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A U a 2 O N U
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' ST. CROIX COUNTY ZONING DE T
AS BUILT SANITARY REP CI
n
'd n ~e srgg$ ,
Owner
Address C o"A ms ~ rvr ( 0 f'
City/State Pc. ~,,,,6 k0, s t.,h s, C
Legal Description:
Lot 0 Blockf/k Subdivision/CSM #
t/4 ~C '/4 <SF , Sec.3-9 Toj~ N-RJ,7 W, Town of R,: ✓e PIN #
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer ~'Ir v',UA `Size ST/PC /'73D Setback from: House 30 Well 8DP1L;"11)0
Pump manufacturer Za +c IIty- Model 13 -
Alarm location -Qpi Be
=
I-Of OF 014"hek- 5'ytic fti4 4 7•
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width G~ Length Number of Trenches
Setback from: House. Well P/L Vent to fresh air intake Av
ELEVATIONS: 9
Description of benchmark l'of C em444 tv j i6ecir- o. A s t vice 6hbutu-e- Elevation
Description of alternate benchmark Du rn 12 mkh 1, ~~1r Cy-44'' Elevation ''S =
Building Sewer ST/HT Inlet ST Outlet PC Inlet
C~
PC Bottom V " q dam- Header/Manifold Top of ST/PC Manhole Cover 0~
-ZO Distribution Lines O O ( ) Bottom of System ` q, -3
Final Grade O + O ( )
Date of installation Permit numbera?,0 State plan number
Plumber's signature License number ~6 rd Datel
Inspector _
Complete plot plan
MOMW HJ.UON UVOI(DU
_P_
a
_ Z_ s
3
40
NORTH 0 101 20 30 i
A_kX 56 deck
4 Bedroom
House a
3
bench top of cemen
wall near west servlc
door 91,74
John Sell As-Built
~r
'aig8~iidd~ 3i `xjeungouaq a1vulolp, mogS.
iano~ aioqmuz 3jurl oildas 3o iajuao 01 slutod amaia3ai ir;uozuoq omjL
Iu0jS S aql 3o 120j 001 UTIRI n SutqIAIana SuiMogs gojaxs MOIA wid d
:2mMopo3 aqj apIno.id aseald :H3IZ0u
• w'scorisfn uepartment of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Wety Ind Buildings Division -
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
262484
Pe l}tlder'yALar11Q: MICHELLE ❑ City ❑ Village E*Town of: State Plan ID No.: RUSH RIVER
CST BMLLElev.: {~J1 UU[ri111VV Insp. BM Elev.: BM Description: Parcel Tax No.:
G~ d~ 1 -1 A9600144
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing d/
.k Aeration Bldg. Sewer :
ti
Holding St/ F( Inlet
TANK SETBACK INFORMATION St/ Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom lg!~
Dosing NA HLMan. ~i
Aeration NA Dist. Pipe a
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
h~.
,o Model Number GPM
TDH Lift Friction System TDH Ft
r Fi
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
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed/Tr nchCenter Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: RUSH RIVER. 35 28 ,17W, NE, SE, CTY YY /
f
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 0519 1) Date Inspector's Signature Cert No
Safety and Buildings Division
Bureau of Building Water Systems
~~■~r■r, SANITARY PERMIT APPLICATION 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. 6 ~r t?
• See reverse side for instructions for completing this application State Sanitary Permi Number
The information you provide maybe used by other government agency programs ❑ Check if"revislon to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan 1.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION t. ^ - &D Property Owner Name Propert Location 31
~fE114 1/4,S ~T~~ 17 A (or W
h
Property Owner's Mailin Address Lot Number Block Number
17
City stat Zip Code ~ Phone Number Subdivision Name or CSM Number
II. TYPE F BUILDING: (check one) ❑ State Owned o ity Nearest Road
❑ Village
IV Public 1 or 2 Family Dwelling - No. of bedrooms own OF t}' -0Y ~1)vtl
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 2 - (,4
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
SystemSystemTankOnlyExisting 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 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
Feet 7 Feet
Capacity
VII. TANK in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ' ! tv { ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, 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) MP MPRSW No.: Business Phone Number:
Briju W aek- lk44~4.(, ll&' I R 13 7 7~s -0 a'
0
Plumb r AcI ress Street, City State, Zip Code):
c! s
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanit ry Permit Fee (includes Groundwater ate Issued Issuing Agent Si
pproved ❑ Owner Given Initial Ch Surcharge Fee)
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
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 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 completeand 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 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.
