733 DATE Dec. 6. 1996_ OWNER Badlands Golf Course (G.Perry) PHONE 715-749-3929 ADDRESS 1018 80th Ave. Roberts, Wis. 54023 LEGAL DESCRIPTION SW 1/4, SW 1/4, Sec.20, T29N, R18W. it TOWN OF Warren COUNTY St. Croix CSTM Robert Ulbricht CSTM2482 i - LOCAL AUTHORITY/ SUPERVISION St. Croix County Zoning Dept_ PROJECT DESCRIPTION: See attached next page. I JAY ED i s~4~~SCONsl~ RELA LA R ULfaR DM(, OF ItIDUSOF SAFEtY ANDUBU D NGSTION$ D11N } DIVISION MUM" I' ONDENCE d*81 GTA SEE COFlFlESP 'Mvn:nunnt I Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEW SPECS. Pg.3 Exterior Precast Grease Interceptor Cross Sections Pg.4 Building Plans A Proposed Seating. ULBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT DESCRIPTION A small (30'X421) golf course clubhouse (with small lounge) will be added on-to (a 30'X51' addition). The new enlarged building will be set up now as a resturant with bar. The existing system (installed 1994) serves 2 public rest rooms. This same system will remain in place serving all the entire toliet/restroom waste for the 4 employees, 68 new total proposed restuarant seatst 18 bar seats, plus a precalculated 119 golf course walk-in players (as determined by St-Croix County Zoning Dept.). The total calculated toliet wastes are: 4 employees (20 gal. each) 80 gals. 68 rest. seats (21 gals. each) 1428 gals. 18 bar stools (9 gal. each) 162 gals. 119 Walk-in-players daily (5 gal. each) 595 gals. Total Toliet Waste: 2265 gal. daily The existing trench system in sandy soils (.8 GPD/ft2) consists of 7 t renches each 5'X'811, for a total of 2835 sq.ft. The minimum sq. ft. required for 2265 gals. of toliet waste is 2831 sq.ft. The existing system is adequete and code compliant However, it is necessary per code that the septic tank capacity be increased. Therefore, a new 1000 gal. septic tank shall be added in series to this existing system. SIZING OF KITCHEN/ DISHWASHER WASTE (PROPOSED NEW DRAINFIELD) For total of 68 rest. seats and 18 bar stool eaters. 12 gal./ seat each, estimated daily wasteflow: 1,032 gals. Proposed: install-a state approved precast exterior grease interceptor tank ( Wieser Concrete Co. ) of 1250 gal., followed in series by two seperate 750 gal. precast septic,tariks for ultimate pre-treatment and clarification.of final.effluents. Installer shall provide that all kitchen waste tanks are provided with above-ground code approved locking covers for. required frequent servicing. Soils in the new (restaurant waste) drainfield area are very permiable (.8 GPD/ft). The minimum required sq.ft. of • trenches required is Proposed: install 3 trenche s, with drop box distributiot i"slope, each trench 51X1001. Proposed capacity: 1500 sq.ft.'~ .y Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page 13 f 1 d Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County S •X Include, but not limited to: vertical and horizontal reference point (BM), direction and percent blo06, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I D N APPI_tggNT INPOAMATION • Plospo n►a1f off hifoo-ninfivej. Out* Personal Inforn At6 you provide may be used f6r secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property owner GoRDOw I Hc•ivi PERRY Property Location (3ADLAN D S G a L. F Got, R S A Govt. Lot :5Mj 1/4560 1/4,3 26 T29' N.R E (or) W Property Owner's Malting Address Lot N BlockN Subd. Name or CSMN /o i8 eo 1f- q use • - - 3yz Cly State Zip Code Phone Number Nearest Road A04.4vO5 R08ER r5 w/S Syo i3 7/5 )7yy- y/fib ❑ city vnla~eN Down Sao tk A0.0% ❑ New Construction Use: ❑ 5pldential / Number of bedrooms Addition to existing building old, ❑ Replacement 2fubllc or commercial - Describe: C4013 JYV vSF ~e4 'Sr4 yip.4.v j Code derived dally low O 0 gpd 2 Recommended design loading rate bed, gpd/fl2 french, gpdR12 Absorption Area required ed, ft2 /3 5 trench, ft2 Maximum design loading rate bed, gpd/1l2 trench, gpdM2 Recormended Infiltration surface elevation(s) S_ p 4 • 3 H (as referred to site plan benchmark) Additional design/site conssidemIms Parent material SCS 7 9 13URX h 4RA21'- e7,rW4E V& .S,¢w O S Flood plain elevation, If applicable It S a Suitable for system Conventional Mound In-(around Pressure AAT -Oa System n Fill Holding Tank U e Unsuitable for system [3-'S 0 U Q S 11 U ❑ U I S❑ U ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots OW2 In. Munseli Ou. Sz. Cont. Color Or. Sz. Sh. Bed , Trench 1 o-// /oYR 31 1-04AI 14SbK f y S A--3 /0Y? / C • y•,e ev ' /o YX 3,0K /7'*- . : s 11 -7 /D VA? Depth to lImiung factor ' Remarks: Boring # p•/~- to y 2--f- • Y •S i Z z 41-21 m )X W11 SQL zf sb C F . s;. G /0Y9 J Ground / s • 7 elev. 'K /7 yy--" v Depth to limiting factor > y.t-in. Remarks: , CST Name (Please Print) Signature ue&_~ phone No 'RvC3~er 2lGt3Rt Gft.T- ?l5 Telephone 0 I83 S Address Date CST Number 119- 1 4LZP,/- -1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2' of PARCEL I.D./ Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munson Qu. Sz. Cont. Color Texture Or. Sz. Sh. Consistence Boundary Roots Bed Trench 0. /Y 109M 'Nal- Z /o YZe Y/41' /L 2 fps ~►+-Fie cts /yr- . S ' . Ground _ S d elev. 7 ?lo. att. ; Depth to ' IImINng factor y Ca in. Remarks: Boring # 0'i3 /o X 3/ 40YAl /fSA& CS• . Y' •S _57 5; Ground s a S elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Ou. Sz. Cont. Color Or. Sz. Sh. Bed Trench Boring # lo L GQ --3/ 11-4~64e -WIT e5 2F 3 a ~s om, c,s' Ground IO s' S C/j S elev. ' . s4CL 4 Depth to ' limiting factor ' Remark'k: Boring # Ground { elev. ft. i Depth to ' limiting factor In. Remarks: ~ 4tl11W_en•fn ro nw w... Fresh Air Inlets And Observation Pipe r1- - Approved Vein Cep o Minimum 12" Abovo ' !'J 111 final Grad* f,44A S- TiPt~~v ~ /f- 9 y O • " Ci Above Pipe Cost Its" 1e Final Grade Vent flee' PER PLUMBING PRODUCT APPROVAL • Synthetk Covering ADES, ALL ABOVEGROUND PVC Mtn. 2" Aggregate PIPING (FROM TANKS 6 SYSTEM AREAS) Over Pipe MUST BE SCH.40 PVC MEETING ASTM 4 aslrlAutbn _ Tee D1785 OR D2666 STANDARDS. PIP$ 2 0 0 0 0 -Izz, a Aggregels i b P«Ibretol Pipe selov 9eneelh Pipe o -Cgkoln2 TeemisellaB At J ~ • -T- 5)/ STBottom Of System ~ -j kq Fresh Air Inlels And Observation Pipe h W Approvod Vent Cap q, t* n 'r Midmum 12" Above / VVVIII ICJ 1~ Final Grade / FI N Ls Huo GR A-1P E-- ZN 3 G Above Pipe _ o• Cod Iron ~ 1e final Grade Vent Alpo' k Synlhetk Covering H Min. 2" Aggregate Over Pipe Oldrllullon Teo PIP# 0 0 0 0 0 Aggr egole o Portkoled.Plpo Below 5 S T~ M 9onoelh Pipo q ~ ~'/`cv • 4 o -Coupling Torminalin, At o \ 7 S Botlom 01 $1114m al ' Fresh Air Inlels And Observollon Pipe Ot Approved Vent Cap Minimum 12' Above k _ 11/ final Grade//.r/%S v l` Q 70 o p ~rn~ C..A d U 1 O w n ~ ~ 1 O N /NL E T Ir O =a w^ c W Q°N,~~~rz • 2 CA C ~a r~ C7 1r"' • 1 ' 1 i Z w L o vTG F7' ~ I ~ N~ f i i N 2 2' 8' , Is.p' 5 4 6'-2' 6 0' 1'-6' g g 'IN I ;r--r I I 0'.p` dy `t' II IG-0' I 4'_p• I © II ~ \ -q I \ Qp Cl I II \ ~ I C 11 ~ II ~ II 11 ii I 11 w M w 11 ~I~ \ l^ ~V~ loll d 0 I " vm u~ tip c~ RI 1h th o y -IN Z; G ~ `C 0 • a- a tot C ~ Z o 7p w • c i i O a~ b r~ p ~ C k ~rOl ~ O C` t ~ o S o ~ 3 5) f r, 4 J _ ' 13.4oGipvos R a. 11 Ili O '1• ~ \C ~j Y ~ b ; ;T► RI b y p to d n R I I x o ~ d~~~~ I°-I O IIoIIO.II~ m of o ~~o I I I I I I ~ , e ~ ~ I I I I I I• ~ "'U a ~ I I ( j I I a Z ~ I 77 140 ~y I I I~I O h~~~ Ib ~ t~ I ICI I°°I I ~ N O I ~p i w c S I( I I I I ~l C h ~ m I I I ~ I ~ rn 101 0 1A) s ~l~ w tl e Z; o N Wry y ~ O y i~ 7 ~y ~ \ ~ p J to • ~ O ~ ec a. Ill t1i y Tso r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County MAILING ADDRESS _j& B 8,0 711 2 gr n 1?j6 /c'TGUi ~'S~OZ 3 PROPERTY ADDRESS ANA 812t111 S r10A 3 (location of septic system) Please obtain from the Planning Dept. ~f3f= 7• C~i'~ CITY/STATE PROPERTY LOCATION !5 UJ 1/4, c51V 1/4, Section __gj_VT__2,..