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HomeMy WebLinkAbout018-1047-20-100 Q ° 3 0 O ^ O `fl t'V b4 O d Q. CO aej t~ ~ O W N x C) co o N Y N Y C v m Q) d N O I LL co ? m m 3 M C) E C) Y O O~ " O ~o V O O_ a Z N O 7 !6 ~ N V N O O Q E N ~j z to o v T p am r N N H U) C to O C C9 N CO O Z d tY ~ ~ cn U fA N In y z O ~ O C) hw E ~ `wJ o cu Ft, N cl I • OI ~ L wI 2 Z Z O O N z v O N cli > O LO N d N IL N O W d i O T O O I G C a L) t~ O O c cn co co 0) Z O O F- F• F- O O N N E LL O .Z C) O = a a aI CL F- 1) O L) a) Q7 N to U o ~ O O OI CJ m d I °2 a u d Q } O O ! I 3 o U) U) C C 0 0 c 'O N 3: 0 r 0) P- o6 N C C a D) O O F- L MM Y : N C C N N V O C N N 7 fr' O a7 E W o0 N E ` (D o C Z L- _ • y O N 2 LL N O N U)I a M n. #t a a • CC O. tV .V N « C [~V E i C C 1 G~ 0 a m 0 vn U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ylj~,c^Rn/ ADDRESSd SUBDIVISION / CSM# ✓o~$%O 7 22a7 sofyf' LOT # 1 SECTION Z/ T29 N-R 17 W, Town of 1 41/ STc CROIX COUNTY, WISCONSIN A PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /OY r r ' /01 fcs¢L~ / " 30 e t[ - 7a/ RdaO~ ,vw /v~.v~/~ r or- 3 r L Od . D O-0 j O-i,~ ~s 0= ~7~ vo S ,7. 37' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. { BENCHMARK: /10,0 / w e/ei2wAriL ,oo•,d -V ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 6/E/=/CS Liquid Capacity: Setback from: Well House 33 Other Pump: Manufacturer puL Model# wEoS~ Size i Z Float seperation Gallons/cycle: 2",rY7 Alarm Location 11,12t 410_F SOIL ABSORPTION SYSTEM Width: Length F ~l Number of trenches /a y ~S Distance & Direction to nearest prop. line: 4.'t'5 Setback from: well: tioyrr House /Os_ i Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom f'p. pi Pump Off 9/, Header/Manifold /d 3,3 Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 7 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93 : j t 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 268687 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: FERN, MIKE & JODY HAMMOND T BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: CS /ZzaOZ9 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Qa<~. Benchmark d i ? g 17 100 rd Dosing ! Aeration Bldg. Sewer Holding St / Ht Inlet 9l 5 95-,5j` TANK SETBACK INFORMATION St/ Ht Outlet "'1t TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake q5. 3' 7 Septic NA Dt Bottom Dosing - , NA Header / Man. Aeration NA Dist. Pipe y 163- 321 Holding Bot. System 55~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer'' Demand 94,1 ~ Model Number G PM TDH I Lift4 ` $1 Lrictionp,cK System AS TDH$03/ Ft mead ' Dist. To Well Forcemain Length l0/ Di a. j`< SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengtlyv, No.~renches DPIT IMEN 1 N nsideDia. dDepth DIMEN I N ~~jj nufacturer. SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING SETBACK CHAMBER Mo el Num INFORMATION TypeO / OR UNIT System: !0!~ DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length ~0 Dia. o~ 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 l / f Bed /Trench Edges ° Topsoil e-Yes ❑ No Yes ❑ No r COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND.21.29.17W, SW, SW, HIGHWAY TT C Plan revision required? ❑ Yes dNo u7.- Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No- ADDITIONAL COMMENTS AND SKETCH - i 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. C • See reverse side for instructions for completing this application State Sanitary Permit Number A&M 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 Owner Name Property Location s6d 1/4 1/4, S T Z , N, R ! E 'Property Owner's Mailing A(Lfess Lot Number Block Number f ".Z J-. W__.,__ Cily. State zip Code Phone Number Subd~vi,sii Name or CSM Number sT"'2 10 2 D II. TYPE F BUILDING: (check one) E] State Owned ill Nearest Road -r-~ Public 1 or 2 Family Dwelling - No. of bedrooms Town of 71 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - Z~ LOtd 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ 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. ❑ New 2. ❑ Replacement 3- ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Exlsting System _ Existing System B) A Sanitary Permit was previously issued- Permit Number p 17 Date Issued /D-7 1PA 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 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 ss Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation `0 S-0611, / SlbO /ts2. VdNe et Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 6 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber QIt/ = AlArailer ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the on ite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: ff. I A r PI er's Address treet, City, State, Zi ode.1 e d o Wj= o IX. COUNTY/ EPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps)'- Approved Surcharge Fee) ❑ Owner Given Initial j 1 ~ /U Adverse Determination (0 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS k 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsitc 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 administrato- or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line 13 if permit is for tank replacement, reconnection, or repair. V. Type of system- Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed -and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin October 18, 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 S96-04065 FEE RECEIVED: 60.00 REVISION TO PLAN S96-03729 FERN, MIKE SW, SW, 21, 29,17W TOWN OF HAMMOND COUNTY OF ST CROIX MOUND 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 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. Inquiries should be directed to me at the number listed below. Please refer to the p number sho above. Si er , Peter E. Pagel Plan Reviewer oRIGINAL Section of Private Sewage (608) 266-2889 8627R/ 1 SBO-5524 (R. OM) { ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S96-04065 DATE Oct-18, 1996 OWNER Mike Fern PHONE 715-796-5330 _ ADDRESS 380 2nd St. Hammond, Wis. 54015 LEGAL DESCRIPTION Tax Parcel # 018-1047-20-100. CSM #509061, Vol-lo, Pg.2707. 1o.0 Acres. SW 1/4, SW 1"/4, Sec.21, T29N, R17W. TOWN OF Hammond COUNTY St. Croix CSTM Dave Fogerty CSTM 3233 LOCAL AUTHORITY/ SUPERVISION St. Croix County Zoning Dept. PROJECT DESCRIPTION: 896- 04 065 REVISION. TO PREVIOUSLY APPROVED PLANS S96-03729 (9-27-1996). New construction. Previous plans were for a 3 bedroom home. Plumber discovered that proposed home is actually 4 bedrogms. Estimated daily wasteflow is now 600 gals. Mound bed and basal area were slightly enlar ged. Septic tank has been incxreased from 1000 gals. to 1250 gals. Force main has been reduced in total lenght, and enters the network with an "end" type manifold. All other elevatio ~:tef'the mound system are identical. The exact location e~.,mQund basal area is the same. M,,, j a w tea`` gCO)VS ; ROBERT W. - ~~Z tY A Q = ULBRICHT a 0111 HUDSON. WI % Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEW SPECS. Pg•3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION ow V on U . C Pg.5 PUMP PERFORMANCE SPECS OCT.,1 s Togo OF sv,P vE yo t''s Rop 4 7-1 ,V w 4o T 40406~e , elmSO. jr /00.0 ' v area ~5 below the downslopo edge it iho the 996-04065 sill lh~ orPlion stem mist rosin oniflill. ss 