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C ~ y O N O N $ 0) o C'4 N co "pi 0 ~ .4 N E ir}~~11 o N E • O N co 2 N 0 Z C H O c da CL r`IV E- 0 t A ca2 l0 Uiv 7 , jo a f t. ww~': yw~Iw : ~r~~~wlllrrrMwM~r~11~IMAr IN i1111M~ial4li Iw~~w~wwrrr Ulm, r ~ ~fl~ DF,~ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS BOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS ( l~~ Irk- DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ll l ❑CONVENTIONAL ❑ALTERNATIVE 0 / State Plan I.D. Number ( El Holding Tank In-Ground Pressure El Mound L C, ADDRESS OF PERMIT HOLDER: IS, I„~ INSPECTION DATE: NAME OF PERMIT HOLDER, y1 e `0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: F. PT. ELEV. R-ao L, CST RE Name of Pluarber: MP/MPRSW No. County Sanitary Permit Number: 07 7/ A SEPTIC T HOLDING TANK: G LABEL LOC G R MANUFACTU R-. LIQUID CAPACITY. ]TANK INLET ELEV.: TANK OUTLET ELEV.. WV PlIll ED. JPRO ES ❑N O ❑NO 1 I- ING: A ENT IN NT TO FRES PROPERTY WELL BUILU LET BEDDING: VENT DIA.: JVJHIGH WATER NUBER ROAD: ALARM. L H INE: A A : ❑YES ❑NO ❑YES ❑NO FEET FROas f 100 SO A; ~ 7t DOSING CHAMBE R: NUFAC CHAMBER: DD LIOUIO CAPACITY PUMP MODEL PUMP/SIPHON MANUS.QC U ER J W y NG LABEL LOCI41NG COVER PTUF.E R 0 pO~ 11 P DED: P V ED: YES ❑NO Gr CSI[// ES ❑NO YES ❑NO GALLONS PER CYCL PUMP A NO CONTROLS OPERATIONAL. JNUMBER OF PROPERTY / WELL BUI G VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE r ~p f 7 A;Y f PUMP ON AND OFF) ❑YES ❑NO NEAREST n H DIAMETER MATERIAL AND M KING; SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE 1 9 or excavation. (If soil can be rolled into a wire, construction shall cease until AIN the soil is dry enough to continue.) M 11~ is /~C.G CONVENTIONAL_ SYSTEM: NIDTH LENGT NO. IDISTR. PIPE SPACING COV ER INSIDE CIA PITS LIQUID EB D/TRENCH THE MATERIAL: pIT DEPTH: DIMENSIONS F ILL DEPTH E11ST IPF )ISTR PIPE DISTR. PIPE. MATERIAL. NO. DISTR. NUMBER OF PROPERTY W L' DILDING'. VENT TO FRESH BELOW PIPES ABOVE COVER EI E I LE ELEV END PIPES ,LINE'. AIR INLET: J FEET FROM NEAREST -0. MOUND SYSTEM: Mound site plowed perpendicular to sl ec th exture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: o s stems to make certain that it ON REVERSE SIDE. SHOW ELEVA- r m is the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS / I / / ❑YES ❑NO ❑YES ❑NO DEPTH OVER THENCH RED DEPTH OVER TRENCH. BE DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES ❑ ❑ ❑YES ❑NO ❑YES ❑NO YES NO PRESSURIZED DISTRIBUTION SYSTEM: NIDTH i LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTN BELOW PIPF FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES O DIMENSIONS (p (,o M 4 PUMP MANIFOLD DISTR. PIPE MANIFOLD AT RIAL NO. DISTR L'ISTR PI E DISTRIBUTION PIPE MATERIAL & MARKING ELE E.L C~ DIA. ELE4 DIA. ELEVATION AND', S~ 7 S ~V PIPES I ` I Z„ 9 DISTRIBUTION INFORMATION IHOLESI OLE SPACING DRIL EDC ECTLV COVER ATE.RIAL PLANSCAL LIFT ORRESPONDS TO APPROVED - _J ~V S ❑NO YES ❑NO COMMENTS: PERMANENT MARKER. OBSERVATION WELLS. NUMBER OF P P TV WELL: BUILDING'. / FEET FROM LINE t0 YES ❑NO YES ❑NO --:IN _;O/ ~(907~ 7l 9 q. S. 3 .19 v a6 Sketch System on Reta' in county file for audit. Reverse Side. RE TITLE D 6710 (R. 01 /82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INWUSTRY; FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Prop ty O wner: Mailing Address: 01 Property Lo ation: City, Village or ownship:" County: t/a t/aS /T NCR. (or) W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned _ , j TYPE OF BUILDING t~f Number of ublic* E3 Variance* ED Other (specify)* OP, P'& - ;1f Bedrooms: ror 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY OCR J6.__ HOLDING TANK CAPACITY gdmiii LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: 4S al . 0- 2:41 (21. EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experiment 1 ❑ Seepage Bed ❑ Seepage Pit 15- ,K Alternative (specify) p-r: j ycljr~} Wig, tom. ❑ Seepage Trench s Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam Plumber. Signatur M MPRSW o.: Phone Number: ro 4 Plumb4r's Ad ess: Name of igner: c~ ro oil COUNTY/DEPARTMENT USE ONLY Si nature of Iss ing Agent- F e: Date: APPROVED Sanitary Permit Number: ❑ DISAPPROVED r I Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DI LHR-SBD-6398 (N.03/81) Jr. o 00 , , / G ♦1 "Ord 17 6/17/80 WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of ti.'I (Pro•oi ~k Location 1/4 _-C, 1/4 S 4,Q T 3o N, R •-;Io (or) W Town or Municipality Street Address aC, I?, 1~'Sf%>hl Lot No. Block Subdivision Landowner's Name : oi c. '";6 k;' S 1 d• l, f r I) n n The application for this site is to serve a: new construction use. LN replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ part of the 3%/5% limitation. This is number T _ of the applications made through this office. one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑ an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑ a lot that meets the site criteria for a conventional pr~uate sewage system. in-ground-pressure If this a REPLACEMENT SYSTEM USE, the Tpe cis replacing: ) a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior-to February 1,'1980. a privy that was installed and in use prior to February 1, 1980. I certify that the above information is true and accurate to the best of my knowledge. Name S iq"t1?'6 Title /a,. Date DILHR-SBD- 6158 (A.7/80) r4 P1'bw # 60 1/78 PROJECT DETAIL DATA SHEET OsfphF ~i. Sr'~`4Q JZ 12, NAME OF BUSINESS YS L'/1 `fig ~►-f ~-r LEGAL DESCRIPTION 1~1 r ~x 30~0_R Zc2 .,___.~~_,osca_JZ-Fw'ns h • ~a~ OWNER MAILING ADDRESS rl'7 62 Z I P 15'6- -F e ARCHITECT, ENGINEER, ~n14ry 1,.,, .S- rst_ ADDRESS 90,git~, ~ j,cvr e, OIr PLUMBER OR DESIGNER c' ,e. rn d Z I P OF,? TELEPHONE NUMBER 9/,6'- Z 4(o -(ozdo 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( } Assembly hall . . . . . . . Seating capacity ( ) Bar . . . . .Seating capacity # of meals served ( ) Bowling alley . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps . • . . • . • ( ) Day use only Number of persons ( ) Day and night Number of persons Catchbasin . . . . . . . . Number ( ) Church . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall . . . . Number of persons ( ) Dining hall . . . . . Number of meals served daily ( ) Dog kennels . . . . . . . . . . Number of enclosures ( ) Drive-in restaurant . . . . . Inside seating capacity Car-service Number of car spaces, ( ) Dump station . . . . . . . . Number of dump stations Employees ( total of all shifts) . . Number of employees 8 ( ) Hotel ( ) Motel ( ) Cottages . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number,of patients ( ) Mobile home parks . . . . . . . Number of sites ( ) Nursing homes . . . . . . . . Number of beds ( ) Parks . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers ( ) Restaurant . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service A ( ) Retail store . . . . . Total number of customers _ ( ) Schools . . . • . . . . Number of classrooms Meals ( )Showers ( ) Self service laundry . . . Total number of machines ( ) Service station . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . Number of persons ( OTHER . . . (Specify) . . . . . pC~ - ~aC~C~S~ ffS COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. Floor drain yes _ X no Number of drains Food waste grinder yes no _V, Dishwasher yes no Automatic clothes washer yes no __2S_ Number of clothes washers 3. Septic tank capacity ~217&O • Heldirrg--+"k capacity q0 5R,zo Septic or holding tank manufacturer - , /};1, C° S'ti o Pu,m A e,, am 4. SEEPAGE TRENCHES: total squa feet width of trenches length o trenches depth i number of trenches SEEPAGE BEDS: total square feet 2 G~ r7.5" width length of beds depth SEEPAGE PITS: total q re feet outside diameter depth low inlet tota depth from top to bottom of pit Signature of person completing form: FOR DEPARTMENTAL USE ONLY Address L9 1),C, / 6-r~- ,y . o ~C,Z 1~(~ i m c zip silo/q,- Telephone Number 215 , z V.6 -6 ZOO Date -Z- State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number L J r Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a- Wastes from the building will discharge to a 'rw;;' ` g gallon capacity septic tank which will discharge to a 'gallon capacity s " pump chamber from which a pump having a capacity of j. gallons per minute against a total dynamic head of feet will discharge through a inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS By: County Other, - Enclosures Cie%iYy1~/ E%1i/C mes Sargent, B erector DI LHR-SBD-6159 (R. 7/81) FINAL WAIVER OF LIEN To All Whom It May Concern: WHEREAS, the