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54720`i AUG - 2 X96
CERTIFIED SURVEY MAP R UCO'YRD
Located in Part of the Southwest Quarter of the Southwest Quarter of Section 9, Township 31 North,
Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin; being that parcel described on
Deed Recorded in Volume 1064, Page 508 in the office of the St. Croix County Register of Deeds.
Prepared for and at the request of
OWNERS:
John E. Kelthley and K. Anita Keithley
RR 1
w Somerset, WI 54025
0 Drafted by: Kristi A. Eylandt
W' W 1/4 CORNER OF SECTION 9
U- ~ j 1 (COUNTY MONUMENT) too
W O ,
z ,
Uj 3: N~ FILED
N JUL 2 4 1996 1110
o Z KATHLEEN H. WALSH
o~ UNPLATTED LANDS hegisterof Deeds \9
a St. Croix Co.,
IN
°o j ; l NORTH LINE OF THE SW 1/4 OF THE SW 1/4
ti
q~j 33.00' S 89'58'57' E 1333.43'
%i~ OOL4 1300.43' ----`""0 3 g~
Ni wi M cal TOTAL AREA: 646,005 SQ. FT. (14.83 ACRES) uj
I
3' ARE XCLUDING R.O.W: 625,008 SQ. FT. (14.35 ACRES) v bM g
zi rLLJ i ~ N I I ~ to ~
W I I W U (REC. AS DUE WEST 660') N
w
ww°{ Z z'
g{ tl I= 3~ = LOT w S 89'52'39" W 662.95'
m
S2: T
ZI -1--j I W I N N=
' Q~ O'-
D' 01 Sbo ~I I " 191
o / w~ 4M UNPLATTED LANDS
zI ~ zl I I :31.89' °M +lifi~ ~VED
(REC. AS DUE WEST) N
43.35' cn
N 89'26'34" W 675.24' W
jut 'q !
U-
0
o UNPLATTED LANDS
CROIX COUNTY _z cn
~ w
C.orrt ehensive plarutir
Zoning and V) ' Parks Cominiitee
o
~----SOUTHWEST CORNER OF SECTION 9
(COUNTY MONUMENT) Jf not recorded
within 30 days of
County Section Corner Monument BEARINGS ARE REFE k0&%i 4QteTHE WEST LINE OF THE
of Record SW 1/4 OF SECTIOWj9oWWy6fSktlFba31 N., RANGE 18 W.
• Set 1" x 24" Iron Pipe weighing WHICH IS ASSUMED T041E;AR-44 00'21'11"E
a minimum of 1.13 pounds per
linear foot.
O Found Iron
REC = RECORDED AS -
~ F w~sC
NOTE: The parcel shown on this map is subiect to State, County and Township
STC - 10 4
AS BUILT SANITARY SYSTEM REPORT
OWNER
„fir"5t 3 i
wa
ADDRESS /
SUBDIVISION / CSM
LOT ~
SECTION_ 1-2_T, 2Z N_R_1,0 W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
A&,
0
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center -r
BENCHMARK'
ALTERNATE BM:
arc. iA e iiJll.J
SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well--44/--/)- House
_ _ Other
Pump: Manufacturer Modelfil Size
Float seperation Gallons/cycle:_
Alarm Location 1Z,
,:SOIL
ABSORPTION SYSTEM
Width: Len th
g Number of trenches
Distance & Direction to nearest prop. line:
~~~^G
Setback from: well House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
%Y/may
PC inlet_ Z~ 71 PC bottom_ gl Pump Off
Header/Manifold 7~L Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:'
PLUMBER ON JOB:
J
LICENSE NUMBER: INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
.Labor a Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 268583
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
LUDOWESE, JAY STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/ ,Iva 11100,60
TANK INFORMATION ELEVATION DATA A9600289 /6-'/-
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark AL Z dl
Dosing/y+ ~O it 0 ~4•
Aeration Bldg. Sewer
y
Holding St/ Ht Inlet y~ 43 /
TANK SETBACK INFORMATION St/ Ht Outlet 7, 7~1_ 9~/ a
TANK TO P/ L WELL BLDG. Ae Intt ntake ROAD Dt Inlet o 0.57
3q_71
Septic r/j NA Dt Bottom -/nQi /
Dosing NA Header/ Man. 7 ? G
Aeration NA Dist. Pipe
Holding Bot. System (~y7 9~.0( '
PUMP / SIPHON INFORMATION Final Grade
Manufacturer p llJ Demand
Model Number ~U A L, C (etc' GPM
TDH Lift `riction System2S TDHp.b'~' Ft
Forcemain Length ~1 Diaa Dist. To Well l
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 9,` DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type Of ajU, Mode Number:
System:6uAa OR UNIT
(l~~
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length 6ZP Dia. / /Z Spacing 04
« o? r U
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of -f xx Seeded /Bedded xx Mulched
Bed /Trench Center Bed/ Trench Edges ) Z . Topsoil M"Yes ❑ No O'Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRAIRIE.9.31.18W, SW, SW, 100TH ST
- r e(,ill'("tLe _41
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 0~%' N-;--~ d
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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 C re 8 112 x 11 inches in size. X • Cre 'A
• See reverse side for instructions for completing this application State Sanitary Permit Number
i=?6
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)}. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Prope Owner Na
-171 Property Location
n
1/4, S TT , N, R -E(O
Property ner's Mailing Add ss Lot Number Block Number
r
G ate Zip Code Phone Number Subdivision Name or CSM Number
( )
11. TYPE F BUILDING: (check one) ❑ State Owned it Nearest ad
21 E] VII iage
/
Public JR] 1 or 2 Family Dwelling - No. of bedrooms Town
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo v /
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
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
11 ❑ Seepage Bed 21,01VIound 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.
