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Parcel 032-2095-30-000 05/11/2005 07:42 AM
PAGE 1 OF 1
r
Alt. Parcel 23.31.19.927 032 - TOWN OF SOMERSET
Current X, ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
JAMES L SALLEY " SALLEY, JAMES L
2021 60TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2021 60TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 7.010 Plat: 2442-SERENITY
SEC 23 T31 N R1 9W PT NW SW LOT 3 PLAT OF Block/Condo Bldg: LOT 3
SERENITY EZ-UT-1205/51
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/01/2001 647106 1651/214 WD
07/23/1997 1175/22 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.010 68,200 190,000 258,200 NO
Totals for 2005:
General Property 7.010 68,200 190,000 258,200
Woodland 0.000 0 0
Totals for 2004:
General Property 7.010 68,200 190,000 258,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 304
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER y R Q q I'~ N Q Q
ADDRESS
4~ S? 1
SUBDIVISION / CSM# LOT
SECTION a T N-R_W, Town of S0 W, 'K ?
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 01
181160
(~Q
a fokcr M4i'AJ
I i
~u V PVC
I s 9?A tX000 ypl 5i-; C ar
1200 P t p C 3 av
ovr(.
INDIC TE N RTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK: Too J 111 SP h l P~
vU•U
ALTERNATE BM- Q,, a y~ o
S1 D; N
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: kS
Liquid Capacity: ~UU Q 1
Setback from: WellOvtC-
House I Other-
Pump: Manufacturer ~o 2 l I p
Model #Size
Float seperation a"
Gallons/cycle:
Alarm Location
/ov oUSQ
:SOIL ABSORPTION SYSTEM
Width: ~
Length S
Number of trenches
Distance & Direction to nearest prop, line:
Setback from: well : GU4K So House
~~pooR ~9.8`I 44'.ey ~p1 ~5 5 other
NZNG^ MonK s.3a
~Np oRiyiWO) ore r oo a o
euoh
ELEVATIONS S!'o;Ng p b
Building Sewer -
ST Inlet. (pj 9. g ~ ST outlet
PC inlet 89.78 PC bottom
0 y~ Pump Off
~ Header/Manifold
Bottom of system ~ S.SU
Existing Gradep
Final grade
DATE OF INSTALLATION: ' 19
PLUMBER ON JOB:
LICENSE NUMBER:
3 ~ a J 'i
INSPECTOR:
3/93:jt
A
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
'I Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
P LAN66'J N~g.G ❑ City ❑ Village IR Town of: State Plan ID No.: '
LAN E GGKK
CST BM Elev.: / Insp. BM Elev.: ~ BM Description: Parcel Tax No.:
/
TANK INFORMATION ELEVATION DATA /O/z
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing ~1~ ~/r t~ aG S 301 9~.1o b'
Aeratio Bldg. Sewer
7~
Holdin St/,~C in
TANK SETBACK INFORMATION St/ WOutlet S~' $(o SQ
ventto
TANK TO P/ L WELL BLDG. Venttake ROAD Dt Inlet
Air In
Septic S-0 /I A NA Dt Bottom
Dosing NA } aii/Man.
Aeration' NA Dist. Pipe
Hq • Bot. System
PUMP / SIMM INFORMATION Final Grade (a sQ S, S~~
Manufacturer Demand
Model Number GPM r~r . i 5,~ 7
TDH Lift Lriction SYetedmTDH Ft
Forcemain I Length Dia. ~ Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tr niches PIT No. Of Pits In si iquid Depth
DIMENSIONS DI
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEAC ING
INFORMATION Type O newer CHAMBER Model Number:
OR UNIT
System: ~anV;
DISTRIBUTION SYSTEM
Header Rdarrifofd' Distribution Pipe(s) x Hole Size x Hole Spaci . ent To ntake
Length TC;- / Dia Length `-jz Dia. `t Spacing CG
SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ys
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOME ET.23.31 19W NW SW 60TH ST
1` Q fIn'Zx Fly M v T i^ 4
f r/Y12,~1 A C t
-t ~~.,.Cdr1 .
v i
Plan revision required? es ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
SANITARY PERMIT APPLICATION Bureasafetyu o oand ff Builuilddinng Waater Systems
teri 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 81/2 x 11 inches in size. (r O' I
• See reverse side for instructions for completing this application State Sanitary Permit Number
a~~a
The information you provide may be used by other government agency programs eck if revision to previous application
[Privacy Law, s. 15.04 (1) (m)1.
