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AS BUILT SANITARY SYSTEM REPORT
OWNER J re- 61e, /7, ax ADDRESS 7ld Al C_
W ~
SUBDIVISION / CSM# cyC-51 LOT
SECTION 2 T N-R-~ Town of e3 s- e fi
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: .S"6h+- ~e ®c s'
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: J~; clwrs7`Py,,J Liquid capacity: „7- Zf p
Setback from: Well 16G V-- House /QO Other
Pump: Manufacturer Model# Size
Float seperation 7 Gallons/cycle:
Alarm Location SW=
-SOIL ABSORPTION SYSTEM
S~ Q Slo{1'4e 46" .
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: 167&1fi' House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: l
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Viscon,s:nDepartment ofIndustry,
PRIVATE SEWAGE SYSTEM County:
Labor andNumanRelavisio INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
PerMONTBRIAN6, STEVEN El City ❑ Village NA of: State Plan ID No.:
CST BM E I e : , Insp. BM Elev.: , BM Description: ~L Parcel Tax No.:
TANK INFORMATION ELEVATION DATA e,// z - ~.~s ~Cc, •
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic yr Sv Benchmark -r /DD G5~
Dosing
Aeration- Bldg. Sewer
Holding St / ~ Inlets°7 r
6.0~ 7oG.9a
TANK SETBACK INFORMATION St/Of Outlet lo7,/5'I
TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet
rl
Septic NA Dt Bottom
Dosing - NA / Man. 3. Z/
Aeration NA Dist. Pipe /p /
Holding Bot. System
PUMP /FORMATION Final Grade
Manufacturer co 0_1~1 Sc, .M
Demand
Model Number t
ix> C all l✓ 3, GPM
TDH Lifti~ Lriction1 I3/ Systedm ~ TDH~/~Ft
Hea
Forcemain Length.,' Dia.' Dist rowell/
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches pI~ No Of Pits Inside Dia. Liquid Depth
DIMENSIONS C~ 75 _2 DIME SIO#S„
SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA Ma f r:
CHAMBER--
INFORMATION ypem n
system: OR UNIT Model Number:
S
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length lo Dia ~ (O~
Length S~ Dia Spacing & I C/
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.)S ~/i~/96.~,~7~5~
LOCATION: SOMERSET.2.30 19W, NEB SW, 170TH AVE ~ r
Plan revision required? ❑ Yes PKNo
Use other side for additional information. /Q
SBD-6710 (R 05/91) Date Inspector's Signa ure Cert No
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit N/u. mber
The information you provide may be used by other government agency programs ❑ Check if r ~n e. pp .vii plic Lion
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
I,da ?IT `Gi/4S ) 1/4, S - T 3Q , N, R E (or)6
Property Owner's Mailing. Address Lot Number Block Number
AN7- o .acre
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE F BUILDING: (check one) ❑ State Owned 0 C, y Nearest Road
❑ Mi!trage
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 20 7,Li
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 6 3°2- 6 - ~O
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting 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 JaMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43E] 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
S6Q Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) r ! Elevation
BOO G'L Feet Feet
VII. TANK Capacity
INFORMATION in gallons Total # of 's Name Prefab. Fiber- Plastic Exper.
Gallons Tanks Manufacturer Concrete Con- Steel glass App.
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank -A. 15-do Z6 t TeY ❑ ❑ ❑ ❑ ❑ --4r- we s Lift Pump Tank /Siphon Chamber 44,d e) ❑ ❑ ❑
❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number:
r -lea
Plumber's Address (Street, City, State, Zip Code):
Q'
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Alen t S re (NOS ps
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination j~x✓~/ ~/C37 4 c,._-
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruil,linga Divmion, Owner, Plumber
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 this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply-
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted.to the county The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; Water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards-
- - - -
I SAFETY & BUILDINGS DIVISION
arn~.
State of Wisconsin
Department of Industry, Labor and Human Relations
June ?9, 1995 201 Last Washington Aver(ue
F', 0. 80Y 1969
Madisor; Wi 5370;
ULBRICHT & ASSOCIATES
ROBERT ULBRICH]
655 O°NEILL ROAU
HUDSON WI 5401b
I
_ RE: PLAN S95-01891 FEL RT .t.IVt:l.t: 180,00
APPLE RIVER HIDEWAY
NE,SW,2,30,19W
TOWN OF SUMMER SET COUN1'r Cif '~l CROIX
MOUND SYSTEM
The Department has reviewed the above--referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin `statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. lhis system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters Mik 'SO--64, Wisconsin
Administrative Code.
