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Home My WebLink About002-1047-40-000 00 00 i Q 0 ° a .°r c c 0 0. 0 O C I ~ n O Cl) O nl c O N O m ti Y N y in m a z~ of ° m 4 m ~ ~ o 3 0~ N 'E v + CD 000 U y + CL 0 O E _N C 00 N C7 ° N O) O Q O I C N.., O O X- z a- c c ~ Eo C 'I. 7 C6 N 7 C N LL c 7 ~C N E LL O - o h - o 0 ac u -C a) CL c 00 m U Cl) f9 v a Z E o °o z~ `m ate, La a m N H S O m I'' c c C7 o O z d c 0 d Z = N = yO N F- o rn o Z c E E '2 N N a N C_ N N N • pea N vl c N N W Q ~ 0 d C O ' o N Q o z m z zF-z o N z c N i N y 'a r- I C - N In N U) ate. ~ }li d Q l0 O C O > CL LO N + W N_ MO c O ° Q G a N d ` .d O 1~ 0 O) N 0 lc~ z > ° F- F- F- o O F- F- F- c w o "'00 0 d0m 003: 31. 3t 00 zo L w FL 1(~rii p y o o ur c in ,n co 00 (A J U 0 ) 0) } 'O OOi m } 15 1- 00 pal m M N m O O O O Z LO O r-- O E N N Cn m ~ (n m N 0. -C cn (D w O ❑ N N N 7 ~j ° p ~ N C ~ I f~ N C 11yi O 0 c 00 0 00 C c O O o N .O C c N N C U Q pOj O L F- y O N CL n gIg O O G 00 00 w c Y C M N Y N ai co z 04 CV N 'D C LO 7 O E pnj v.= F- F- N • o o m v c~ u m o o a a w E E v O i■ O N M N fZ z y 2 F- N O z NL9 (n _ E V ~ s. ~ GI ~ N ~ xt EL II a CL, 0 m 0 w CL L: i E L c c c (D r~ o m 3 0 3 % o "~1 A U 0 O v5 0 0 m 0 Z~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS-01 :2.10 r SUBDIVISION cSM# LOT # SECTION ~ V T 2_ l N-R W, Town of 94~- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • ~ rYr t I f+ / e c~' f( rV may, gL 0) 05 G a~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this. form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /has t /60 ALTERNATE BM: v U SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Jc+s t q ec ` Liquid Capacity: U Setback from: Well (j (J House_ U Other Pump: Manufacturer 2U/ le,a Model #Size Float seperation 9.11 Gallons/cycle: ~C1 Alarm Location SOIL ABSORPTION SYSTEM i Width: Length eO -*0 -1 &V Number of trenches Distance & Direction to nearest prop. line: /1 1 Setback from: well: House ~(G Other ELEVATIONS Building Sewer N ST Inlet, ST outlet S PC inlet Cf U. L 5 PC bottom Pump Off' / SJ Header/Manifold Bottom of system Existing Grade Final grade II DATE OF INSTALLATION: PLUMBER ON JOB: r a, LICENSE NUMBER:/-,? 4 q& INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX 'Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: El City 11 Village Town of: State Plan 1 0.: MENTINK, JON & JEAN CST BM-E~l~e1v. ~ / Insp f. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA I d82"L TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r , Septic P_Sf-C / eCQS Z~ Benchmarks Dosing 7Z Aera ' Bldg. Sewer Holding St/ Inlet TAN SETBACK INFORMATION St/,,Hf Outlet d, SD Vent irIto ntake ROAD Dt Inlet S t TANK TO P / L WELL BLDG. A Ar Septic NA Dt Bottom a?3 ?(o,c Dosing ~-~o NA Header / Man. Aeration Dist. Pipe Holding Bot. System PUMP /S'INFORMATION Final Grade Manufacturer A r) Demand Model Number 'GPM TDH Lift~ya1 Friction, 3a System TDH Ft Forcemain Length Dia. ;~-Il Dist. To well p~ SOIL ABSORPTION SYSTEM BED / TRENCH Width l Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth . v DIMEN IONS ill go /4 1 1 3 DIMENSIONS IG- xt, SYSTEM TO P / L BLDG WELL LAKE/STREAM L. 1D urer: SETBACK CHAMBER 'D INFORMATION Type O Moe Number: 0\ System: ca o >Sdr(o b'® +r OR UNIT DISTRIBUTION SYSTEM Heade Distribution Pipe(s) , i ze x Hole Spacing Vent To Air Intake Length~ 4D a. J Lengthy i;ia. 7 "Spacing 0 SOIL COVER x Pressure Systems Only xx Mound Or At-Gr ystems Only G4` Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched K,. Bed / Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ' ❑ No COMMENTS: (Include code discrepancies, persons present; etc.) LOCATION: Baidwind.20.29.16W, SW, SW, 220th Lot 1 7' z - &,93' -7,!q' P',/dl = 93,8 ~ bU3 7,6-3 ' 9q,o1, Plan revision required? ❑ Yes 246 Use other side for additional information. /l I PA/X SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division r~~i~.r■r,. SANITARY PERMIT APPLICATION Bureau ofBuiIdingWater System! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 e- Attach complete plans (to the county copy only) for the system, on paper not less County than 8 12 x 11 inches in size. • ~'^O1~C 0 See reverse side for instructions for completing this application State S ni+- ter 9,92 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 INF RMATION Property Owner Name~^ Property Location d ~c~ / t rat r r' / ,SG/ Zia s Zia, SU T , N, R l L f(or) W Propep l ner' Ilig Address Lot Number Block Number City, Sta ,Zip Code, Phone Number Subdivision Na a or CSM Number ~c~w s' L(O z-- v~ P'3 s- v ~2 y- 7 7- II. TYPE F B IL ING: (check one) ❑ State Owned o qty / Nearest oad C Public 1 or 2 Family Dwelling - No. of bedrooms L ° Iolwan OF 94 9G III, BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) c v 1 E] Apartment/ Condo GG 2 - /Dq 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 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 21M, Mound 30 E] Specify Type 410 Holding Tank 12, ''~eepage Trench 22 In-Ground Pressure 42 ❑ Pit Privy 19-0 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) ?Zt- Elevation G G ! 