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property ner Name Property Location Q~
'Q F,I~ ro N k.~1 /4 S k 1/4, S T 3) , N, R 1 E (or) W
Property Owner's ailing Addikks Lot Number Block Number
C, State ZipCQ~ie ~ Phone Number SubdivisionNaQieerC~SMNu ber
O r 2'e- e lt! V ( A
II. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms o Towan OF 6Me 0+-L St
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo ) 3,A - U 7 S-
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. tgNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
______System ________System Tank Only______________ Existing System _________ExistingSyrstem
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
Rewired (sq. ft.) Proposed (sq. ft.) (Gals/cl y/sq. ft_) (Min./inch) Elevation
1.5® vV 7()(3 • 5 5 9 -50 Feet M b Feet TANK Ca act
VII.
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. Site
New Existin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank 1 - Ola j Q S ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamberl I I ,66 -f ❑ ❑ ❑ ❑
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) /MPRSW No.: Business Phone Number:
.Tire, Biu A-Afz ~ MP TS - A ' N
Plumber's Address (Str et, City, State, Zip Code):
0_7 0 3~5 bra s C U j
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signa a (No St ps
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05194) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUC=TIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any ne,.rr 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-
V11. 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 isto fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than-8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water Systems
In accord with ILHR 83.05, Wis. Adm. Code 201 E. Washington Ave.
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 81/2 x 11 inches in size- _57~ &0
• See reverse side for instructions for completing this application State sanitary Permit Number .
The information you provide may be used by other government agency programs E] Check if reGislon o revlicati
on'
{Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Pro erty Owner N me Property Location
&1114 5a)1/4, S a3 T 3 , N, R/9 E (or) W
Property per's Maili Address Lot Number Block Number
Cit State Zip Code Phone Number Subdivision Name or CSM Number
J71 P 1.5 P_ i -r S ( > ' 1 L5, r,& A II. TYPE F BUILDING: (check one) ❑ State Owned E] City Nearest Road
,
ile /0%
Public 1 or 2 Family Dwelling - No- of bedrooms o vowan OF D
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~j
1 ❑ Apartment/ Condo ~~02 ~oS - 3d
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. , New 2. Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. E] Repair of an
------System System Tank Only______________ Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11tIlSeepage Bed 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
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
`15o loo Req reed (sq. ft.) Pro b d (sq. ft.) (Gals/da /sq. ft.) (Min. inch) E tion
S,SU Feet Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Plastic Exper.
New Existin Gallons Tanks Concrete st ucted Steel glass App.
Tanks Tanks
Septic Tank or Holding Tank 000 1 ee k
U E
] 1:1 1:1 ❑ 1:1
1
Lift Pump Tank /Siphon Chamber El ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Pber's Name: (Print) Plumber's Sign re: (No Stamps MP/MPRSW No.: Business Phone Number:
-de r - 103 /,,5 7. 0
Plumber's Addr s (Stre t, City, Sate, Zip Code):
G(J~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapprovednitary Permit Fee (Includes Groundwater E-0,xv- te Issued Issuing Agent Signature (No Stam s)
A roved Surcharge Pee)
pp E] Owner Given Initial ON
~i
Adverse Determination 7Xo jk/~Xz 44
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
3
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 13 if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
', •:
.:
P 3. L �� 7 DLOT AN ! , HQ5 S `) I- (, I I �. � \.
: .., PRn J L: C I _._...... ._ P L, UV.b .H
NAME .Lad ......_� . N A I Erin -au -. /-
I,�. o c ,n I �� ��.,�. �- v c E N s =1 -
I" - ____..__. .._. : i. . :4 - .... DATE, _...... _ ____.._.
•
r- P L 0 I M A P
I BrIf4 c1 / 1. Tory i Sf t1 ripe L= WWO, 0
Co',i �30 .�y,
Ut l;tjcs * '' Note 11001 ; s fAittLeg k .So' r • f. toas t
• P y� M
—`— - A66Acr la `s (de)1 r IS l'Ac,.kt.irt -1- 1
Qe 012.00 ram,
I ►wt.e
310 'a' .