7Sr Feet 991-12 Feet
VLI. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank - Q 6" ❑ El El 11 13
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, th undersigne , a me responsibility for' s lla ' n f the onsite sewage system shown on the attached plans.
Plu b s Name ) 17PIuber' i : (N tamp MP/MPRSW No.: Business Phone Number.
lumber' dress tree City,Sta Code).
Le
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Age Sign o m
Surcharge Fee)
Approved ❑ Owner Given Initial ~
Adverse Determination ~e
X. CONDI IONS OF APPROVAL EAS NS FOR DISAPWVAL-
Of
-6396 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit 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:
I. 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, re(onnection, or repair.
V. Type of system. Check appropriate box depending on system type.
f
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, nuatimr of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all s(otic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental ; roduct 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.
N
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1st Street 2226 Rose Street 201 E. Washington Ave 1340 E Green Bay Street 401 Plot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P 0 Box 7969 Suite 300 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606
Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614
Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office
where your review was scheduled. Please call any of the listed offices if you need help filling out the form or haq9IG or what i/r(orp~ti~tcL.
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your referent U l~ 1
1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time:
Appointment Date Reviewer Name Plan Identification Number
2. PROJECT INFORMATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Projec Name
City [3Village 52Town Of: County
Project o ation
r
GOVT LOT 1/4, 1/4,8 2 T N,R eUr
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type I (include new and existing tanks)
Up To 1,500 gallon septic tank $110.00
A At-Grade 1,501 - 2,500 gallon septic tank $120.00
H Holding Tank 2,501 - 5,000 gallon septic tank $160.00
M Mound 5,001 - 9,000 gallon septic tank $ 200.00
N Non-Pressurized In-Ground (conventiondq 9,001 -15,000 gallon septic tank $ 300.00 .
Over 15,000 gallon septic tank $ 500.00
P El Pressurized In-Ground
0 Other: _ Up To 1,000 gallon dose chamber $ 70.00 )
1,001 - 2,000 gallon dose chamber $ 80.00
Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00
4,001 - 8,000 gallon dose chamber $120.00
D F1 Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber . . $140.00 . -
P r-1 Public Building Over 12,000 gallon dose chamber _ . $160.00
S E] State-Owned Building Up To 5,000 gallon holding tank $ 60.00 .
5,001 -10,000 gallon holding tank $100.00
Code Derived Daily Flow "Y5 gpd Over 10,000 gallon holding tank . $150.00
Check If Replacing Existing System Experimental System (additional one time fee) Q$33000.00
Revisions To Approved Plan 2 R"IWED.. .
Petition For Variance: Setback QU`510 .90
ij~ .
0 19
Site Evaluation 225
Petition For Variance Plumbing . $225.00
Revision WMA78WGS.. DIV.
0 Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
E] Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 .
Subtotal: / D
Priority Review: Enter same amount as Subtotal:
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee:
5. SUBMITTING PARTY INFORMATION
Telephone No (include area code & extension) Com n' ame/~ VCota Per n
n
2--1 Z
No. & Street Address Or P.O. Box City, Town or Vrll ge, State, Zip Co e
I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers.