undersigned has been employed by (A) NCIR-THtL,Z';T to furnish labor and materials for (B)1' work, under a contract (C) for the improvement of the premises described as (D) S l; T///-'a 71-/' in the ii'; c .t. ;,yi/_) (City-Village) of `l Ff County of -5-T r g State of 5C e_'/ V ~'iAi of which ji 7 -/z is the owner. NOW, THEREFORE, this; day of D Fr for and in consideration of the sum of (E)J .3 T A5_-X Dollars paid simultaneously herewith, the receipt whereof is hereby acknowledged by the undersigned, the under- signed does hereby waive and release any lien rights to, or claim of lien with respect to and on said above described premises, and the improvements thereon, and on the monies or other considerations due or to become due from the owner, on account of labor, services, material, fixtures, apparatus or machinery heretofore or which may hereafter be furnished by the undersigned to or for the above-described premises by virtue of said contract. (F) 4'/2--_al4 ,1 r_J.y1- (SEAL) (Name of sole ownership, corporation or partnership) (Affix corporate I seal hereGrl't~" - (SEAL) (Signature) TITLE: INSTRUCTIONS FOR FINAL WAIVER IA) Person or firm with whom you agreed to furnish either labor, or services, or materials, or both. Ia) Fill in nature and extent of work; strike the word labor or the word materials if not in your contract. ICI If you have more than one contract on the same premises, describe the contract by number if available, date and extent of work. IDI Furnish an accurate enough description of the improvement and location of the premises so that it can be distinguished from any other property. IE! Amount shown should be the amount actually received and equal to total amount of contract as adjusted. IFI If waiver is for a corporation, corporate name should be used, corporate seal affixed and title of officer signing waiver should be set forth; if waiver is for a partnership, the partnership name should be used, partner should sign and designate himself as partner. . Designed By The Construction Industry Affairs Committee (CIAC) TOPS 3458 RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ..vU,USTRI"; C DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: NHZIP MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: - - 4 22 /Bo N/R20 (or) W If W 4j, COU T OWNER'S BUYER'S NAME: MAILINGADDRESS: r,it~f ctSF~h, 1.c9"s. 3 ©8Z} . 0"/,f/f 641/1-&P. OP. ✓a -Sa>i ~g v-? USE DATES OBSERVATIONS MADE 5 S' i4ec, NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: I ❑Residence 1N I ✓~,~n ~L/ ~p~E~ ❑ New Replace RATING: S= Site suitable for system U= Site unsuitable for system r2gS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(op ional) ❑U 1ZS ❑U INS ❑U ❑ S Lr, Vex U ❑ S ,U .r - uA, If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 33 (3X,8 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ! 1 1 / r T /1 0.1 Maki1l, - l " L -CA ,4-64-4d 'ig V 0.3 -j T " It I/ B- Z, 1011 98 In n f- > I D 9 1z"a♦5, 1. a 3"Ca .l515 vrV/ (All B- 104 70 1#7 h n e > 104 8"/4hL. 1" 51k, 36 , fo616-1 6 B- 4 98 no n > n. S Reed, RS „ 16 S 181 /7 B- S' f OD B V1 U 00 7 36130• l r 5 3 - B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 1 _3 W A)Q .3 l -3111-" 3 N P- Z• ° 0 3 Z Z 2 P- 0 3j 6 J' -3 1 Sa /0 P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their) cation on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ~0 EJ.' - - . . 1 f`~ r rd. s BPI- IN A~A -1 µ6 { 1P t i 51 E 4 PP+ E n~mlu, E r INSTRUCTIONS FOR COMPLETING FORM 115 - aSBD " 6 395 To be. a corny ete and accurate soil test, your report must include: 1. Cornpl I description; 2. Th u dust clew ' ind'= whethe is is a residence or commercial project; 3. MAXI iher of or comma t use planned; 4. r +z --lac i; 5, boxes. A SIT ~b SUITABLE FOR A HOLDING TAN _Y IF ALL. . _D OUT BAST ON SOIL CONDITIONS; 0, PL own her ing profile descriptions a id it plot plan; 7. LL ~XUrately lo, your test locations. D-- ,r-~f, A . -ired; 8, sr yoc . 1_~ nd vertical `erence point ar 9. Cc all I)i xes as to ~ s, addresses, flood plain ~ rT, tie ,pro, 10- ..d -Iai- does riot, r'u VA,'- e box; 11 ant =rd your cer number; 12. ,p ALL SOIL =STS MUST BE [TH THE Lt 1': ~iORITY WITHIN 30 DA; -PLETION. _,.,.EV'. s --j FOR CERTIFIED SOIL. TESTERS T, nb )ls _l BR `s col) - C 1011i S5 gr Gi ,I (ur cler :3") L5 L C - v L t rr is t, s l - b : iTi I ' 9I l Fan sli I rte BI - E Gy -f _ Y Loarn R - mot fff t I CC , vrim nl - d . # HV - N w. .,xtrares E- - V rence Point r ;A1 I:.TY & BUILDON I,L PAk IIVII'N 1 0 1 REPORT ON SOIL BORINGS AND D INI)UtiI liY, IVISSION i /\{t(1{t AND N.O. BOX 1969 PERCOLATION TESTS (115) MADISON, WI 53707 fIIMAN RELATIONS (H63.09(T) & Chapter 145.045) 77- OCATION 4F(JlON I( WN IUP MUNICII'ALII-YT N0 BlK NO UBDIVI ION NAME PJ W 22, /13ON/R 1, ,T W JU I OWNER ,/FIUYEH.,NAMf M/Cll_IN(,LADDRESS ,JY "11 , r 1 71 r r { /1 fti' a r r i _ ~ • ~..1 tlt.i DA fES OBSE RVATIONS MADE ' Nt:).itkUllMi. CONMIIWIAI Itl',(:H)PHON PROIIII [11 (;Iill'IION`, ISf'IC01Alf(")N 1f^"51. 1 ~liesu)u nrt: I lNevv Hrplace 1 { I 1. r I vi Ali BATING S- Site suitable for s"toro U- `iUu unsui Gihle fur sysUern ~)1JVI N I IUNAI MUUNI) 1N liliUlllJl)Nlit I1RE Y 7 LM IN F I4 1 1IOLOfNG TANK HILC OMMENl11 L) SYS1 EM'(oj. a 1) j_ AS u s c u..1 [IS u o s u_1. tl I citolauun Iests are NOI ieywiecl DESIGN}iA rF: If any portion of the tested urea is in the (under s Hb,3 Uyf~11b) indicate -l--~_--- I Floodplaut, indicate Floodplain elevation: PROFILE DESCRIPTIONS ho ffING Tt)1AL_ ) Ir if 0 GftOUNDWArEH INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TF.xTUHE, AND DEPTH Nt1MdlFi Drl'lHIN. ELEVAIIUN - Ol3SEHVLD-__ EST. -11GHE 1013EDIIOCK IF OBSERVED (SEE ABBI-iV.ON BACK.) - _ - - -_-T.-_. C~,-R . "4 r7r7 C 0 IC -q r .V -51 gj, L v ea l ~ / co 1/9 7876 no tie- 9 C7 Of.,0-6 Ile QUI 17 Ltd ,!i l1. , 1 ' E J _t r11 3 i -4? -1 :0 PERCOLATION TESTS T-E T DEPTII WA1 ER IN HOLF. TEST TIME DROP IN WATER I EVEL-INCHES RATE M,NUTES _ - NCH rvl)MBEIi P PE R INl Hf:-S AFTER sWEI LING_ IWIERVA1._MIN_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sa(tie or distances. Describe what are tale hair zontal and vertical elevation relerenCt: points and show their IocatlOn on the plot plan. Show the surface elevation at all burings and the duectiun and percent of land slope. ri SYSTEM ELEVATION E _ 100' W,-+f s I g -3 21, 1 o f (3-2, 31' ' 3 sa`' too t~ P- I- q q P-2 I------> fi' 29' 38 n-4 t3-I V? 1 98 -110 ~b r>.3 98 TN f19, (2004 ~jC.,2 ~tGU 3t g~5 yv Gtj r (0 _ jo S 1'F.R Kars MOUND SYSTEM If. IN-GROUND PRESSURE SYSTEM-Continued. 1. Wastewater Load, Total Daily Flow = 10. Force Main: Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = gpm• Adm. Code and PROVIDE A DETAILED Diameter = y in. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. epth to Limiting Factor = ft. System Head = 2.5 ft. 3. L dslope = % Vertical Lift = "R ft. 4. Dis nce from Dose Chamber to Friction Loss = ft. D ribution System = ft. TDH = ft. 5. Elevati Difference Between 12. Pump Selection: Pump nd Distribution System = ft. Pump will discharge at least 152. cP, pm 6. Absorption rea Sizing: at . S7„ J ft. total dynamic head. ,o Area Req `red = sq. ft. Pump modelandi anytfac ~rer. C W Bed or Tren h Length (B) = ft. ft_~~ Bed or Trenc Width (A) = ft. 13. Dose Volume: Trench Spacing C) _ ft. 10 Times Void Volume of 7. Mound Height: F111 Depth (D) Distribution Lines = gal, ( ) = ft. Daily Wastewater Volume + z Fill Depth Downslop (E ft. 4 Doses in 24 hrs. 0 = gal, Bed or Trench Depth ( = ft. Backflow = gal. Cap and Topsoil Dept ( = ft. Minimum Dose = gal, Cap and Topsoil De h (H = ft. 14. Dose Chamber: 8. Mound Length: Volume = 'y L2 gal. End Slope (K) = ft. Total Mound L ngth (L) = ft. Ill. ONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: Wastewater Load, Total Daily Flow = gal. Upslope Co ection Factor = Use section H 63.15 (3) (c), Wis. 