2- ,SfJlrlrESrE" Fort'«' /yd/N o,v rave i 1,/A) M ay ovvp iN ~ooo~~ Tv ~E- d/e i .v T M O To Mosr a, / 25b T ° .5,e r/ 1 4 ~ "Z 93.0 p Sew Y RED~M Raxk Es i rc PER PLUMBING PRODUCT APPROVAL ;CODES, ALL ABOVE-GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCH.40 PVC MEETING ASTM D1785 OR D2665 STANDARDS. wo Got 5c'A 30 e =3~cK PI'TS XN = 6 x fS rii3 C, 1`iPAo~ P5 z of 5 [CROSS SECT100 OF JAIOuAjD toiTti QED Oto OF % ro 'DiSTRi(3uTto,V A331P -SATE G , TNi clr,3 Fs s pip r►J Cr of ropsorL sysrEM E IEVA rioN (Mi FORM TOE W /O 2. • LIS All 14 G"1'lU E F ► RATIO t1 Mao. l e ~3) ' ,i' SAND . ll/ lll/ ll/ i/l i~% /I/ plow~~ T o P so uu ~ FORM I_ Z %'s I o P F- FORCE' jH h N E 1 WAT100 Uu DER QED ~e/. y~ 1.0 Fr Et_Evhrio►~ S , E ~Z Fr. l"VERr of 2.„ IAT£RA(S 2- FT. .~S Top of Rock 103.31 H /.S FT. ' -rop °F 2 IATERAIS 996-04065 PLAN VIEW of MOULD - Wi rti 13E D i ffA) -D FO L4:> FORcE MAW A (o FT• K 1° Fr ---a- h l0 r w zg Fr *01- r Ber, OF To I . 3 o.f 5 D'STRiBuTIo,1 PIPE Oe'rwoRk LAyou'r 596-0~06~ A R OSIJ ~U Fr R 3.o Fr X I N c ES FoRcE MR(►`1 n t o o Fr• y C9 of 2' p v c _ r~oNFs VARCAGLE TOTAL, V(g t U 01L)M E 16'7 Gals 'PisTgacft HoIE D~i4METER INCHES Lh1ERA~.. " ~ INC lies MANIFoLr> 2 _ rNC0 EFs Fopce FAIN - Iu~NES Of HoIE S/ p ; PE z~ Zr~VERT ELEVi1TIOK) or- LATERAk 5 1oi. is pE FoR RTE D Pi pE 'DETAi i-- 6,u_D ~Ap R CD • ReMouE- ml DRill BURRS \ Y PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,41E g of 5 -VENT CAP 4"C.T. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WIIJDOW OR FRESH IVmIti. w/lv,4,(A0l,0&-IA13El AIR IIUTAKE 1~'^0 CIE b'19/On/ GRADE ZIs I L..... 00 O CONDUIT Whim. f l~ U.4n r,v 11~ INLET PROVIDE I AIRTIGHT SEAL 9~----~'' ~ pr APPROVED JOINT A 5 III 1J/C.I. PIPE IN 00 I III APPROVED JOIWTS EXTEIJDIfJG 3' 1. '`fv I I I W/C.I. PIPE ouTO SOLID SOIL VD 00 ( I ALARM EXTEAmuc. 3' / B D • 11 ~ l I i I ONTO SOLID SOIL o / (y~ / I ON RZ•Z ~ 'I I ELEV. FT. 1 PUMP OFF '~E Dhh l~ D ~40 ~ /t VA f io d BLOCK RISCR EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC ILA V8 3• ly DOSE TANKS MAIJUFACTURER: IJUMBER OF DOSES: 3 PER DAa TANK SIZE ZOO GALLONS DOSE VOLUME looms ;177• `13 ALARM MAIJUFACTURER: T. GIECTRO S,JC • INCLUDING BACKFLOW: GALLONS MODEL NUMpER: O FF w CAPACITIES: A= 20 y~ SWITCH TYPE: MERCU y F/onr Z -INCHES OR GALLO►JS B = IWCHES OR 7 GALLONS PUMP MANUFACTURER: C1'OULDS • C. :MCHES f`ICHES OR G~ 8~5 MODEL NUMBER: GuFOJr11 h10 `iE,4D Y2 /6 I D-,gZj SWITCH TYPE; P115YBACe- )A9RtvRy F/0,4 MOTE' OR GALLOtIIS PUMP ANp ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTION PIPE. 40' 7S FEET -rA_NF SPtCS -I- /•11NIMUM NETWORK SUPPLY PRESSURE , , , , 2.5 FEET EAGGA; p 4- SOD FEET OF FORCE MAIN X 3. YF,/ 90 loo Ft.FRICTIOIJ FACTOR.. FEET t- OA I S ZO TOTAL DYNAMIC. HEAD = 17• Z 3 FEET /f ts, ROVAJO INTEtLNAL bIMENSIONS OF TANK: LENGTH ~;WIDTN -;L•IQUID DEPTH 896=04065 Submersible Effluent.Pumps 3885 tfk,rl ~"~i AVAILABLE CERTIFICATIONS ETL LISTED SUBMERSIBLE PUMP CLASS I AND 11 DIV. 2 AND CLASS III DIV 1 AND 2 ETL TESTING LABORATORIES, INC. CORTLAND, NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION S A PERFORMANCE RATINGS (gallons per minute) MODELS 1~fI0i WES511H WED511NN Series HP Volk Phase Max. Amp RPM Solids Wt - ) WES512H WE0712H WE1012H WE1512H WE0512HO WE1512HH WE0311L No. WE0311L WE0311111 WED532H WE0732H WE1032H WE1532H WE0532NN WE1532HH 115 9.4 WE0312L WED312M WE0534H WE073/0 WE1034H WE1531H WE0534HH WE1531HH WE0312L 230 4.7 HP % %1 '/1 % 1 1'.4 %1 1:4 WE0311 M '/3 115 9.4 1750 56 RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 1 4.7 11 5 100 70 60 90 106 - 60 - WE0511H 115 13.0 10 80 65 76 87 102 112 56 84 WE0512H 230 6.5 15 60 57 72 84 100 108 53 82 WE0532H 208/230 3 3.4 20 36 45 65 79 95 105 48 • 77 WE0534H 460 1.7 - 10 1 -25 25 59 74 91 100 45 75 WE0511HH Y2 115 13.0 60 30 50 67 85 96 40 72 WE0512HH 230 6.5 _35 40 61 79' 92 35 70 WE0532HH 2081230 3.3 5 40 26 52 72 86 30 67 WE0534HH 460 3 1.65 i5 - 10 43 64 80 25 64 WE0712H 230 1 10.0 _50 30 54 73 18 60 WE0732H 'Y 2081230 3 5.4 3500 17 42 65 12 58 WE0734H 460 2.7 . 