2 Uv I Z O U U r- 94t s~ 160 Feet Feet VII. TANK na lons Total # of Pretab. Site Faber- Exper. INFORMATION gal Gallons Tanks manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank G d t, ere-L N 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber t/ ? 5,z" 1 t ' ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility r installs 'on of the onsite sewage system shown on the attached plans- Plumber's Name: (Print) Plumb 's Sig natur ItViz tamps) PRSW No.: Business Phone Numb Z, Sty 7t5'= Ace- Plumber's Address (Street, City, State, Zip Code) IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary permit Fee (Includes Groundwater LDate Issued issuing gent ii _nature o St mps) Approved ❑ 'y►"~t Surcharge Fee) Owner Given Initial ~ Ad verse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) 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 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. 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 81/2 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. PLOT PLAN Page I of \~lD ►~,v. ooZ- lo~l~-~{p SCALE 1"= y ' 4R~11? ~Z L I1.A-- I a as , dts~; 6u~~o,~ b~rbrEt9u 3 tLq%9 be C p r) G ht;d wcs n Pre cRs-E B. a .Z eM bc=97.2A e%~ -n c,- tcLGl: 166 fo bt4,60.1 derl'--d per Cod lwo-rX, -5j. q0 b040- 6~ S. d;,~ . El eA 31"1, S r 1 ~.1 L 8 Y ~.a 6 8 . s. J . SaC. ObSer'da~:on ~0r ~Ce✓a~ an 8.3 o-9 'i 1 I`) - ~o -~''LC rtabe n.tede~olover ~i~neQes T J d~ s Erv'b k~i c" der z'v .rca~h riZ rrtih: ai r<,,, 1 B~ - ~L. l00• o~ o~ SP1kzl t0` ~Qov~ G12.oV►.~p ' itv S Ll 6'` Ll iq - 1NOO~) F(--T ~ [-o s T. I ~I II PUMP CHAMBER CROSS SECTION AND SPECIFICATIOUS See ILHR 16.19 VE1.1T CAP For Electric y C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIOU BOX MANHOLE COVER WITH PADLOCK 25 FRCM DGGR, Tr, WINDOW OR FRESH 12"MIU. AIR INTAKE I k~arn'ing Label GRADE - I `1" MIA.1. / 15" MIN. COIJDUIT-- 18"M IAJL.T PROVIDE I Approved Joint AIRTIGHT SEAL I i I I V I APPROVED JOINT A I III APPROVED JOINTS w1c.Z. PIPE I III W/C.T_. PIPE EXTENDING 3' I II ALARM EXTENDING 3~ ONTO SOLID SOIL B i ( I ONTO SOLID SOIL I I I ON C I I I PUMP OFF r D See ILHR 83.15 "Aside EGer/= CONCRETE BLOCK for 3" bedding RISER EXIT PERmrrrED GIULy IF TAIJK MANUFACTURER HAS SUCH APPROVAL SPEGIFIGA71QUS Note: Pump and Alarm Are On Seperate Circuits Number of Doses: Per Day Septic Tank Manufacturer. n ~e Gallons Per Day/ of Doses: s/ odd Gallons Pump Tank Manufacturer /N;c/cdeS n -Cca.sf Volume of Backflow:....... + /G V0 Gallons Septic Tank Size 4 2,60 Gallons Total Dose Volume: X10 Gallons Pump Tank Size 75O Gallons 7s9o off' Uo~d doP o~+ d:s~. /tetwarK= (..757- Alarm arm Manuf acturer : =iii, v8'~g• Model Number: ,y. W, ioi Capacities : A ao~'¢ i nches or yoi~63 Gal 1 ons Switch Type: file-C",r4 + B d inches or 39• dv Gallons Pump Manufacturer: :7-cQ,QQQ,,.• + C- inches or 0.43 Gall ons Model Number: 1197 + D 7 inches or Gallons Minimum Discharge Rate: .20 gp,K /S.70'770. , Total = 3d /a inches or 150.cZ Gal l ons -v - Vertical Difference Between Pump Off and Distribution Pipe: /,7,&0 Feet Minimum Required Supply Pressure: ►1A Feet Feet of Force Main x_/,Lo FrictionFactor/100 Feet: + LLo Feet _LcO Inch Diameter Force Main Total Dynamic Head: _ 1lr.70 Feet Internal Tank Dimensions: Length i~ Width 611 ~ ; Liquid Depth 38ya( HEAD/CAPACITY CURVE C, '3 N I- a W HEAD CAPACITY CURVE EFFLUENT MODELS 1 34 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE I t EFFLUENT T AND D DE DEWATE TERING J2 1 53-6 SERIES 6739 97 98 137.139 101 193 166 to IM 000 IM 1M R. IA Gal Lao _Galas Gal Ln Gal Uri Gal Lin... GaL La'! Gal 49'a'.. Gal Ltn: Oat L•,t. Gal Lft Gat Ltn. 30 6 1.62 43 103 5e 912 n 95 273 104 304 toe 401 e1 131 e1 2J1 ' 6a 220 166 6p 166 "aa 29 10 3,06- 34 IZO 46 174 a1 1 n 300 100 37~: 61 231:,;. et 231:. W 720 141 600 161 972 90 16 167:. t9 72 >6 :1J3 46 170 64 242 91 344.. tb 217: 60 217' W ?20 142.: 6V t46 W 26 65 20 7.12 16 67 26 96 36 t34 42 3101 50 ZZ3 eo 2$7. w 220 136: -1¢ 140 630 4 30 74 200 67 21~ 60 223':. 54 220 121 `4N 133 '.W* 24 30 A14 66 244, 66 2f 64 90 0114 61 929 121 ;N* 127 --:411. 75 40 1219 48 174: 46 172 66 2ft 76 !!2. W 220 105 :.:397 114 ::.431 22 186 60 1621:- .341 100 -379 7 QD 1 •,29 ~ ~ ~ 126 61 191; 60,1'210 w 120 00 16 47.:. 43 191`; 36 13• 58 220 71 alp 16 3= 20 65 70 21.34 30 111". 10 : 62 197 61 143 70 216. 163 so 24,06, IB 14 W' 46 170 29;;:/00 M ...204 - S"S 90 W.14 32 111 2 '.I • 3? 140 21 55 100 30.4•-' u M 501- 16 Lock Valve: 1926' 23,76' 23'26' 60' 00' aT 7Y tt6' M' llr 14 12 EFFLUENT & DEWATERING Warning: Model 185 should not be subjected to less than 30 feet TDH. 8 `8 ALfi 20 Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. 