2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals
NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually
The information you provide may be used by other government agency programs [Privacy Law, s 15 04 (1) (m)I
SBDW-6748 (R. 09/94) OVER
S96-40901
Private Sewage System Plan Index/Checklist
All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered
by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each
set is signed. Your cooperation expedites your plan review and shortens plan entry time.
Plan ID # Owner's ame
/ A Q ~ I Z) 4 alk-gg
Legal T1yscription ` J Address
CityNilllage/ToCounty
r
Contents Comments/Special Instructions
Page # Included Two copies needed for all
plans
1 Plot Plan
2 Plan View i° S~~L) F7 Return by Mail
3 149,4~eA 5;
4 Tank & Pump/ Q Fax Letter to (County) (Submitter)
Siphon Information Circle One and Provide Fax ( )
D System Sizing (Public)
S F1 Call for Pick-Up: ( )
0 Other
I, the undersigned, hereby certify that the Seal (if applicable)
plans and specifications submitted
herewith were prepared under my
direction and control.
Plumbe si r License/Registration #
d ress city state
Signature
i
For Office Use Only
Attachments:
Application SY$TEHA
Soil & site evaluation ~~lydp~-~E gIAGE
Fee lty
Needed for Holding Tank Submittal: ~~i~~yt ~N~tr.! loft
One copy of notarized holding tank
agreement. (Originals to County)
310tIS
MAN RE1A
Needed for At-Grade Submittal: i NV
Original signed and notarized OF tggUSTBY+ uBOR NO ®U`101t1GS
Application for "Use of an At- IDOL IR M OF AF
Grade"
County on-site p0 t4 0 L_ t, E
One additional set of plans SBD-10268 (N.01/96)
C2
l
. :moo.
~-i yS' p m
i
ILI'
/S~.GS
Designer,
Rote: Non-Woven Filter Fabric
4" Observation Pipe '
~ Dislribv110n Pipe
ASTM- C 33 Sond /
H G Alter. Pas, of
" Topsoil Force Main
E
0. % Slope
Bed Of 2 Force Moin Plowe d
Droin Rock From Pump Layer
D
Cross Section Of A Mound System Using E
A Bed For The Absorption Areo F .AJ
G
A Ft. H
B Z:jFt.
1 Ft.
J Ft.
K_Ft.
Alternate Position L Ft.
of
Force Main ►+'Ft.
L
J 14~Observotion Pipe
mA~fi
o Force Main
W From Pump
c
3
Qo Distribution Bed 01 ;2- 2 %i
Pipe Drain Rock
1
4 Observotion Pipe Permonent Marker
Pipe or Rods.
Pion View 01 Mound Using A Bed For The Absorption Area
PAGE -or 7
PERFORATED PIPE DETAIL
and
DISTRIBUTION PIPE LAYOUT
Perforated Schedule 40
PVC Pipe
End /
Cap
,10
" a r ~C
~a Holes Located On
i~.,•'' Bottom Are Equally
k Spaced
End
Cap
Schedule 40
l PVC Force Main
Last Hole
Should Be
Next To
End Cap
Owner's Name: p feet
Plumber/designer's Signature:
x inches
y inches
Dates License No.: Hole Diameter inch
Lateral Diameter inch(es)
Force Main Diameter inches
Z Holes per Lateral
feet. Invert Elevation
of Laterals
Page 0 f
a~
b
• ro
ON
ro
w
U
ro
A
Ow ~
a p _
U ~ -
r. 0
w v - -
A W - -
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1v~0 n1
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14
a
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a
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ON N a c
b
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i
• PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VEIJT CAP
4*C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
25' FR¢M DOOR, JUQC.TION BOX MAIJHOLE COVER
WINDOW OR FRESH 12"MIU.
AIR INTAKE
GRADE
` 0 MIN.