6 30 54 3 54 WE1012H 230 1 12.5 70 -65 16 40 51 WE-1032H 1 2081230 3 7.0 1 5 26 47 WE1034H 460 3.5 ' - 75 14 43 WE1512H 230 1 15.0 -OU 4 40 WE1532H 2081230 9.2 90 33 WE1534H _ 460 3 4.6 100 24 WE1512HH 1 230 1 15.0 80 110 15 WE1532HH 2*230 9.2 120 5 WE1534HH 460 3 4.6 -metat'parts;BUNA-N S96-04065 elastomers. METERS FEET • Temperature. 1600 F (71° C) 90 maximum. 1 _ MODEL 3885 • Fasteners: 300 series 25 fio - T SIZE 3/," Solids stainless steel. r • WEt 1 Capable of running dry 70 without damage to 20 WIE j components. 60 _ SGPM WEO Motor: _ sFr • Single phase: 1/3 HP, 115 or Q 15 50 910 v An w 1171;n Rann• ~ . 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 268687 Permit Holder's Name: ❑ City ❑ Village 29 Town of: State Plan ID No.: FERN, MIKE & JODY HAMMOND CST BM Elev.: Insp. BM E ev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA v' TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I 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 Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Numer: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing e SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only "i Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched \'O\ Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND.21.29.17W, SW, SW, HIGHWAY TT 3 ri wry s- i - s ,~1 J f 3 iT I~~~.' _ ~l+ l ~ al~✓✓t/ ~l- C.~/x.l"~~~-....1 'e . f e ~ f.~c," ~ ~ .tfl~.i'~ _../nYld~/lYj/~j~C~' - y/ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division vp`'■~' ; 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. • See reverse side for instructions for completing this application State Sanitarrryy P4rmiitt (N/Iuumberr The information you provide may be used by other government agency programs ❑ Check if revision to previou pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1/4 w 1/4, S T , N, R E (o Property O e Majl g Addre s Lot Number Block Number City State Zip Code Phone Number Subdivision Name or CSM Number .v li.,r o ( eD La 'L oL . 0 2 a mss"VF,061 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Ro d E] Village t~ ❑ Public 1 or 2 Family Dwelling - No. of bedrooms -T own OF w iT III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - o --Zo i ®v 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ 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. jZ 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 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev_ 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Ca altoacits Total # of Prefab. Site Fiber- Exper. INFORMATION in g Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks r~ Septic Tank or Holding Tank t71 ❑ ❑ ❑ El I E I I ED] 1 10- -J 0 Lift Pump Tank /Siphon Chamber f+ VIII. RESPONSIBILITY TATEM ENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. a/n PRSW No.: Business Phone Number: Plu er's Name: (Print) Plumber's Signatur • o St ps rz o6~ 2T s. r Plu is Address (Street, City, State ip ode): L/ jy_Q IX. COUNTY// DEPARTMENT USE ONLY ❑ Disapproved SItary Permit Fee (indudesGroundwater Date Issue Issuing Agent Signature (No Stamps Approved ❑ Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V V, SBD-6398 (R. 05194) DISTRIBUTION: original to Counly. One copy To: Safety 8 Ruildings Divrion, Owner, Plumber INSTRUCTIONS z 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3_ All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsi'te 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, 608-26673815. 