12 V733 4 ;M.7,59 2• t5 t0 188 2 SEWAGE & DEWATERING GALLONS ,0 2 30 401 50 60°7° 6020° 100,01204140 160610 WARNING: Model 293 should not be subjected LITERS ° zn~Pt+t to less than 15 feet TDH. a W W 24 EO TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING 75 SERIES 262 2.6 267 M 292 204 2.2 213 K-1 2.6 70 FT. M Gal. Lka. Gal. Um Gal. Lira. Gal. Lim Gal. UM Gal. Un. Gal. Lira. Gal. Lim Gal. Urs. 20 5 1.52 90 341 126 484 126 161 120 484 130 492 ,60 8B1 140 530 225 852 85 0 3.OS 227 337 337 337 95 360 58 590 121 4N 205 778 157 22.5 85 50 189 0 1N 169 133 238 135 511 108 401 130 492 taS 700 id 60 20 6.10 10 38 to 36 10 38 33 125 106 401 06 333 119 450 144 636 25 7.62 76 288 68 257 104 401 136 515 163 5M 30 9.14 43 163 47 178 90 340 121 458 140 530 16 40 12.19 5 19 SO 189 M 356 115 435 50 15.24 49 337 50 60 19.24 13 S0 49 220 59 223 11 70 21.34 25 95 45 Lock Valve 14' 21.5' 21.5' 21.5' 26' 35' 17 50' 62' 77' 12 40 35 10 30 eI 2s SIN 6 20 15 1 262 :Zzz 10 292 _T I 2 S 262 266, 267, 266 264 294 29S 0 GALLONS 10 20 30 40 I SO 60 70 60 ( 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 L- 1 I I I I I I 4.- LITERS 0 80 160 240 320 409 480 S60 640 720 800 880 I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of 3 Labor and Human Relations DivkAon of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code s COUNTY Attach complete site plan on paper not less th size. Plan must include, but ST~ C-. W LX not limited to vertical and horizontal ref ere n~ i % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a t ce to nearest~r o C) Z - 10 y.-)_ q0 APPLICANT INFO RMATION-PLE PRIN ALIt iN RMA IA r EVIEWED BY GATE . F_ ROPERTY LOCATION OVT_ PROPERTY OWNER: , Sly 1/4 SW 1/4,S ZDT Z't N,R 16 E( W ZblNl ~'I lU oll~ PROPERTY OWNER':S MAILING ADDRE %16~, LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE - ZIP C0 , ,%`,PHO MBER []CITY []VILLAGE (MOWN NEAREST ROAD wi~u w I s4 o f, ' >3 t N Zzo •nf s T,. New Construction Use X Residential / Number o Brooms Additi.Qn to existing building Replacement O Public or commercial describe Code derived daily flow b b'ZJ gpd Recommended design loading rate - bed, gpd/ft2 0 , S trench, gpd/ft2 Absorption area required - bed, ft2 \ZZQ) trench, ft2 Maximum design loading rate o L bed, gpd/ft2 0 • S trench, gpd/ft2 Recommended infiltration surface elevation(s) S j~, f~G k~- 3 ft (as referred to site plan benchmark) Additional design/ site considerations SttP LL Q W "RZ' ~-1#N3 W / b Ws~E tom- "H 1--l Parent material s l -\-I k"L Flood plain elevation, if applicable 1V • R - ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem +0S ❑U MS ❑U RS ❑U [5& S ❑U ❑S MU ❑S P U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o-1.Z 10"tR 3IZ - si Z P yv-, h eS - p.Z v ~z~y 7. S `~t 2 3 l y - 51 Z►~ s b>z w, v F~. cS a s o b .3 ~-S`i R ~Ll s o s g v~. - o.~( o.S Ground 41-8 Z. S tz j - s 1 z s 1-z v~ elev. 9v-3 ft. Depth to limiting factor Remarks: Boring # ::Z Z tb-2.~ 10`12 3!6 sl) Z'FSbk >n.`FI• (-S 3 zl 3~ 7_S `~2~1y S ~ Z.'FS bk m~~ ck., _ o• S n. I, Ground elev. - 6g S k tZ 313 - L sdh m '~4 - o • 0 . S C ft. Depth to limiting facto 6 N Remarks: CST Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: S_~ 6 g Date: l CST Number: Q-~- ~s M00576 PROPERTY OWNER 1-1eK1'71XJV SOIL DESCRIPTION REPORT Page --.L-,Of PARCEL I.D.ff 00,z- Boring# kizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 3 0-1 do VL 31 Z - s i Z s b Yw~~ a.s 0-S a, t K°:z Zg tZ S) Z`FSDk )h C S _ o.S o.6 Ground 3 Z$-67 ~•s `42 `f ~6 - 1 OSQ) v- elev. ~~•0 ft. Depth to limiting factor Remarks: Boring # v o _ t0 tb `i R- 3 l Z SLR Z ~ 9 b 1~ vv<~~ CL y Z to-z~ s wzz 3! - s Z s bk m`F~. ~s - O- S o. 6 Ground elev. °t6.16 ft. Depth to limiting ?t6 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: f Boring # iI Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 73. .~zv.~ ~v`nNk . ~~lD ►UV ooZ- lob-l-~(p SCALE - 1"= ' PCW~?L1~ LINE r ~t >rt°L~13 i~Lqg4 i B- $ •Z B b 't`K+/1rc y 8 ib X-t_" s- 1~iu tk B l1 s, i TA .l 4 8 J G_ 66, iEL at I n 1 ~J J , 1 'hxicl--:Z~4 k_ Pr'r_'Y'ft 1~owNSLoP~' rt - ItR t "Oki q,S-Z6$ LQ-4 _°LS (715 425-0165 _ 1400576 CST Signature Date Signed Telephone No. CST # 347733 CERTIFIED SURVEY MAP o Volume 2 Page 572 1 1`' ctl FILED co APR 13 1978 JAMES O' CONNEII hephter of Deeds r n IN Wiz county, Z Whom in M z° CERTIFIED SURVEY MAP 9 ~'d RECORDED IN VOLUME 2, PAGE 497 34-7 79 q3 33' 33 S 87°3I'44"E 200.02' 3m~ 166.99' U4 N APPROVAL OF THIS MINOR SUBDIVISION I DOES NOT MEAN APPfiCVAL FOR • 6tSI;.D ING ;a!c OR I.P'3,C , ~r:c• . rE"r':R TO H62.~_0. z ° LOT 1 0 _ APPROVED I 3.00 ACRES TO LINE S APR 12 1978 ,p 2.50 ACRES TO S ,O;x RIGHT-OF-WAY LINE coAnP ._aws v: ...n,, .INc Ln ~ .D W • = I IRON PIPE FOUND • o = I" X 24" IRON PIPE WEIGHING 1.13 LBS/LINEAL FOOT L w w • O • O p_ O C-04 -o oN SCALE IN FEET O 3.03'' 166.97 • 33' 33' ; 200.00' 100 50 0 100 N 87 38 Od'W m 0 CERTIFIED SURVEY MAP c,a RECORDED IN VOLUME I, PAGE 241 rn ~ co = FOUND NAIL a CAP SOUTHWEST CORNER SECTION 20, T29N, RI6W Volume 2 Page 572 FORM NO. 985-A ' MG M:II•r Conpvry® Stock No. 26273 CERTIFIED SURVEY MAP NO. 1821 VOLUME 7 , PAGE 1821 BEING A PART OF THE SOUTHWEST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 20, T. 29N.,R. 16 W,, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. 8 8 MID PREPARED FOR: MR. JON MENTINK MAY271987 BALDWIN, WIS. INi 4p MICHAEL BRILES-OWNER A CSM N0: 1040 \ \ \ 111 l I I I 1111 I I ! I ! / ! `CG•p•N S87. 