f SAFETY & BUILDINGS DIVISION
State of Wisconsin'
Department of Industry, Labor and Human Re1ations
March 22, 1996 2226 Rose Str t
La Crosse WI 603 ( b
cF
WEGERER SOIL TESTING
421 N MAIN STREET ~k E
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S96-40131 FEE RECEIVED: 180.00
SELL, JOHN
NE,SE,35,28,17W
TOWN OF RUSH RIVER COUNTY OF ST CR.OIX
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.
Sincer ,
%
erard M. im
Plan Reviewer
Section of Private Sewage
(608) 785-9348
SBDA-7997 (K. 18M)
i
• y
Page 1 of 6
MOUND SYSTEM 9."'o A y BEDROOM RESIDENCE
LOCATED IN THE N~ 1/4 OF THE SE 1/4 OF SECTION 35 T Z8 N, R W,
TOWN OF \Z USIA CzIlik 1Z, , ST• C-ZtojX COUNTY, WISCONSIN.
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER '
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
So tt ti s 'i
t
\\18 GvTh}(Z I.~ ~r~..~
C)ilt %--bh L1 , M Ki s 5 1 Z$ i'eS:: aw
MAR 2 0 1996
SAFETY & BLDGS. DIV.
PREPARED BY
WEGEf~ER SO I TESTING
AND
, ~i
GIE SYS~EMDE~ = G~i S~FZV I c--r=-
SON
<<~TE.,,.......,o<
~
gj pt a J v F.O. BOX 74 421 N. MAIN ST. Q e** O
RIVE? FAUS. VI 5022 ID TIJ-SL~1oJ ELS 4"TN,
1iE1A~~~S s s ft
s
l SIG O
vo.
MANt
ON~~~G~ ~~N 13 1 °t q 6
5~•E
JOB NO. 9 6 - 3 6
PLOT PLAN Page Z- of 6
} Scale 1"= q O,
o
ao
03
z
Z LS
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iJ BDRr-~ i ~ ~ I~ 1
it' oF ~-i"gve v C. i bo tuoT C11MAyer
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LAST ZS' ~RUF-t TAti1zS, -
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (Y required)
3. Install 4" observation pipes with approved caps. ( required)
4. Septic tank to be \Z 5 O gallon capacity manufactured by
w'tLS~m Co10 cK.tSg V-jz~DQi~ - ~P -r1u 8E w ~Eselt Xoov Girt. Thpuk,
5. Bench Mark eLA-V. loa.p' or,, spike Z' Hgoue- GR-ayND iN ~Z"Di A• -TV-EEE•
C sIM MOuE FoR Lochltot~~
6. Divert surface water around mound to prevent ponding at the uphill side.
Page 3 Of b
96
Approved Synthetic Covering
S7- '1 C- 33 Distribution Pipe
Medium Sand
G
Topsoil Elev . X18 . Z
3 `
b
Z % Slope
Bed Of 2N- 2 %2 Force Main Plowed
Aggregate From Pump Layer
D 1.0 Ft.
E N•\ZFt.
Cross Section Of A Mound System Using
A Bed For The Absorption Area F o.8 Ft.
G 1-o Ft.
A Ft. H 1. 5 Ft.
Linear Loading Rate= GPD/LN FT B BLI Ft.
Design Loading Rate= -11-GPD/SQ FT I lq Ft.
J S Ft.
K l•b Ft.
rate Position L to Ft.
of
Force Main W 19 Ft.
L
Observation Pipe
B ~ K
A I -
j
•f
N N
Distribution Bed Of 2 - 2 2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
t Page q of
Perforoted Pipe Detail
S.W A,
0
End View
Perforated /
End Cop PVC Pipe
as Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
P
PVC
Manifold Pipe
PVC Force Main '
Oistn ution
Pipe
Last Hole Should Be I
Next To End Cop
End Cop
P D Ft.
Distribution Pipe Layout S 3 Ft.
X by inches
Y k_ Inches
Hole Diameter 'IV Inch
Lateral 'fy Inch(es)
Manifold 2,- Inches
Force Main Z Inches
# of holes/pipe 8
Invert Elevation of Laterals 9'S .1 Ft.
Place 1st hole 3 Z~Ifrom center of manifold with succeeding holes
at 6 ''intervals. Last hole to be next to the end cap.
• PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOUS ' PAGE 5 OF
VENT CAP t
y"C.Z. VENT PIPE WEATHER PROOF
APPROVED LOCKING MANHOLE
JUIJCTION BOX COVER WITH WARNING LABEL
lO' FROM DOOR. IY~MIU.
WIWDOW OR FRESH I
AIR INTAKE I
GRADE I 'I' MIN.
O 0
gZ 1
I 18' Mlu.
COUDUIT--
WAIN. \
PROVIDE I
IM LE T AIRTIGHT SEAL I III V
I III
APPROVED JoluT/ A Tank construction shall comply I ICI APPROVED JOWTS
with ILHR 83.15 and ILHR 83.20 I I
I
I I I ALARM
_I II
a I I
I I ON
C I I
CLEV. FL PUMP-~ --J
OFF
0
L 0l~ COLICKETE BLOCK
3" APPRWfD
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPEGIFICATIOUS
005E ~.JILSCR
TA1JK MAIJUFACTUiLCR: 231`12,M 1212.(»U eaS NUMBER OF DOSES: PER DX4
TANK WZE: 1D0O GALLOWS DOSE VOLUME z 1-) Z. 3
ALARM MANUFACTURER' S' S' ~ L"(3 Sy5'TN'1~I S INCLUDING OACKFLOW: GALLONS
MODEL k1UfAbCR: \ O 1 ~'I~"' CAPACITIES: A= ) y IMCHES OR L}01 • GALLOUs
SWITCH TYPE' M1QM CQ\-tlLf 8 = Z IIJCHES OR S7 4LLOW5
PUMP MANUFACTURER: KS$tL1JvTR GPI" Rflkj~f r- IAICHESOR 1,2'3 GALLOWS
MODEL NUMBER: ~a D= I(411ZIUCHES OR 416' 3GALLONS
1nk 2CU)ZY NOTE: PUMP AWO ALARM ARE To ac
SWITCH TYPE:
MINIMUM DISCHARGE RATE 3~-GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEW PUMP OFF AUO.DISTRIBUTIOW PIPE.. Q'49 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . 2,50 FEET
+ 80 FEET OF FORCE MAIN X -21 F3,/00FT.FKICTI0U FACTOR. -1-11 FEET
TOTAL. DyUAMIL HEAD = 1119 FEET
DIAMETER
IMTERNAL- DIMEIJ510Ne OF TAWK: LENGTH ;WIDTH - ;LIQUID DEPTH 3 6) iz
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER = Z 8• -I I GAL/INCH _
En Pr E 6 (5 F 6
Li HEAD CAPACITY CURVE 3 7/86 1/4 - -
'L MODEL "98"
30 4 5/8
I r
8 I
25 A
3 5/8
= 6 20 m + +
L) p
:2 111*~
a 4 3/16
0 4 15 Jy.lB
O
F 10-
1 1/2-11 1/2 NPT
z 77•Yy
5
0 4. JC<v
U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS 80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 12
HEAD UNITSIMIN
FEET METERS GALS LTRS
5 1.52 72 273
10 1.05 61 231
15 4.57 45 170 3 5/16 1 J
20 6.10 25 95 - \
Lock Valve 23' '
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
• Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - 1/2 H.P. 2- Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control Selection switch. Refer to FM0477.
Model Volts-Ph Mode Amps I Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075.
M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify
duplex (3) or (4) float system.
D98 230 1 Auto 4.5 1 or 1 & 7 - 6. Four (4) hole "J-Pak junction box, for watertight connection or wired-in sim-
E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 &5 Alex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by
a quali-
Piggyback Mercury Switches, FM0477; Electrical Alternator. FM0486; Mechanical Alternator, tied licensed electrician. All electrical and safety codes should be followed includ-
FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732. Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
Z AWL TO. P.O. BOX 16347
ZAM T
LouisWft, KY 402564347 Manufacturers of...
SHIP TID- 3280 Olt Mfliers Lane
„
® tso2) 77s 2raI . r(soo) t;12a PUMP `Qu~~i~r/~aMVS S~~ /9.~9
FAX (502) 7743624
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and 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 81/2 x 11 inches in size. Plan must include, but S~
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR
dimensioned, north arrow, and location and distance to nearest road. $
FfU* APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION DBY DATE
r'
PROPERTY OWNER: PROPERTY LOCATION to
1`F tV S t`Tt l_ GOW -L$T 1\X 1/4 SF" S T f V1 E
PROPERTY OWNER'S MAILING ADDRESS LOT If
BLOCK # SUBD.
KAW
l 1 'l 8 G ~Tlt• 2l E - ~ ~•~/CE \
CITY, STATE ZIP CODE PHONE NUMBER CITY E]VILLAGE DOWN
omretotu~- "N SSIZ$ (bt2}739- OZZ $ lZvS~} R1V
[4 New Construction Use [k j Residential / Number of bedrooms y AdditiQn to existing building
j I Replacement [ I Public or commercial describe
Code derived dally flow b o0 gpd Recommended design loading rate o 3 bed, gpolft2 trench, gpolft2
Absorption area required SbD bed, ft2 Soo trench, ft2 Maximum design loading rate o . S bed, gpd/ft2 a . 6 trench, 9pd1ft2
Recommended infiltration surface elevation(s) 9 8 r ft (as referred to site plan benchmark)
Additional design / site considerations f"to~►-~U w/ 6 ' K 8 4 ' Bail • M t x-i t MUM t r OF SAID FILL.
Parent material s ou M s C \ Tt Flood plain elevation, if applicable N . P • ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem [I S CUU ® S O U EIS IOU ❑ S O U ❑ S R'U EIS RIU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ftBoring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. ~ce Boundary Roots Bed Tnich
•"-"r.A~~3~+4R
:i;{~;AVt I
;Vy F ~SblL 'VAjt (~-S Zr~ Otis O.6
1-Z-1 t O `11Z Y~ 3 511 Z'F ~ ~h w►'~N C S 1 M o, S o. 6
C1
Ground 3 Z-)_Sb tu`LR Yl6 I •s4vt. S/a S o~,.~ ►+1 ~I '
elev.
4-7.0. ft
Depth to
limiting
factor .a
Remarks:
Boring # _
u b-1 ~O`1SL 3 12 Si 2w,S~k wt~1- S
Z` Z 1-t(3 l0`'12y13 - 511 Z`FSb~ l+t'~F- cS ZwI 0- go. ~
~'i Z8 10 IZ Y.13 - SI 1 3 ~s~k M~6 C S 1,' a. S `o. b
Ground C\ 1.S`t R S/$
elev. y zg-4S ! wl rz. Sly / ` 1 0~, wt 1'1' - - 0 V) Ilk
T). Z ft
Depth to Co ru w S w► 1 p ~ ti 7 f / S ~ ~ r ~~T S
limiting
factor
Lai
Remarks:
T Name:-Please Print Arthur L. W e e r e r Phone 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: 6' 3 Date: ` t}} CST Number:
PROPERTYOWNER S~FL..I, SOIL DESCRIPTION REPORT Page Z Of 3
PARCEL I.D. # O Z$ - ) W4 3 -10
C Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
El'ol Z, ZM3hbr V, cx,S Z S c.6
toy R X1/3 _ si) 2 `~sUYt `Fh C 2-~ 'S 4 L
Ground 3 1') -2 S Uy-j R._ y / 3 S e) t \n S 11'~ IZ v►7. `F~
elev. C CS w~ 0. Z. o_ 3
.
967 ft. 25-33 tOti12S/y CA
,SyR S1S C~ o~ v►1'~i - - -
Depth to
limiting
factor
Z S''
Remarks:
Boring #
Ground
elev.
ft.
Depth to
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factor
i
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
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Remarks:
Boring #
ti
Ground i
elev.
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Depth to
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Remarks:
BBD-9330{R 05/9?1
PLOT PLAN Page 3 of 3
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~rvt2, ) 1 1 Rq 6 (715 ) 425-0165 M00576
CST Signature Date Signed Telephone No. CST #
Y in Department oflrKlus", SOIL AND SITE EVALUATION REPORT Page ~ 3
Labor and Human Relations -
brvision of Safety 8 Buildings in accord with IL HR 83.05, Wis. Adm. Code'
COUNTY
C~ IX
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plant must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ID. ff
dimensioned, north arrow, and location and distance to nearest road. O Z $ - 1 p y 3 - 1 p
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
~O k* 1V S tTLI_ GGVT-W N-X-- 114 S F" t/4,S 3 S T Z`a N.R X-1 E
PROPER1TYY 8 ER':S MAILING ADDRESS LOT # BLOCK If SUBD. NAME OR CSM * `
T* R. EE
CITY, STATE ZIP CODE PHONE LIMBER CITY []VILLAGE UOWN NEAREST ROAD
~f`dltDh~l: "N SStZt (6) 2}~39- ozzg RvSVRIVE 1? crH `t `t y
New Construction Use (,1() Residential / Number of bedrooms L/ Aft o to erds*tg building
Replacement I ) Public or commercial describe
code derived daily flow 6 0o gpd Recommended design loading rate o. 3 bed, gpM2 trench, gpd/ft2
Absorption area ret)ttired SO'D bed, ft2 Soo trench, ft? Ma)dmum design loading rate o • S bed, gpd/ft2 Q • 6 trench, gp&V
Recommended infiltration surface elevation(s) 4 $ . Z r ft (as referred to site plan benchmark)
Additional design /Site considerations f At,_O_' w/ 6 'X 84' BM - M') l xj1"U" t r or SA/vD Fr LL
Parent material s x c"T4 ou M s 1 ~ C ~ T► Flood plain elevation, if appfi2* Na . A . ft
S = Suitable for system CONVEN ION& MOLNJD WGROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDM TANK
u= Unsuitable for stem o S UU ® S 0 u o S Ia U O S ®u ❑ S WU o S~ U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Wiles Texture Structure C mistence Bou'dary Roots GPD/ftin. Munsell Qu. Sz- Cont Color Gr. Sz. Sh. Bed rends
r
~O`'tR 3!Z SL ZwL sb12 r,1~~ 0. S Zvn o,S 0.10
z-z~ to`tCt-Yl3 _ SO Z'F-5bh w~h cg ti o,s 0.6
Ground 3 zi_sb ivYR YlG C1~ -s-m. Sla S1 own '~t -
elev.