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; frictiondoss; pump performance (urve; 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 A BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin September 27, 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 S96-03729 FEE RECEIVED: 180.00 FERN, MIKE SW, SW, 21, 29,17W TOWN OF HAMMOND COUNTY OF ST CROIX MOUND 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 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. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. S' ce ly, r P g Plan Review O Q 1{r Section of Private Sewage t~ (608) 266-2889 8019R/ 1 SBD•95M (R. 09/98) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S96-03729 DATE Sept.-27,1996 OWNER Mike Fern PHONE 715-7-95-•5330 ADDRESS 380 2nd St. Hammond, Wis. 54015 LEGAL DESCRIPTION Tax Parcel #018-1047-20-100. CSM#509061. Vo1.10, Pg.2707. 10.0 Acres. SW 1/4, SW 1/4, Sec. 21, T29N, R17W TOWN OF Hammond COUNTY St.Croix CSTM David Foaerty,CSTM3233 LOCAL AUTHORITY/ SUPERVISION St. Croix County Zoning Dept. PROJECT DESCRIPTION: New construction, for a proposed 3 bedroom home. Estimated daily wasteflow-450 gals. Soils are fairly permiable in the upper 1211 (.4 GPD/ft2 ) but seasonally saturated at 30" due to massive sandy clay soils. It was determined by the CST that these statas present a permiability restriction, and a mound type system was indicated as being required. Proposed, a very.l ft- narrow mound system using 121, sand fill is proposed. r d '1 yr 00 UL BDERTW AIW. D1160 HUDSON, W1 •4 ~S I G~ 00\ //!r/!Rl1I111111ll111 Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEW SPECS. Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION P9-5 PUMP PERFORMANCE SPECS S96-03729.. csi s 13/1 = Togo OF sv~PvEyo t''s .fop .47- ,vcv v II. below the downsiope edgy of the 1be Jill 25 wis sass nil"" fill"• ' ~bso lioo ss Snil ~ -IoY-&,k of x " Luc yd lr6-ES rE- ~ FoRc~ ~•!iN Lf rri ~~°,e,t o,v 77V V t c 1 z.5 Tv ,~E-aRi .vT MOV.oQ ~N /000 TD ,~-1osT P~ t~~T • /000 ° SEPri c T j 4 'Z_ 93 0 3 13 ED I') Opt ES l TE WO f yy~ _ Go7 SG~QG~ : / 30 e = A9,f CK Go-f P o' TS o = E X Is rw c,- ! ",e P5 . z of 5 Fc7poSS SECT IOAJ of MouAjD w i r ti BBD O@D eF " ro • DiS'tpiau-rlOki z~ A99erSATE- G , rk ckxs Fs 9 Pi p'N 6- oF ropso(L sysrEM E I EV/1 t'ioo Uu i FORM Y'° E ,u N a, /OZ . y5 E 4 RATIO Mao. e • . ~3) il' SAUP . PIewto To P So 1 ' V N 1 F•O(? l~ I o p E FORCE" 1 h N E I tVATAOO Uu ~El~ Bev, ro/, ys ' F T. E Fr. INVERT OF ~Z lAT£R/4(5 /oZ• 95- , FTT • op of Rork /o3.z~ G / o FT. N /•S FT. • T°p of j y „ IATERA IS /03.09 , PLAN VIEW OF MouK)D wi r ff 13E o i C~aTR/~f_ roPaz MAiAJ A FT• L a 7& Fr K io Fr FT' w FT k / z F r d W z( 0 ` FT- BEV OF %2•~ To I PUc CADDah i„ cE"TRA~. MAK) FO X17 D►srRi BOTIok - ' Pipe ►VETLuoR k -fo I.C. • vo l",x o~ 41,e -tolcc, - _--T p _ D►STR► 13UT 1o N LATERAIS SAP S z- (BUG FORCE LAST Hn1E 5 N1N 11 f3E Ntr~T To lRND CAP VOID V010,LAt FoR /hod. Fr. gA~S, FIRT- IEVArio&3 or- 2 FORCE MAW 24p / O 2 . PERFO RAVED PIPE DET'Ati L N o1Es l o ' at , A TF v ox-) f3c~~ror1 SHAH (3E Y VARiA(3LE y (R 0 NII\/ 5phcFD. D►ST~t~cE p 3CP Fr NoIE Di Ah~ Tr- R ►N , R L AT-ERA L I z / ►a, MAGI FOLD " IN . FoRce- MA i k) 2 - ►ucl.~ 5 or I~o~ES/ p i P.E,, f 7 PUMP CHAMBER CROSS SECTIOU AMD SPECIFICATIONS PAJE" ~ of 5 -VEAIT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING , JUUCTIOU BOX MANHOLE COVER WIN25'DOW FROM M FRESH H DOOR, to/ 4v,41,0 1A) 1AAE/ I2"MILD. AIR INTAKE ~"'Apt, ~I£ GRADE I 4" MIAJ. Z.