COQDUIT
\ \ 11,
INLET %PROVIDE
AIRTIGHT SEAL I I i I
If I I
APPROVED JOIA1'f A I I I i APPROVED JOIWTS
w1C.Z. PIPE I I I ( W/C.I. PIPE
EXTENDIU(s 3' I II ALARM EXTEQDI►JG 3'
OgTO SOLID SOIL B I i ( ONTO SOLID SOIL
- I
I I oN
~ I I
I
• PUMP-
• OFF
D
CONCRETE BLOC4t~,
RISER EXIT PERMITTED ONLY IF •TAUK MAULWACTURCR. HAS SUCH APPROVAL
SPECIFI.CATIOUS
i:P71C AND -
pSE TAWKS MAQUF'ACTUR6R: WMBER OF DOSES:' (3-21E
~ER DAy
TAWK LIZE: GALLONS DOSE VOLUME: GALLONS
ALARM MMJUFACTURER: ' CAPACITIES: As a INCHES OR CALLOUS
MODEL WUMBER: B= .ice INCHES OR _ 9 GALLOWS
SWITCH TYPE: C=INCHES OR 1ST GALLOQ5
PUMP MANUFACTURER: 0= IW&HES OR ,7 GALLOWS
IACMEL NUMBER: NOTE: PUMP AND ALARM ARE TO BE
DWIICH TbIPE: IA15TALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE. KATE GPM
VERTICAL. DIrFERENCE bETWEEU PUMP OFF AND DISTRIBUTIOU PIPE., `
.,cAe FEET
♦ MINIMUM NETWORK SUPPLY PRESSURE 2.5~ FEET
FEET OF FORCE MAIN X -&L_F/oo rtFRICTIOU FACTOR.. FEET
TOTAL DYNAMIC HEAD - FEET
1UTERMAL DIMEIJSIONS OF TAUK: LENCaTH ;WIDTH _;LIQUID DEPTH
51G►JE0: LICEWSE WUMBER: DATE:
Performance Submersible EffI ent
curves Pum.nsRE
METIERS FEET
90
MODEL 3885
25 SIZE 3/4' Solids
WE1SH
70
20 WEIOH
80
160- -WE07H
15 50
WEOSH
40
10 30 403M
4:
WE03L IN,
S
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
0 10 20 30 (Wlh
CAPACITY
UGOULDS PUMPS, INC.
sa~cA pus ~w rocx
METERS FEET
120 MODEL 3885
35 SIZE 3/4" Solids
110 -WE15HH.IN
100
30
90
25 80
S 70
y~ 20
60
h
WE05HH
15- 50
40
10 30
20
5
4
10
0 0
0 10 20 30 40 50 '60 70 80 90 100 110 120 GPM
1 I 1
0 10 20 30 rn'M
CAPACITY
91955 00um Pumps, Inc. ftgo* July. 1915
C'1 dll ~
yW 7
OPTIONAL WORKSHEET
1. MOUND SYSTEM II. IN GROUND PRESSURE SYSTEM-Continued-
1. Wastewater Load, Total Dally Flow = gal. 10. Force Main:
Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = gpm.
Adm. Code and PROVIDE A DETAILED Diameter = in.
LIST OF SIZING ON PLANS. 11. Total Dynamic Head:
2. Depth to Limiting Factor ft. System Head = 2.5 ft.
3. Landslope = % Vertical Lift = ~llL_ ft.
4. Distance from Dose Chamber to Friction Loss = . / ft.
Distribution System = ft. ('Di' ft.
5. Elevation Difference Between 12. Pump Selection:
Pump and Distribution System = ft. Pump will discharge at least gpm
6. Absorption Area Sizing: at ~ ft. total dynamic head.
pu o el and manufa tuner:
Area Required x1• ft•_ lJt"~
Bed or Trench Length (B) = ZaL ft.
Bed or Trench Width (A) = ft. 13. Dose Volume:
Trench Spacing (C) = ft. 10 Times Void Volume of
7. Mound Height: Distribution Lines= ._.22Z' gal.
Fill Depth (D) ft. Daily Wastewater Volume
Fill Depth Downslope (E) = ft. 4 Doses in 24 hrs. gal.
Bed or Trench Depth (F) ft. Backflow = --13.)2 gal.
Cap and Topsoil Depth (G) = 1, 6 ft. Minimum Dose = e`r _ gal.
Cap and Topsoil Depth (H) = ft. 14. Dose Chamber:
8. Mound Length: Volume = gal.
End Slope (K) _ ..J/-), ft.
Total Mound Length (L) _ a6L:~_- ft. III. CONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal.
Upslope Correction Factor = Use section H 63.15 (3) (c), Wis.
Upsiope Width (J) = ~ ft. Adm. Code and PROVIDE DETAILED
Downslope Correction Factor = LIST OF SIZING ON PLANS.
Downslope Width (1) = D ft. 2. Required Septic Tank Capacity = gal.
Total Mound Width (W) _ Z ft. 3. Percolation Rate = min./in.
10. Basal Area: 4. Absorption Area Sizing:
Infiltrative Capacity of Refer to Table 2 in chapter H 63
Natural Soil = 9- gal./sq.ft./day and PROVIDE A DETAILED LIST OF
Basal Area Required = M- sq. ft. SIZING ON PLANS.
