HomeMy WebLinkAbout030-1029-30-100
-0 C,
° 3 0
n' r O
•a: ov ~ I
m o
0 o I
0
o O
c
I ~ I
m
O
of , o
F. ' c II
c
m
N ~
v z N
c _
LL c N
o w
II
z°
3 `t
v ~ I
0) w z N
z c
z (L co
z
o I
o z
U
d Z d m c z
N H N
c E a
-o
N O O
~~V 7 Q
N
O
a)
•
fV _
c
a` I
O
zmz
_ z
N
c vc I
N N
O E E
" o _ i Y
L ~ d
IL a ~o c cD co co
G N_ y' i O O O O O
>
`l O D 0 d ~~Upp N N N
Q O c F F O U c~ N N N
N~ z N> 3 3 3 ° O o It 't v
~i 0 0 0 z o 0 0
7 O N
J O O N
fq J U w 0)0) rn
O N 0 O
N N N N N N
N p p E a0 M
0 O Q N ~ LO L
O CY1 N _ n
(D m N S~
0 N Q Q
Ci O O- N H
O O O_ c N C
LO N LO co 0)
O O Q O O OU ID W 0 0 0 0 0 0
" M p H U N c r a 0 0 0 o o
r N N N N
V N - c W M
CS n to lA
t ' 0 p oi NO ` i r- :3
N T M c a Z, N -5 Z
• r1~]l O O fA N O N z C/7
O ~
v ~ E y I
EL L: a Y
• 0 G Oi u N
. « C
c c 3
r A UCL OfAU
l l
i
~ It
Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3
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 8 1/ J 1' the e trl Oi n must County
K
include, but not limited to: vertical and horizontal ydfgrence point (B .fl and 5r C,PDi
percent slope, scale or dimensions, north arrow and location and dis nce td st road.
Parcel I. D. #
0 30 -i0 L. F-30
APPLICANT INFORMATION -Plea "rift all irifQrmatlon Reviewed by Date
Personal information you provide may be used fors ary p" es (Privacy Law, s. 15.04 (1)
Property Owner P(o rty Location Q
G/iV,P/t
L Ey 4'' fp Lot /v) 1/4 VS 1/4,S T 21 N,R 19 E (or )(0
Property Owner's Mailing Address of # Block# Subd. Name or CSM# ` 15,
/ 3 $ 6 PitiE- UILtw Tie IT RO Ur 13kOOC tf
City State Zip Code Phone Number Nearest Road
J ) S~//~'s%%f! ❑ city ❑ Village Town
bvGTo.J ZZ/ Sf<o~Z (71
eNew Construction Use: El-Residential / Number of bedrooms T Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow &00 gpd Recommended design loading rate bed, gpd/fib ' ~ trench, gpd/ft2
Absorption area required ~DO bed, ft2 DO trench, ft2 Maximum design loading rate-' 7 bed, gpd/ft2--j trench, gpd/ft2
Recommended infiltration surface elevation(s) 5 M • 3 /a yd` ft (as referred to site plan benchmark)
~FM
Additional design/site considerations $i T~ TESTED ' ,P~Qu/~PFS `10 /J~~ ?y~~ 5,Y5" 7
Parent material 5c5 54•0~ !t$ AKEle j ,1 t7T Flood plain elevation, if applicable
5%`T oU
Fu= = Suitable for system Conventional Mouunnd In-Ground Pressure AT-Grade System in Fill Holding Tank
Unsuitable for system ❑ S E flu Ei 5❑ U ❑ S L~f U ❑ S i /U ❑ S U~-G ❑ 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
0- S/ io y/e 3/~ S/ 2w 5,6e / lz1f,"e es f s .
2. - 42- /o y~P yl3 si/ .2f s6/e --FA- s F
Ground 3 2 to ylo 13 -S~ 1 f 5;6.(e M4 ~ie $ f
elev. 5// 140
f/e W 1 f ' ' 3
Depth to 75yK// fz -3-
limiting .S Yle S1ee. 7ily f/
factor 149 be S
yys Remarks:
Boring # /0 i2
z 2- -13 6 ,e y3 s/ 2f5AX' /w fie s 2 .s '
z
-3 10 ,Q 3 S~/ Z~ 6.~ fie cS 2 f , S ,
Ground
elev. 0 _ 7575 re 2 sl O /w N
.145 10
y~ft. S Y2 Sl ~
Depth to
limiting
factor
3ig-Jin. Remarks:
..2 Telephone No.