Th s_.plan submittal approval will exp two years iro+n the approval date, or
if a sanitary permit 3s obtained, plan approval will expire on the day the
initial sanitary pernrrt expires. The 1 irensed plurnbr~( responsible for this
instal.lation shall keep one set of plans with the Department's stamp of
approval at the construction site. l-he installer shall notify the appropriate
inspector when inspections can be made,
A11 permits required by the City, village, township rr county shall be
obtained `prior to installation.
Inquiries should be directed to rrie at the number listed helow. Please refer
to the plan number shown above.
Sinc:-rely,
v>n . th St.iemko n L
Pla Reviewer GIN
Section of Private Sewage, 0
(608) 266-8230 7:00 to :3:45 Mon. the, Fr',
S11DA-7987 (R. 10184)
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road 9 Hudson Wl 54016 Reg. Designers of Engineering Systems
715-386-8185 ' Private Sewage Consultants
PROJECT INDEX S95,-01897
DILHR Plan I.D. # 595-01897 Date June 29. 095
`
Owner Apple River Phone
715-247-3452
Steven Montbriand. Hide-away Resort
Address 710 170th Ave. Somerset, Wis. 54025
Legal Description Part of 95 acres. NE 1/4, SW 1/4, Sec.2, T30N,
R19W.
Town of Somerset County St.Croix Cty.
C.S.T. Robert Ulbricht CSTM2482 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept. & Wis.
PROJECT DESCRIPTION Dept. of Health & Social Services
An Apple River "tubing" resort (Apple River Hide-Away)
has 100 tent & R.V. camp sites. The sites are currently being
served by code compliant approved priveys. However, the Wis.
Dept. of Health & Social Services is requiring all campsites
to also provide a sanitary vehicle dump staTION.
s
Even though most of the said 100 sites are strictly for
tents, owner is providing for the flow from each site. Over-
estimating, each site will be rated C 5 gal/day. Total estimated
daily wasteflow for design purposes will be 500 gals.
Soils are very permiable (.7 GPD/ft2) for "beds", but
seasonally saturated at 34". For design purposes, a loaDing
rate of .6 GPD/ft2 is recommended, and system is designed as
such. A long curved mound type system is proposed.
s,4Nt*T,gRY J h)/-if STA1r10t,)
Pg.l PLOT PLAN VIEWS
9
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS
Pg.3 PIPE LATERAL LAYOUT
! Pg.4 DOSING CHAMBER CROSS SECTION co
~a
Pg.5 PUMP PERFORMANCE SPECS A RON" I
Pg. 6 WATER TOWER SPECS a M160
HUDSON.
Pgs. 7&8 DRAIN HATCH/BASIN SPECS q, I G~
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-r01-AL Of-:-"opk Uor E-- S95.01897
12, ke
_ P R
\ 1 1
To
7° Fr
~ P
\ R -3,0 Fr
X 670 INcNEs
FoRcE MAk3
~s Fr. 2 of PVG y INGNES
VRRi*A(3LE
'Di ST^~ C~
TOTAL V(9(D UOJUME -z1,11 GA15.
I
H olE ~D,AmE:TE R /y I)JCHe5
LhTePAL I 2 INc"e5
MAWFOLD 2 ►NCI~~s
Tw I►JG~ES
1VATe S 5 PE q ZuvERT' ELEUAT1o►J
PR /
conditton.G1flY op LATE IeMs
oft ED
v ta'~IOAS
wn %
S tAso% 01NG
,,NOpSZS~ ~ Ej'l pM
p AF
~v%slog qp
~NGE 'DE T^% u p c L
EE CORaE N~ PE R Fo R ATE D P ~ P E ® .r--~
• - J \
MovE All DRit1 BURRS Y
.
S95-0189'7
PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOMS P4 ~f OF S
-VENT CAP
4`C.I. VENT PIPE WEATHER P APPROVED LOCKING
JUNe1S MANHOLE COVER
?-5' FROM DOOR. ~11A C,W/ lvl~/fN1oC~ 1i9/3El
WIUDOW OR FRESH 12p~V . ally I
AIR INTAKE Ca itI
pr /ON 4"MIM.
lip N R~ ~ 18" MIW.