•• 1oao ,)
va • • cs, .,r 1<
O 50' % cIJpNou-t` /yd
SW • 1
I a 1,
19, AltW1eM
I 4 a �, 3o ,L . 3 4,' -30' - I73' fd.
r. 0 I I ` 6' lot I It+s t
• q AlJ
. e1
'her.)c,I-1 ryIAKK
•
N.
T
_ . ______
, FRESH All: INLETS AND OBSERVATION "PI.PE
CIIOSS SECTION _
.T\ Approved Vent Cap
Minimum 12" Above r �'A
Final Grrlfle___ __i
99,80
1
i
4 " Cast Iron
Above Pipe Vent Pipe
To Final Gracie-- •
Marsh Ilay Or Synthetic Covers ny
•
•
Min . 2" Aggre(pi I
Over Pipe \`, v... I --`J .
Dis tribu Lion — .___ Tee `
•
Pipe _.. ....,I `���� i
30i-ar, OA Aggregate V �_._ Perforated Pipe Cc1o .,
Ilencath Pipe e. --Coupling Terminating r
rS �O _ ' .`!... . ._ . Bottom. of System..
'
.�......._. ._.._ ... .. .. .... . .... ......_. ....... ... . ,w.w r.... . r r. �.
1_0..1 2. LOT 2
CERTIFIED SUR-? N
VOL 7, PG. I
TI-I STREET
N00°000911W 1246.53'
TO THE (A PUBLIC
— — — — — — 420.00' — — — 66.0
— — N00°00'09"W 1246. 33 — —
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1
Wiscbnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and'Human Relations
Gvi&ion of Safety & Buildings in acco 05, Wis. Adm. Code
8 COUNTY
Attach complete site plan on paper not less than 1 inches in siz JG ust include, but ~
not limited to vertical and horizontal reference dir@S4ion %,o p , scale or PARCEL I.D. #
dimensioned, north arrow, and location and dis to nearetkoa
APPLICANT INFORMATION-PLEASE PI R f~dFORMAN REVIEWED BY DATE
PROPERTY OWNER:, 07TY LOCATION
r OT 1/4 1/4,S T N,R V(or&
i
PROPERTY OWN ':S AILING A DRESS L # LOC # SUBD. NAME OR CSM #
14. ~~Ajzz!e
CITY, STATE ZIP CODE 'HON ❑CITY LLAGE [MOWN NEAREST ROAD
( q
Z 2.r- 7- ?
New Construction Use_f Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow :6Z gpd Recommended design loading rate r,5-- bed, gpd/ft2 ~ trench, gpd/ft2
Absorption area required f_ bed, ft2 _ trench, ft2 Maximum design loading rate , S bed, gpd/ft2-Z trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material - Flood plain elevation, if applicable ft
rj-
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S ❑ U ® S ❑ U ® S ❑ U [0 S ❑ U ❑ S 1Z ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
Ground
elev.
2W ft.
I
Depth to
limiting
factor
Remarks:
Boring #
Ground 7 ,
elev. _
~&L ft.
Depth to
limiting
factor
? 9~
Remarks:
CST Name:-Please Print Phone:
Address: 1
Signature: ' Date: CST Number:
PROPERTYOWNER~ 4ewdSOIL DESCRIPTION REPORT Pageof
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundEry Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
14
Ground
elev. 1
Depth to - -
limiting
factor
> 9~
Remarks:
Boring #
Ground Z-Z
elev. -
-Z/ tq'q'- Z 5'
2~ ft.
Depth to -5
limiting
factor
y 9/")
Remarks:
Boring #
kti;:Qi::4:•i:•iii:•i: ?
.t..
7
Ground
elev. -
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
~j,`~: r~l ~~'to✓7` ~GJ~ ,$'yJ ~j~~ see o~3 ~//~Gt/
a
b
G,S1,bi a3~~
3i6
~6, ~c' /f/wk
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
^Gi
MAILING ADDRESS !v~ I ` S7-, /VdSo~r LfSC ,
PROPERTY ADDRESS CCO ~ 'Y12 Q^S~
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE ~o~le►^Se]~T Wsc
PROPERTY LOCATION 1/4, 1/4, Section J.3 T3, _N-R
l? W
TOWN OF'_ 53Mnrz5 e ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER -3
CERTIFIED SURVEY MAP _ , VOLUME PAGE 3 c--), LOT NUMBER 3
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: ~T
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
v - L V V
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 C_
VREG L.