Basal Area Available = M6 sq. ft. Required Area = sq. ft.
11. If Standard Tables from Chapter / Length = ft.
H 63 are Used, Indicate Table No. Width = ft.
12. For the Distribution Network, Use Numbers 5-14 in Section 11. Number of Trenches =
Trench Spacing = ft.
11. IN-GROUND PRESSURE SYSTEM 5. Distribution System:
1. Depth to Limiting Factor = ft. Lateral Length = ft.
2. Landslope = % Number of Laterals=
3. Percolation Rate = min./in. Lateral Spacing = in.
4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in.
5. Wastewater Load, Total Daily Flow: gal. System Elevation = ft.
Use section H 63.15 (3) (c), Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL
LIST OF SIZING ON PLANS. Fill in All Items from Section Ill
Required Septic Tank Capacity = ~f1QZ gal.
6. Absorption Area Sizing: JB~p,!qy( V. SEPTIC TANK
Percolation Rate = , 3 min./ifi. 1. Capacity = gal.
Area Required = sq. ft. 2. Manufacturer:
System Length = - ft. 3. Show Site Constructed Tank Details on Plan
System Width ft.
7. Distribution Pipe Sizing: VI. DOSING TANK
Hole Si/e = in. 1. Capacity = gal.
ft. 2. Manufacturer:
Hole Spacing =
Lateral Length I't. 3. Pump 104nulaclurer:
Lateral Siic in. 4. Pump Model:
Lateral Spacilig It. 5. Operating Head= ft.
Distance IYnm Sidewall•lo Pipe in. 6. Flow Rate= gpm•
8. Distribution Pipe Discharge Rale: 7. Show Site Constructed Tank Details on Plans
Number of I loles Per Plpe
1 low Per Pipe JtPIct. V11. HOLDING -TANK
1. Capacity = gal.
4. ManilcilJ SiiinR:
ype (Centel or end) _"LIa 2. Manufacturer:
Length = ft. 3. Show Site Constructed Tank Details on Plans
Diameter = In.
-SHOW ALL INFORMATION ON PLANS-
DI LHR SBD-6761 (R.03/82) . / G
. W nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of
Laver aM 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 41
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARC
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R I DBY DAT
IZI f1 5
PRO RTY OWNER: PROPERTY LOCATION _ , t..
GOVT. LOT 1/4 t 1 T T CA(JVf
PROPERTY OWNER':S MAILI ADDRESS LOT # BLOC # SUBD. NA SM~t' y
,--2,2227 A 's t
CITY STATE ZIP CODE PHONE NUMBER ❑CI OWN
G -3~
New Construction Use y(J Residential / Number of bedroomsZ [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate .~2 bed, gpd/ft2__,_? trench, gpd/ft2
Absorption area required bed, ft2_ trench, ft2 Maximum design loading rate -?bed, gpd1ft2_ g 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
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S O U [2 S ❑ U ❑ S o u ❑ S B U ❑ S [3 U ❑ S ZU -
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. nt. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
11~772T -?a 177,
Ground
3 k(W ~V, All-' All
elev. n
A~.Z ft.
Depth to
limiting
factor
Remarks:
Boring #
_ c
S p
Ground
~elev.
/L ft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print i Phone: `
s -
ddress:
Signature: Date: _ CST Numb
PROPERTYOWNER Jx7,-/,J SOIL DESCRIPTION REPORT Paged
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 Trends
A11,4 4UZ
Ground
f
elev.
,ft. c
-
lel
Depth to
limiting
factor
2
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
07 , 7 , A601r"
i
0
J'" y/
547207
CERTIFIED SURVEY MAP
Located in Part of the Southwest Quarter of the Southwest Quarter of Section 9. Township 31 North,
Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin; being that parcel described on
Deed Recorded in Volume 1064, Page 508 in the office of the St. Croix County Register of Deeds.
Prepared for and at the request of
OWNERS.