-, IB"MIN. CONDUIT ~.o r~lC To IULET PROVIDE I ~J1-I~._r AIRTIGHT SEAL APPROVED JOINT A INy~{~ANK I III APPROVED JOINTS W/C.I. PIPE I n U A I III W/C.I. PIPE ZXTENDING 3' dp01 I 11 ALARM EXTENDING 3' ONTO SOLID SOIL B ^ g I II ONTO SOLID SOIL . g 1 ~y ti~ I I C So I I ON II - ELEV, FT. ' PUMP OFF t _t J D ~.0 y 'fok ~ /E VA f I BLOCK RISER EXIT PERMITTED OUL9 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE GtI~EKs ~,V ' TANKS MANUFACTURER: KJUMBE ROOF DOSES: PER DA-4 TANK SIZE: /0400 GALLOMS DOSE VOLUME f& ALARM MANUFACTURER: S.1' ~LECTRO IMCLUDING BACKFLOW: /~+Q GALLONS MODEL HUMBER: ~C CAPACITIES: A= INCHES OR 300 GALLONS SWITCH TYPE: ~EQCVR, 1~ t-1DAT-_ 8= -2" INCHES OR ya GALLONS PUMP MANUFACTURER: GOV LDS `-Q C= 9 INCHES OR led GALLONS MODEL NUMBER: 3885 SE'p~~s GuEO3II M D-yea p f~--INCHES OR GALLONS SWITCH TYPE: f ISSIAWCK NOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE RATE-30 _GPM INSTALLED OM SEPAR/~ATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. I~'Z FEET -AAA) 5 PE-65 ' -I- MI►UIMUM NETWORK SUPPLY PRESSURE 2.5 FEET E/1C..G~ I`T O~'" J~ F) tit FEET OF FORCE MAIN X FYO F,FRICTION FACTOR.. 2-2-5- 7 FEET ~qUrIs Z~ TOTAL DyIJAMIC HEAD = ~ • ZG FEET Rovuy INTER"AL DIMEUSIOMS OF TALIK: 1 FAITTU / A.iinru v 7 .~u'. r.rn~• ✓Q A Submersible Effluent Pumps 3885' AVAILABLE CERTIFICATIONS ETL LISTED SUBMERSIBLE PUMP CLASS 1 AND 11 DIV. 2 AND E CLASS III DIV. 1 AND 2 ETL TESTING LABORATORIES, INC. CORTLAND, NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION sp PERFORMANCE RATINGS (gallons per minute) MODELS WE0511H WE051INN Series HP Volts Phase Max: Amp RPM Solids WI (lbs ) ' 1b/I0i WE0512H WE07120 WE1012H WE1512H WED512HH WE1512HH WE0311L 115 9.4 NO. WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WE0532NN WE1532HH WE0312L 230 q,7 1750 56 1 WE0312L WE0312M WE0534H WE0734H WE1034H WE1534H WE0534NN WE1534HH HP % % '/2 8/4 1 1'/2 '/2 1 ~i WE0311 M 73 115 1 9.4 RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 4.7 5 100 70 80 90 106 - 60 _ WE0511H 115 13.0 10 80 65 76 87 102 112 56 84 WE05 2/2 6.5 15 60 57 72 84 100 108 53 82 WE0532H 2H 208!230 3.4 I 20 36 45 65 79 95 105 48 77 WE0534H 460 3 1.7 25 25 59 74 91 100 45 75 WE0511HH 1/2 115 13.0 60 30 50 67 85 96 q0 72 WE0512HH 230 1 6.5 8 35 40 61 79 92 35 70 WE0532HH 208/230 3 3.3 40 26 52 72 86 30 67 WE0534HH 460 1.65 45 10 43 64 80 25 64 WE0712H 230 1 10.0 50 WE0732H % 208/230 5.4 4°B 30 54 73 18 60 3500 ~ 55 17 42 65 12 58 WE0734H 460 3 2.7 • 60 6 30 54 3 54 WE1012H 230 1 12.5 70 65 16 40 51 WE1032H 1 208/230 7.0 l0 5 26 47 WE1034H 460 3 3.5 75 14 43 WE1512H 230 1 15.0 co 4 40 WE1532H 208/230 9.2 90 33 WE1534H 1 460 3 4.6 100 24 WE1512HH 1 /2 - 230 1 15.0 80 110 15 WE1532HH 208/230 9.2 120 5 WE1534HH 460 3 4.6 'i metal parts, BUA-N elastomers. METERS FEET 896 • Temperature: 1600 F (710 C) 90 _ maximum. • Fasteners: 300 series 25 _ - ° - MODEL 3885 m-- SIZE Solids stainless steel. W.E1 { • Capable of running dry 70 w w.. _ __r ! ' I without damage to 20 wEi t components. 