Location of property IUW 1/4 SOJ 1/4, Section 9-3 , T_3LN-R 1 Q W
Township . c~ YK4S ~ Mailingaddress (S'[~. qTk gj-,k
Address of site
Subdivision name Lot no. .3
Other homes on property? Yes o
Previous owner of property s7L-re ar"_A~
Total size of property 7. I AcecS
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? K Yes' No
Is this property being developed for (spec house) ? Yes o
Volume` a- and Page NumbeANW 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 tn'avoid
delays of the reviewing process. If the deed description
references- to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. s Y'%30 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 o fice of the County Register of Deeds as Document No.
Cj
Signat of icank/ Co-Appf"Ic.ant
Date of Signature Date of Sign tur-.
STATE BAR OF WISCOti ' - 1yt32
454ZUO NVARRANFY DEER
P~-, 4
DOC')h1ENT NO. IT,
Steven A. Parent a,d Patricia C. Parer._. -Zkla _
s yi and wife~__ APR 29 )t)t~ #
Patricia Parent
fig
11:15 A. conec)s .ncl warrants to ('iCe Or J. Lancer, a Sin-gl son•-
tHiS SPA,:F RE;ERVED OR REiIORiANG ;;ATA
NAME AND ADDRESS
St. Croix Couny, -
u,c fullo%cing descnbed real estate in
State of Wisconsin:
032-2095-30
PARCELCENT:F:CATiON NUMBER
Lot 3, Plat of Serenity in the Town of 5zrnerset, St. Croix County,
Wisconsin.
Y
TRA ` a ER
7• s
i
This is not homestead property.
{ (is not)
Exception towarramies: Easements, restrictions and rights-of-way of record, if any. ~
:c •
Dated this day of 'March , A.D., ly 96
(SEAL) - /1 C c t G-4 (SEAL)
Steven A. Parent _ ?atricia C. Parent, a/k/a Patricia Parent
y (SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Steven A. Parent, Patricia C. State of Wisconsin,
ss,
Parent, a/k/a Patricia Parent
a County
authenticated this day of March 19 96 cersonally came before nie this - day of
'1 - 61t4 19 the above named
s
. Kristina Og and
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706 06, Wis. Stats.) : r wrli, be ihe)person who executed the [on gang
D 1 I A 1 ~ ~ i r 4 _u kn mledoe the sane.
~t Pan „ 10-0015/10-0016 !
M T he alarl7l package features a six inch double magnetic bell with
either 115V/8V or 230V/8V translormer for mounting on a standard
Alarm Package Sylstem. When the A-Pak is utilized in a simplex system, 10-0225 - The A-Pak is used in a duplex Mercury Sensor float Switch is needed to actuate the alarm.
Utility
i box is not included. UL listed components, CSA approval available.
10-0053
"A-Pak" Alarm System consists of metal panel with light, horn, sensor
Q float and water proof cable splice kit. 120V/12V. NEMA 1, UL listed )
and CSA certification on entire alarm system.
10-0028 (115V/1 Ph) "A-Pak" Residential alarm system features a 254" bell with I I5V/8V. NEMA 1, 10 0053
10-0015/10-0016 transformer for mounting on standard utility box. Includes mercury sensor float switch to activate alarm. i
tt
HEAD/CAPACITY CURVE
W SEWAGE and DEWATERING
WARNING: Modal 293 should not be subjected to less than 1S last TOM.
2• 80
7S '•r\ i MODEL I I I 1 - _
22
70 I V 295
2 6S
0 , f I t I
MODEL
60
U
16
its
I++
t -
1 t..