CST Name (Please Print) Signature
Ro (3ERr- ?dQP/GG' %5 =3 -
Address Ulbricht & Associates Date CST Number
y SOIL DESCRIPTION REPORT tip
PROPERTY OWNER L ` GUCk~` Page 2 of
PARCEL I.D.# L07- .41 - TPoyT B Pec f 1 I(S r
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots G~DM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
`3 -7 /o 4 ka_ s, 2,M 4W 4MIlf/e cs 3
/o Yoe X13 - s// f s/f e /M 6e eS Jvf , y
s/~• ~~jt !/i~ /N'I~~~ C'(.C~ S
Ground 3 ) 30 /0 W3
elev.z -ft• ~,v~ ,Q 3/ G 2 aQ J`,~ G O
5yR S
Depth to Vie _V/
Q i
limiting - 7. S lie 11f l / / N N
factor
30 in.
Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
- - - Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
A/o . Lo 7-
6 OA S
Ba ~y' yy
33
SuG6~57 D )-10 UAL) S YS r4'".-l 6'146U,
w~ S~~p F,•l~ ioo. yam.'
SCkGE % ~ 3 a
a o/~ ~~~~e ~rTS BZ iL' \ 8~t 2 . Top o F
Fo vv,o
~j
1,Z - WA 311
C7 -
w
1
0
y a
W ~
e $i 5u66E5'TED e0-J70u~
134 ,-~a o~ -tG,,,a •whll ~~a • ~
w ~J
s
' I.
iJ,~QCE ~ ~
's 7
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,,1
ADDRESS
SUBDIVISION / CSM# LOT
SECTION_ _T-29 N-R f C W, Town of ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
ERYTHING WITHIN 100 FEET OF SYSTEM
f~9u~'~ ~.~r~ce ~
r
9)-A ,
161
6a'
INDICATE NORTH ARROW
6 .RAJ - - -
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
BENCHMARK' 79 ;2 - gCJ /
ALTERNATE BM:
~
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:
_j~ La/-,' Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer ,4
s Model Size ' 11
Float seperation Gallons/cycle: Jy/
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: Length :5J Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well:- House Other
ELEVATIONS
Building Sewer &,-,q~ ST Inlet._ 7,5.7? ST outlet
PC inlet PC bottom Pump Off
Header/Manifold 9 y K 7 Bottom of system
2/ 7 s'
Existing Grade Final grade
DATE OF INSTALLATION:, "A
PLUMBER ON JOB:
LICENSE NUMBER: ,25-9
INSPECTOR: zvAy
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ';T C'ROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
262387
Permit Holder's Name: ❑ City ❑ Village 55 Town of: State Plan ID No.:
F MT(-RAFT, I ST JOSEPH
CS ev.:
Insp. BM Elev.: BM Description: Parcel Tax No.:
Ql - A9600199
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic v'' f Benchmark
/sJb. 'x,06' ~
Dosing:!t~" ~O zrp
y8-SS ,39 6. /G r
Aeration Bldg. Sewer ` , a-ra_. a • 76, qJr
Holding St/Ht Inlet /a 83 175• A
TANK SETBACK INFORMATION St / Ht Outlet , n,S y y '
Vent
TANK TO P/ L WELL BLDG. Air Ito ROAD Dt Inlet ~
Air ntake 7
Septic s 5/ 3 NA Dt Bottom 704611
Dosing Jr- ~g NA Header/Man. O3 wt- 7
Aeration NA Dist. Pipe
C~ q2, S7
Holding Bot. System , 73,
v
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
~r GPM
Model Number z') E n 5-//
TDH Li ft L, I y System TDHp%,,.~ Ft
Forcemain Length S/ Dia. ?a Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width Length No. Of Tr riches PIT No. Of Pits Inside Liquid Depth
DIMENSIONS `f DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Model Number:
System:y c Q y DO 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 oo a xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center ' a Bed /Trench Edges ap' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
T;'-CA`. 101 : ST JO.S737 .7 . ? 9.1 q' 7, E, LO`!' 21, GOLDEN OAKS LAT
7. 6 9 9-
tAp
~//,Zo~
Plan revision required? ❑ Yes Y No
Use other side for additional information. >b tt„ /(o
SBD-6710 (R 05/91) Date I spe or's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings
r SANITARY PERMIT APPLICATION Bureau of Building water Sy
201 E. Washington Ave.
I In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison,*[ 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. S
• 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 ❑ Check if Oaw/"Z(t 1 rebrpGs plicil
(Privacy Law, s. 15.04 (1) (m)]- State Plan I.D. Number
APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Propert w n e r Na a Property Location
S 1/4 1/4, S T , N, R (or
P~~ ner's Ma g ss I of Number Block Numb
City, St a Zip Code Phone Number Subdivision Na a or CSM mber
II. TYPE W BUILDING: (check one) ❑ State Owned ❑ itN❑ Village
Public 1 or 2 Family Dwellin - No. of bedrooms Town o
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 ❑ 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. Eg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Exlsting System ExfstingSystem
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 CA 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 ./'nch) Elevation
Feet 97,-l Feet
VII. TANK Capaaty site
in gallons Total # of Manufacturer's Name Prefab . Con- Steel Fiber- Plastic Exper.
INFORMATION Gallons Tanks Concrete glass App.
New Existin strutted
Tanks Tanks
El El E] 1:1
Septic Tank or Holding Tank .f s
Lift Pump Tank /Siphon Chamber vil ® ❑ E ~ ❑
VIII. RESPONSIBILITY STATE-MENT
I, the undersigned, assume responsibility for i stallation of he onsite sewage system shown on the attached plans.
Plum er' Nam Pri Plumb is gn r am s) MP/MPRSW No.: Business Phone Number:
Plumber's Address t~~t,'Ci y,State, i ode):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanit~ Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
XApproved Surcharge Fee)
❑ Owner Given Initial U
' kko I
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
r t
Ji INSTRUCTIONS
o
S
,anitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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 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 WisconsirLAct 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.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Lrabor and Human Relations
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. ISO
,
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County odo- o-
I
include, but not limited to: vertical and horizontal reference point (BM), direction and S l~ 79 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 Property Location
1 Govt. Lot 1/4 1/4,S T N,R (ord)
Property Owner's ailin Addres Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number Nearest Road
❑ City Vi age Town
S
ZZ
New Construction Use: Residential/ Number of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow 41,M gpd Recommended design loading rate bed, gpd/ft~_trench, gpd/ft2
Absorption area required h260 bed, ft2'/0O0 trench, ft2 Maximum design loading rate gybed, gpd/ft2_,~/ _trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material .4h' L -sFlood plain elevation, if applicable Alk ft
r=u-= Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
Unsuitable for system ® S [D U ~ S El u 0 S El u U EXI S ❑ U ❑ S 0 U ❑ S ® U
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
'
Ground 77 -7 S
W2 Z elev. /
jK-~-ft-
Depth to
limiting
factor
Remarks:
Boring #
z2 S
Ground 7 1-24)
elev.
ft -y J1 r
Depth to
limiting
factor
min. Remarks:
CST Name (Please ri Signature Telephone No.
, I ZZ
f
~ UZ2
Address / Date CST Number
- yr'
SOIL DESCRIPTION REPORT
WNER Page ~ of
EL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
17
/ r S
Ground
Old
elev.
Depth to
limiting
fact r
in.
Remarks:
Boring #
s _
Ground
elev. S:~ Z62
Depth to
limiting
fac or
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Rundary
Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground '
gLo 3
elev. Depth to
limiting
factor
fi'n' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
P
GJ.~h y,
Ae- -4'L
I
•1
~ ~ ~ ~ ~ t
f '
'i i
a r i ' ~ ~ ~
I
~ f1 ~
~ r f 1
_ ' ~ i ~
_ ~ ~ ~ ~ ~
~ ~ r ~
I i
i
~ ~ ~
r ~
. ,
. ;
Ti r1ttL1 r
~ t
l
1
„
.