2 ~
I! 3(9 011Sy'~e~ 6 4
IE v~+rl o ti ~s 11~
, o14o
/ ~ - - -
f oqrQ INLET ~ORRE p PROVIDE I I
~ AIRTIGHT SEAL I III
I III
APPROVED JOIWTS
APPROVED join'A INy~~rJ K I I III W/C.I. PIPE
w/C.I. PIPE I Y~ ~U yy~~ I II EXTEMDIUC, 3
EXTEtJDI11G 3 0~ ~V ALARM ONTO SOLID SOIL
O/JTO SOLID SOIL B ~~0~' 3' 1 I II
yo I I
Om
C
ion ~z I .
ELEV. FT. PUMP OFF
r
D - 9z
D p1~~ BLOCK
god
f
~E
RISER EXIT PERMITTED ONLY IF TANK MAIUFACTURER HAS SUCH APPROVAL
SEPTIC E 5PEC,IFI'CATIQUS
DOSE TANKS MANUFACTURER: /4'l/1 PJ,5,STEPi A) PPE ~~9S7~!o. IJUMBER OF DOSES: '3 PER DA-4
/&7
TANK SIZE. GALLONS DOSE VOLUME
S-J. ELECTP-0 INCLUDING BACKFLOW: GALLONS
ALARM MANUFACTURER:
MODEL .IUMBER: T~N~r fl~>K'7- -W X01 f~W CAPACITIES: A= ZD INCHES OR GALLOWS
SWITCH TYPE: he! I?cUt?y F-)OAT" 8= Z INCHES OR GALLONS
7 INCHES OR GALLOI IS
PUMP MANUFACTURER: GovLy r- _
MODEL NUMBER: /NEB 3~~L /3 I,r 1 D= INCHES OR 2'25 GALLONS
SWITCH TYPE: P(Iff BAC1- Mf:R(VKY /DAT- MOTE: PUMP AMD ALARM ARE TO BE
INSTALLED ON SEPARATE CIRCUITS
MINIMUM DISCHARGE RATE GPM
VERTICAL DIFFERENCE BETWECU PUMP OFF AND DISTRIBUTION PIPE.. ~',o FEET -rAA)k SMEGS
2.5 FEET 6A(( A, ~t P t
4- MINIMUM NETWORK SUPPL9 PRESSURE .
loCTIOU FACTOR.. - = FEET Z
-.z- FEET OF FORCE MAIN Y, y 0' F/o ptFRI ~Ur ~S
+ o
TOTAL DtJUAMIC. HEAD YFEET r
r..~u• CAIf_TN D Z -WIDTH ;LIQUID DEPTH
' a
X95-089`
Submersible
Effluent Pumps
3885 ~
AVAILABLE CERTIFICATIONS
ETL LISTED SUBMERSIBLE PUMP 0
CLASS :,AND 11 DIV. 2 AND
CLASS 111 DIV 1 AND 2
ETL TESTING LABORATORIES, INC.
CORTLAND, NEW YORK 13045 G1086131480
CANADIAN STANDARD ASSOCIATION S P
PERPORM ANCE RATINGS (gallons per minute) MODELS
WE0511H WE0511HH Series HP Volts Phase Max. Amp- RPM Solids WI. (Ibs.)
series WE0512H WE0712H WE1012H WE1512H WE0512HH WE1512HH WE0311L 115 9.4
No. WE0311L WE0311M WED532H WE0732H WE1032H WE1532H WE0532HH WE1532HH WE0312L 230 4.7 1750 56
WE03121 WE0312M WE0534H WE0731H WE1034H WE1534H WE0534NH WE1534HH WE0311M /3 115 1 9.4
NP % '/3 /z 1 1'/z WE0312M 230 4.7
RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0511H 115 13.0
5 100 70 80 9; 106 - 60 - WE0512H 230 6.5
10 80 65 76 87 102 112 56 84 WE0532H 2081230 3.4
15 60 57 72 84 100 108 53 82 3 1.7 WE0534H 460
60
20 36 45 65 79 95 105 48 ' 77 HH 1/2 115 13.0
_.25 25 5749f 91 100 WE051
45 75 WE0511HH 230 1 6.5
S 30 50 67 85 96 40 72 WE0532HH 2081230 3 3.3
3 35 40 61 79 92 35 70 WE0534HH 460 1.65 3/,°
5 40 26 52 72 86 30 67 WE0712H 230 1 10.0
45 10 43 54 80 25 64 WE0732H_ % 208/230 5.4 3500
50 30 54 73 18 60 WE0734H 460 3 2.7
17 42 65 12 58 70
55 54 WE102H 230 1 12.5
" WE1032H 1 208/2 ✓230 7.0
6 30 16 54 40 51
3 WE1034H 460 3 3.5
70 5 26 47 WE1512H 230 1 15.0
75 14 43 WE1532H 208/230 3 9.2
90 4 40 WE1534H 460 4.6 80
90 33 WE1512HH 1 /z 230 1 15.0
100 24 WE1532HH 2081230 9.2
-110 15 WE1534HH 460 3 4.6
120
metal parts, BLINA-N
elastomers. METERS FEET
• Temperature: 1600 F (71o C) so 1
maximum MODEL 3885
.