'Upslope dth (l) = ft. Adm. Code and PROVIDE DETAILED Downsi a Correction Factor = LIST OF SIZING ON PLANS. Down pe Width (1) = ft. 2. R wired Septic Tank Capacity = gf I. Tota ound Width (W) = ft. 3. Per lation Rate = Inin./in. 10. Basal ea: 4. Abso tion Area Sizing: / iltrative Capacity of Re r to Table 2 in chapter H 63 atural Soil gal./sq.ft./day and o VIDE A DETAILED LIST Of Basal Area Required = sq, ft. SIZIN ON PLANS. Basal Area Available = ft. Require Area = sq. ft. 11. If Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. Width = t. For the Distribution Network, Use Numbers 5.14 in Section I Number of enches = Trench Spacl = ft. If. IN-GROUND PRESSURE SYSTEM S. Distribution Syste 1. Depth to Limiting Factor = ONE ft. Lateral length = ft. 2. Landslope = Q ` Z_ % Number of Latera = 3. Percolatiorr Rate min./in. Lateral Spacing = In, 4. Proposed System Elevation = ft. Distance from Sidewa to Pi 5. Wastewater Load, Total Daily Flow: o ` in. oo gal. System Elevation = {t, Use section H 63.15 (3) (c), Wis. 750 mire Adm. Code and PROVIDE A DETAILED 3o -e, Ai w IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. £ n,tot ytE w Fill in All Items from Section Required Septic Tank Capacity gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = s min./in. 1. Capacity = gal, Area Required = o? ~P ✓ sq. ft. 2. Manufacturer: System Length = ft. 3. Show Site Con7rted Tank Details o~yPlan System Width = ft. V• 7. Distribution Pipe Sizing: J/ VI. DOSING TANK Hole Sire in. 1. Capacity gal. Hale Spacing = :l ft. 2. Manufacturer. Lateral Length 9' It :I, Pump Md ulaclurer. Laler.tl Slic in. 4. Pump cl: I atrial Spdriog it. 5. Operating Head= ft. Disl,ntu• Irolll sidrw.dl•lo Pipe (t. Flaw,*Rate= gpm N. Distribution Pipe Di.clidige R,ttr: 7. Shgly Site Constructed Tank Details on Plans Nullifier of I toles Pri Pipt. 1low Pui 11I11V r gpnL VII. HOLPING'IAN K Manifold Siting: 1. Capacity = 1 Ypc (conies M end) `'r 2j` Mdnulaclurer. Length = ft. 15. Show Site Constructed Tank Details on Plans Diameter - In. -SHOW ALL INFORMATION ON PLANS- DILHR SBD-6761 (R.03/82) ' ~'/,;;~,yE"~ .~,r,•?k^F r~s u~" A'~+,a .'-fir ;~-r%_-:f..., d 1 ; e4 f t00 r+ r , i 7 I 00 - +-i - 100 I t L,j U1 f l .L 3 rt, T, U)/ +p p ro 0 LA e. or, f oc"? i l t "lL f.19 P- A " c x . i ti cv r rle r /9 Y r s/r r g )Ast,,,, one EAeh rJ, f f~2'7 ~hsPFtl~taV, 9 e- f) E. CZ> 9,7 UO PC R K£ r al rzoko 'I tAmt OF CROSS SECTIOKI OF A BED SySTE.M SOIL -FILL Z" OF AGGREGATE D151 K15UTIOU PIPE APPROVED SYNTHETIC COVER. MATERIAL OR 9" OF STRAW 2° OR MARSH HAy ° aor-%-P_14 AGGREGATE ELEV. OF'`FEET__., I DISTRIBUTIOU PIPE TO BE AT LEAST IUCHES BELOW ORIGIWAL GRADE ARID AT LEASTIO JUCHES BUT WO MORE THAW H2 INCHES BELOW FINAL GRADE MAXIMUtA DEPTH OF EXCAVATIOU FROM OKIGIWAL GRADE WILL BE Q1 ES e~CMINIMUM DEPTH OF EXCAVATIOU FROM ORIGIIJAL GRADE WILL BE 1t3£-tME'S 4 C7, SIGiJED: LICEU5E DUMBER: DATE Page _ Uf R Perforated Pipe Detail 0 ~i End View ~Perforoled End Cap) , PVC Pipe i . goo ce Boles Located On Bottom, S Are Equally Spaced S \ X~ Q mac'. PVC Force Main From Pump / PVC Manifold Pipe , Alternate Position Of Distribution Force Main From Pump Pipe Last Mole Should Be Next To End Cop End Co p Distribution Pips Layout P ,mot ,A ('Tr\ R S~ 11 R S r f X Signed: Hole Diameter S /a Inch Lateral l /Z. Inch(es) License Number: Manifold Inches Date: Force Main " Inches PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VENT CAP 4"C.T. VEfJT PIPE WEATHER PROOF APPROVED LOCKING JUMCTIOU BOX MAWHOLE COVER > Z5' FRCM DLGR, WIWDOW OR FRESH 12"MIU. AIR IIJTAKE GRADE I Y"MIN. 15. COWDUIT INLET PROVIDE I L AIRTIGHT SEAL I LI I P I III ~}~1~ v APPROVED JOW7 r A I III APPROVED JOINTS W/C.T. PIPE _ I III W/C.I. PIPE EXTENDIJJG 3' ( I) ALARM EXTENDIAIG 3' ONTO SOLID SOIL B I I I ONTO SOLID SOIL ON C I PUMP-,-- - J OFF D 'eq r COUCKETE BLOCK i~ I,~r n RISER EXIT PERMITTED GUL'd IF TAUK MAIJUFACTURER HAS SUCH APPRO~I SPEC IFICATIOUS SEPTIC AND j/ DOSE TANKS MAMUF'ACTURER: 61P ..x,.!'1 c° . IJUMBER OF DOSES:( 7 - PER DAS TANK :,IZE: -5"000 GALLOWS DOSE VOLUME gj ? 3 GALLOWS ALARM MAMUFACTURER: CAPACITIES: A=_ .l IIJGHES'`QR CsALLOAIS MODEL IJUMBER: 8= °2A3IMCRES Oft. GALLONS SWITCH TYPE' F ~"='L✓; 1" CcM r IMCHE'SOR'AOR _ CALLOUS PUMP MAMI)VACTURFR: L^?©~ D= INCHES OR '5-14,; GALLONS MGI)FL NUMBER: q 2 }J j NOTE. PUMP AND ALARM ARE TO BE 5WI1CH TYPE; IAI5TALLED Ow SEPARATE CIRCUITS PUMP 'DISCHARGE- RATE ,-GPM VERTICAL Dl+hLR.EWCE BETWEEM PUMP OFF AUD DISTRIBUTIOM PIPE. " FEET r + MIMIMUM NETWORK SUPPL9 PRESSURTE✓. . . . . . . 2.5 FEET +.1-5 ~ FEET OF FORCE MAIN Xf'7/3Z F/ooFTFRICTIOM FAC70R..~L FEET TOTAL DYNAMIC HEAD - FEET I/ IMTERMAL. DIMENSIONS OF TANK: LENCsTH ' 9 ;WIDTH LIQUID DEPTH ~T !7~t St'WiEO: "y LICEMSE HUMBER. :af DATE: ' PERFORMANCE RATING Gallons Per Minute Model WP0511 WP0512 ; WP071.2 WP1012 WPH101 3882 WP0532 WP0732 WP1032 i WPH103 Series No. ► WP0534 WP0734 } WP10341 WPH1034I HP 10. t/z 3/4 1 1 Submersible RPM ► ~ 1750. , 34-50~ Sewage I_5 150 170 ; 180 190 I 10 126 154 - 168 170 Pumps 15 94 125` 152 1„ 1y50 = m 20~ 56 90 i 121 128 , E~ 3 25 17 49 81 107 c } 30 14 ! 40 86 Certified m li 35 10 64 Canadian Standards Imo- 40 43 Association 45 J2 50 4 4 SPECIFICATIONS Max. Series HP Volt Phase RPM Solids Amps. j Wt. W PO511 /2 115 1 1750 2" 9.0 108 WP0512 'h 230 1 1750 2" 4.5 108 ' W P0532 1/1 208/230 I 3 1750 2" 2.2 108 'WP0534 1/2 460 3 1750 2" 1.1 108 WP0712 I 1/4 230 1 1750 2" 6.0 110 ' W P0732 3/4 208/230 3 1750 2" 3.6 110 'WP0734 3/4 ( 460 3 1750 2" 1.8 110 WP1012 1 230 1 1750 2" 9.0 114 ' WPH1012 1 230 1 3450. 2 11.0 114 WP1032 1 208/230 3 1750 2" 4.2 112.,. WPH1032 1 208/230 3 3450 2" 7.0 112 WP1034 1 460 3 1750 2" 2.1 112 WPH1034 1 460 3 3450 2" 15 112 *CSA Listing pending. 50 O 40 10Se 30 P P r0 Serle ~ I{p ~ Ser/e 20 - IfA: - p SSer/ 4 M fi _ t O .w .+wi+.•m-~,....:,.. vna.rc+.u..., .__.ww_.r .,r u.. ,.r., r., Nib- - 10 COMPOSITE 20 40 60 80 100 120 140 160 180 PERFORMANCE CURVES Capacity-Gallons Per Minute SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. Wisconsin Depart;*ntof Industry, PRIVATE SEWAGE SYSTEM County: Labor and'Cuman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL SINFORMATION `5 A Q 7-" Pe~rrlit.l-iO i a WAKOLD W. ❑ City ❑ Village X R Town of: State Plan NO.: CSCCT::BAMKElI,evV:1~ Insp. BM Elev.: BM Description: rParZ-eel TANK INFORMATION ELEVATION DATA 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. Vent to ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosi ng 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 oss 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 DIMENSION LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Model Number: OR UNIT System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes [I No ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.22.30.20W, NW, SE, Hwy. 35 - 64 Z~YS~I Plan revision required? ❑ Yes ❑ No 1 _H Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNg STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than `O -73 8% x 11 inches in size. E:] Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION IlAkot-n IV ~f Al? L O &W 1/4 ,E '/4, S T , N, R 2,0 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # (o U CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER AIA I-] ITY 11. TYPE OF BUILDING: (Check one) El State Owned ❑ VILLAGE NEAREST ROAD - 3s-4 N Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 0--30 AO.2 Q 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 NJ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ~ Replacement 3.E1 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 CC Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 320 1 67a, 19 p % s Y" ! ~ Feet 9 21 !r Feet CAPACITY VII. TANK Site in allons Total #of Manufacturer's-Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank 12100 Q 61W F1 1 171 F1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er" Signature: /MP No Business Phone Number: F/C &_#1,717- T S Plumber's Address (Street, City, State, Zip Code 5,69 GL6~ yo IX. COUNTY/DEPARTMENT USE ONLY, ❑ Disapproved Sani ry Permit Fee (Includes Groundwater ate Issued Issuing Agent Si o Stamps) Approved ❑ Owner Given Initial nj urc(~ harge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be r 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ♦ I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations October 9, 1995 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHI & ASSOCIATES R0BLR,f ULBRICHT 655 0' NL I LI. ROAD HUDSON WI 54016 RE: PLAN S95-04016 l-LL RECEIVED: 110.00 CROIX MILL WORKS NW,SE,22,30,20W TOWN Of SANIT JOSEPH COUNTY 01~ SI CROIX NON. PRESSURIZED IN--(;ROUND 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. lhis 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. Sinc ely, n eth Stiemke Pla Reviewer Section of Private Sewage (608) 266-8230 7:00 -to 3:45 Mori. thu Fri ORIGINAL SBDA-7987(8. 