John E. Kelthley and K. Anita Keathley
RR 1
w Somerset, WI 54025
~)ik - W 1/4 CORNER OF SECTION 9 Drvfted by. Krlsti A. Eyivndt
(COUNTY MONUMENT)
J a i' L
3 FILED fl
j
JUL 2 4 1996 ►
N ~ Z KATHLEEN H.WALSH
9
UNPlA7TEJ LANDS RNISlef of DOW$
SL Croix Co., Will
NORTH LINE OF THE SW 1/4 OF THE SW 1/4
S 89'58'57' E 1333.43'
100~i 1300.43' S~
I M I ial b•
NW
i TOTAL AREA; 646,005 SQ. FT. (14.53 ACRES) ~O W1
't ci. AREA EXCLUDING R.O.W; 625,008 SQ. FT. (14.35 ACRES) b~ s~
z; CrI
g; F-- ; o N t° wow c a.
o{ w w w } ; aU LOT (REC. AS DUE WEST 660') " 0
1
z m w S 89'52'38" W 662.95'
7i ►~i Wi NI INSN
o; va o1 I $ f 0° ;M UNPLATTED _LANDS
31 89'
i° (REC. AS DUE WEST) vt JiPPROVED
J = 643.35' ~n
N 8726'34" W 675.24' W •r
c~ UNPLATTED 'LANDS
CROIX COUNTY z ~
40.1900 nslve Plaruvr w
xoWnQ and F
L.L
SOUTHWEST CORNER OF SECTION 9 Pants Cony ittaa
(COUNTY MONUMENT) If riot rocorded
within 30 days o!
4e~ County Section Corner Monument BEARINGS ARE REFEASON a6fiHE WEST LINE OF THE
of Record SW 1/4 OF SE0TIOIA00V3t&f Iba31 N., RANGE 18 W.
• Set 1" x 24" Iron Pipe weighing WHICH IS ASSUMED T0419AARW 00'21'11"E
a minimum of 1.13 pounds per
linear foot.
O Found Iron
REC = RECORDED AS
Wis0NOTE: The parcel shown on this map is subject to State, County and Township
rAW
laws, rules and requlations ( i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix
County Z, i
Zoninq Office and the appropriate Town Boord for advice.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER (}~j + r~ t1 t I.. Ll D W c S
MAILING ADDRESS 311 t,~ Sr Cat I.4 5ti Jam,;_
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE' /
PROPERTY LOCATION 1/4, [ t! 1/4, Section T-.Si-N-R_L?_W
'OWN OF StT"$R I°RQ /r l 7ou:_h 5`i ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MA>I's ,VOLUME, PAGEZ9 LOT NUMBER j_
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 (I)
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 t e St. Croi
County Zoning Officer within 30 days of the three year expiration date.
SIGNED: aa
DATE: 711 1 /
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
b '1 U 1UU
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 .-1- rl L. Lti b W sc S
Location of property 1/4 1/4, Section I-,T/N-R W
Township 5T PKR~RtL Mailing address
Address of site
Subdivision name _ Lot no. _
other homes on property? Yes~4 No
Previous owner of property Le
Total size of property JrJ,~i ,q~
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 No
Volume" and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMLNT NUMBL•'IZ, VOLUME AND PAGE
NUMBER AND THE SEAI. 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 dead 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. 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.
5. a e of Applicant 4CAWppilca t:
1
Dcite of Signature Date of Signature.
` /0
9&0(Pa°Oq
07/30/96 TUE 14:14 FAX 1 715 3 6 6560 ZILZ & ESTREEN X00 r
t;T
'N
OL x.191 PACE' 2 8 8
547709 STATE 6A'1 OF WISCONSIN FORM 2 - 1962
1j
WARRANTY DEED
REGISTERS OFFICE
DOCUMENT NO.
ST. CROIX CTY., WI
Wd br Record
John "E. Keithle an K. Anita Kei-thl oy,
hu AUG 2 '~~96
s and and wife, • at 43o
M
wasp anti C anni e M-, Reyis,•erctDeeds
conveys and warrants to Jav 11LdCL.
I
! 'Ludowese, husband an,d wife, as
survivorship marital, nr°P_=-
_ THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS rr
the following described real estate in .t Croix County,
State of Wisconsin:
ti
PARCEL IDENTIFICATION NUMBER
i
Part of the SW1/4 of the SW1/4 of Section 9, Township 31 North,
Range 18 West, Town. ?t-Star Prairie, St. Croix County, Wisconsin,
being that paxcel'Ldescribed on Deed recorded in Vol. 1064, Page
508, in the office eE the St. Croix County Register of Deeds,
further described as: Lot 1 of Certified Survey Map recorded in
Vol. 12, Page 3131, as Doc. No. 547207.
T A oSFER
This is _ n a t homesi,md property.
XXX (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
Dated this C~ any of „ Jul , A.D., 193,6-
~(SEAL) (SEAL)
=nE- thle
. (SEAL) j (SEAL)
'y
K Anita Keithl Pg
. tr•r.Vr. ATT7/" •TTI%Ai ACKNOWLE V VIA E