• Fasteners: 300 series 25 eo SIZE 3/4" Solids
stainless steel.
• Capable of running dry 70 WOW
without damage to 20-
w 1
components. 0 60-► s~Pnn
Motor: weo I _ 5 i
s
• Single phase: 1/3 HP, 115 or a 15 50 '
230 V, 60 Hz, 1750 RPM; o WE05H
40~ I
1/2 HP, 115 V 60 Hz, ,
3500 RPM; 1/2 HP through 1o 30
WEO
1 ..i ~ 1 i
11/2 HP,230 V, 60 Hz, 1. 1. .
3500 RPM" i WEO3L ~ ! .
ti 1~orrnri•te Tube Company
Romort
05400 WATER TOWER VACUUM Df1EAKEn
rr (USE OS4Is nEPAIn KIT)
-0189'
\OS400 urPEn 9 5
NOSE ASSEMBLY
OS406
AnM PIPE
s 6°
OS413 PIPE
BUSHING
OS433 SETSCnEWS (2)
OS430 HEAD SPIIING
OS412 INSIDE ASSEMBLY
10'4" 140SE ASSEMBLY -
IOS4OS TOP
JIIEAD CASTING
L4 OS404 HEAD SPnING _
OS403 BOTTOM - - ` -
11EAD CASTING i~
L OS433 SETSCnEWS (2)
05413 PIPE
BUSHING
OSf14 UPPEn
PIPE
~ I
O OS402 BODY PIPE /
/OS43S NOZZLE {
i ASSEMBLY
054 1S SHUTOFF VALVE
' I
ti
S95-01897
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Wisconsin Department of Industry, SOIL AND SITE E V A L U Page - of 3
Labor and Human Relations . 4!
Division of Safety & Buildings in accord with ILHR 83. S. Adm. CQ4
Attach complete site plan on paper not less than 81/2 x 11 inches in siz . stipclude, bu~
not limited to vertical and horizontal reference point (BM), direction and to or. LLD. #
dimensioned, north arrow, and location and distance to nearest road.
7EWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO
PROPERTY OWNER: 1~P19/E A01'1169- 11119E • Aw,}y APIE'SePT P
ST V,---_/ /110N T,6R i',4Nj~ GO w 1/4,S 2 T 319 N,R E (or~W~
PROP RTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
/719 -fe, ifVZ . /'f1RT °F ifGreS
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEAREST RQAD
~j''r~ '
50AfE,pSE T zi, 519,0 ZS (7/5) z y 7 - 3 X -2 So.NE,es~'r- 70
[New Construction Use[ ] 5 s r~ r~ oti, U"/" ( ] Addition to existing building
[ ] Replacement [ Public or commercial describe A00 5Pi14F5 - ot!'~y e~~yP s1rE5
Code derived dairy flow SDD gpd Recommended design loading rate - 6 bed, gpd/112 ~ 7 trench, gpd/ft2
Absorption area required -//7 bed, ft2 y/7 trench, 112 Maximum design loading rate - 7 bed, gpd/ft2 - 9 trench, gpdtft2
Recommended infiltration surface elevation(s) see ft (as referred to site plan benchmark)
Additional design / site considerations s' rE ,sue; ir,C~l o,v y Foe i*-loy_vD T yoE sYS TEi~-r
Parent material C Z Flood plain elevation, if applicable ft
v
~
s = Suitable for system CONVENTIONS MOUND IN-GROUND PRESSURE AT-GRADE DE ❑ SYSTEM ~L ❑ S HOLDING ~TAW
U = Unsuitable for s stem ❑ S 20 CC'S ❑ U ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boux~ry Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
l O-/ /o y,1 --711- /s /mar al s s Z _F .7
2 da-30 /a ,t° 3/2 1S
Ground 3 34 - ~Yp /o yle Sly ~s S , 7
elev. / C Z .