10/84) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX S95 -0401(%) i DILHR Plan I.D. # S95-04016 Date Oct. 1, 1995 Owner Harold Carlson Phone 1-612-439-2419 Address 9462 Otchipwe Ave. No., Stillwater, Minn.55082 Legal Description Part of a 1.88 acre industrial parcel, ID #030-2029-80. NW 1/4, SE 1/4, Sec.22, T29, R20W. Town of St_,_a0_s_.ph_, County St. Croix C.S.T. Robert Ulbricht CSTM 2482 Installer Local Authority/ Supervision Zoning Adm. St. Croix County Site Address: 1441 Hwy.35-64 PROJECT DESCRIPTION Houlton, Wis. 54082 A conventional (gravity-fed) replacement system for a commercial/lt. industrial building with 16 employees and 1 floor drain in the rest rooms. Total estimated daily wasteflow:370 gals. Soils are very permiable (.7 GPD/ft.2) and suitable for a conventional system. Soils to a depth of 3' below the bottom of an existing drywell are code compliant; it's proposed to keep this D/W connected for continued re-use ahead of a new drainfield. No credit for,the capacity of the D/W (unknown) is being considered in this design. PLEASE NOTE: This system is designed to treat only human waste from the restroom for 16 employees. No other commercial/ industrial waste of any kind is allowed by code to enter this system. The proper disposal of such other wastes must be approved seper&tely by code by the Wis. D.N.R. (715-684-2914 Baldwin, Wis. DNR). SPECIAL INSTALLATION CONDITIONS 1. A 1200 gal. precast existing septic tank has been inspected & serviced recently by a licensed pumper/hauler, and determined by him to be code compliant & in good shape with a capacity of 1200 gals. See attached copy of St.Croix County Zoning Dept. certification for re-use report. 2. Drywell, as noted above, will also be kept intact for re-use, 3. Installing plumber will provide that manhole cover is a min. 24" in diameter, with code compliant tongue/grooved cover with code-compliant warning label. Cover will be secured with lock if left above ground, or buried no deeper than 6" below finished qrade. ! s _ A~4 was S95-04016 Co cal N ~0 0,0 ~1 y M ~a ,on p o onditt ~ w a N5 110 y Ii ~ R~ ~ r NpM~ NC,S ~ R ~La~ ~ ~ RI p►Opg ~ L A C ~ p~• V18wp ND~NG~ ~ y ~ ~ c ~Spp _ o W 'cj -b w~ L o Ll\ y 0M ~k r NAZ o 70 c) IZe ~ m~ Q ~ ~ i o SYSTEM GROSS SEGTlok 97.33 +o APPRoOCd USNT ,7 95 .04016 hi,~ r 5 Nan 6IPAP 975'0 eAP a," 6~i ¢Z~ N - o 6~y,~tr~ - C6vE 3G to Yom, UG /VDU 5 y u 7A 46. ~.f 8,Pic -1 Al C,pDSS o C> d d o 5~, .X719 PUc PEiP~ap~TED r lvASt/EIJ ,4 yrr*ec- TE" p C 1 l I i~ ~ L l s y S TEM - - - T/o~~ Car iNTo IiusPEcTio,,j P/' E SYSTEM PL},,-J U I C w 3 6 S~S~ 3 ' SON Cow ,ors & HUMP t 9UR U~ 0 eqq r M®e L Of ,N~s , • p1Y1S~ON O NGE Q• T-/ RESp~N 7&IT'yEAJ T SEE G ~ N ' SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations September 7, 1995 209 West First Street Route 8, Box 8072 Hayward WI 54843 JACK WELCH & ASSOC HAROLD CARLSON JACK WELCH 9462 OTCHIPWE AVE N 161 83 AVE NE SUITE 309 STILLWATER MN MINNEAPOLIS MN 55432 RE: FACTORY/OFFICE HAROLD CARLSON BOND TECH INTERNATIONAL 1441 HWY 64 N ST JOSEPH County of ST CROIX Plan Number. 95-07-0811-B Area: 11,355 square feet Suprv. Professional, Building.: JACK WELCH Your Building alteration plans have been conditionally approved. The above-referenced plans have been stamped CONDITIONALLY APPROVED based upon review for conformance to the current edition of the Wisconsin Administrative Building and Heating, Ventilating and Air Conditioning Code, chapters ILHR 50-64, 66 & 69. These plans have NOT been reviewed for conformance to the Plumbing Code (chs. ILHR 81-86), the Electrical Code (ch. ILHR 16) and any ILHR code not specifically mentioned. Subject to local regulations, construction may proceed except for those - conditions listed below. The necessary corrections must be made before construction begins. The owner, as defined in chapter 101.01 (2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. The owner shall notify the state building inspector and local officials before taking possession of the building. The building will be inspected during and after construction. ILHR 50.15 EVIDENCE OF APPROVAL. The architect, professional engineer, designer, builder or owner shall keep one set of plans bearing the appropriate stamp of approval at the building site. All future plan submittals required to complete this project must be submitted in quadruplicate, and be accompanied by the Plans Approval Application form (SB-118) and fees. When the building volume exceeds 50,000 cubic feet, all application forms shall include the name of the building or component designer AND BE SIGNED BY THE SUPERVISING PROFESSIONAL OF THE PROJECT. SBDA-6928 M. I6/84) SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations JACK WELCH & ASSOC September 7, 1995 Page '2 This approval does not include approval for a septic system. If this project is in an unsewered area, a sanitary permit must be obtained prior to the issuance of a. local building permit (ss 101.12 (3)(h). This review does not include heating, ventilating or air conditioning. The owner should be reminded that HVAC plans and calculations are required to be submitted for review and approval prior to installation. ILHR 54.14 (1)(a) As two-hour rated furnace room enclosures are not shown, the owner is to be reminded that heating equipment and water heaters must be electric or approved direct vent sealed combustion chamber appliances. This building is classified as No. 5B, exterior masonry, unprotected const. Sincerely, JACK A. MILLER Plan Examiner (715) 634-8964 cc: State Building Inspector, R-4 Dahl (715) 232-6600 Thursday Building Inspector, ST JOSEPH SIfDA-6928 (R. 10/94) f ' , $i"T>~ .1-v1~,C'~ss %yl// ~1.vf! 3S-~~ /~v~-TO•r~, 4J, s. ~S"~~BL ksconsin Department of Industry, SOIL AND SITE EVALUATION Q 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 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 7 ' 457d O x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 030 - 10 2. J- k)O eg f4,,s 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 L Property Location H,4Roi_o e 14 Govt. Lot 41&) 1/4 S~ 1/4,S 2-2-- T Z 9 N,R 20 E (ooo Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 9y62_ orc,~~Pw~ 14v~, Avo- ciity State Zip Code Phone Number Nearest Road 7T/~GU~T i ~1~/. 550 2 2- y3~ yy~9 ❑ City ❑ Village Town W J?JC'" i/ ❑ New Construction Use: ❑ R idential / Number of bedrooms Addition to existing building UT'Replacement Public or commercial - Describe: Oy~l YE • /4" - 1/vDyS7Xy. 1 S. c Code derived daily flow .370 gpd Recommended design loading rate I?ed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required 62 9 bed, ft2 4/4-3 trench, ft2 Maximum design loading rate gibed, gpd/ft2__, trench, gpd/ft2 s Recommended infiltration surface elevation(s) Jr ft (as referred to site plan benchmark) Additional design/site consid tions Parent material 56y .33 ~l~~P~~iyll~T- Sif vyf GUf!!/.f f~ Flood plain elevation, if applicable N ft S = Suitable for system Conve tonal Mound In-Ground Pressure AT-Grade System in Fill Holding Tank BJ U [l. ~E] U ❑ S U = unsuitable for system 1 2-S ❑ U ❑ S [E u 2'-S-- ❑ S [B-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 /oYl3/-1- 4e '5 ~s /vim a Cay r¢~TD il/ es, Ground Z - 7S //v S elev. Depth to limiting factor Remarks: Boring # /3 /D Ar_ SG GPLi CS /vf N Z ; . 3 q 7,SY,P 3/~1 f ye.~ .7 Ground elev. Depth to limiting factor > 9~ln. Remarks: CST Name (Please Print) Signature r Telephone No. ul ht Associates 7/,5-3P6 -PI e5 Address Private Sewage Consultants Date CST Number Qee n.►reu od /i - - Dr- "q . . - s*_ SOIL DESCRIPTION REPORT 2 PROPERTY OWNER Page of `J PARCEL I.D.# 030 -.2-0 0 Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 l 01 /OYR 3/i- lye & d~ N : N VJ~ -7,S Ye -31141 15 Af _kO Ground elev. ft. ~j _5 Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to - limiting factor __.--in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fF 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) STA7 - W gt~7S T Go 7- ~ ~ v y a ^ IN D w~ UN Q 1 ~ Q. L O o Ilk Q 1 ^ S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property /t W 1/4 ~S,E 1/4, Section T 30 N-R o~ W Township 5'j', Zee e,0,4 Mailing address Address o f s ite Subdivision name Lot no. Other homes on property? Yes X_No Previous owner of property Total size of property Ae-12, = S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X' Yes No Is this property being developed for (spec house)? Yes __)C_No Volum nd Page Numbe /P~ as recorded with the Register of De 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 office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for t e 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. -nz/ Signatu e of Applicant Co-Applicant Date of Signature Date of Signature i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER A¢;e MAILING ADDRESS 5;"11C10 mar o fm ~ PROPERTY ADDRESS/' A/ f/ / vs Gds (location o septic system) Please obtain from the'Planning Dept. CITY/STATE lJo~lJ~'~'5 PROPERTY LOCATION IV W 1/4, 1/4, Section 02y~ , T %e N-R o4~1 W TOWN OF v..