31144" E U- 135.01' STEVEN J. s WAAK Ox z s c y• • J 2 • • MENOMONIE,: r N z Ig - WIS. 0 o CSM NO : 572 SIU IRJ\\\`\\\~~ F- w ~ to w m Z a ¢ lwi n' h ~ W K (A U NOTE: OUTLOT I IS TO BE SOLD TO w THE ADJOINING PROPERTY OWNER. w o O.I OF LOT I OF C.S.M. NO. 572. o x 1 ~ rn O- 0 1Q ~ LEGEND ' z 'vim tis. 1 Ow MF- tio -0 N GI • FOUND I° IRON PIPE ww w o QI O SET 3/4" X 30" RE-ROD DETAIL SKETCH JI WEIGHING 1.502 LBS./L.F. NO SCALE Wi FOUND BERNTSEN MON. a CSM N0: 241 HI Q' J, 8 1 N87036'15"W I ZI SCALE 1so 200 5.00' J SEE TAIL N 3! 200.00' 1 0 100 200 400 N S87936 OD ! N 130.00' 1s N87.36' 15" W rr 1 O 1 z N87036' 15" W _ UNPLATT£D LAND 0 s In rc _ O K, Z~ APPROVED I S.W. CORNER p 20_29_16 MAY 22' 9187 Ia`d0 iC`tdiTly ~.OrreH.+i-i•L'r Volume 7 Page 1821 CEDAR CORPORATION 604 WILSON AVENUE I 2 MENOMONIE, WI 54751 PAGE_OF_. (715) 235-9081 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT "T~ r,~ St. Croix County OWNER/BUYER J O (e n e h lC MAILING ADDRESS Y 7 2 2 U { -r c PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE 124 Lt/ ' S y°G - Z--PROPERTY LOCATION S 1/4, S 1/4, Section U , T Z~ N-R_11_W TOWN OF 4 /4 ~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 3y2 ?-Pj •L CERTIFIED SURVEY MAP K94 11 J, VOLUME _ q, PAGE lam, 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 maintaine st a com eted and returned to the St. Croix County Zoning Officer within 30 days of the three ar p rati date SIGNED: DATE: > / S 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 Stu n C , 4 Location of ro7 Z., ty.~4l 1/4 S lc/1/4, section Z C~ TN-R l` /W Township 4 M ailing address P/ ? G ~ < s c ~ /c/ , Address of site s subdivision name d 2 /J r,2 Z Lot no. Other homes on property? Yes No Previous owner of property Total size of property /P6* /0/ Z, /9.4 c,- r- Total size of parcel 3, 7 S'- Date parcel was created I// c r9 '1- Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes ---NO Volume V ~ and Page Number 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. 3 5-0 9 / 9 , 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. nature of plicant Co-Applicant D e o Signature Date of Signature DOCUMENT NO. I 4-1 ATE BAR OF WISCONSIN-FORM I I - WARRANTY DEED ~7 9 1414 AC.E RESERVED fOR RECORDING DATA a - - REG; :'tits O<<1CE - - and `'l 3 , rlils DE FD. n ++ie between ;Q:3li- :t•. rr,ett i :Y i.:ba :d anti wipe as j:)it t Lena-it: , ST < CO., 1~✓IS. - Rec'd. for R_-cord this n _ ;grantor day of JLZ:; ` A.D. f 91 - - and ' 1._ ",e ~zd Jean ,t, Menti hu bard a::g . a - - wife :i- j_,int to :^t' i p Grantee. eyuler of 'Jeer W t t n e + s e t h That the said Grantor, for a valuable cons ideraricn ^nA dollar and other.v-alua le consi.do ra tion afiuAN To conveys to Grantee the following described real estate in County, State of Wisconsin: Iiy~lal~i STATE LiA.N11 That certain parcel of land or tract of real estate located in the Southwest Quarter of the Southwest Quarter QV19 of Section 20, 'r 29 N, R 16, W. Town of Baldwin, St. Croix County, Wisconsin more fully described a3 follows: Tax Key No. BEGINNING at the Northwest corner of said Southwest Quarter of the Scuthwest Quarter of Section 20; thence S 6?o z6' a=~ng the North line of said quarter-starter a distance cf 200.00 feet; thence S 00_ ✓2' W parallel with the 0 '.vest line of said Section 20 a distance of 65=.40 feet; the .e ?I 87 36' W a distance of 200.00 feet to said Jest line of Section 20; ":hence f+ --G 02' E along said secticn line a distance of 653.40 feet to point of beginning, the 3c-_-ve descri:Ied parcel containing 3.00 acres, more or less, SUBJECT TO easelitentS, rrivileges and rig ht cf ways of record. IrT, W ~.eVa~ rLL This _i3_ r-10-t--homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto `_e?onging; And Ronald Rhernettor and Linda L. me ettoz warr.+rits that the title is good, indefeasible in fee „mple and free .+nd clear .)f encu^',rances except and will warrant and defend the same. Dat_d this - - - ----dad- of 19 7 •r•lJ~^/~i I^J (SEAL) _ tsEAI.) « 2 o%ld . t our 4 !SEAL) - (SEAL) AUTHENTICATION ACKNOWLEDGMENT Si,{natures authenticated this -day of STATE OF WISCONSIN ss 19 St. Croix _ County. Personally ca=e before me, this /241, day of « August s--_ the above named _ TITLE: MEMBER STATE BAR OF WISCONSIN ~~~n31d E` =etton and _Lj,7da_Il`- (If not, is Ronald °her^.etton authorized by 70(,.06, Wis. Stats.) :herr~ t__-.-=--------'-- Li r. d a ` e ^ e t t o n- and This instrument was drafted by - - known --',,e-'he person 5- who executtd the fore- WARRANTY DEED TM1s SP C= IICSCRY[D FOR RECORDING DATA ' > DQGUMENT NO. • ' ` ' STATE BAR OF WISCONSIN FORM 2 -196E #"CMA E 399 _ _ - y .LGt57ER5 OFFICE 5T. CROIX CO., WIS. ichaei-•E-1•.Briles- and Kay .M.- 3riles r h~~~band and 2bed. for Record this 17th wife...-survivorship..marital property...- June A.D. 19.!7 " 2:00 P conveys and warrants to .......JorkAt•,Mentink and Jean. A. Mentink, ;iLua- and.. and- wifg_,.. suxhiY4xship-- maxital . property . • d DWI - ' RETURR TO :Jon M. Mentink Baldwin, Wi. 54002 . the following described real estate in ._............................County, State of Wisconsin: Tas Psa d No:.............................. Outlot One (1) Certified Survey Map Number 1821 Volume Seven (7), Page 1821. ' Being a part of the Southwest one-quarter of the Southwest tee-quarter (SW-2SWy) i of Section 20, T.29N., RAU., Town of Baldwin, St. Croix County, Wisconsin. ~i EE13 This S..N0T..........._ homestead property. (is) (is not) Exception to warranties: 0 day of June Dated this 1__th 87 . - - .9 ---.-(SEAL) A~' - -----------------------(SEAL) ichae1 E. riles ---------------------••••--•--••-••--••••----.------.------•••-----•(SEAL) (SEAL) ' • Kay . AUTHNNTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. - authenticated this day of 19 Personally came bedwie ane this 19..... day of Ju1e--._,.-__--_ _ 19.$7the above named M Birchaeileshl E. -Ues and Kay M. • husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not - authorized by 1706-06, Wis. State.) to me itno be the peasea __4 who executed the anglLmckmawledee the same- ®ra »rw zees - s •.a >Rtloa '00v t •oN 31304S r;i<sNoosta Ao Iva aavas i3.Usia ilagi ~opq ".lid ao p.dkl .q plnogc 41»d= tut al fulafl. SU092" jo SOMMe Oboe.,. 61 E ' 1 Q yloS -pa2palASOU)PT io Paisa. uaR3ns dam aaa_4su8[g) u U, 11 om; i~ uol;aiidxa equIs '1ou 31) ad I ail .4te3orl -c! • S;unoD--------- 7CZ45: 1 ^tS s r,s `s ds ` - >~p A® Q31,dVtlC >SVM y,N3Wfitl15N1 SIHl DOCUMENT NO. i WARRANTY DEED THIS SPACE RESERVED FOR RECORC.NO DATA j! STATE BAR OF WiSCXINSIN FORM 2-1982 I• 499685 !1 ill. 1011pvz 403 ~ REGISTER'S OFFICE ~ ---y: ST. CROIX CO., Wl Jon M. Mentink and Jean A. Mentink, Rec'd for Record - . husband and wife, each -i n his---o r her Y 2 6 1993 own r..gh.......................... t t II - - at 10.50 M ii y conveys and warrants to -Terry- A. Nelson arad -arbaraL . Ij t, Nel.so.n, husband and- wifz-, hold7ng_>315 5uryi_yo - ft&W of Deeds ii - shi.p..rnarital ..property - - ' l 4r { II RETURN TO -I it ~4? =.r the following described real estate in $t._,_CirO][-____ _ County, State of Wisconsin: Tax Parcel No_______________________________ a The South 140 feet of Outlot 1 of Certified Survey Map filed May 27, p 1987, in Volume "7R, page 1821, office of the Register of Deeds for s= St. Croix County, Wisconsin, being part of the Southwest Quarter of the Southwest Quarter (SWi of SWi) of Section Twenty (20), Township Twenty-nine (29) North, Range Sixteen (16) West. f:7~0 F~ This --.AS..AQt........... homestead property. i (I0 (is not) Exception to warranties: Easements and restrictions of record. r: 1` 1 Dated this Z'~------------------------ day of 19..93.. J ~i t .(SEAL) __..._...._.(SEAL) _ n M. Mentink tr-" i~ (SEAL) <ZY,441-1 A. . . . .....(SEAL) z e~-d a. _Menti nk__ F ;t AUTSBNTICATION ACSNOW LEDGMBNT j; Signature(s) STATE OF WISCONSIN St. Croix Sa. authenticated this day o!----------- 19--- Personally came before me this ....derY of 19.93--- the above named ~n---A TITLE: MEMBER STATE BAR OF WISCONSIN _ 'i ^ (If not- ft` authorized by 1 706.06, Wis. Stata.) ~v t.~_aelk wn to be the person 5. who executed the <t,.. ( . ! `v-•- t ' ckanwled the same. THIS INSTRUMENT WAS DRArlZO SY ~r y• Thomas A. McCormack = K z = f, L j BaldwinWI 54002 PZP~ s...ra-h - N yr PUbfic S-1 C-rft /?F'----C unty, Wis. (Signatures may be authenticated or acknowledged. Bob; ominiSsion is perlnanent_(If not, state expiration are not necessary.) Li~ -LICb!Y.N.4C.,(;t @ 01-! w. 19.- i My Comrnlssw Expires Mw 6. 1994 -I 'Homes of persons sinning in any upaaity should be typed or printed beles ftew sicnatures. WARRAMM DEED STATE RAH CW M729MMSIN Wisconsin Legal Blank Co., Inc. j, FORM No, x- 1982 MttwaukeP. Wisconsin 4'. t All t O C N O I Val N y O c j O ~ I I c I I N I I C I I ti I I I I ~ I cL I I I I c m z = z c LL o ci c I 0 a E a cr) m v CL cep E E `n =0 =S N c a m d d a m I c t9 I 0 I O z c v d z g ° ° 0 I c E E -Zo I v v Cl 2 Cl) N ca (D CD a) CL CD N to N p m L a cL, t 0 I o zmz zp~z N z aci aci N ~ I a ~ I r j O. r O c I N 41 N W ° A a o G G a o G IL CV U) U) Flo orn5 ~ o a m o al cn I o ~ I iSOOSSO c1)000 zo 4i CL CL - a. IL IL 3 y 7 O U) C O O N C LO LO N fA J V -~p co OOi CD 001 a) I ~j m M N m co c A _ o o o I~i~ N O O _ N a- 0 N c d U) co N c c4 co U) 0) z U) N Li N N H N y H I v 0 O 6 f~ N C h_ N C ` O Cd o Q r co p ` 00 p y C E co F p e a~i E c 0 aUi C v°, v a °o .,t CO I. N Hq V) m _upi to I r- N co - a) co co Ci S C O N , V Z C aNp N N L w =O z ' O O h d1 a) H C a) • c c m l aci :2 5 0 M `m o aci o c'n o f I O O N m N f- Z N 2 H N O Z y z=5 22 (n I _ € I V I IL 0 CL ad.2 maw maw tt`~i~t E c c c ~1 A t~a~ '0(A o3v~ici ~ Parcel 002-1047-40-000 01/05/2007 10:28 AM PAGE 1 OF 1 Alt. Parcel 20.29.16.298D 002 - TOWN OF BALDWIN Current X_', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner MATTHEW A & NYLENE SPARKS O - SPARKS, MATTHEW A & NYLENE 817 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 817 220TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 5.750 Plat: N/A-NOT AVAILABLE SEC 20 T29N R16W IN SW SW COM NW COR SW Block/Condo Bldg: SW, E 200 FT S 653.4 FT, W 200 FT, TH N 653.4 FT TO POB BEING CSM VOL 2/572 ALSO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OUTLOT 1 OF CSM 7/1821 EXC THE S 140' 20-29N-16W THEREOF TOWN BALDWIN Notes: Parcel History: Date Doc # Vol/Page Type 08/29/2006 833290 WD 08/17/2001 654108 1701/457 QC 06/20/2001 648855 1664/260 QC 07/23/1997 1011/403 WD more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 153687 288,200 Valuations: Last Changed: 10/27/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.750 38,100 256,600 294,700 NO 00 Totals for 2006: General Property 5.750 38,100 256,600 294,700 Woodland 0.000 0 0 Totals for 2005: General Property 5.750 13,000 166,500 179,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 548 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 I AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP , ~ SEC. 20 T29 N, RAW ADDRESS 's ST. CROIX COUNTY WISCONSIN. SUBDIVISION , LOT LOT SIZE .3 AGr~5 PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1- -7- F1 .11 1 • T N~ . O ~'w Pf 7 _r A I- U. IWO, A ~R m fV I di a e ozt-hi A-r-roow m7 A I C d/e I SCAl,Tt:~ SEPTIC TANK(S) /e,?6o MFGR• 4,1ee S CONCRETE X STEEL NO. oT rings on cover 1/,- ee Depth 2j"' PUMPING CHAMBER SIZE PUMP MFGR. 5DEL NO. GALLONS Per Cycle _ TRENCHES NO. of width. length area BED NO. of lines width 12' length gyp' area G0 ,o dept to top o pipe 261 ° NUMBER OF SEEPAGE PITS Outside diameter total 'pit area AGGREGATE PERK RATE /z AREA REQUIRED 9`1.5 AREA AS BUILT 960 a Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is Tioted the County will make every effort to determine cause of failure.` GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THI-- IN 0 DATED 2/46 PLUMBER ON JOB LICENSE NUMBER i • AS BUILT SANITARY SYSTEM REPORT PMR ' TOWNSHIP SEC. T N, R rt W -0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. -"r ~ t ' `':3DZVISION LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _FF f: a I di~cate North; Arrow S CAL . r~-i- - QTIC TANK(S) MFGR. CONCRETE STEEL NO. of rings on cover Depth DRY WELL ~tNCHES NO. of width length area no. of lines width length area pipe I de th t top of 1 0 AGREGATE 'AlC RATE G-ftAT REQ VIM ND AREA. B LT disclaimer: The inspection of this system by St. Croix County does not imply complete .opliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for 13tem operation. However, if failure is noted the County will make every effort to ietermine cause of failure. ,1EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED PLMIBER ON JOB LICENSE NUMBER Z . REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i•tany Penm.i.t 67K State S P p.t.ic.2 NAME rawnahip I( I n S.. Cnoix County Loca.t.iox Seat,.on SEPTIC TANK Size l fv"J gat.tona. Numbers o6 Compa,%tmen.ta I DiA tance Fnom Weft 1 6•t, 12$ on gnea.ten e.tope bat Buitding_ i_3 6,t. Wettanda - 6t. H.ighwa.ten 6.t. DISPOSAL SYSTEM D.ia.tance Fnom: Wet.t 6.t. 12$ on gneaaten atope "_~t. Bui tding l 6t. W e.t.tanda F#. H.ighwa$en 6z. FIELD DIMENSIONS: Width o6' ,trench l 2 6t. Depth o6 rock be.tow..t.i.te in. Length o6 each tine 6.t. Depth o6 Aock oven .t.ite ~ .in. Numbers- o6 ,t-inea Depth o6 -t-i•te below grade .inr To.ta.t .teng.th o6 tineaIVO 6#. Stope o6 •tnench 4.n pen 100 6.t. D,i.a #ance between t,inea ~ At. Depth xo ' b edno ck 6.t. To#aat abaoabtion area 6,t2 Depth to gnoundwa.ten 6.t. Requined area 6t2 Type o6 Coven: Papet o S.tnaw PIT DIMENSIONS: Numbe/'Le Ghavet around pi.ta yea no Ou.ta.i04 ,t Depth below in.te.t 6.t. To#a.t area 62 , z Ahea ne 6.t2 rn INS ED B Y TITLE APPROVED. ,DATE 197 REJECTED DATE 197. a PLB State and County State Permit #19~~ 00 Permit Application County Permit # Q 7 for Private Domestic Sewage Systems County ~f• ~.Po ix *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: ~ ~ rN 7_ 7 ~AGd~~:~ , C~c.~t S /~oRrr~ ~l.r dr B. LOCATION: .Sln,) T(A) Section .Q, T JN, R ID (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family -L1- Duplex No. of Bedrooms No. of Persons _S D. SEPTIC TANK CAPACITY fDQQ Total gallons No. of tanks OIVe- HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation _1K Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. NewXReplacement Alternate (Specify) Seepage Trench: No. of Lineal~ Ft. Width Depth Tile depth (tqp No. of Trenc es Seepage Bed: -X Length 0 ---~-Widthl&_/ Depth ~_Tile depth (top G r No. of Lines IWO Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME e- k f C.S.T. # and other information obtained from (owner/builder►. Plumber's Signature MP/MPRSW# _ Phone #/l 46~^'~97,0 Plumber's Address ~t! PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Q8 _ of S e, to o o - - oP~ y - _ E ~p f G~ 0 fL-. m 5'0 FQ. Sef+ « k~ Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application d Q Fees Paid: State Count Date d Permit Issued/Rejected (kart e) S~ d d Issuing Agent Name Inspection Yes N0 State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 EH, 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SE DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEAL P.O. BOX 309 MADISON, WISCONSIN 53701 / ~~pREPORT ON SOIL BORINGS AND PERCOLATION T STS LOCATION: 56611/4, WI/e, Section 2Q, T29N, R LQ * (or) W, Township or NloRW4N"y Id Lot In 0 Lot No. Block No. County . ~Ror Subdivision Name Owner's Name: ~(or,~czld Mailing Address: ! ~~►tdw6l W TYPE OF OCCUPANCY: Residence X No. of Bedrooms T,Re-e- Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 5-(0:79 PERCOLATION TESTS / SOIL MAP SHEET 1 SOIL TYPE it T 1_)I ` ~A In PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER ,1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIll P 50, I1 ,f + ~O U 11 O Y. / / /O 36 oP SCI G, I~! 