~N-R_ /8 W TOWN OF LU/AIl~:~~ 1V ST. CROIX COUNTY, WI SUBDIVISION &A LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 1/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: j DATE: St. Croix County Zoning Office Government Center l 101 Carmichael Road 11/93 Hudson, WI 54016 S T C - 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. - - Owner of property Location of property 5LV 1/4 41/4, Section ;ZLI) ,TN-R_.f 8-W Township CJ fa^,te ~ Mailing address Qk4g-P Address of site 101A 80 r* A S'Y013 Subdivision name Lot no. Other homes on property? Yes___,k_No Previous owner of property Total size of property C", - 01L~ 6-4c-~ Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ 1 Yes No Is this property being developed for (spec house)? Yes __)L_No Volume and Page Number 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 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 the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the clullaU1,11oil I fill fit' rift I'1 wyal dm, mill 1 1143 ran11113 I1na Iloaii fill I y i of list Marl 1 ii the office of the County Register of Deeds as Document No. Signature of Applic nt Co-Applicant 4- 30-9-7 Date of Signature Date of Signature STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, ADURESS$ SUBDIVISION / CSM#_ ~lq LOT SECTION _Tg ,9 N-R /B W, Town of Lo,q,p/,►:Al ST. CROIX COUNTY, WISCONSIN PLAN. VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,3-.SX/TJtJ` r/~E/frcN~S - P 1lox - - - - - - O&P Box - - - - - - - - - - Af&14✓ 0000 GC 7, /,CSO GL• GRE~sc /wTc?, V CLU/3 ~oust~ on 5'caL~ / y0 EX1S;r1n6- INDICATE NORTH ARROW W *C, C JIM Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. aENCHMARR: /3nTTa M .cnf F o.* 'AD SIQlArz /V UJ ~ iaiy'E% ALTERNATE BM: ;6EPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_ Liquid Capacity: lrLS, Setback from: Weller House /Q' -Other • anufacturer Modell Size Float seperation cle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length __Z42.0 Number of trenches Distance & Direction to nearest prop. line: 3Cl Setback from: well: 17p# House 60 Other ELEVATIONS Building Sewer t ST Inlet: 15,/S ST outlet: PC inlet PC bottom_ ACA pump Off',4 Header/Manifold X9.93 iF.LrBottom of system ,St S7, yt Existing Grade ?Z Final grade y DATE OF INSTALLATION: P. 9`97 PLUMBER ON JOB: "1. I _ yt LICENSE NUMBER! 320 S- INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Sanitary Permit No.: GENERAL INFORMATION (ATTACH TO PERMIT) 284337 Permit Holder's Name: ❑ City Village Town o : State Plan ID No.: BADLANDS GOLF CORPORATION WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 042-1056-70-000 D ' /00.01' r~ k~ TANK INFORMATION ELEVATION DATA A9700176 TYPE MANUFACTURER CAPACITY STATION BS HI ~FS ELEV. Septic 41 pg a Benchmark 00. o ' Dosing <-IT Aeration Bldg. Sewer 45,4 -;L' 9 ss- ?4/. Gs' Holding St/Ht Inlet qlr' g"I 3, TANK SETBACK INFORMATION St/Ht Outlet o3'q P, TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 1/0, -loo, loo, NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Sao • as,o, Manufacturer Demand Model Number GPM TDH Lift Lrict System TDH Ft Forcemain gth Dia. H Dist. To Well F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _ 1 160, j ' DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER INFORMATION Type Of ld1A.r~ Model Num Number: System: rd~ p v' V A4 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 [Bed epth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No Ye, I COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 20.29.18.315A,SW,SW 1018 80TH AVENUEt as/Ja,U` &4d- f, d Cl y1-?7 6~ IS.Y3' Car 3 5~ ' ~q a a Plan revision required? C] Yes E] No Use other side for additional information. 9 -F5- SBD-6710 (R 05/91) Date In pe is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: 3 .,5 X /0 0 r a la" I Trench 1. 2. 3. 'a Header 1 ` End .o. 56' 9k. 33 / System SF' s 7 Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. fiCt, . Cl0/ • See reverse side for instructions for completing this application State Sanitary Permit Number g4~3 3 7 The information you provide may be used by.other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property~wner Name Property Location UR ~1/4 1/4, S T , N, R l8 E (or~ Property Owner's Mailing Address Lot Number Block Number T// Cit State I Zip Code Phone Number Subdivision Name or CSM Number Wine S-910.1 3 IVA II. TYPE F BUILDING: (check one) ❑ State Owned icyl Nearest Road ❑ v age 10 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF O rk E 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 6 Z/2. T JOS4 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ~J Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 50 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 Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑.Specify Type 410 Holding Tank 12 191 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~rp g7• S Elevation S`OC7 . 7S Feet. Syr o ~''~eet Ci at VII. NTANK FORMATION in gall city Total # of Manufacturer's Name Prefab. CoSite n- Steel Fiber- Plastic Exper. New Existin Gallons Tanks concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank j Q E ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plum r' Signature: (No Stam MP/ RSW N Business Phone Number: @WAW-Al 5C WA7 'I -r 3 ! 5--S' g-6 G S'/ Plumber's Address (Street, City, State, Zip Code): 5'g O 5 IX. C U Y / DE ARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater [~ate Issued Issuing Agent Signat re (No amps) Approved ❑ Owner Given Initial Surcharge Fee) O~ /Q~ Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Division, Owner, Plumber ~ r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any ne,ev criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed. pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary. permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1. through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations December 6, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S96-04733 FEE RECEIVED: 160.00 BADLANDS GOLF COURSE / PERRY, GORDO SW,SW,20,29,18W TOWN OF WARREN COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. V i A. T C:zl KcoAz 997 ORIGINAL a. sT 'R y ZONcoGpFF4G'~ 6)r f^~ \ % SUDA-6928 (x. 10/84) .r s+ i w L£6£-99Z (809) OhMaS aleAlJd 10 u0143aS aaMa JAaa ue Ld ueLulnb saw d `,KLa.A ou }S 'anoge uMogs jagwnu ueLd a44 of JaJ8J MOW •Mo Laq pals } L jagwnu aye. 4e aw off. p9'43aJ Ip aq p Lnoys sa LJ }nbul ££LVO-96S Ndld 9661 19 aagwaoa0 Z a6ed S31VIOOSSV V 1HOIH@If1 suopulaM uutung pus Ioqu-I lg lsnpu13o juatupudaQ UiSUOasiM 3o OJUIS LOLS4 at9u0391 luo9ip9w 696L xoH'O'd enueA`r uol2uiyseM'3 log NOISIAIU SJNIU7Iafl V A151JVS SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations ULBRICHT & ASSOCIATES Page 2 December 6, 1996 PLAN S96-04733 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si nc rely, mes Quinlan Plan Reviewer Section of Private Sewage (608) 266-3937 SUDA-6929 (x. 10/94) ULBRICHT & ASSOCIATES CO. Reg.Designers of Engineering Systems 655 O'Neil Road • Hudson, WI 54016 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S96-04733 DATE Dec. 6,__1.9.96_ OWNER Badlands Golf Course (G. Perry) PHONE 715-749-3929 ADDRESS 1018 80th Ave. Roberts, Wis. 54023 LEGAL DESCRIPTION SW 1/4, SW 1/4, Sec. 20, T29N, R18W. TOWN OF Warren COUNTY St. Croix CSTM Robert Ulbricht CSTM2482 LOCAL AUTHORITY/ SUPERVISION St. Croix County Zoning Dept. PROJECT DESCRIPTION: See attached next page. • 15 C is j+�°1 PO I i�ROR �, IIUMAN RELAT100$ 1*(1!jj ?u4ivI. OF IND , ,1°71vs1ot:0sArETiAi0BU1LI1F DNQS � a. 1 �.7i � �.,�.t,�UO \tip ..