615 ft. 7 0' /O y y
Depth to 1
limiting
factor
ySS
Remarks:
Boring # [ L2-17 /0 0312- 15 14,
yiP ~S S Z f -
s 7
21 /0 Y1? 3/~ es,
2 33
7
3 3 - yG 7 SY/? y16
Ground I
elev. - 7, 5- S/ -7, Sr 511 fi
Depth to
limiting 3
factor
yr$5 Remarks:
CST Name:-Please Print 0 (3 E R 7- -24 L_G R t C 14 T Phone: 715 _ 3F 97
Address: "y 1~jr e517.1_1 1-'T Z
o:___....... uk.twht it Assoc a e8 Date- CST Number:
PROPERTY OWNER s' ~4NT/3~igND SOIL DESCRIPTION REPORT Page 2- Of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tn
::3>: / 0-2 z /o yle z s ~
.,..n.. z 2z 37 /0 3/z 15 ~ifyi G/S a s /`ic . 7
Ground 3 7 .2, 5% / c I `l 5 S { s6~~/ Q S N N
elev.
/07 6S ft. ~D yX S, vie C 2 s d, S o"
Depth to
limiting
factor
Remarks:
Boring #
0-/1- /o
L x-10 /o Y 3/2 S ~s S zf 7
Ground'
Z
elev y 70 /4~ C-
~n
/off 05, it.
S yP 5/e
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
mot......:::.>:.:
Ground
elev.
ft.
Depth to
limiting
factor
,4pp/6 kwtER h~~vE= ~tw y
PROPERTY OWNER S, 104N7-13O'14NP SOIL DESCRIPTION REPORT Page ?of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence EkxxdEty Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
3 / 0-22- /o R ;/-2- = ""7
Z 22 37 /O 312-Ground 3 J~ 1, S% / Y S S S6ir"f / Q S u
elev.
z AL
C S a, S
yle , -I I
/07 ! ft. 7 /O
Depth to
limitlng
factor
Remarks:
Boring # 1,60
L -10 /o Y 3/2 S 140 WS S 2- 7 /0 Yl
Ground
elev. G 2 P -
rift. ~n
10f.
S/8
S YR
Depth to
l mitlng
face
i
Remarks:
Boring #
I
F'm J-
Ground =
elev.
ft.
Depth to
limiting i
factor
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
pp-
a 1
1y' , pV 1, Q
v ` WQ
hVI
e ~
N-4
M
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6 rr
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LU IS(
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER S y e,rJ Za ,y'71''h <<w
MAILING ADDRESS 710 l 7 G 7% 14 V c So m c r^ s 42," 5S ,lD .1 S`
PROPERTY ADDRESS e
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Sc m a -e'7- W i
PROPERTY LOCATION 1/4, S' GJ 1/4, Section T _?41 N-R__ZZ_W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION d~a d F 9 s c w 3 LOT NUMBER
CERTIFIED SURVEY MAP I 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 xpiration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property S T8 L~ J ~1?a,y tb Q. +~G!~
Location of property,( 1/4 5e;J 1/4, Section , T Se N-R~W
Township S~ ey'~Mailing address /d l7d f'LI
Address of site
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel ~S aa y, a'
Date parcel was created
Are all corners and lot lines identifiable? Yes _,k_No
Is this property being developed for (spec house) ? Yes _,,&'_No
Volume '.70d and Page Number 9;? as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER 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. ~y 7G 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
DOCUMENT NO. iTATE BAR OF MISCONSiN-FORM It
LAND CONTRACT-Individual and Corporals
PAGE ? 27 THIS SPACE RESERVED FOR RECORDING DATA
VOL 700'
397693.
MISTERS Off'1GE
CONTRACT, by and between Frances Hinz Sir C"X CO., WIS.
("Vendor", Aald. JW ROCOM INS 9th
whether one or more) and Steven S. Montbriand _ day of NOV A.D. 19 84 L301
►
A A
("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
In St. Croix Colrnty, State of Wisconsin:
RETURN TO
James F. hammers
P.O.Hoat C
Stillwater, MN 55082
Tax Key No.
An undivided one--half'interest in: That part of the Southwest Quarter
(SW4) of Secti<,n 2, Township 30, Range 19, lying Southerly of the
Apple River, subject to flowage rights, lying and being in St. Croix
County, Wisconsin.
j
S116 .
homestead property.
(is) (is not) •
Purchaser agrees to purchase the Property, and to pay to Vendor at - Vendor' s de.5ctnation
the sum of S 120 , 000.00, in the following manner: S10#000-00
at the execution of this Contract, and the balance of S 110, 000.00 together with interest from date
hereof on such portions as remain from time to time unpaid, at the rate of ten (10 per cent per annum, until paid
in cull, as follows: Monthly payments of $1,061.54, or more,. ccmmencing 30 days
from the date of this Contract and monthly thereafter until the entire
remaining balance of principal and interest is paid in full.