2y N l5 / Y. j Z 1 21 P-2 . 6p ly" Y /6" 2y No 1.5 P_3 N N /('01111 2y /yo 45 12 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 17211 f7 2 72 j' > / S A/ $2., 13--e3 112-11 > G .0 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feeygf_VaV greas. Indicate number of square feet of absorption area needed for building type and occupancy. ff _ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. • o e . 1 1 4P 14 t 0 1 5 I S§11 b~ i E Q A 42-01 e I Re-k I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief.// / .0.4 ! T O L" / f Certification No. Name (print) Address dill r w t.. Name of installer if known le Ole Ile it CST Signature COPY A -LOCAL AUTHORITY r., SOCIAL SERVICES .,;4.;1"... AtiT'. 'J' !`I VISION 01' HEALTH, Bil`2LA11 01- i '!V -14MFNTAL HEALTH • ..rt'"a P.O. BOX ,09 " MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESS 'N _'a,~ Y., Section, 4K%, 11 (or) W, Townsnip oriRttt!re+pahtl--/I~G.Tl c1 w/ - rs,,. - • Block - - - County X--- ~ubdivisiop 01ame~ vcnnername: $-1_ L~`-G-~1~Q'L`_4-- - i:ng Address: A L , c.L~, S - - YPE OF OCCUPANCY: Residence No. of Bedrooms G-_ Other :rFLUENT DISPOSAL SYSTEM: NEW - -)!(-----ADDITION -_REPLACEMENT d ,ATES OBSERVATIONS MADE: SOIL BORINGS _ '3'- gr - 7b --PERCOLATION TESTS "5' / r7 ~o ,OIL MAP SHEET - SOIL TYPE Q F'r` -,C,OA r» PERCOLATION TESTS TEST DEPTH OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL., INCHES RATE CHARACTER NUM- INCHES THICKNESS IN INCHES SINCE HOLE OWE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 % P_ So A4 tslo 16' Pt A 4; o b + 119L FY-.k ;Lit '_41~ t SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OYSEFiV D ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) All- IF 40 5.0, Z (IF 07 N a k fr sit. S PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitablipreas. Indicate number of square feet of abaorptiW &rW needed for building type and occupancy. Indiab sale or distances. Give horizontal and vertical reference points. Indicate slope. ~01 hall dILL- Or dldk- r" 5 j"4 PS o Q , 0 3 A > 0011T 141 r • o Q R 140 G 4e_ e4 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are oorrM to the best of my knowledge and belief. f L Name (Print) yG L T Certification No. 4t Y_ Address Name of installer if known CST Signatu COPY A LOCAL R . 1.5 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ' P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS L ATIONsJ;~ '/a,,Z"'/a, Section-~K , TgfN, R&OW W, Township ~ivj& t No.tame: Block No. County %wner s M '4: L,S R division Name Mailing Address: TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS y -2 7PERCOLATION TESTS 7O SOIL MAP SHEET S*01"L TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P-2 /do "ROOT 40 NO 3; yL SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ I 17Z 414r B 3 72 //a r7.2" o 1 _s 6 7.~. /VD Z " a1 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 7 i H W b _ 1s ~ ~ R t. R ~ O ~ p r" 3 ' .I t N 0 Z 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are corre to the best of my knowledge and belief. Name (print) 6' of A c, -<M Certification No 17,A1 Address Name of installer if known CST Signature COPY A-= _LOCAk AUTHOIZIJY _ tUNITED STATES DEPARTMENT OF AGRICULTURE SOIL CONSERVATION SERVICE 3120 E. Clairemont Ave. Eau Claire, Wisconsin 54701 V S\VUBJECT: On-site Soil Investigations for Sewage Disposal, DATE: May 26, 1978 Ron Phemetton property located in the northwest corner of the SWj, SWj, Sec. 20, T.29N, R.16W, TO: St. Croix County, Wisconsin Wesley Sander District Conservationist Soil'Conservation Service Agricultural Service Center Baldwin, Wisconsin Participants in the investigation: Wes Sander, District Conservationist, St. Croix County James Wolfe, Soil Conservationist, St. Croix County Tom Nelson, Assistant Zoning Administrator, St. Croix County Ron Phemetton, Property Owner Del Thomas, Soil Scientist, SCS, Eau Claire, Wis. The area investigated:is mapped on field sheet BSA-2FF-31 as 33-C-2, Wycoff loam, 6 to 12 percent slopes, eroded. Pit number 4 conforms to the concept of Wycoff loam. Pit numbers 1, 29 3, and 5 consist of admixtures of soil materials from nearly Vlasaty and Freeon soils and have interpretive characteristics of these soils as noted in each individual write-up. Pit 1- Approx. 210 ft. south of north lot line and 95 ft. west of east lot line 0 to 7 inches, very dark grayish brown (10YR3/2) silt loam 7 to 15 inches, dark yellowish brown (10YR4/4) silt loam 15 to 23 inches, dark brown (7.5YR4/4) heavy sandy loam 23 to 38 inches, reddish brown (5YR4/4) mottled sandy loam 38 to 72 inches, brown (7.5YR5/4) mottled clay loam Estimated depth to seasonal water table is 23 inches. Inclusion of Vlasaty Note: Soil has many gray tongues beginning at 24 inches and extending vertically to about 48 inches Pit 2- Approx. 