,
,
I '
I
I
_ FF
-j -4 - r. _ - - - - -
- r IF
fit
_ _ , - > - - - 1-- - - }
I
I
I
' I I I I
i i
rl
I I I 1 - i T r I~ r---~- f
I i
l
, t
a~
b
b
.d
•d
w
4J
U
rd
A
b
A ~
O W
u r.
9 O
4) -A
w 41
w
44 N
A W
d'
O
•.i
q
b
N
r a
a,
N ~ t
a
w
O
a
O ~a
.,.r
4
U
W
N
N
N nC.f~
a,
N
U
b, cn a
a
. -r
PAGE OF
PUMP CHAMBER CROSS SECTIOQ AND SPECIFICATIONS
VEWT GNP
ti> VENT PIPE fr-T WEATHER PROOF APPROVED LOCKIKIG
T JUNCTIOIJ BOX MANHOLE COVER
~ 25' FR¢M DOOR,
WINDOW OR FRESH 12"MIU.
AIR INTAKE
GRADE
I `1" M(1J.
. I
CONDUIT
18'/'IIN. \
INLET PROVIDE I
AIRTIGHT SEAL I I i I
I I I
7
APPROVED JOINT A I I) ( APPROVED J01WTS
W/=. PIPE III W/OX. PIPE
EXTENDIN¢ 3' I II ALARM EXTENOING 3'
0gT0 S000 SOIL B I i I ONTO SOLID SOIL
~ I GN
C I.
• PUMP
• OFF
D ~
CONCRETE BLOCK
i
RISER EXIT PERMITTED OIJLy IF •TA1JK MAWLIiACTURCR HAS SUCH APPROVAL
SPECIFI•CATIOUS
i PYIC AND J ^ ,
U•SF TANK$ MANUFACTURER: QUMBER OF DOSES:' "zz-PER. D"
TANK SIZE::' GALLOIJS DOSE VOLUME: GALLOI,,JS
ALARM MANUFACTURER: CAPACITIES. A= IWCHES OR GALL0Q5
MODEL WUMBER: B= INCHES OR GALLOWS
SWITCH TYPE: - C=INCHES OR 17Z- GALL OU5
PUMP MANUFACTURER: ] Du INCHES OR _ GALLOIJ5
MODEL MUMBER'. NOTE. PUMP AND ALARM ARE TO BE
IUSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE. RATE GPMr&2 co?,o /
VERTICAL,DIIYEREMCE bETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET
♦ MIAIIMUM NETWORK SUPPLY PRESSURE ' FEET
+ FEET OF FORCE MAIN X ..L. =F Ioo FxFRICTIOQ FACYOR..~ FEET
TOTAL O'J JAMIG HEAD = FEET
IUTERNAL DIME SIOQS OF T K: LEAJCsTH ;WIDTH LIQUID DEPTH
31GQED: LICENSE WUMBER' OATE: L
A'fli'es Submersible Effluent
Performance
Curves Pumps
METERS, FEET
90
MODEL 3885
25 SIZE 3/4" Solids
WE1SH
70
20 WE10H
60
-WE07H
15 50
W E05H
40
10 30 WE03M
WE03L
20
5
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
0 10 20 30( m3/h
CAPACITY
~GOULDS PUMPS, INC.
Se*CA Pnus rEW YCPK ,),.I
METERS FEET
120 MODEL 3885
35 SIZE 3/4" Solids
110 WE15MH
100
30
90
25 80
70
20
60
O
F
WENHH
50
15
. 40
10 30
20
S
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
1 .1 i
0 10 20 30 m'/A
CAPACITY
• 1985 Goulds Pumps, Inc. EMtcove July, 1985
C38Ac
I
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
O WNFR/BUYER
MAILING ADDRESS
PROPERTY ADDRESS
(lo ation of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4,_ 1/4, Scctiun' T _N-R_,~2_W
TOWN OF 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 expiration date.