• �'' SEE CORRESPONDENCE 44:4' ::S * S I . Pg. 1 PLOT PLAN VIEWS Pg. 2 SYSTEM CROSS SECTIONS E. SYSTEM PLAN VIEW SPECS. Pg. 3 Exterior Precast Grease Interceptor Cross Sections Pg.4 Building Plans & Proposed Seating. • S. This design for installation is based entirely on measurements, elevations, ' landscape conditions (slopes etc. ) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persona (excavatere, laborite) shall not be construed as an assumption of responaibii '. ,y by the designer for the workmanship, construction, plat ment, substitution or selection of- any components not s ecified, or any assumptions by the plumt`Er that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather onditione (wet/frozen voile) by any such parties or persons. /ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg.Designers of Engineering Systems 715-386-8185 Private Sewage Consultants • PROJECT DESCRIPTION A small ( 30' X42 ' ) golf course clubhouse (with small lounge) will be added on- to ( a 30 'X51 ' addition) . The new enlarged building will be set up now as a resturant with bar. The existing system ( installed 1994) serves 2 public rest rooms. This same system will remain in place serving all the entire toliet/restroom waste for the 4 employees, 68 new total proposed restuarant seats, 18 bar seats, plus a precalculated 119 golf course walk-in players ( as determined by St.Croix County Zoning Dept. ) . The total calculated toliet wastes are: 4 employees ( 20 gal . each) 80 gals. 68 rest. seats ( 21 gals. each) 1428 gals. 18 bar stools ( 9 gal . each) 162 gals. 119 Walk-in-players daily ( 5 gal. each) ---- 595 gals. Total Toliet Waste: 2265 gal. daily The existing trench system in sandy soils ( .8 GPD/ft2) consists of 7 t renches each 5 'X' 81 ' , for a total of 2835 sq. ft. The minimum sq. ft. required for 2265 gals. of toliet waste is 2831 sq. ft . The existing system is adequete and code compliant However, it is necessary per code that the septic tank capacity be increased. Therefore, a new 1000 gal . septic tank shall be added in series to this existing system. SIZING OF KITCHEN/ DISHWASHER WASTE ( PROPOSED NEW DRAINFIELD) For total of 68 rest . seats and 18 bar stool eaters. @ 12 gal ./ seat each, estimated daily wasteflow: 1032 gals. Proposed: install a state approved precast exterior grease interceptor tank ( Wieser Concrete Co. ) of 1250 gal. , followed in series by two seperate 750 gal . precast septic; tarik,s for ultimate pre-treatment and clarification of final effluents. Installer shall provide that all kitchen waste tanks are provided with above-ground code approved locking covers for required frequent servicing. • Soils in the new ( restaurant waste) drainfield area are ' very permiable ( . 8 GPD/ft) . The minimum required sq. ft. of • trenches required is 1-2-�� Proposed: install 3 trenche s, with drop box distributior�l '6�i`'slope, each trench 5 'X100 ' . Proposed capacity: 1500 sq. ft.,' • '/� /T f .� Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page_LL_LL of•j, ;2. Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County 5 n / Include,but not limited to: vertical and horizontal reference point(BM),direction and (iLQ /�v percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.N Arrf a;ANr INrOflMATION - I'laaaaniIrt all her.,manor'. fievleweri fly ueia Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I Property Owner GGRDoti) 1 l-j )i PERRY Property location _ f3AiDLSr.) D S Ga- F coc� Rs - Govt.Lot Se() 1/454y 1/4,S 20 T 2 9 ,N,R /,' E(or)W Property Owner's Mailing Address -Lot N Block# Subd.Name or CSM# /oig eo r- 4u1 • 7/5-7y9-32K City State Zip Code Phone Number Nearest Road 6,401-44/P5 R0802T5 to/5 I syo z'i( //5 )7yy-y/fib ❑ city WA/ L A/ �t"n I S'o Kt,4(E-. RD , 0 New Construction Use: ❑.��Residential/Number of bedrooms Addition to existing building [I] E Replacement Public or commercial-Describe: CC.0/3 ff o 1.), E- #PE5r'4-'f4 v% Code derived daily flow //0 0 gpd Recommended design loading rate bed,gpd/It2 trench,gpd/f12 Absorption Area required bed,ft2 7 5 p eq trench,ft2 Maximum design loading rate bed,gpd/It2 trench,gpd/ft2 Recommended infiltration surface elevation(s) S� II • 3 ft(as referred to site plan benchmark) Additional design/site considerations Parent material SCf 5..? /3 uRK ti 4RD 7--• O U7 wA s ti �,�� ft�. r¢ OS Flood plain elevation,If applicable S = Suitable for system Conventional , ,Mouund In-Ground Pressure AT- de System n Fill Holding Tank U = Unsuitable for system L�S El I� s ID El L"f S El ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots I GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench 0-/I /oYie 3/2_ 40/fAi /fSh/C C'S 2-f- • f ; • 5 Z G l3 /0 a /ri /D/tAi heih,e /hi �if, es• /f • y: •S Ground 3 Zf /0 ye yy - --L _ //SA / /4/7Gie„ a3 /L . y: /s elev. y 8 Depth to . limiting factor - , qJn. Remarks: Boring# / 0-0_ /oYR 3 2._ ____ o in i-sh/t Eff iliaill z-F- • r .•5 II Aahl IIMINI --- 5/L. 2 FS6/ . IL IIMIN . s ; . NM /0 i . MI Z5 / i d$ Igall . 7 : •8 Ground in /0 / 5/ S d 2t . -1 ' ej lim elev. ' / Depth to MAIRIPAIMIIIII__- limiting -- 1�lA��__— factor > 94___in. Remarks: , ANIIIIMMIIINIIIMIIIIIIMINININEEMILMIIIIIIIIIIIW CST Name (Please Print) Signature r" - • Telephone No. lz o r3 p e r ?,r r;[3 R t C'L T � / I -715 - 3 Cp• g I S 5 Address Date CST Number 4/911. f /?` 26 6157 i 2 7fz-. TO T.q-L-- Ulbricht&Associates -)f— J�/ 5E-4-Ts , y 6/is77 Cr Private Sewage Consultants ' / 655 O'Neil Rd. EMpLo't S, ,%T G� w4-57 Hudson,Wis. 54016 0A'c y ( 6 4rkitodA-1 5 ;i :X/SliAv6-- Before local toning ' perms eon be wonted . T o/!�=rS .9.�,E- 4o v v�c 7-� Ta THIS PROJECT WILL SEpEP/i-r — g,t:/'S RA,G— y -4.-A- REQUIRE STATE LEVEL PLAN AID OVrt. Pans o i.o sys r s --•RviN G- P/Ro• sue/3 will nee. M Is sullmftted cv^cC. /o tix) Q.t)2flt._ , /i/ a) by a onallgil designer per LUSA 113.08 (2) 4f Df T'oti S$ p/'SAt .w , • Fresh Air inlets And Observation Pipe (/ s 6 r— Approved Vent Cop A" Minimum i2'Above 111 Final Gr.d. it �— f/A1/s/7/EP 9/P06— 0 Ai" Cies Irew `01" 360 Above ripe - .._ .to Final Grade Vent rip. . PER PLUMBING PRODUCT APPROVAL $ynlhelle Covering (CODES, ALL ABOVE-GROUND PVC kiln. 2' AggregatePIPING (FROM TANKS & SYSTEM AREAS) Over Pip I MUST BE SCH.40 PVC MEETING ASTM 0 01,1►levtlon }� ._._Tee D1785 OR D2665 STANDARDS. Pip. o 0 0 0 o • w e Aggregate b PwlOrele/ Plpe Below J Beneath Pipe o --Cppling Terminoling Al 3 5)/ STE.y -4"— • tletlom 01 System 1w. o 90•0 W � W • Fresh Air Inlets And Observation Pipe si Approved Vent Cep t/n aMinimum 12"Above • ,(� 11 Final Grade 7/ FINISHED 6-RA-PE— . kiii TRE ►.� c H— 7/ 75 N it 2N - 3 G Above Pipe __4 Cost Iron 10 Final Grade Vent f'Ipr • kl v Srynlhetic Covering kU V) kii . 2 Aggregate Over Pipe OIslrlbuilon --Tee Pipe o 0 0 0 0 . e •o V G. Aggregate o Pertbrolod Pipe Below . Beneath Pipe o ---Coupling Terminating Al c 5 y S T� A-4 676-0. ^�-'- 1 Bottom 01 System Lu Fresh Air Inlets And Observation Pipe • of O Approved Vent Cop • Vk W . Minimum 121 Above �� 11/ Final Grade j 6,0/.5 fi/EP yif4Q& ir 0 t . u_ 3G _4' Cost Iron • 2-q Above Pipe Vent Ply. 10 Final Grade • % Synthetic Covering 1 Mtn. 2" Aggregate I Over Pipe I t Distribution _ ( o 0 0 0 0 Tee Pipe • U 'S • Aggregate a Perloreled Pipe Below G Benson Pipe —Coupling Termineting Al 0 Bottom 01 System Sys TEA/ e/Ev . g7, cD ' . 2 D -fib e,., �-1 -4 (3 `- .764 `�"--tr. -t( Q o a o ,4 M C m cnd 11 1 �' (�� W n O I- , 1 Q d7V 1 N /,v[ c T ti . 1 w•— c N - A o � c) � � rn W N n r a � -oNgp �___ ( I _• G G 0 0 c7 a. 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Imo _ _ _ W � 9 . , , t Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page , of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County S• n / x Include, but not limited to: vertical and horizontal reference point (BM), direction and (iLQ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner G oRDOAJ i HL•iD i PERRY Property Location (3ADLAO D S &101-F COU RS G:- Govt. Lot Sw 1/454U 1/4,S 20 T Z 9 N,R /.9 E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /o i8 eo rf - 4 U- • - - 3 yz City State Zip Code Phone Number Nearest Road 08,5k r5 lVI S 5110 2. 3 (1/5 )7yy- y~~b El city ❑ Vii A/ Town FO K^ A V,= . RD ❑ New Construction Use: RR idential / Number of bedrooms Addition to existing building ❑ Replacement L'~Public or commercial -Describe: C4013 Y0 vSE Code derived dally flow /0 O gpd /575 Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, It 2 Maximum design loading rate bed, gpd/ft2 trench, gpd/I12 Recommended Infiltration surface elevation(s) SAM- p 4 3 ft (as referred to site plan benchmark) Additional design/site considerations P? 7-TIE-Z-1 Parent material SCS 7 9 f~ VRX h 4/QD711_ evT w~ t~In. si¢~v05 Flood plain elevation, if applicable ft S = Suitable for system conventional Mound In-Ground Pressure AT-G~de System n Fill Holding Tank U = Unsuitable for system ~ ❑ U ['r S ❑ U ❑ U Cr]'s ❑ U ❑ U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o-11 ioYR 31"I fAf Hshk 407k e5 z -f . y • s Z• -;-3 /0Y~e / rt h4 Ground elev. /D sL 1* 11 /7 ~S y3- 1/_7_11t- I/ f4o Depth to limiting factor > q f In. UjT Remarks: Boring # 0-a lo Ye 31;,- 2-- 42 3 /O ~5 s c • 7 .8 Ground /Q s d 7 elev. yy. 24-ft. Depth to limiting factor > f*.in. Remarks: CST Name (Please Print) Signature " Telephone No. -Ro(3E Er 24 L, (3R t ckT -7rs - 3 c-- g 1 ~3 -5 Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench o•iY /o R 312-Z Yl? -2-F "7/Q 5 h -6e Ground s elev. 5162 Wft. Depth to limiting factor Remarks: Boring # 0-/3 /o ye 31 GO /fsde ~►~rf ~'S / rc • Y; •S ' z 3-17 /L zfShk-- ,h4 Leg- .s' 6 57 5L ti 3 7 o V14,1 5 Ground s o s G~ ; • lj elev. 8 y. eft. . Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots DtftF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # /D 310- /0 GQ /~S~l~i' ~S Z • S z Z a I! ~ S/L. 2 fps c s~ Ground .9 f f S C/~ S 7 elev. Depth to limiting p factor 7 6 &-In' Remarkb: Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: v I3ADG.avD s RAID A, v, °O o ► v' w ~o y `J 0 n1 -0 C: z° =~r I '1 vJ c c ~ ~ 0 I o ~ m I ~ i r~ z o Q i•0 n z o Ct ~ 'o~ o e 3 UJ rr, a S T C - 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. Owner of property C24~~ Location of property SjCV 1/4_ 1/4, Section ,T_,ty N-W Township Gy 0_AAA~vL Mailing address 101?; Oc4g-P W -5 c/o -0-13 Address of site U8 -80 rff 41/013 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property jam` Total size of property u".& ]j Qrt.cia.Q off, G,~ Total size of parcel,A Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _)C_No Volume and Page Number 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 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 the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for -the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applic nt Co-Applicant Li- 30-13- _ Date of Signature Date of Signature s r y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ~ ►VVNICII/11111'I;It ~ CO~,o ~ 'MAILING ADDRESS &A 60 7H A ~J jr-_ b %Z /t rl CUi ~ 51YO-2 3 PROPERTY ADDRESS 1,0, 16 rft' d Ofl eW j S C11r Y02- 3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE f ailez eT 5 fj)/, PROPERTY LOCATION 54V 1/4, S40 1/4, Section. oZO, T~21_N-R_1d_W TOWN OF (VA2/14 /t , ST. CROIX COUNTY, WI SUBDIVISION &A , LOT NUMBER JV4 CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: -J DATE: -9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . 519579 vot'~~~9r~ ~4 QUITCLAIM DEED GORDON T.''. PERRY AND HEIDI J. PERRY, husband and wife, hereby grant and convey, without warranty of title, to BADLANDS GOLF CORPORATION, a Wisconsin corporation, the real estate legally described as: The Southeast Quarter of the Northwest Quarter (SEN of NW4); the Southwest,Quarter (SW4) of Section Twenty (20); and also part~of the North Half of the Northwest Quarter (Nh of NW4) of Section Twenty-nine (29),moreest fully described as follows:' Commencing at the corner of said Section 29; thence South 5 rods to boundary the highway; thence Northeasterly along the line of said highway, 92 rods to its intersection with the North line of said Section 29; thence West to the Point of Beginning, all located in Township Twenty-nine (29) North, of Range Eighteen (19) rcest, EXCEPTING therefrom the following described pat 1. That certain parcel of land locaedSin tope Southeast Quarter of the Southwest Quarter SWh); the Northeast Quarter of the Southwest Quarter (NEk of SWh); and the Southeast Quarter of the Northwest Quarter ( 5E4 of NA) of Section Twenty (20), Township Twenty-nine (29) North, of Range Eighteen (18) west, more fully described as follows: Commencing at the South quarter corner of said Section 20; thence Noorth/South 00 degrees 00' 00" East (assumed bearing on th 1/4 line of said Section 20), aofistance of 99.00 feet to the Point of Beginning the pparcel to be 23' 20" herein described; thence South 89 degrees West, 1025.98 feet; thence North 09 degrees 351 19" East, 378.15 feet; thence North 85 degrees 59' S9" East, 249.99 feet; thence North 24 degrees " West, East, 295.36; thence North 37 degrees 18 39 343.41 feet; thence North 06 degrees 31' 35" East, 341.44 feet; thence North 03 degrees 50' 25" West, 221.45 feet; thence North 46 degrees 45' 42" East, 155.26 feet; thence North 14 degrees 05' 15" West, 366.32 feet; thence North 08 degrees 09' 08" East, 489.46 feet; thence North 01 degrees 47' 33" West, 216.53 feet; thence North 05 degrees 10' 14" West, 175.21 feet; thence North 00 degrees 00' 58" East, 289.77 feet; thence North 17 degrees 12' 44" West, 441.11 feet; thence North 18 degrees 09' 00" East, 360.54 feet; thence North 89 degrees 291 49-ofathe on the North line of said Southeast Quarter Northwest Quarter (SEN of Nwh) a distance of 720.61 feet; thence South 00 degrees 00' 00" East on said North/South 1/4 line, a distance of 3881.48 feet to the Point of Beginning, containing 66.97 acres, being subiect to easements 2. Commencing at the South 1/4 corner of said Section 20, the Point of Beginning of the parcel to..