60 Motor; _ %.C-f! 5Fr Single phase: 1/3 HP, 115 or Q 15 50 _ f 230 V, 60 Hz, 1750 RPM; o EO H Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page __L of~ Labor Lmd Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but f-1, not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 10;6 r GOVT. LOT 1/4 u, 1/4,S T N,R / E (ordV PROPERTY OWNERMAI NG ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ham' CITY TATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN NEAREST ROAD os l/) 9G- o T VI New Construction Use Residential/ Number of bedrooms -3 [ ] Addition to existing building j I Replacement [ ] Public or commercial describe Code derived daily flow _4A-0 gpd Recommended design loading rate ed, gpd/ft2 . S trench, gpd/ft2 Absorption area required 375- bed, ft2 37S trench, ft2 Maximum design loading rate _--bed, gpd/ft2 . trench, gpd/ft2 Recommended infiltration surface elevation(s) /03.0 ft (as referred to site plan benchmark) Additional design / site considerations / '~,A mot L~~ Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ®U OS ❑U ❑S ❑U ❑S ❑U ❑S 0U ❑S mU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench z 6 c v y. s Q- v 213 I 74a Ground 114-30 - c c n2 C /C - Z 3 elev. r _ f t. Depth to limiting 4 factor Y rr r Remarks: '051" mv ~ Boring # 'C4 4: •iv. :iii I X ,ft S44 -S Ground c a c elev. ~o_ c L k Iyr v i - . Z . 3 2, ft. 46 Depth to S - $ • s- - do A*t v limiting factor * Remarks: 4- CST Name:-Please Print Phone: vi Address: ~p P rvL Yol3 I Signature: / ate: ST Number: PROPERTY OWNER /ll.~t/irsa SOIL DESCRIPTION REPORT Page _[~of PARCEL I.D. # a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh < 0- -r /Z z 3 Ground Z ZZ s c c c 5 v, s elev. ft. 3 c . Y e- 5 .7 Depth to 3o s c sy w - „ limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # • Ground elev. ft. Depth to limiting factor Remarks: Boring # M Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) t 0 I z C N to l 401 POO* C 9 y ~a 3 Y 1 J LI 1 1 t A Y J` W a 1 s ~o ;4 t. p n ~ h S Z Q~ p Z S It -b A I s i FILED NOV 1719930 9 sosml JAMES O'CONNELL Register of Deeds Q CERTIFIED SURVEY MAP ANNABELLE D. HANSON N Part of the Southwest 114 of the Southwest 114 of Section 219 Township 29 North, Rance 17 West, Town of Hammond, St. Croix County, Wisconsin. 0 O .O 1 1 Owner's Address: 36741 Grace Avenue R w Zephyrhills, Florida 33541 0 X :mow M a Phone No. 1-81'-2-78?-4109 CL ~q s L6 h \ UNPLATTED LANDS O \ O O N 9000'00E 399.90' p O W q 2 2 b ~ ' N J O v W LOT / C.S.M. , h 3 a VOL. 7, 0 3 I 3 M Q h PAGE /875 2I ° N ~ O ~ b Q 2 20 m J N Q: 2 r(T(SBB•30'27"E'1 ~ N 90.00'00" E LET L p ,Q. 13 20J.39' 7 W ? m /0.000 ACRES aj ~ I Q h b 435,'599 SO. Fr. b b m 0 O 9.538 ACRES EXC. J J 7 ROADWAY R ` Q 415,493 50. Fr, a, N J p a ' vJl ° Q 3 q J QI y J N HIGHWAY SETBACK LINE ° o e 2 M O ~ 609, 29 N 90. 001001E 300./0' 609.29' /7(6,00' N90.00'00"W,,2625.39' M b~~ a S'L /NE SW //4 S 114 COR. SEC. 21, SW COR. 'SEC. 21, T29N, R17W, PIPE FOUND/ T29N, R17W, t!COUNTY L07- / C.S.M., VOL. 7 A- GE 1827 SURVEYOR'S MON. ) 0 Indicates 1" x 24" iron pipe weiGhinZ- SCALE /"=200' 1.1' lbs./lin. ft. set. 0 50 /00 200 300 400 600 • Indicates 1" iron pipe found. _a\lltl 1111111j„_ 1 ~ -.A CERTIFIED SURVEY MAP ANNABELLE 0. HANSON Part of the Southwest 114 of the Southwest 114 of Section 21, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Description: That certain parcel of land located in the Southwest 114 of the Southwest 114. of Section 21, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southwest corner of said Section 21, thence N 90000'001fE (assumed bearing on the South line of the Southwest 114 of said Section 21) a distance of 300.101, to the POINT OF BEGINNING, of toe parcel to be herein describes; hence N 01029'3311W 4300.15'; thence N 90 00'0011E 209.391 (recorded as S 880--30127"E); thence N OR 2913311W 434.26' (recorded ass N 00000'00T1W); thence N 9000010011E 399.901; thence S 0102913311E 864.411; thence N 90 0010011W 609.29' on the South line of the Southwest 114 of said Section 21, to the POINT OF BEGINNING, containinc- 10.00 acres, being subject to easement over the Southerly 33.001 thereof for C.T.H. 