47 o fL
Depth to
limiting
factor ~r
Remarks:
Boring # _
b-1 V_ 3!Z SO Z.`w, Sbk wtct.S Z,Vy
Z Z 1-1f3 \O`'tli_.Y13 - Sll Z`Fsble 1+1'1- cS Z•,.1 p- To• ~
~ rh O. S o: 6
I 18 22 lv `f rL y1'3 - S1, 3 ~sbk M+ 1, CS
Ground c~ ,.sy ~ sia
elev. y U-14S toItz sly / R 3 ~1 0~ _ _
q, • Z ft
3 COrv ►vS mft" tp kQ ? f7 S«T- 00VrS
Depth to
limiting
factor
Z8'
Remarks:
TName:-Please Print Arthur L. We erer Phone: 715-425-0165
f S:
e
gerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: 6`3 6 Date: ry- `I' 19`} L CST Number: 76
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D. f1 07-8
GPD/ft
Depth Dominant Color Mottles Structure
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourclary Roots Bed Trends
3 1 0- mz -i I Pt s t 1 2, m 5 b IT w, 0--1 z 0" o. 6
2. 6 - l'? 10 y R y 121 S t~ Z `F 5,6 vt * C 2 -P O • s t. L
Ground 3 1~-2S Lb`i tZ /3 Se.) ~a 3'6ir V.CS a. Z o_ 3
elev.
a 6=1 ft. 2S~33 tQ`'t,Zsly R 5l>, c► ow. w►`Fi
Depth to i
limiting
factor 1
Z_S"
Remarks:
Boring #
i
Ground
elev.
ft.
i
Depth to '
limiting j
factor
Remarks:
Boring #
i
• •z i
Ground
elev.
ft,
Depth to i
limiting
factor i
i
Remarks:
Boring #
' Kt C4 ii
I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
~Fl~•A3301R OS/a?l
Page
PLOT PLAN 3 of 3
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96-3(1
715 ) 425-0169 M00576
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER d M V
Y 1 C~ bra ,
MAILING ADDRESS
PROPERTY' ADDS / /'n / __J~T
(location of septic s tem) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, 1/4, Section M S T N f 1i
TOWN OF u S h 'Own S r ST. CROIX COUNTY WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expir tion date. -
SIGNED:
DATE: . }1,174
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 Ch e- f 0- Ca
Location of property E 1/4_1/4, Section ,T N R W
T wnship Lo h iV t x- Mailing address a t~wm W;
` D s r
Address of site,
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property Irr T1 f ~~.SD
Total size of property ex
Total size of parcel CL
Date parcel was created
Are all corners and lot lines identifiable? es No
Is this property being developed for (spec hous ? Yes Volume1110- and Page Number qL 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 ffice of the County Register of
Deeds as Document No. ,5~9-7o? 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 orded in
tlye3- Y c of the County Register of Deeds as D c ment No.
S a-fture of Appli ant C - plicant
A Da e of Signature Date of Signature
k. i
f Stagy , ..ar of Wisconsin Form 2 - 1982 -
53'728 WARRANTY DEED
DOCUMENT NO
d
Barry J. Danielson and Karen B. Danielson DEC 7 1995
husband and wife, j
II,, F;t 9:30 A. M
conveys and warrants to John Sell and Michelle Sell,
husband and wife,
" - _
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St Croix
n
County, State of Wisconsin:
(Parcel Identification Number)
The NE1/4 of the SE1/4 of Section 35, T28N, R17W, St. Croix County, Wisconsin.
II. TPA ta
$ FER
This i G (is) homestead property.
Exception to warranties: Easements, restrictions and rights-of-way of record, if any.
I
Dated this 9M November 95
day of , 19-
I~
II
(SEAL) - Barry J. Danielson (SEAL)
Karen B. Danielson
(SEAL) - - -
~I - (SEAL)
wren B. Danielson ss.
~I
County.
autheinticated.this day of November 19 95 Personally came before me this day of
19 the above naftted
* Kristina Ogl nd
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland
Attorney at Law
Notary Public _ County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.)
19
'Nn m,•~;1 po""n, cirmlig in om r;Ipm 'IN ~hnnhl he IYped ;a hnnhal hel-, Ihvi; IF
mllmr~
IN 11111 010% till U N I \ 11, 11.114 111- %1 IM 4INNIN Wisconsin Local Blank Co., Inc.
14 014 111 No, 2 1982 Milwaukee, Wis. I
I
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