•• be herein described; thence North 00 degrees 00, or East (assumed bearing an -the Borth/South 1/4 line of said Section 20) a distance of 99.00 feet; thence South 89 degrees 239 200 west, 1025.98 feet; thence South 09 degrees 35' 190 west, 100.58 feet; thence north 89 degrees 23' 20- East on the South line of the Southwest Quarter (Swk) of said Section 20, a distance of 1042.74 feet to the Point of Beginning. IAAS 1w ~1A1_ t w i y - do ! 4 part of SWhSWh and the SEhSWh of Section 20 and part of NANJWk Of ',section 29, all in T29N-R18W, described as folows: Commencing the the A corner of sa-d Section 20; thence N8'j58308"feet to hence t SouSh line of the SW% of said Section, S10 18106"d, 47.58 feet to the Northerly right-of-way of a town road (80th Avente) , being the point of beginning of th8gs f et ription; thence S88 46'48"W, along said ri:ht-of-way. ; thence r N89 201080W, along said right-of-way, 270.71 feet; thence N010 011224E, 757.63 feet; thence N870 02'24"E 868.61 feet; thence S250 37'45"W, along the Westerly boundary of a parcel described in Volume "7430, Page 512 at the St. Croix County Register of Deeds Office, 295.54 feet; thence S85°45'13"W, along s boundary, 249.95 feet; thence S10 18'06"W, along said boundary, 526.47 feet to the point of beginning. l~U tEDGORDON F. PERRY I J. PS Y P STAT~k OF WISCONSIN) ACKNOWLEDGEMENT COUNTY ) `.T' ~ho , 199 4 the above- 46,40. dame before me, on ] u known to be the persons xecuted the foregoing ii d acknowledged the same. Notary Public, Wisconsin. This instrument was drafted by Clarence W. Malick, 413 Brookwood Drive, Hudson WI 54016. REGISTER'S OFFICE ST. CRW CO., VA Wd for Reoord JUL 2 8 1994 St 11:10 A. As eysrralt~l T r .t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER__~a,c~,r/ ~DQ!/1l'.~l ADDRESS Ia t g SUBDIVISION / CS~M#q~~~~Q~ q LOT # /,sue ~~~Q SECTION 24 T N-R 1g W, Town of ST. CROIX COUNTY, WISCONSIN VIEW SHOW EVERY 00 FEET OF SYSTEM A r 0 P D` 14~ Q c ~Oy9 a Q/~~or INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION ~,Q2c d Manufacturer: Liquid capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length ~l Number of trenches Distance & Direction to nearest prop. line: ( &g 7o ,:o Setback from: well: 6,4- Housed Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade I DATE OF INSTALLATION: S 2 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt ~h~ art st~g0.29.18.3 g#MDS RD. AfVkE E County: Labor and Human Relations INSPECTION REPORT S.afe"ty and Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan D o.: CST BM E ev.: Insp. BM Elev.: BM Description: 7 Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300047 S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. -77 Septic .,G'~ ! Benchmark re n.-' Dosin Zc_06 , I L4-, 13, I 3 5! Bldg. Sewer Aeration F Ho St 1>4 Inlet ~7 TANK SETBACK INFORMATION St/Xt Outlet 5.5 97,9f 7 Vent TANK TO P/ L WELL BLDG. Aii tntoake ROAD Dt Inlet rl Septic > Z!~ NA Dt Bottom Dosing NA Header / Man. r Aeration Dist. Pipe Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade urera o~'dio ~.h-f i Man b ,,a Demand / rs~7 mil'-3-~ Model Number GPM TDH Lift Friction H Ft Loss ea Forcemain Did. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Widths Length No. Of T nches IT No. Of Pits a ia. iquid Depth Z'j N I N DIMENSIONS ING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREA INFORMATION Type Of ne,.jC'arul .3C~HAMBER Model Num er: System: :fercl os `a/G OR UNIT DISTRIBUTION SYSTEM Header / 1149mifeN Distribution Pipe{s) / x Size x Hole Spacing ent To Air Intake Length i11-~ Length 7? • Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over Depth Over xx Depth Of xx ed / Sodded xx u c ed @~ /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WEN 20.29.18.315A, S 11/2 , SW, BADLAN' DS D ~4/✓' i' / CZ-C Plan revisio6 required? ❑ Yes M_V o S 3 / / Use other side for additional information. / SBD-6710 (R 0S11) D/~te Inspector's Signature CertNo ~~J /1'( t/',c~-!r..,~~~` d~~t~i'~ tTilk'%1 ~-1.~~.~,✓~n ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: x,93 jq' F "t '7 Lo 1 SANITARY PERMIT APPLICATION =aQl~!LtHR In accord with ILHR 83.05, Wis. Adm. Code couN STATE SANITARY PERMIT 41 -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Checsion to previous application -See reverse side for instructions for completing this application. STAT N I.D. NUM Kl~ 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 'jlfJ1 17,0 PROPERTY OWNER PROPERTY LOCATION 66%0^1411 AJ e r. '/45'1..1 t/4, S T Q; N, R J E (or PROPERTY OWNER MAILING DDRESS LOT # BLOCK # lea ~ ~ l~Cv c CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISIO14 NAME OR CSM NUMBER L✓ lSQ 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLA =W OF: 4041 GE y DgPublic X1 or 2 Fam. Dwelling-# of bedrooms ' PARCEL TAX NU III. BUILDING USE: (If building type is public, check all that apply) V 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 220 In-Ground 42 ❑ Pit Privy 1130 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 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) SCf ~OOy ELEVATION ~T_ Sec -e- 92 f- Feet Feet CAPACITY VII. TANK Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Septic Tank or Holdin Tank Tanks Tanks o20200 -2 F -421~ Lift Pump Tank/Si hon Chamber F-1 I F-1 1 11 1 11 El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: - T~ Q;11;Aj,i Plumber's Address (Street, City, State, Zip Code): ry ` S IX. COUNTY/DEPARTMENT USE ONLY gent Signature ❑ Disapproved Sa ry Permit Fee (Includes Groundwater Date Issued rsum" 3!*:;~~ Approved ❑ Owner Given Initial Surcharge Fee) / Adverse D t rmination ~tJ cI/ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ti 1. A sanitary permit is valid for two (2) years. r 2:' Your sanitary permit may be renewed before the expiration date, and at the tirne ut rorie,a al any new criteria in the Wisconsin Administrative Code will be 4pplicabie. °.3. All revaions to this permit must be approved by the permit issuing authority. 4. Changers in ownership or plumber requires a Sanitary Permit l ransfer/P.er ~,r ! 'r=oan 63°9) to be submitted to the county prior to installation. 5. Onsite sewage system!• inust be properly rraintainea. The tank(s) in-,: ~t K r~ fr.~.? by a lic;3ns_id - - pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your loc,ai s,-ode administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax lomber(s) of - where the system is to be installed. Il. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Fam. y 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 replacemer;i, reconnection, or repair V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requesf,~-rf in ##1-7. VII. Tank :,-Ifcrrr;afion r'ii' In the capa. i y of every new and/or ex ;ri , tank, list t`:e a; qxl :i nurr.her of tanks and ie<i;. k,~rer's rams indicate prefab or site conciuu ted and tank aria r~+i,Jl. f EC;,r')!ete for a// septic, pu r and holding tanks for this system. Check ,,,erimerital pr _ Jai ,o„ I tanks received experin i~_,roduct approval from LiI_i Ft. VIII. Responsibility statement. Installing pitimber is to fill in name + c-kse rivwbe7 wilr+ r r+n~f,; i ite prefix (e.g. MP, etc.;, address and phone number. Plumber must sign app`ic:ati)n form. IX. County/Departrnent .1se Only. X. County/ [)erarirner,t Use Only. Complete plans and specifications not smaller than 81/2 x 11 in,,hes must be subr) tr-d i It e county. The fauns miss" inclu(bE . e following: A) plot Oan, drawn to scale or pith oomple e di I._ loc&tiorl of holdir g to^k(..`• sc . or other tat ±rrl~nt tanks; builder"to: I water service; streams- and Iak~ •,?~rrl Qiphon :?ray ibution boxes, so;, ~sL-(-,.d l,r4 cy= +P "-s(Y;E'l+ sys';em areas. and t . bui''d.r,, g . S) ho. izonta _ i is !r+ Sri: r,~. C) complete spec f s :lr s for pumps and controls, Jose ve a vr3, elevat in d fferencl ; f! on oss; pump Performance curve.; pump model and pump manufacturer; D) cross section of the soil abE;,oration system if required by the county; F) soil test data on a 115 form; and F) all sizing informatior. - GROUNDWATER SURCHARGE 1983 Wisconsin; Act 410 included the creation of surcharges (fees) for t r+urn'3ier C' regulated practices w`;ic" can Effect gr-gundwater. The r=+onies collected through t e=se surcharges _.r ~,s,~,• ~,r m:)nitorin, grc _ v~ates +:ui watE r-co4tamination inve..si`g-i6rinc. and establishri• E zrr tir~}° _ SBD-6398 (R.11/88) ~~VIS/D~ TD ~/~P/eov~D /dG~~tl s ILHR 83.08(2) , sql-ono 333 PROJECT INDE): SHEET ,3,}OL/pv~5 GDLi~ CGV, j Owner ~aPOo v Eti°it° y ~/S Nf - f2 /028 70 Tt' ~vE /ZORQe7-5 S~Oi3 i Address Address Site location TD ~,v pF 4/13Af1r~V - S T' • C RO X COU v T y I~ COG~T~9// ID v~ ~E~ FD/e ~~OPOS~ D /VC~U GO//c Project Description covese-, Run-,01:o6- 41o 14:ivaoS 16AEpI &01 ~l/D %,PE~SE laeo'004EQ . sC47141 - e1V1f ~7y / s ue . ~S Z5; o~D ~o~{-mss y' ti~ ~ov~s~' • ro ~ies~ ivy// _ ,,,y_ j4-SP y ~ %tTt',P o cri`Dooi(' SIbv eT s +looR Q ITEM Plan View P ~x pag ~z of Soil Absorption System avf D"o0~° SpOR°To Ali P 011 1-0043% DEPT OF INDUSTRY, I~I{ 11 +04&t PA, ILy 7) DIVISION of SAFI TY A 4PILDi@4U4 ~ R 3 p 1993 - 13 t S 6-AI SEE CORRESPO!vDENCGAFETY & BUILDINGS •t r~.G PLUMBER: M+.u 1'M 0 n RECrvi (~E`l7 S l 5,c4u A, A R, ~6 r~ 1.0 JA a of 2- G\/-STEK 0 PL OT PL A~ N TEST s iT6 's ToP OF v R i uG~ R/~ck sir I3.M, 3 U. R. Pr o T ~ aC N pipE NRRk[BD w/ 16ri, . p6~~LG' IEVATrO~J = /00- 0 p v cn Zc r ~ wo 10 T ~Sys~• S a~ S7. . \ •~Pi.. \f r \ ~3 Nl~ 3? 41-Z ~ V go ~r y ` to Al ~!o) ST.FTE R?peooao pmcAsr To DkOP (UDXES - MA.,+A"UVSP, qp Fey s P~~ M'D&sT f ret*fST pRodccrS BOX "JLETS : TR£v cG~. R _ / d I.O ' s° TRE,jct, g 3 mod, a T ~v 40 io a TReN~ C = 49.O /dU0 TR EN CG. 7) 9~, $ P AJk of /Oyz i a G' g9.yo ,30 - a Gc e M~~le'ST~ipv P~t~Cq- S 7- C, oc \ a~ . s& " - 0~R yz. Alf a S91'00433 w~4 RECEIVED ~I PRI,,A . MAR 3 0 1993 { • - SAFEN & BUILDINGS 20y 2 EP D . OF INDUSTRY DIVISION OF ydirtlY (BERG ~oGs4T~o~.1$ v 2 ~Q O = £ K ~'S Ti ~JG 6 RiIUE 4 e ~ 2- 2- TyPI'C i L. SC ftt--"ttT ('c Fa I2 i4LL -7 TPA C-S Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12".Above Final Grade I i _ 4° Cost Iron Above Pipe Veni iii Y/ /If U~ 'to PRIVATE SEWAGE S S -E- ' 3 i & ' Final Grade Conditionally Synthetic Covering r%P"N"ED Ar K w Min. 2" Aggregate Over Pipe DEPT. OF )NousTnY, LasOR & >;of'v9~1►) )VISION OF SAFETY A;,, P uilii 1'NUa Tee Distribution o o Pipe C C ° SEE CORRESPONDENCE <n w Aggregate 0 Pertbrated Pipe Below Beneath Pipe o " Coupling Turninatlnq At Bottom of system RECEIVED MAR 3 1993 S91-00433 SAFETY & BUILDINGS TVE-va4-- S ySTE,y IV4Z- Fi;v,S hl v /~Pid.POr~ Dflidt-L o~ ~ E/~v~rr~o.v 9•P~DE 9~P.f~c- ~ ~1-crF!%/ 2:51 Ile /040 /0/ ,0, o/o " 2 y " 8'[ 48 TIMfi 1IIiR MY M a _ KM Mit 1 0. CoatrRCt, by and between David..D.....Coyar....and Caral ~T. Mf as....4ia...~►1 RM r. vndttr : . 4199 ' ~lOtete ogre) and GQ.rdon .F.. pan y ..and ..~R1di ...J.. ~ ~ a ; IA ; aM.: as..anrxlv.orsb,1.Q >waldt:al...proparty..:....... ("Purchaser". whether one or more). ~ ~ _ atlta a W agrees to convey to Purchaser, upon the prompt and full per- f ,tarie7f of We contract by Purchases, the following property. together with the 'a train^ pe9Ms, dxturss and other appurtenant interests (all called the "Property"), CCOj,x. County. State of Wisconsin: RETURN TO Y~ .Y sa Attached Exhibit A ;I 41sx Parcel No. I S r . 1. Y L i - f s..... . homestead property. (is t uch(l a grow to rchase the Property and to pay to Vendor at .their.. rev14enca of:..3s 730. _ in the tollowin manner(a) f 5.,..•. totieeutiott of thiaCe>ntract; and (b) the balance in of $ the 7.7r.t ~.5....~ , together with inwredffi"4 0 ~ on the balance outstanding from time to time at the rate cf... .Q per cast per aanwN . aai in Am, as follows: e.in'wonthly instaklmanEs cgrenCias July 15, 1991 >~Ehly ft the 13th day of each worth ' Ireatter. Said t< t tslbwnts shall be in the afsotent at 638.45 ' + . however, the entire outstanding balance shall be paid in NH on or before the ..:......1 . d~ aR ~ I It 94 (the maturity date). anutMN ir► McMttra a~+~i y{ any default in payment, interest shall accrue at the rate of d.......: % Per * (which shall include, without limitation, delinquent interest and, upon acceleration or mstrritJr, tl ,a rte Coheres). unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably tNttirGF aeaaal taxes, special assessments, fire and required insurance premiums when due. To the extentreceiwsd lg'Vef.' owe" to apply payments to these obligations when due. Such amounts received by the Vendortar Ow"Gai of aneeasm*nta and insurance will be deposited into an escrow fund or trustee account, but shall not bear iner*4 tsnlus 9tbtrrwi3e required by law. ngi Paynstate shall be applied first to interest on the unpaid balance at the rate specified nd then to pr' Any . many be prepaid without premium or fee upon principal at anytime after . June low -e~;;~~ ~s}a~ytwrwlwFprM~atrwfareeN perwt+estwtrwf Newtbw' In the event of any prepayment, this contract shall nut be treated as in default with respect to P11100t 801 W the unpaid balance of principal, and interne Iand in such cieMe accruinK interest fl m month to month shall)slrl trur0 1 as unpood principal) is less than the amount that said indebtedness; would have h,en had the monthly parnteate %ift node as first specified above; provided that monthiv paN menu shall be rontu.aed in the event of credit of any proceeds { itipmence or condemnation, the condemned premises being thereafter excluded herefrorn Purchaser states that Purchaser is watistied with the title as shown by :he title r vidence submitted to I'utrcMs~r f for examination except: y 7. t 7 1 None , ~1, y -77 7 1 : t 'vr r~n # r qo ~ 4 ~O amod j • twe lrhdOr d~ttni ion or repair D of t~ IF ropeft covenants not to Boma k w amt allow waste to be committed on the pp~ 1 ' coadtdon and repat)ir, to p tM~'roperil lrae fbm liens superiar to 11Yi laws. woustncw n ragakAionsat=ASg Prtoperty• t is base the purghase prim with interest and other moneys, be hall II at tbs times +aa~a I= =Property. specMed, Vendor roll on &W. 'a Warranty Deed, in fee Ail . K ht Property. ltw and clear of all iwrt c ' 01 0 or encumbrances crated by the act or default of Purchaser, and except: ...tlOge... ~ K F J Lr . . ..........r. , A who s agrees that time is of the amnos and (a) in the event of a default in the payaessR el 1io11ioh continues for a period of... 30 ...............days following the specified due date or(b) in 1 sf~r obligation of Purchaser which continues for a period of venall~ or mail), then the entire ou nduh~ 1 1M doe and p~yalt}a in foU, at Vendor's option and without nogos wave tt►t fo+ Agbts and renitedhes (subject to any 1' yaw or in equal ; (l Vendor may, at his option, term natc is ittbe Property andyeuhcuver the Property back through .,tract f upon Purchaser's ftdl paym• at of the entire outstanding bats~pwrs al in elfsct on each data and other amounts due ereunder (an whicDh' amages for failure- to fuifill this Contract a _ forfeited as liquidated damages- to cam}r, or (ii) Vendor may out for specific performance of h a yrptmeat of a colas outat. ding balance, with interest t hireon at the t asnottgqto"~dMe hrretm~ t wl, ch event the Property shall be auctioned at Asst or ~itf ei for may aue at law for the entire unpahd tasy ds~~~s thu Contract at an end and remove this Contract as SR v r; hibeewt of Purchaaw is insignificant; and (v) Vendor may have a receiver appointed to collect any rants, issues or profits during r ( vl Notwithstanding any oral or written statements or actions V " whali oaly be binding aeon Vendor if and when pursued in litigation 'r a a fees of Vendor incurred to enforce any remedy hereunder (w and es penses of title evidence shall he added to principal an l in any judgment. #<T ° Iserutament or durat~g the pendel,cy of any action of foreclosure of this Con F, t of a receiver of the Property, includingg homestead interest, to collect the rents, ency of such action, and su( h rents, issues. and profits when a co i ' ro not transfer sell or convey any leggal or equitable interest in Lhe Property r render this Vontraet or by option, longterm tease or in. any other way) wh tttalow either the outstanding balance payable under tht, Contract ix first arstisngnmept of Purchaser's intere under this C(,ntract soleX as seco ty (4 tofan ituch transfer, sale or conveyance %.thout Vendor's written consent,tltg is this Contract shall become immediately due and payable in full at Vendor's hake all payments when due cndcr an> ni rtgaize outstanding xgainat the WNt ftr arty mortgage granted by Purchaser r under in} nou. secured theeab~~tt,, reoNllt of the amounts then due under this Co ntract. Purcha.er ma% make any Weh Vendor fails to do so and ail payments so mad. 6% Pur(haser shall by l onsi Vmli os rr thtaitre anydefault without waiving any other subsequ.-nt or mot default of Purchaser,. ~)!c „ ate: 'O this-0twitract shall be binding upon and inure w the henefits of the heirs legal essigns of Vendor and Purchaser. (11 n,,t an owner : f the Property the spouse otf Vondate s :4. ' to release homestead rights in the suh)e(i Property and agrees tc join in the > f► tahads in "fil hereof.) - 9th June p !i~ VJI " e ri.«~11►1d of Gordon F . P grry a`~ Couol J Coyer Heidi J. Perry ~l AUTHENTICAI'lON A('K*%OWlYMMBNT h , skmthre(il IP r1O P. L r, y' L' R /q wry l'ATF l )F WIS( ()Ntil tt>-Jr St. Croix ~'l~il GQ~~R ('cushy: t 2204 h•I~ hilly , ante netore me this - :~hi'Mrlntivi'ledthis ,11a~ Jug✓E June t~ the David e G x Gordon F. Perry, Iie3t_ .rM1i: mBER ti'1'A'I'F. 14,1. 1{ t F 41 IM 1 )NSIN t„ mu known to k he m-i-sonst xrrliR J VOL PA XMDIT 11 The Southeast Quarter of the Northwest Quarter (Sz% of NWIC); the Southwest Quarter (SWe) of Section Twenty (20); and also part of the North Half of the Northwest Onarter (N4 of NW4) of Section Twenty-nine (29), aiose i3 fully described as follows: Commencing at the Northwest y corner of said Section 29; thence South 5 rods to the highway; thence Northeasterly along the boundary line of said highway, 92 rods to its intersection t: with the North line of said Section 29; thence West to the Point of Beginning, all located in Township Twenty-nine (29 North, of Range Eighteen (18) West o EXCEPTING th'_refrom the following described parcels: 1. That certain parcel of land located in the Southeast Quarter of the Southwest Quarter (SEh of SA); the-Northeast Quarter of the Southwest Quarter (NEh of SWh); and the Southeast Quarter of the Northwest Quarter (SE4 of NWh) of Section Twenty (20), Township Twenty-nine (29) North, of Range Eighteen (18) West, more fully described as follows: Commencing at the South quarter corner of said Section 20; thence North 00 degrees 00' 00" East (assumed bearing on the North/South 1/4 line of said Section 20), a distance of 99.00 feet to the Point of Beginning of the parcel to be herein described; thence South 89 degrees 23' 20" West, 1025.98 feet; thence No-th 09 degrees 35' 19" East, 378.15 feet; thence North 85 degrees 05' 08" P. East, 249.99 feet; thence North 24 degrees 59' 59" East, 295.36; thence North 37 degrees 18' 39" West, 343.41 feet; thence North 06 degrees 31' 35" East, 341.44.feet; thence North 03 degrees 50' 25" West, 221.45 feet; thence North 46 degrees 45' 42" East, 155.26 feet; thence North 14 degrees 05' 15" West, 366.32 feet; thence forth 08 degrees 09' 08" East, 489..46 feet; thence North 01 degrees 47' 33" West, 216.53 feet; thence North 05 degrees 10' 14" West, u 175.21 feet; thence North 00 degrees 00' 58" East, 289.77 feet; thence North 17 degrees 12' 44" West, 441.11 feet; thence North 18 degrees 09' 00" East, 360.54 feet; thence North 89 degrees 29' 49" East on the Vorth line of said Southeast Quarter of the Northwest Quarter (SE4 of NWh) a distance of 720.61 ' feet; thence South 00 degrees 00' 00" East on said North/South 1/4 line, a distance of 3881.48 feet to the Point of Beginning, containing 66.97 acres, being f subject to easements of record. AA! l VOL at the South 1/4 corner of said 2. Com oncinq of the parcel to describe 20, the point of 8e section 9innin9 uth 1/4 line in d: thence worth 00 degrees 00 00- be here on-the Worth/So East (sssuwed bearing 900 teet: thence ~f of said Section 20)~a disWeste 102598 feet; ththence e ce : South 89 degrees 236 20" 100 58 feet South 20, a line a South 09 degrees 3519" west, Worth 89 degrees 23, 20@@ )sof said the Section the Southwest Quarter (S inning. distance: of 1042.74 feet to the Point of Beginning- September 30, 1988 in Vol filed - M;,p 3. Lopage 2031,r Doc1e No. survey 441838. VNk "7", art c_ NW of as follows: Commenc+in$ - at 4. Part of SWkSW~t and 29the N R 8W SW described on 20 and part along the section 29, all in T thence N89 thence p corner of said „ection 20; thence 1043.30 feet; M~ the- sit SW~1 of said orth~rli f-way of a town roso Soutdh line of the 10 18106"W, 47.58 feet to the Nnn ng ht-ofthis descriph' , S being the point of beg 125.85 feet; (80th Avenge), said right-of-way, thenW along .,-of-way, 270.71 feet: thence S88 46'a o g said riq~ o 866.61 th N89°20'08"W, N87 02 24"E •61 feet:cft; f. NO1°01'22"E, 757.63 feet; thence parcel Regis boundary of a °'45"W, along the Westerly ~,r_ the St along S25 37 11743", page ;5'13 W, along described in Volume .54 feet; hence s85 Of f ice, 295 Dc:a said boundary .Y of Deeds 9.95 feet; thence S10 boundary, 24 oint of beginning. 1 526.47 feet to the p t~ y 3^ i ems' _ s a. + 4. s 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 pormit issuance. ,should this development be intended for resale by owner/contractor,(spec house), thenia 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 121 e ; Location ofProPert w 1/4 _5V 1/4,, Sec ion r,~'~J , W Township e n Mailing address -t~ to gle 7r f A she p S rya Address of site J Subdivision name t3 / h e~ -CO 41 fi f of no. Other homes on property? ves No Previous owner of property f Cdr pro/ Co Veil, Total size of parcel q - Date parcel-was created Are all corners and lot lines identifiable? ! ~ Yes No Is this property being developed for (spec house)? Yes ±~No / , volume ~4and.Page Number .3k,9__ 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 & 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 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 the office of the County Register of Deeds as DocumpmF un a7AI o- S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER lSardon r QrTv 5C o:ff #0, ADDRESS FIRE NUMBER CITY/STATE ZIP PROPERTY LOCATION :5 1/4 1/4, SECTION-120 , T-,J, N-R r g W TOWN OF_ ( J-)Q T 'r 1?Y\ , 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/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/IV tJN1etPAt'ITY; OT NO.: lK NO.: SUBDIVISION NAME: 5F- 1/ sw V/ zo /Tz9 N/R leE lore W wAr R RE "'.j p~Q r oF• I Is Acecs COUNTY: 3It1)L/vjpS CotrvrCLU13 MAILIN ADDR SS: c/p GpRD~ti1 E12RY '715-7y9-392_y ~?'CiPO/)( Go/FSffa LauuG-E 1'0-2e 70-t-1, AOE, RORE'RTS wIS~ Sti023 USE 4 E y /o yes S-b a IS ^ I Q S 2- F10012- D PAIa 5 DATES OBSERVATIONS MADE NO.BEDRMS.: JCDESCRIPTION: TESTS: Gor F S Hvp IvvuG~ XNew ❑Replace MAP C 29 set Pt oU6 (qCr' PfARct, 30, (ll l t No FOOD p1aE A41?e/' . N o k r -Ft,Gt E v c.c) y1 S T£ . M o &J? N S E Gz~ v~,e 4 7-A tD . RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: r YSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) DS DU 10S DU CAS DU ❑S DU 0S DU Co&u0E.SrroaAL - -rRffAacJ,eS If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: CLAS S S Floodplain, indicate Floodplain elevation: - PROFILE DESCRIPTIONS .5C5 59 B0ekt1-4RDr- 6AT-rPS CoHPIEX BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED H ST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) C, -y„ /0YA 272 si P►0WED 4-1y6.e; q`- /JL YR y/G 57 B- 109 103, 10 > 10a INnaGe, n„fr,c,, 14-28"/0 yR S/P 5) O*Sg,Le-/4 /O R ep Ci 5 O M, ,Q w. 0-9 "io yo? 2/.x PI wEO; q-I & /oy~ey y cqr.e B- 2 `jG !01.10 Ito 5w; 1(e-96 „ /o yR (,/6 S , M,Sg CgeAJvIjy), %jeI JAL, n►, . 11 2 q/~ , 0-12•, /o yR A/.2 S ( ~ p low eu • 12.,- 17 10YR_4/4 5/ zC,r B-J /`,e /00,15 ~j 7Y6 %vfi,Cw 17" 54 Ru~R d1? gR~sii YS) 0IMSgI c B.~ IID >tl0 0-12."/00/e3/Z/ptowE0; 12-2Z1, yRf/4 5.yj 2n„PA ' %%f r,Cwj2z-ZO"7S y2 y/G 5111-9bk_)r#Kfr,CW , B- zG 110" 75 yR 5/8 9R,4UW11y S) ICg►" mvf/' 9tO p/ I B- S 7 CO 10,'10 rl v-y„~o yR 312. 51,1, plowe0; J°- Is„ 7,s fr 4112 5, ~lf5bk, rw,Fr, CW IS'- 0" 7-S Yk 5/,G I eAV&//y S/ /-4„Sb,e M4Tr PERCOLATION TESTS 31,° 1. S rQ 51,0 gfAut /iy 5/ 2f 5b, it, nnfi cw 36"-q6" 10 IQ S/e 5 I nn S n,+fr EST DEPTH WATER IN HOLE TEST TIME DROP I WA V I H RATE MINUTES NUMBER INCHES' AFTERSWELLING INTERVAL-MIN. PERIOD t RI PER INCH P-~ 3 S l// I /i(. //i4 3,3 P- 3 vZ P- P- P- 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. H ('&4, TR E"N C-k~.S tow T PE At) CA £5 SYSTEM ELEVATION. _ (z) 77-o t 5 1 L D P- ~l IZ / I i ~ I 1 I ~ r PL oT P L. )P~ N TEST SITE iS -raj) OF R i V6~ 6A~k 5er) 13. M, u. R. 1-!-" PjpE- MARKED L-/ 1AT6, ~IEVAT1010 y i ~ ' J 1a 9~• ZO4 zs , 2 . ~s - j ~zs ~o a 9s' 50 Ito (pl•~p, ~~A / s / 20P ~oy.Z a mod, . 3s / i J0 Go yz ~ \I a, z3y 2 t • = 13AG,~,~~C pi TS I ~ X= OE:RG (oCATICPJ ! d = FK1•Srir 6 PADE ILHR 83.08(2) PROJECT INUEY SHEET 715 - 7y 9- 3 f f1 Owner r~DiPDD.V ~i~Ry - Rgp`~a 4S C o vaT RY G-o / F G v g d z 7D 1► A- u.e . 2 0 !3t RTS Gc9 i S. S yo Z 3 Address Site Location I l$ 4~c,.e s 5 ou f L` %Z a F $ CJ Siff e- T. Z O ~ j 2 f( N R l W To 4i-u o ~CJ~4,P~~`•v , 5,7;- Gipo i ,r eo v-v;r Y Project Description e'06k 4iL LD U~U ~C ~o~ P~t'o~o S D ~vtw Go/,~ CO!>/ZSE . 13 WL-Pi:o Cvi// 16 DDS lr~Pt ~f Ste` ~it'oDvcp , "'v a l3WI,(,P/ V Co; l/ 7(4/. 35 Sfo o/.s/c4 rfbe 5 w: o~ l - y p~-o y~~--s v Zf--/ao~Q Ok~t i a S 'C S b a e~ Q. C-G~ - - o a ~~.Q x PC) 3 S ~.Q 3-5 S+ZDoIS x ~1 Page 1. Plot Plan & SYSTEM Plan View Page 2. Cross Section of Soil Absorption System M f a i u 5 Z E S p T t c T,tOk y~f rt750 Si 2r~G- ~ SQ.FT. T2E~►Tn~,~T COa~~NT~'o~~+lL PLUMBER: FOR. T-PENC 4.4 S , cLA-SS r SoiLS ~?Z 35 Se4TS x , z X110 = 770 i~1 1P. UC~(~ 3 9 M ptoy~t s x, 4 K //O FInoQ .DRai.Z S u l x ii.~ 22-0 W STEK PLAQ V Ew PLOT PLR N I TEST 5 rT6 is TOP OF - - Q I vGE Rack - v l.k SET 13.FA, 6 U. R. PT o y" PipE MAlzk-&D L-/ lom' . IB VATOn~ = /C~CJ. O ~ ti a qi? c4 emss`rZO4 s f3 s 6 ` v1~ '4 \Sy 5~~, o' S•T;~6,f ~ ocl 'es 3f /z lc / o ~o a 9~' 50, fro r' ~''ro A, L3) STATE R?Peo°av PPS-CASr !0I'Q hog s~ V O•k~ DROP UyeS - ►-i~auF/~e~uRER ,9 'F,,y O wits~k co^'cReTE pRodvcrS • RF,4 4C%~ o/; .~a Box h-3 QaTS : rt R £N N r RED TRE,., U,. C = 49. o TR EaCe, 17 = 9~. 5 - y1 _ op a / liz PRecAST- SETPTic- -r4AjK- M~fiNUf~1~Tv~2ER . yz. ~ wi£s£R Ca.~C•eeTE ~ PRoD~cTs IP ~o..A. aAOS~p ONM S",AGE SYSTEM av DEPARTMErl -'J RELATIONS -S /3A;V17 x= Pepe- SEE ,4 Teo CORRESPONDENCE W d = F'Kr'5rt'oG- GR~41~E ~ 2 of 2 Fresh Air Inlets And Observation Pipe I T'/ P i C j L_ roR TREK c ke S 3 r7) - Approved Vent Cap Minimum 12".Above Fi n a I Grade 9Y"W,6 % /0/0 3& Above Pipe _ 4" Cost Iron . -to Final Grade Vent Pipe Synthetic Covering Min. 211 Aggregate Over Pipe Distribution 5c4.•2-7z-9 Put Tee Pipe 0 0 0 0 _0 , Aggregate o Perforated Pipe Below Beneath Pipe Coupling Terminating At 0 Bottom Of System S IL QNSITE SEWAGE SYSTEM gar r CST /PARTU :4 " RELATIONS 41 V `h SEE CORRESPONDENCE P Fresh Air Inlets And Observation Pipe V h , Typl'c.AC_ -Fop, T12ENCt%t S (f 6 3) Approved Vent Cap Minimum 12" Above Final Grade { SAFETY & BUILDINGS DWISION Tommy G. Thompson Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN. APPROVAL Offi(e of uivision Codes and Application 201 Latt Wd',hinyton Avenue P.(1. Box P-J69 Mattison. W1,_: onsin 53107 tiOMF,`SITE: SEPTIC PLUMBING owner: (;CRIKIN PLRRY 655 WWII- ROAD 10[8 1011-1 AVENUE HUDSON WT 54016 0131,0-1 W1 54023 RE: Plan Number: S91-00433 Date Aplirover1: April 8, 1991 Gi'llon% Per Day: _ 495 Dato Received: April 8, 1991 Project Name: BADLANDS (1011 CLUB lcc~itiun: SE. ,SW;20.29,1€3W l own of WARREN C.oun t y: S1 CROIX The 1)lumbinq plans and specifications for thi,; project have been reviewed for compliance with applicable code requi(ementc- This approval is based on Chapter 141), Wisconsin 'Statutes and the Wisconsin Administrative Code. The plans are :tamped 'conditionally approved'. This approval i,, ccentiagent upon compliance with any ,tlpulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or c.o+int:y shall be obtained pricer to c:onstru(Jion. The 11censed plumber rospoosit,le for this installation shall keeTa one scat of plans with the department's approval stamp at the constrm-tion site. The installer' shall notify tho apprgiviate inspector when inspection can be made. 1 h i ap(1r oval wi 1 1 s,xp i r e two years from the date appr overt or it a sanitary permil;is obtained, it will expire the day the initial sanitary perrnit expires. The ;sect ion of Pr ivitc, )ewage has r eVit'w►:,d these plans for private sewage system rode requirem,.,nts only. these plant have not hrr,r► rev1(-,1W( for the code requiremerrt, set too th in Sv( ti(rn 11, fit? 82 for general plumbiny or in Chapters 50-64. of the Wisconsin Adrr►inistr,itivf~ code This approval is tc:)r- the following components only: NEW CONVENTIONAL Inquiries concerning thi,, approval may be made by talliny (608) 266-3937. SBD-6413 4 K. 07/901 - - { SAFETY & BUILDINGS DIVISION Tommy G. Thompson Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations HOMPAIh_ SEPTIC PLUMBING P~ilr> 1 Sin: r,rely, i~'l d g c: LG C_ti_y G y. JAMES (UINLAN Se(J icon of Private Sew,+ge Division of Satety and Biililding Fj'{'vol "r.' 11.i0U9r►/ l U r.;r: GURDON PERkY Privat.~ Sewage C.on,41tant _County 11W-'_S~iMP Plunibing Consuit~nk 0wnAr F'lr.imi) E" r Lrrv ironmerrta l ilf-~1':110., SRD4423 t R. 01/801