'ITT" R.O.W. purposes and also being subject to easements of record. Each parcel shown on this map is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office for advice. Dated: September 23, 1993 U "Revised this 26th day of October, 1992.11 0 f~ C N C This instrument drated by rJames 0. Filkins M V Q N State of Wisconsin) V County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Annabelle D. Hanson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and etttttil~t®~ correct representations thcrecf. ,4, NS/ °~LAURE E'• ~m~WMU H o: STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS .2 Ole ST T- ~ leUL. S'eW! PROPERTY ADDRESS (location of septic system) Please tain from the Planning Dept. CITY/STATE /~l~i~J/ft?d/~/.1~~_~•s" S~/©/~ PROPERTY LOCATION 3 44<) 1/4, Section l T~_N-R_ / 7 W TOWN OF /7iGYl~YDI~/' ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUMEZ, PAGE Z?07, LOT NUMBER C / 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 te. d County Zoning Officer within 30 days of the three yeArtion SIGNED: DATE: of/~ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 &01& T Lce~ Location of property_j(&) 1/4S'&t) 1/4, Section Ze ,T N-RAW Township Mailing address rep 1 .~T• 1LA&eM0Ao0- l.W.,C S"01.- / T Address of site ar c M E7 7 Subdivision name Lot no. Other homes on property? Yes___/ No Previous owner of property /~,aFLc,E' Total size of property + Total size of parcel Date parcel was created %~4Q 3 Are all corners and lot lines identifiable? _-J/ Yes No Is this property being developed for (spec house)? Yes L/ No Volume 4oS / 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. S`pq -5-x'j- , 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. 5S0?S3~' Signature of Applicant Co scant i • Ij 7M1! RSS3mIao MR =CoRb;No DATA ~I ~i DOCUMENT NO. F STATE BAR. OF WISCO 1ro8~ 1- its WARYv O8W 'I , REGISTER'S OFFICE 509535 Aru~abelle This Deed, a(k(a +dio OD., +d I made between D bz1. _ . b~ P~er..gf..... a ...._.le.sos%_ a--gidaRa,_•by__(an- Hanson ra be~>ED X41993 NOY fe tor, - - o •Idl vi...-.-•- I d and.....••----.__ as.=vivorsbik -t41__PrQpexty........... . ° Grantee, 1 C Witne$Seth, That the said Grantor, for a vahwhft oausidw&tion--•--- P" 1111111MV11111114 TO orae.dola►x_ox otex.8- Yaluehe__ roix - -.-C----- I conveys to Grantee the following described real estate is St _ County, State of Wisconsin: s 'Paz Pared me: A part of the Southwest Quarter of the Southwest Quarter gbt'W'io of f SW~) of Section 21, Township 29N, Range 179, Town of Hammond, County, Wisconsin, uo~e particularly described as: Lot 2 of Certified Survey Map, recorded in theOffficee fatthee Register of5Deeds, in Volume 10i Certified Survey Maps, at page ~~ti~t Eh { This ° homestead property. . (is not) 'f'ogether with an and singular the hereditamea4 ad afrartepaacos theraanOs belonging: And.... Sr8AKAU!..--.....---••--•-•----••--. - warrants that the We is done. indefeasible in fee simple aari irec and clear of sacsmbraaces aaxpt easements, restrictions, reservation and covenants if any of record, and high-..ay rights of way, and wilt warrant and Mand the same. 'dlttd. "Y 93 Dated Shia Lovember - (SEAL) (SEAL) Annabelle D. Hanson by _ Evan Hanson,--her Power of Attorney -(SEAL) (SKAL) AUTRUNTICATION ACKNOWLEDGUNNT Sig "re( Bvan Hanson ilATE OF WISCONM ea. - - - 22nd Ptasonally cans before ee IN & -._......_y the above named Sd..ard F._ Vlack----------- sri i iaz=zR STATE Buis of wiscoxsrx - _ - by $ 708 06, Wis. Stab) ~s ae known to be the perasa wbo e:erated the fs~abng inetrwnent and adhww%ds'e the wne- I ~ 1