~`firy ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER /r/eft CERTIFIED SURVEY MAP /Y94 , VOLUME PAGE IV9 , LOT NUMBER -IV-47 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. UWe, 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 Cro,~ County Zoning Officer within 30 days of tite three year expiration date i DATE: C--1101C-7- St. Croix County Zoning Office Government Center 1101 Carmichael Road Iludson. \k'I 54016 S4~o ~Z. le"If Sep 7:7. T. S. ST. CROIX COUNTY ZONING. OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~f~,C1dGD ~/V~.s4~v res a located dt: 1/4, S~ 1/4, Sec. ".Z , T 27 N, R 2,0 W, Town of ST• ~oSF~~f--- Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced t cA4 Did flow back occur from absorption system? Yes No,'~,_(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: i'aC, C c;~u`~ 1 S 1 Construction: Prefab Concrete Steel Other Manufacurer (if known): A e of Tank (if known): (Signature) (Name) Please Pr i t /770 (Title) (License Number) /'9 h/ (Date) Farm to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Named S 'w*.l ft--_S I g n a t u r e MP/MPRS 5/88 00(:UMEt f NO STATE HAIL OF WISCONSIN FORM 3-19821 r/114 SINCE RESERVED rOR R[COHDIN6 DATA GUIT CLAIM DEED 4.f C S2 7 S9 3PA'r `19 REGISTER'S OFFICE 11 Harold W.-..Carlson...and.._- aeque.1.iaJJ.-.Car.1sanr.._......... ST. CROIX CO., WI j li husband--and-.wife Recd for Record I at FEB 1: 1991 'sit-c►aims to .....Harold--W......Caxls.arl...~.r1d..,Incquelin..Ii_.-.. 9;00 A. M I Carlson as Trustees of. the..IRazpl.d...I....Caxlson...... n I Trust 0 X 1 Register of Deeds the following described real estate in ......9t......Cr.Qi& County, State of Wisconsin: R[,uRN .o I An undivided one-half interest in and to: Tax Parcel No: II All that part of the Northwest Quarter or the southeast Quarter (Nw4 of SET) of Section I li Twenty-two (22), Township Thirty (30) North, Range Twenty (20) West, St. Joseph Township, St. Croix County, Wisoonsin, described as folicws: Cc[mnencing at the Southwest corner of the Northwest Quarter of the Southeast Quarter (NWT of SET) of Section Twenty-twoo (22), Township Thirty (30) North, Range Twenty ('9) West, St. Croix County, Wisconsin; i thence East along the South line of said Northwest Quarter of the Southeast Quarter (NW; of SET) of Section Twenty-two (22) for Six Hundred Sixty and No Tenths (660.0) ' I~ feet; thence North and parallel with the West line of said Northwest Quarter of the Soutt.east Quarter (NW; of SET) for Six Hundred Sixty and No Tenths (660.0) feet -to the {i point of beginning; thence East and parallel with said South line of the Northwest II~ Quarter of the Southeast Quarter (NW'4 of SEi) for One Hundred Thirty-two (132) feet; thence North and parallel with said West line of the Northwest Quarter of the Southeast Quarter (Naps of SE.) and seven Hundred Ninety-two (792) feet Easterly therefrom to its intersection with the centerline of Wisconsin Highways 35 and 64; thence Southwesterly along said centerline of Highways 35 and 64 to its intersection with a line drawn parallel with said West line of the Northwest Quarter of the Southeast Quarter INA of SE:) and Six Hundred Sixty (660) feet Easterly therefrom; thence South and parallel I with said West line for Five Hundred Ninety-seven and No Tenths (597.0) feet to the point of beginning. Con`.aining 1.88 acres, more or less. i lug The West Six Hundred Sixty (660) feet of the Northwest Quarter of the Southeast Quarter (NW% of SET) of Section Twenty-two (22), Township Thirty (30), Range Twenty (20), South of the centerline of Wisconsin Highways 35 and 64, excepting the South Six Hundred Sixty (660) feet thereof. Subject to said Wisconsin Highways 35 and 64 right-of-way easement. Containing 4.1 acres, more or less. i This 1.S-_ not homestead prope-ty. (is) (is not) = January............... 79.91.... Umtcrl this 28th day of . . . . l~ ' .rl (SEAL) (SEAL) • • Harold..W. -Ca~ls.On I~ _ i ....................(SEAL) .:..(SEAL) • Jacquelin H. Carlson ~I AUTHENTICATION ACKNOW~LEDGMENT Signature (a) STATE OF bvMZMhhK i`1INNE O'1'A ~I ss. County. WASHINGTON authenticated this ........day of 19...... Personally came before me this `.......day of I I January 19.9.1.- . the above named f Harold W. Carlson._ana..Jacquelin... Carlson ~I I TITLE: MEMBER, STATE BAIL OF WISCONSIN i (I[ not . . l authorized by § 706.06, Wis. Stats.) to me known to b the person ..5........ who executed the I' foregoing i rument aRa mel ) ge the same. No. S-26 Mortgage-Short Form-Individual and STATE OF WISCONSIN Corporate. (Rev. 1966) Form No. 26 Published by Eau Claire Hoek k Statinaery Co. DOCUMENT NO. 2 7 3 3 7 8 Mortgagor KNOW ALL MEN, that3tillwater...Farm.•EVipmen-t..-C.many.,.... ---Minne-sDta---Go•>rporat.ion of---- ftQx'-..a-'-•-•-...--.•••• .............-..a~~a.CtnP~r4l7ti-& a.tiw...-...............--.-............-••--..-.-....., Mortgagee herein called the mortgagor, whether one or more, mortgages to.~_....•.R.-.W tfir.-E..---Gear-ZS-On-.................................. of........-.:-s St,3:J Z:>ats- ....--...a-.-.t~1I111 herein called the mortgagee, whether one or more, the following described real estate in_.. -.-$t..-...Cr.0 X....-. .........County, State of Wisconsin: Description •The West Six Hundred and Sixty (660) feet of the Northwest Quarter of the Southeast :quarter (NJ of SET) of Section Twenty-two (22), Township Thirty (30) North, Range Twenty (20) West, St. Croix County, Wisconsin, b=aoq* x'XX South of the center line of Wisconsin Highways No. 35 and 64 excepting the South 660 feet thereof and subject to said Wisconsin Highways No. 35 and 64 right-of- way easement, containing 4.1 acres more or less. I Consideration This mortgage is given to secure the repayment of-._eaTwenty.~'ive--- 'hp sa d-•and •-110/l)Q-•_-•Dotlars (Q%000.00 ) according to the terms of a note or notes bearing even date herewith, executed by the mortgagor to the mortgagee. Tax Clause The mortgagor agrees to pay all taxes and assessments on said real estate; to keep the premises insured for fire and Insurance extended coverage for the sum of at least $25,00Q.9Q- to pay the premiums thereon when due, Clause and to comply with any coinsurance provisions, in companies approved by the mortgagee with loss payable to the mortgagee as interest may appear, and all policies covering the premises shall be deposited with the mortgagee. Mortgagee In case of default in the payment of taxes and assessments, or in case of failure to keep the premises so insured, may cure the approved policies deposited, the mortgagee may pay such taxes and assessments, and effect such insurance and pay the Defaults premiums thereon, and the amounts paid shall immediately be repaid, and unless repaid, shall be added to the indebtedness secured hereby and bear interest from the date of payment at the rate of....a5... per annum. Option Clause In case of default in payment of any principal, interest, taxes, assessments, and insurance premiums when the same shall become due, or in case of failure to keep approved policies so deposited, the whole amount of the unpaid principal shall at the option of the mortgagee become due and payable without notice, notice being hereby expressly waived. Remedies In case of default, the mortgagee ma sue at law or foreclose by action or advertisement and the mortgagee ma sell the Power of may Y may Sale same and give deeds of conveyance to the purchasers pursuant to the statutes. ~i Foreclosure In case of foreclosure proceedings, whether abated or not, all foreclosure expenses, including reasonable attorney's fees, Expense shall be added to the principal, become due as incurred, and in case of judgment, shall be included therein. Limitation Unless an individual mortgagor is also obligated on the note or notes herein described, such mortgagor shall not be Personal personally liable on an move judgment. III Liability PA IN WITNESS WHEREOF Li this mortgage has been executed and delivered this STS t..-Clay.. of_----_-..-------. A. D., 19-(~....-.. SIC ED ND SEALED IN PRESENCE OF n III Stillw~,t r' uF~ -Company I!~ ~.GA 8 am`- - -l (SEAL) Harold W. Cnr] son, Vi RP- Prwsi rlpri --B.~-......----•-------••--•---•--•---•---•------.--.-........--.._...----•°••--••-----°-....--(SEAL) Barbara A. Streich livid L. Carlson, SPCrAt-nrv INDIVIDUAL ACKNOWLEDGMENT `l•leJJ-J STATE OF County of. W&shJngton ss Personally came before me this......... day of-...