200 ft. south of north lot line and 30 ft. west of east lot line 0 to 8 inches, dark grayish brown (10YR4/2) gritty silt loam 8 to 22 inches, dark brown (7.5YR4/4) loam v -2- 22 to 32 inches, brown (7.5YR5/4) loamy sand 32 to 49 inches, dark brown (7.5YR4/4) and reddish brown (5YR4/4) mottled strata of silt loam, sand and sandy loam 49 to 63 inches, reddish brown (5YR4/4) mottled sandy olay loam 63 to 72 inches, brown (7.5YR5/4) mottled loam Free water in the form of seepage at depth of 49 inches. Estimated depth of seasonal water table is 32 inches. Variation of Freeon Pit 3- Approx. 100 ft. south of north lot line and 50 ft. most of east lot line 0,to 12 inches, dark grayish brown (10YR4/2) loamy sand 12 to 27 inches, dark brown (7.5YR4/4) sandy loam 27 to 42 inches, brown (7.5YR4/4) sand 42 to 50 inches, reddish brown (5YR5/4) strata of sand and sandy loam. Mottled beginning at depth of 48 inches 50 to 65 inches, reddish brown (5YR4/4) mottled sandy loam 65 to 72 inches, gray (5YR6/1) and dark brown (7.5YR5/4) mottled olay loam Free water in the form of seepage at 65 inches. Estimated depth to seasonal water table is 48 inches. Variation of Freeon Pit 4- Approx. 60 ft. south of north lot line and 35 ft. west of east lot line 0 to 12 inches, very dark grayish brown (10YR3/2) loamy sand 12 to 48 inches, dark brown,(10YR4/3) sand 48 to 72 inches, reddish brown (5YR4/4) sandy loam Estimated depth to seasonal water table is greater than 72 inches. This soil is a sandy variation of Wycoff. Note: Although no additional borings were made, I believe this soil condition is representative of all of the high ground that lies generally northeast of pits 3 and 5. Pit 5-Approx. 50 ft. south of north lot line and 75 ft. west of east lot line 0 to 10 inches, dark grayish brown (10YR4/2) heavy loamy sand 10 to 27 inches, dark yellowish brown (10YR4/4) light sandy loam 27 to 35 inches, dark brown (7.5YR4/4) loam 35 to 43 inches, brown (7.5YR5/4) loamy sand 43 to 50 inches, reddish brown (7.5YR4/4) silty clay loam and sandy loam strata 50 to 72 inches, light olive brown (2.5YR5/4) and light brownish gray (2.5YR6/2) mottled clay loam Estimated depth to seasonal water table is 50 inches. Variation of Vlasaty Delbert D. Thomas Soil Scientist Eau Claire, Wisconsin c ST. CROI X COUNTY 3 WI S C 0 N S I N -5581 Ex. 49 & 56 ~~11~1 elf 114 1R Z O N I N G O F F I C E 386 f- t COURTHOUSE HUDSON 54016 May 24, 1978 ¢ Mt. Ronatd Phernetton B at dw.i n Wisconsin 54002 Dea& S.L&: The St. Cxo.ix County Zoning Ojj.iee, Haxatd Baxber and Thom" Netson, has inspected your property on severat occasions to detetm.ine d.j thete was an area that a pkivate sewage d.iz pas at system eautd be tocated. On out 6i,rst tt.ip, we jaund hates that were jutt aj watet. Out second t&ip was with the ee.rt.i6.ied sa.it testex and ptumber, Mt. Gate Smith. Again, there was water in the pexeatat.ion test hates. Out third visit to your property was at the request o6 Mt. Everett Botdt, sa.it teste& and ptumbet. Mottt.ing was jaund in the pereotat.ion test hotel Based on these 4.ind.ings, this o66ice beets that it is .impass.ibte to get a so.it abs axpt.ion system in this area. I am, there6ote, reeomme:nd.ing that a holding tank be used bar you& ptopexty. 14 you feet that this is not pxapex, I woutd suggest that you have a back hoe dig test hates and we w.itt inspect them when we .axe in the axea. 16 you have any questions on this matter, ptease contact this osj.ice. Yo 'k's t,&uty, 1 HAROLD C. BARBER Zoning Admin i.st&ator HCB:1h cc: Westey Sander, SCS Dennis Sorenson, Dept. of Heatth Btbert Betthotd, Div. ag Heatth Gate Smith Everett Botdt ST. CROI X COUNTY N W I SC O N S I N I Z O N I N G O F F I C E 386-5581 Ex'. 49 & 56 COURTHOUSE HUDSON 54016 May 24, 1918 ~v Mt. Rona.bd Phetnetton B a.2 dwi n Wisconsin 54002 Dear S Lx: The St. Croix County Zoning Obbice, Hatotd Barbex and Thomas Ne.2son, has inspected your property on severat occasions to detetmine tib there was an anea that a private sewage dis pos at system cou.Cd be .located.. On out bixst tAip, we bound hotel that were butt ob water. Out second txip was with the ce&ti4.ed soil tester and ptumber, Mr. Gate Smith. Again, there was waxer in the petco.2at.Lon test hotel. Out thikd visit to your property was at the request ob Mt. Everett Botdt, soil tester and ptumber. Mott.b.i,ng was bound in the petcotation test ho.2es Based on these bindings, this obb.i.ce bee.2s that it is impossible to get a soil abs orp-tion system in this area. I am, thetebote, recommending that a ho.2ding tank be used sot you& property. Ib you beet that this is not pxopex, I would suggest that you have a back hoe dig test hotel and we wilt inspect them when we ate in the anea. I j you have any questions on this matter, pteaz e contact this ob bice. Yo rs t,tu.Ly, HAROLD C. BARBER Zoning AdminiAttator HCB: jh cc: Wes.Ley Sander, SCS Dennis Sorenson, Dept. ob Heatth Bxbett Berthotd, Div. ob Hea.2th Gate Smith Everett Botdt