SIGNED: /~Ly~'`✓ Pd~~
DATE:
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.
L
owner of property 6A(
Location of property
WX- 1/4, Section Z,N-R_W
Township , Mailing address
Address of site - '
!a
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel (/S0
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume 41 and Page Number jf- 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 decd 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. :2S 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 Appl ant Co-Applicant:
- & , ~/(o - 6--l L
mitc of Signature Date of Signature
"7- -'T -
tk AV
JF IL
o a
vip y
CoMPANY
-
~ a
PO'SwEs
s
1
T..D Rf_ PUBLll_,.
_,y a.. ai Ti~M '.~ua~e.w-s canpsnti
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
v
.a•k4 r ~s r . "v. O
O O •AA ~ -
D w ~ s ~ o
\\o Ul
553.8p / \C/
Cfl \~c W C4
_ w -
~ 3 78.73
r Z
- 8
w z
O
00
O
OD w
G) w
/a x9862,
r
\S / S 00 N
~ \ = N - O
00
O \D < 'IJ r0 a0
OD \ i r0 --I
D ~G, N N
O ~
00
tiF o
Cp Ito`
/ 562.97'
O
OD N
M i -n
• r
DOCUMENT NO.
STATE BAR C- WISCONSIN i:OPM ' - > 2
S'22U~ WARRANTY DEED
11 143
This Deed, made between - - -
APR 15 1996
11:30 A. t"
and. 3n1 sna e, aS s.,rr:r') r_!
Witnesseth, That the said Grantor, for a valuable considerat,on -
4e UPN
conveys to Grantee the following de -ribed real estate in r • _ -i - J ~I
County, State of Wisconsin:
Tax Parcel No: s ' -
A parcel of land known as Parcel #21 located in the Northwest
Quarter of the Northeast Quarter of Section 7, Township 29 North,
Range 19 West, Town of St. Joseph, described as follows:
Commencing at the Northeast corner of saia Section 7; thence
South 3 degrees 39 minutes 50 seconds West (true bearing) 330.46
feet; th,3nce South 88 degrees 55 minutes 30 seconds West 1535.49
feet to the POINT OF BEGINNING; thence South 0 degrees 46 minutes
West 562.97 feet; tint-Ace Southwesterly along the Northerly right-
of-way line of a proposed town road 212.38 feet on a 211.83 foot
radius curve concave Southeasterly whose chord bears South 60
degrees 35 minutes 20 seconds West 203.60 feet; thence North 27
degrees 51 minutes West 738.50 feet; thence North 88 degrees 55
minutes 30 seconds East 529.98 feet to the POINT OF BEGINNING,
St. Croix County, Wisconsin.
~ TRANSFER
This is not homestead Property.
(is) (is not)
Together with all and singular the heredltaments and appurtenances thereunto belonging;
And tine said r2nt,,)r
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
-asements ar.,, iestrictive Cove.zn:.tS
and will warrant and defend the same.
day of . 19_
Dated this
1
(SEAL) (SEAL)
~
i a
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGEMENT
Signature(s) _ STATE OF yv;SCONSIN
ss.
A County.
Personally came before me this day of
19 d L r:1 .19 L_ the above named
authenticated this day of
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person who executed the
authorized by 4 706.06, Wis. Slats.) foregoing nstr ment and acknowledge the same.
L
1. .
t
r
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
p p p p p 11 p p ST. CROIX COUNTY GOVERNMENT CENTER
*Nun 1101 Carmichael Road
Hudson, WI 54016-7710
- - (715) 386-4680
September 18, 1997
11
To Whom It May Concern:
On September 25, 1996, a sanitary septic system was installed for
the Michael Meyers property located at 1098 Golden Oaks Lane. The
legal description for this property is Lot 21, Trout Brook Hills,
part of the NWY4-NE1/, Section 7, T29N-R19W, Town of St. Joseph, St.
Croix County, Wisconsin.
The sanitary system was code compliant for a four bedroom home, and
was inspected at the time of installation by this office.
Sincerely,
aj-
Mary OVhkin~s
Assistant Zoning Administrator
POWTS Inspec. Lic. No.4626