---.-•-. ylr 1•.q ~ 7. ~ ~ V/7 the above named -~-E. to me known to be the persons who executed the foregoing instrument and acknowledged the sam,e-.,i~s+.• V I Notary Public County, Wisconsin My Commission expires - CORPORATE ACKNOWLEDGMENT STATE OF I C. 11 N N F-j CD y :C+ w CD CA a t1i m o CD w C„y^~ .r ~I / O t1 (D CD CD C., :I- o w d t~~ z c d a _ :c+ CD e ' ° E W o n i i No. 8-4. Warranty Lees-t,ommon irorm-To Corporation. (STATE OF WISCONSIN) Published by Eau Claire Beoa a Statloaery 00. (Sec. 236.16. Wis. Statutes) Form No. 4 µ2.11906 This Indenture, blade this 16th day of Isay , A. D., 19 74, between Ordella Lentzo an unremarried widow, and Henry J. Lentz and Marilyn M. Lentz, husband and wife, part ies of the first part, and Stillwater Farm Equipment Co., Inc. a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, located at Houlton , Wisconsin, party of the second part. Mit rZ,entb, That the said part ies of the first part, for and in consideration of the sum of One Dollar ($1.00) and other good and valuable considerations, to them in hand paid by the said party of the second part, the receipt whereof is hereby confessed and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and consumed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unt-) the said party of the second part, its successors and assigns forever, the following described real estate, situated in the County of St. Joseph and State of Wisconsin, to-wit: All that part of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) of Section Twenty-two (22), Township Thirty (30) North, Range Twenty (20) West, St. Joseph Township, St. Croix County, Wisconsin, described as follows: Commencing at the Southwest corner of the Northwest Quarter of the Southeast Quarter (NW-4 of SE4) of Section Twenty-two (22), Township Thirty (30) North, Range Twenty (20) West, St. Croix County, Wisconsin; thence East along the South line of said Northwest Quarter of the South- east Quarter (NW4 of SE4) of Section Twenty-two (22) for Six Hundred Sixty and No Tenths (660.0) feet; thence North and parallel with the West line of said Northwest Quarter of the Southeast Quarter (NW4 of SE4) for Six Hundred Sixty and No Tenths (660.0) feet to the point of beginning; thence East and parallel with said South line of the Northwest Quarter of the Southeast Quarter (NW-4 of SE4) for One Hundred Thirty-two (132) feet; thence North and parallel with said West line of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) and Seven Hundred Ninety-two (792) feet easterly therefrom to its intersection with the centerline of Wisconsin Highways 35 and 64; thence southwesterly along said centerline of Highways 35 and 64 to its intersection with a line drawn parallel with said West line of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) and Six Hundred Sixty (660) feet easterly therefrom; thence South** ZUL'rttrr with all and singular the liereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part ies of the first ,Hart, either in law or equity, either in possession or expectancy of, in and to the above bargai TRAN premises, and their liereditaments and appurtenances. O 'Uri T' abr imb to ~~aTb the said premises as above described with the hereditaments and appurtena unto the said party of the second part, and to its successors and assigns FOREVER. FEE ,Idi .i 11)c %eib Ordella Lentz, an unremarried widow, and Henry J. Lentz and. -Marilyn M. Lentz, husband and wife, for themselves, their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said party of the second part, its successors and assigns, that at the time of the ensealing and delivery of these presents they were well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet u: l peaceable possession of the said party of the second part, its successors and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, will forever birARRAN 1' and DEFEND Ptt UUMCOO Mijurot, the said part ies of the first part ha vehereunto set their, hands and 1974•::;~t` s, ?A s this 16th day of Uay , A.D., ~w Si ned and. Sealed in Presence of Ordella Leniz ' ;r• y a,.. y!~ rT.....,.... 9:o'r. Tors it 'M i Q_-;l, 1.3. i i 2 - ~ ~ ~ j ~ i j i a ~ ~ s m y' g S ( 'ti a o Its (b t3 KbI cD b 23 t a Z80SS N14 'aa4QMTTT4S gaaags puoDas ugnos 9ZT sbbzag • 0 gaagoU - Act pa?. Jp.tp spM quauin x~ suT s-Uuy _--~-sasrdaa uorssrururoo SN `orlgnd ~fre;oN S Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268559 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CARLSON, HAROLD ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 960) 72 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 rl 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 I Loss Friction System TDH Ft TDH Lift Head Forcemain Length JDia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Mode 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 /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.22.30.20W, NW, SE, Hwy 35 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: I e Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count, than 8 112 x 11 inches in size.. I • See reverse side for instructions for completing this application State sanry Pe ;m it Number.,~logSS`~ The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION G - O Z Property Owner Na a Property Location S ~14 1/4,S T30 ,N,R ©E(orjo Property Owner's Mailing Address Lot Number Block Number ity, State Zip o e~ Phone Number Subdivision Name or CSM Number v 1 r 4,5708_4 (&/X dyW-_2IV1!F ACA II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest R~ 3S ❑ village Public 1 or 2 Famil Dwellin -No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0,30 -80 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 K 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 -l------System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 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 d Q Feet Feet VII. TANK Capacity site in gallons Total # of Prefab. Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete strutted con- steel glass App. New Existi n Tanks Tanks -9- El I El I El Septic Tank or Holding Tank -1 Coo +U1 ❑ ❑ Lift Pump Tank /Siphon Chamber to ❑ 1-1 El Ej VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for installation of the onsite sews stem shown on the attached plans. Plumber's Name: (Print) Plum er Signature=Stps) P/MPRSW No.' F~lness Phone Number: 3-~ 11Y AZ 77"7- lu tier's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Late Issue Issuing Agent Signatur t s) A Surcharge Fee) l 3V S- pproved ❑ Owner Given Initial i f`1 Adverse Determination . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6396 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Suety & Buildings Division, Owner, Plumber 1 , INSTRUCTIONS 1 ~ A sanitary 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-thi3 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-c4 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. - ,y I ( SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 2, 1996 2226 Rose Street La Crosse WI 54603 SCHMITT SONS ST CROIX EXCAVATING 586 VALLEY VIEW TRAIL SOMERSET WI 54025 RE: PLAN S96-40932 FEE RECEIVED: 520.00 INTERNATIONAL TECH SYSTEMS NW,SE,22,30,20W TOWN OF ST JOSEPH COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. SBDA-7887(8. 10184) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations SCHMITT & SONS Page 2 August 2, 1996 PLAN S96-40932 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si erely, Gerard M. im Plan Reviewer Section of Private Sewage (608) 785-9348 6938R/ 2 SBDA-7997 (K. 10/94) . y w S96-40932 RECEIVED SEPTIC SYSTEM AUG - 1 1996 for SAFETY & BLDGS. DIV. International Te-ch.nningy SVStems NW1/4 SE1/4 S22 T30 R20W St. Joseph Township St, Croix County AGE SYStEM S~ Page #1 Work Sheet P 'R1VATE ditioTtu1ly Page #2 Plot Plan C®n Page #3 Seepage Bed Plan ED tis Page #4 Dosing Chamber PIR01 TtEu~ro ~ Page #5 Pump Curve 1!~ ~ "Vaku w~o~wss Page #6 Soils Evaluation sov, of q~pus"N YIS~ ~j ~6/ N,0E~1GE SEE GoR By Donavin L. Schmitt 586 Valley View Trail Somerset, Wisconsin 54025 715-549-6651 RSW 3205 3z~~L-W-- 7-31-96 516- yc ~3V-- VIC -----L-~s_ @- o - - - - - - - f/Ze, e- r r- ?.41vr~ . rr~, - - - - _ , ~',¢~c X12. _ - - - - - ' r /77 to G 3°ooPIC ? j S' T 1 ~ Q ~q O~ 'ARK/NG r4 L F Q o a 1 ; Id21 ~ 5G9LL _ /y= yon Top OF EX1S"1vc- W&-11- A /Gf~j~ CP5 -y This approval es not include review of any plumbing up ;t am of the septictholding tank. See sectio ILHR 82.20, Wis. Admin. Code to determin ! whether plan submittal and approval is required f r that plumbing! 79XI57',VVG U-)t LL ~R9wii+rG oR' -3/-9C oRAwl 131V. T=cfNOe0G y ~(Yina-~ c ..LNTE1~/YAPOMA L T S YY T C/"/S 584 C)14 cc EY UrEuv 7-,e q00 6 7,1/ S% N_ 5 UIT E" -~f/aO <SorrE,2s~T GUi` • ~~io z s faun sow G~~' . yo G ~'!/>2scu 3zG s I t i ~ I r ~ j ~ I II 3, I J ~ ~ 1 I ~ I ~ ~ f1 %tRAGS 6' c~, C ~ ~ I 1 I ' I I I I 4 ~ I I ~ 1~ ~ 1 I I 3 oc G'oc~ oc I c'oc I) ~'oc s I l it I I I ~ I 14 I i -o,ecc-- 1, ,%l+l I I ~I' i I I ' 6 BOG- ! I ~ ~ ~oc ~ l 6roC- ( ;`oc , 6 `oc II ` I~ ~ I I II i I ( i I I 4 I i l i l ~ l I } I I i r III; - y" s~r~ vo Pvc I/us/~c1/o N I k 1 ~i i'/~~S 1 I I 1 1 ~ ~ ~1~. I III 7 _ %4 To A D-- C,' coc-p D b ®c - i SCC,{~AG~ ~'cQ « Np sc%~LE PAGE OF PUMP CHAMBER CROSS SECTION Akio SPECIFICATIONS VENT CAP '1°L.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION 90X MANHOLE COVER 25' FROM ODOR, I2•M11~. wINoow oR FRESH AIR INTAKE GRADE 1 `I' MIN. 10' MI IJ. - 10'P111J. PROVIDE ) INLE T AIRTIGHT SEAL I P-F I ~I~ v APPROVED JOINT APPROVED JOINT A I I W/C.I. PIPE W/C.I. PIPE III ALARM EXTEuDING 3' EXTENDILI(a 3' ( II ONTO SOLID COIL OWTO COLID SOIL e ~ I ON C I I LLEV. `3 FL PUMP OFF r D CONCRETE BLOCK APPRa RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL U0011" 5PCC,IFICATI0KlS SEPTIC E DOSE j,,~/ ~c /c; WUMBER OF OOSfS: PLR OA4 TAUK MANUFACTURER: TANK SIZE: 361*)0 GALLONS DOSE VOLUME INCLUDING oAC►crLOw: _ ~5, 3 y, 8y GALLONS ALARI'1 MAIJUFALTUR.GR: 7 ~ LL :3 7 p~ ZIQdo..~7f'- P%ODLL NUMBER: CAPACITIES: A= ILICHES 09 WYL5< GALLOAIS SWITCH TVIC: ~L4 8 = INCHES OR 112-1 LLONS LOWS -L_I►1CHES OR 530, AL 3 F'~ PUMP MANUFACTURER: 7/0c- L -w q MODEL NUMBER: _a 7 D o ~INCHES OR GALLONG SWITCH TYPE: / L MOTE: PUMP AND ALARM ARE TO OE IN5TALLE0 ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE 3 7, Z GP~~ VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD.015TRIBUTION PIPC.. 315 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FLET + COD FEET OF FORCE MAIN X '2 .F~DfLFRICT101J FACTOR.. FEET TOTAL D'JNAMIC. HLAD = ,1 FEET IMTERNAL DIM SION OF TAUK: LENCYTH ;WIDTH - ;LIQUID DEPTH dry J d ` LICE.WSE NUMBER: J Q~ DATE: 5 IGW E 0: HEAD/CAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 185 should not be subjected to less than 30 feet TOW TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING S3-SS SERIES 42 48 97-50 165 Ff. M, Ga. Ltn. GW Ltw GPI Lh GY UM GM. UN Gil, Ltre Gal.. Lh G>a. An: GW.: LW. G41. SUri G11Ltn. Gil. Ltn: S 1152- 15 57 28 106 43 163 72 273 104 394. 106 401 61 231, 61 231, 58 >820 155 597 a 155 367 10 3M i 1 g~j 61 231 _ 56 ;20 MB "g 151 67g is 4.5~ 9 34 iR as ig 72 4s t7p rm az 91 a44 60 22Z 60 221 51 540 20 6 10( 2 1 8 7 s28 25 9S S 36 136< 82 310 59 22$ 60 227. 58 .220 136 15 140 530 25 7.62 8 30 74 280 57 24 59 223 58 '..220 128 484 133 $03 30 0,14 65 246 55 2% 58 220 00 340 58 5220 121 458 127 491 W~ 40 12.19 46 174.. 46 172- 55 206 75 233 58 220 105 .897 114 43t 1- ryj 50 1524 21 60 33 125. 51 191 58 219 58 220 90 341 100 379 60 .1829 15 57. 43 .161 36 136> 58 220 71 ,289 0 <72.. 70 21,34 30 114.. 10 38 r. 52 .197 51 101 70 266_ 1 1 80 24.3E - 14 53 45 170 28 108 r. 54 .204 90 27A3 . 32 .121 2 ' 4 37 a40. is 34 100 3418 1e ,0 21 79 1 1 110 32.001 7 25 8 3a 32 105 Lock VYv4; 21' 22' 1925' 23' 26' 56' 66' 67' 73' 114' 81' 112' 30 28 t 26 24 75 5 0 22 186 = 70 V 20 Q 65 165 0 18--10-- . 0 55 16 163 50- 14 45- 12 40 185 35-- 10 30-- 1891 8-- 25 6 20. 4 15 188 10 N§98 2 5 42 48 53,55 57,59 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 80 160 240 320 400 480 560 640 _ 0 FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219. 'Labor 'and Hunlan Relations w w • • , • • • • • ^a- -i_ - Division of Safety & Buiings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not lens than 8 1 /2 x 11 inches in size. Plan must include, but St- Croix 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. 6.3 6 - Zd z 8 d APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Z. Z International Technology System GOVT. LOT NW 114 SE 1/4,S fib T 30 N.R 20 {tr) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1441 Hy. #35 na na na CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Houlton, W1. 54082 St. .7MeDh St. ( ) Hy..35-64 [x] New Construction Use [ ] Residential 1 Number of bedrooms Addition to existing building [ Replacement { Public or commercial describe mfa 90 emtsloyees, 6 floor drains Code derived daily flow 2100 gpd Recommended design loading rate .4 bed, gpd/ft2 .5 trench, gpol Absorption area required 5250 bed, ft2 4200 trench, ft2 Maximum design loading rate _ .4 bed, gpdRt2_.j_trerdt, giXW Recommended infiltration surface elevation(s) 92.00 ft (as referred to site plan benchmark) - Additional design / site considerations alt s vstem el = 91-101 Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND I"MUND PRESSURE AT-GRADE SWIM IN FILL HOLDING TANK U= Unsuitable for s smm S❑ U KiS O u His 01U ®S ❑ u ❑ S ®U OR [Ell SOIL DESCRIPTION REPORT Depth Dominant Color mo>lles Texture Structure Consistence Bwidary Roots GPD/ft Boring # Horizon in. Munsell 13u. Sz. Cont. Color Gr. Sz. Sh. Bed Tt>er& 1, 1 0-12 10yr3/4 none s1 2mgr mfr cs 2f .5 .6 L.- < 2 12-25 10yr4/4 none si lcsbk mfr gw if .4 ,5 Ground 3 125-84 5yr3/4 none scl 2mgr mvfr na na .4 .5 957T* ft. Depth to limiting factor +Remarks: H-3=25% stone Boring # 1 0-10 10yr3/3 none 1 2mgr mfr cs 2f .5 .6 2 10-22 10yr4/3 none scl 2mgr mfr 9w if 1 .4 .5 t 2 3 22-54 5yr4/3 none sc1 2mgr mvfr gw na .4 .5 .Lma. Ground 4 54-84 5yr3/4 none is Osg mvfr na na .7 .8 94.1 ft. Depth to limiting factor Remarks: H-3&4= 25% stone T Name:--Please Print GaRY L. Steel Phone: 715-246-6200 Addrew: 1554 00th. Ave. New Richmond, WI. 54017 Signabxe: Date: CST Number: 7-30-96 cstm 022,98 PROPERTY OWNER 1Nt. TeCt1. Systems SOIL DESCRIPTION REPORT pap--o PARCEL LD. # CPi 3 T ZZc Z -Cl Boring # Horizon Depth Dominant Color Mottles Texture Sere Consistence Barifty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmtdt 3 1 -9 1 r3 3 none 1 2msbk mfr 2f .5 .6 2 -51 5yr3/4 none Bel 2mgr mvfr gw if .4 .5 Ground 3 1-84 5yr3/4 none sl 2mgr mvfr na na .5 .6 93ft ft. Depth to fimiting i +8411 Remarks: H-20=25% stone Boring # 1 -10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 El 2 0-21 10yr4/4 none 1 2msbk mfr 9w if .5 .6 3 1-61 7.5yr4/4 none Bel 2mgr mvfr 9w if .4 .5 Ground elev. 4 151-84 7.5yr4/4 none s1 2mgr mvfr na na .4 .5 95.0 ft Depth to limiting facbr +84„ Remarks: H-3&4= 25% stone Boring # 1 -10 10yr3/3 none 1 2msbk mfr gw 2f .5 1.6 5 2 0-24 7.5yr4/4 none s1 2msbk mfr 9w if .5 .6 3 4-50 5yr4/4 none Bel 2mgr mvfr gw na .4 ~ .5 Ground elev. 4 0-88 5ry4/6 none Bel 2mgr mvfr na na .4 .5 95.0 ft Depth to U*ng tacclixx +88" Remarks: H-3&4= 25% stone Boring # 1 -11 10yr3/3 none sil 2msbk mfr 9w 2f .5 .6 6 2 11-24 10yr4/4 none sil 2msbk mfr gw If .5 .6 3 24-88 5yr4/4 none Bel 2mgr mvfr na na .4 .5 Ground elev. 96.0 IL Depth to limiting factor +8811 Remarks: H-3=25% stone inn a~~nre ncrfn~ STEEL'S SOIL SERVICE Gary L. Steer International Technology systems 1554 200th Ave. CSTM2298 NW4SE4 S20-T30N-R20w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 1 N 1"=40' 13M.= top of well @ el. 100, system to be 20' from critical slope line of ditch 7 ~InA ao f Opel,", ,fit ~1 {a 0 "Al Gary L. Steel 7-30-96 Wisccnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page i-of --1 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 8 1/2 x 11 inches in size. Plan must include, but St. Croix 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. - 2 0 7 ~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 22- International Technology Systems GOVT. LOT NW 1/4 SE 1/4,S W T 30 N,R 20 fqr) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1441 Hy. #35 na na na CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN r REST ROAD Houlton WI. 54082 ( ) St. Joseph St. Hy. 35-64 [x] New Construction Use[ ] Residential / Number of bedrooms (J Addition to existing building ( ] Replacement " Public or commercial describe mfg. 90 employees, 6 floor drains Code derived daily flow 2100 gpd Recommended design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2 Absorption area required 5250 bed, ft2 4200 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 92.00 ft (as referred to site plan benchmark) Additional design/ site considerations alt. system el. = 91.10' Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U KIS ❑U ®S ❑U 10 ❑U ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trt nch 1 0-12 10yr3/4 none S1 2mgr mfr CS 2f .5 .6 1 2 12-25 10yr4/4 none Sl lcsbk mfr gw if .4 .5 Ground 3 25-84 5yr3/4 none Scl 2mgr mvfr na na .4 .5 95.6'. ft. Depth to limiting factor +84" Remarks: H-3=25% stone Boring # 1 0-10 10yr3/3 none 1 2mgr mfr CS 2f 1.5 i.6 2 2 10-22 10yr4/3 none Scl 2mgr mfr 9W if 1.4 .5 3 22-54 5yr4/3 none scl 2mgr mvfr gw na .4 .5 Ground ~`ty 1 ft. 4 54-84 5yr3/4 none is 0Sg mvfr na na .7 .8 Depth to limiting factor +84" ECE[Vr ' Remarks: H-3&4= 25% stone I UL 3 199rs CST Name:-Please Print GARY L. Steel Phone: 715- 200 ST CPDX co INTY Address: T ZONING pFRCE 155400th. Ave. New Richmond TnI. 54017 Signature: Date: = 30-96 7-c PROPERTY OWNER INt. Tech. Systems SOIL DESCRIPTION REPORT Page - of,, # C' ZO fC7 PARCEL IA Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 2msbk mfr yw 2f .5 .6 1 -9 10 r3 3 none .."_.3...._`.. 2 -51 5yr3/4 none scl 2mgr mvfr gw if .4 .5 Ground 3 1-84 5yr3/4 none sl 2mgr mvfr na na .5 .6 93e1eJv ft. Depth to limiting factor Remarks: H-20=25% stone Boring # 5 .6 1 -10 10yr3/3 none 1 2msbk mfr gw 2f . 2 0-21 10yr4/4 none 1 2msbk mfr gw i f . 5 .6 4y 3 1-61 7.5yr4/4 none scl 2mgr mvfr gw if .4 .5 Ground elev. 4 1-84 7.5yr4/4 none sl 2mgr mvfr na na .4 .5 95.0 ft. Depth to limiting factor +84" Remarks: H-3&4= 253/6 stone Boring # 1 -10 10yr3/3 none 1 2msbk mfr gw 2f ,5 .6 2 0-24 7.5yr4/4 none sl 2msbk mfr caw if .5 3 4-50 5yr4/4 none scl 2mgr mvfr gw na .4 .5 Ground elev. 4 0-88 5ry4/6 none scl 2mgr mvfr na na .4 .5 95.0 ft. Depth to limiting factor +88" Remarks: H-3&4= 25% stone Boring # 1 -11 10yr3/3 none sil 2msbk mfr gw 2f .5 .6 '....6... 2 11-24 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 24-88 5yr4/4 none scl 2mgr mvfr na na .4 .5 Ground elev. 96.0 ft. Depth to limiting factor +8811 Remarks: H-3=25% stone SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel International Technology Systems '1554 200th Ave. CSTM2298 NWISE 4 S20-T30N-R20w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 N 1"=40' BM.= top of well C el. 100, system to be 20' from critical slope line of ditch h~ '41 !~~'/r v0 Gary L. Steel 7-30-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1141140 C P Sa d MAILING ADDRESS M,2 D T &z , A o Al PROPERTY ADDRESS (location of septic sy tem) Please obtain from the Planning Dept. CITY/STATE ,//a C61L" IYQ S 2 PROPERTY LOCATION (d2 1/4, 1/4, Section, T__L.Za_N-R__,.t0_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION & LOT NUMBER &,4_ 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: f Lam' / DATE: i St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 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 #-"Q 1,t2 YC,c[R-XaM Location of property ~ur 1/4 SE 1/4, Section ,T 30 N-R~W Township- ,It W- Mailing address 9Y6~ T~~ f A025: N- srlV / /!JA 08 Address of site-'3~y/ &'Wc rd" Subdivision name ^/,q Lot no. _1YA Other homes on property? Yes No Previous owner of property A L AMT d R tl ,,,,7' Z &A 'TZ Total size of property Total size of parcel Date parcel was created /~f,4y 1~7y Are all corners and lot lines identifiable? -,_Yes No Is this property being developed for (spec house) ? Yes ~No Volume LITI-L and Page Number JA6 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. ~ 1,91f6 , 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 Applicant Co-Applicant Date o Signature Date of Signature - (Sec. 236.16, Wis. Statutes) - Form No.4 Publlsh•d by Eau Clair* tlaaa w atauoa•ry s:•. This Indenture, Nlade this 16th day of May , A. D., 19 74 between Ordella Lentz, an unremarried widow, and Henry J. Lentz and Marilyn M. Lentz, husband and wife, part ies of the first part, and Stillwater Farm Equipment Co., Inc. a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, located at Houlton , Wisconsin, party of the second part. a ~itttrK~rt That the said part ies of the first part, for and in consideration of the sum of One Dollar ($1.00) and other good and valuable considerations, to them in hand paid by the said party of the second part, the receipt whereof is hereby confessed t and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unt-) the said party of the second part, its successors and assigns forever, the following described real estate, situated in the County of St. Joseph and State of Wisconsin, to-wit: All that part of the Northwest Quarter of the Southeast Quarter (NW-4 of SE4) of Section Twenty-two (22), Township Thirty (30) North, Range Twenty j (20) West, St. Joseph Township, St. Croix County, Wisconsin, described as follows: Commencing at the Southwest corner of the Northwest Quarter of the Southeast Quarter (Nw4 of SE4) of Section Twenty-two (22), Township Thirty (30) North, Range Twenty (20) West, St. Croix County, Wisconsin; thence East aloncl the South line of said Northwest Quarter of the South- east Quarter (NW4 of SE4) of Section Twenty-two (22) for Six Hundred Sixty and No Tenths (660.0) feet; thence North and parallel with the West line of said Northwest Quarter of the Southeast Quarter (NW4 of SE4) for Six Hundred Sixty and No Tenths (660.0) feet to the point of beginning; thence East and parallel with said South line of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) for One Hundred Thirty-two (132) feet; thence North and parallel with said West line of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) and Seven Hundred Ninety-two (792) feet easterly therefrom to its intersection with the centerline of Wisconsin Highways 35 and 64; thence southwesterly along said centerline of Highways 35 and 64 to its intersection with a line drawn parallel with said West line of the Northwest Quarter of the Southeast Quarter (NW4 of SE4) and Six Hundred Sixty (660) feet easterly therefrom; thence South** 1I ur'"l.oQtt, tr with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part ies of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargaiRxRA premises, and their hereditaments and appurtenances. SO ~t1tlr anZI To )oib the said premises as above described with the hereditaments and appurtenan -into the said party of the second part, and to its successors and assigns FOREVER. `•N• tai i)e %aib Ordella Lentz, an unremarried widow, and Henry J. Lentz and . -Marilyn M. Lentz, husband and wife, r Ij for themselves, their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said party of the second part, its successors and assigns, that at the time of the enseaing and delivery of these presents they were well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbranc.es whatever, it i I and that the above bargained premises in the quiet iml peaceable possession of the said party of the second part, its successors and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, will forever 1YARRANT and DEl+END: 11!1 [ulit=0 Mijaraf, the said part ies of the first part lea vehereunto set their- - hands and i. s?sl s this 16th day of Lsay , A. D., 1974.,-,: Jt•': Sig.aed and.Sealed in Presence of Ordella Lent A,. .,x;; a _ .~Se~„j j %r _ t. k.21 Q L:, L:, Henry • E i AIL Or ? ~ _ ! ? i i SY + ~ nIH 3 I S I O \J J y~ IV }b~~ ( i j •i 'V Q as ~D i y~ COO i ! a. b a. CPQ + ? b O t3 fs 1...1 ' `c 1114' ii o . 1 + Z80SS N714 'a@4PMTTT4S 40aa4S PuoaaS ggnoS 9ZT sbbzag • o gaagog Vic-[ paa.lp:zp s~M :?uazzzna~ suz G-ruy alydxa uorssrruuroo Apr x.. lorlgnd .f re}oN I W► / , JI' I i ~ Z 1 QI 1 I 1i r-NORTH LINE OF 66' -R9 °`J`Jj42" E ~C 98;50' 02 ~55~42"W 228.82' 2.76 ©54,64' 55.36 173.46' N i i SG Cc - c~ ! 3 SG• / I I ~ in L. •s, o HOJSE 6 I o'r GARAGE PARCEL I JSATEL_ITE ,Cri / D i 5!~ G SEPTIC i VENT gyp` i i ~UUUIII III///,,, z a ~I c~ / C So, Go' ~ 1 S s~4~ 85, f W 95 ° 76 0 °5s,56 c; l z l j~ W / w PARCEL IN 336 / 471 v' w 3 ~uiLDln;. W .9 v N I zZ- 30 N841039'47uW Z I O t 47.05' kD -N i A• N - _FEE TITLE FOR HIGHWAY 01 IN -434 / 182 ^ - zz °I.. ,010 N v N~co° o v POINT OF BEGINNING v`sA OF PARCEL A- - - - - - - - - - - - - - -i - - - - j (N00'00'00"E) E) ~ E~82 TH 35i AND 64.1 r N0012'18"W CA ZA, 17" 6. I 69.82 Z ? 'S1. o 27 - I I - I m I MOVlE SCREEN `~Ca 236 W O I v p N C+ ~ a zo a ~I tic X0,9 y1~ I.- I 163.62 N O~. °ap FS A 100. N001 2" cn SASS! I (NOO. 0'00"E . \ IS /SSA 'NORTH LINE OF THE SOUTH 100 FEET OF THE NW 114 OF THE SE 114 \ EAST LINE OF THE WEST 165.0 FEET OF c; u! THE NW 114 OF THE SE 114 r 1 _ o ~o`,, Op O llpN / I o c ~pT 0~ C 4.34 ~OAA m~ rw. o o~sy%9 SO / ~n Tt O 7.0 Q ~ - - - - - - 287.0 °~j- o,R °c z N ~ 6 Z I aN~ ICJ cn~Cc ~ frl C:Ozb Z 2oz m m ,O rma / 273.7 t~-O z OA~~ o~ Z ( O'-2 ~ co Z I 200 mvi I{~+, ~ I m A uzi I N ~ ci z sa ~ O w X I TWO I 14 I t~D -4 co ~ ~ \ I N t I ¢ a 26.86 i +