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor payments sufficient reasonably to anticipate
the payment of taxes, special assessments, fire and required insurance premiums. To the extent received by Vendor, Vendor
agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes,
assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless
otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount
may be prepaid without premium or fee upon principal at any time after , 19 Mhete
dcay~4sexm~p~pxpmeta0zo(~aml~Ialxiatthxxnt~nEta>~ssfOn~tf 3Virottotr~x
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the
unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid
principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first
specified above; provided that monthly payments shall be continued in the event of cr:dit of any proceeds of insurance or
condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for
examination except:
► . VOL U PAGE
Purchaser promises to pay when due alt taxes and assessmentsrreMed on the Property or upon Vendor's Interest IN R
~nd to deliver to Vendor on demand receipts showing such payment.' t + ~oo~a` ,
.e>. Purchaser shalt keep the Improvements on the Property insured against loss or damage ocL 1yr;lre, extended%
coverage perils and svcb other hazards as Vendor may require, without co-insutance. through insurers approved by Vendor.
in the sum of =full insurable yal~P . but Vendor shall not require coverage in an amount more than the balance
owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standrrd
clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing. the original of all policies cover-
ing the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lose to insurance companies and
Vendor. Unless Purchaser and Vendor otherwise agree In writing, insurance proceeds shalt be applied to restoration or
repair of the Property damaged, providers the Vendor deems the restoration or repair to be economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property is
good tenantable condition and repair,, to keep the Property free from liens superior to the lien of this Contract, and u
comply with all lads. ordinances and regule'lons affecting the Property.
Vendor agrees that in case the pum.hase price with Interest and other moneys shall be fully paid snot all conditions
shall be fully performed at the times and in the manner above specified. Vendor will on demand, execute and deliver to the
Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens
or encumbrances created by the act or default of Purchaser, and except:
Purchaser agrees that time is of the essence and in case of default in the payment of any principal or interest when
due. of in the pe%form9kce of any of the conditions, covenants, or promises of Purchaser. and such default shall continue
far a period of-_-"-_- days, then Vendor may, at Vendor's option, declare the contract at an end. all rights of the
Purchaser under this agreement cancelled, and the amounts paid by Purchaser hereunder forfeited, the some to remain
Vendor's property as rental of said premises and as liquidated damages for the failure completely to fulfill this agreement.
and Vendor shall forthwith and without notice have the right of re-entry; or, at the option of Vendor and without notice to
Purchaser, notice being hereby expressly waived, the whole amount of unpaid principal shall be deemed to have become due
and payable, in esse such option shall be exercised, the unpaid .principal and interest together with all sums which may be
or have bear paid By, Vendor as herein authorized with interest on such disbursements at the rate aforesaid shall be collect-
ible in a suit at ljvr,or by foreclosure of this contract in the same manner as if the whole of unpaid principal had been due
at the time when anysuch default occurred, and the indebtedness shall.embrace, with unpaid principal and interest, all the
sums so disbursed with interest as. aforesaid. Incase of legal proceedings to enforce any remedy hereunder. whether abated
or not, all expenses, including reasonable attorney's fees, shall be added to the principal, become due as incurred. and in
case of judgment shall be included the:eic.
Upon the commencement or toeing the pendency of any action of foreclosure of this Contract, Purchaser consents to the
appointment of a receiver of the Property. including homestead interest. to collect the rents, issues. and profits of the
Property, during the, pendency of such action. and such rents, issues, and profits when to collected shall be held and
applied as the covet shall direct
,__AA4r.
I I-, All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors
and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse'of Vendor for a valuable consideration
joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made
in fulfillment hereof.). r1
Dated this day of 198 4
~._(SEAL) (SEAL)
France Hinz `
s
(SEAL) (SEAL
AUTHENTICATION - ACKNOWLEDGMENT
Signatures authenticated this f~ day of STATE OF WH;CWgW.innesota 19A as.
l Washinni_on County.
Personally came before me. thisday o
the above named
a
Tr.LE: MEMBER STATE BAR OF WISCONSIN Frances Hinz and Steven S.
(It not, Montbriand
authorized by 1706.06, Wis. Stets.)
This instrument was drafted by
to me known to be the persons ho executed the fare