34
1/0 t C 14 IS t • ' MODEL - -
I~ 40 293
32 105 1 12
100 OF 10 3S ~T..• \ i - t - ' - - - - - - - - -
_
F
T~
30 30
16 MODEL '
N -r { I 6 20T 2e2 MODEL
292 -
20 15 1--i _T_ -
10 1V M EL - MODEL
11 MODEL 2 262 _-MODEL 294
S 1 1 2N,1e7.2N
leg
76 1 \w ' +
12 0 l0 20 so •o 50 607o 60 90 100 tt0 uo 130 110 190 t90 t70 too 1 9o 200 Ito 220 230
To- t GALLONS
~ (M' i ODEL LITERS 0 6o 160 _ 246 320 400 160 660. NO 720 906 sea
u \1\ }
165 FLOW PER MINUTE
Is Go. 3-- 55
t
Mo.
is
1,.. I MODEL ,
u so - lee
14 '6' I I ~-yI HEAD/CAPACITY CURVE
12 40.
MODEL i EFFLUENT and DEWATERING
>f - ! I I 185 WARNING: Model 1e6 should not be 6utalected to teas than 30 teat TON.
30 - MODEL
137.139
~ l , I f i , I -
0 20 r.. i , MODEL i
t I i 161 I 7
1 MODEL a \ , 1
97
.MODELS 1,
s3 ZA9FZZICIT A9
2 _ , ss, i I\ I i. 1 I
6 t0 s7,
s9 i'• I ~ ~ ,
0
GALLONS to 20 30 40 so bat 70 e0 9o too 110 120 130 140 150 160 1 32180 Old MOIers Lane
P.O. Box 16347
LITERS 0 e0 160 240 320 400 lea 560 640 P.O. lie, Kentucky 40216
FLOW PER MINUTE (502) 776'2731
Product information presented here reflects conditions at life o1 publication Consult lactory regarding discrepancies or inconst3tenas•-,.
ti
y 82 PRIVATE SEWAGE SYSTEMS - II
PAGE OF
PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS
VENT CAP
4'C.I. VEkjT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
~ ARCM DOOR,
,d K\ CCW CR FRESH 12'M►U.
AIR ?,'-AKE I
GRADE I Y"MIN.
i
-7 18" hIAI.
CO►JDUIT-- \
11~
PROVIDE
AIRTIGHT SEAL I III ~
IAJLET -7
I III
I~ APPROVED .DINTS
APPROVED JOINT A I III 4/C.3:. PIPE
L C.2. PIPE I III ALARM EXTENO!U6 3'
ICT G 3~ I I I ONTO SOLID SOIL
QNTO SOLID SOIL D I I
I I QN
C I I
I
CLEV. FT. PUMP ,
OFF
r
0
CONCRETE BLOCK
RISER EXIT PERMITTED CNL'J IF TAUX MAQUFACTURCR HAS SUCH APPROVAL
SEPTIC E SPEC.IFICATIOUS
LOSE
TAAIKS MANUFACTURER: ee S NUMBER OF DOSES: PER. DAM
TAWK '!ZE : O C~ _ GALL D~} 5 DOSE VOLUME
S J~ IQC~~C' S Sf~'M INCLUDING BAC•K_~ FLOW: -~^O-GALLONS
ALARM- MANUFACTURER:
MODEL /DUMBER. 1 Lw CAPACITIES: A= INCHES OR ~o GALLCUS
SWITCH TYPE' 1", ~C-u- B =~Q~-INCHES OR ,3I_00 GALLOUS
DUMP MAAIUFACTUR•CR: Cz y C=+NCHES OP. 17S,-,, UU OA_LOUS
%1ODEL NUMBER: 4f D:I_INCHES :R Ql-i V GALLONS
5WITCH TYPE: I • Qr~2.t MOTE: PUMP AND ALARM ARE TO BE
IN5TALLED ON SEPARATE CIRCUITS
MINIMUM DISCHARGE RATE GPM
VERTICAL DIFFERENCE CETWEEN PUMP OFF ANO DISTRIBUTIOU PIPE.. FEET
+ Mi1.JIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2 5 FEET
+ TO FEET OF FORCE MAIN X -~1 F '0"FRICTIOIJ FACTOR-_) FEET
TOTAL O'JMAMIC. HEAD = I - 5 FEET
yr,.
II
INTERNA_ DIMENSIONS OF TAQK: LENGTH -.WIDTH ;LIQUID DEPTH
51G~.:EC:~ LICEIUSE NUMB=R: ~~V / DATE: