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Parcel 008-1098-70-000 12/12/2006 11:59 AM
PAGE 1 OF 1
Alt. Parcel 35.28.16.5298 008 - TOWN OF EAU GALLE
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
O - JONES, PATRICIA O & ROBERT L
PATRICIA O & ROBERT L JONES
2528 PIERCE/ST CROIX RD
SPRING VALLEY WI 54767
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 15.000 Plat: N/A-NOT AVAILABLE
SEC 35 T28N R16W 15A NE SW W OF RR EXC Block/Condo Bldg:
STRP 30 RDS WD W SD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
35-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/09/2003 748611 2470/542 WD
12/09/2003 748610 2470/541 QC
877/505
417/276
2006 SUMMARY Bill M Fair Market Value: Assessed with:
171541 23,300
Valuations: Last Changed: 10/11/2000
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANDS G6 15.000 15,400 0 15,400 NO
Totals for 2006:
General Property 15.000 15,400 0 15,400
Woodland 0.000 0 0
Totals for 2005:
General Property 15.000 15,400 0 15,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 008-1099-30-000 12/12/2006 12:00 PM
PAGE 1 OF 1
Alt. Parcel 35.28.16.532C 008 - TOWN OF EAU GALLE
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
O - JONES, ROBERT L & PATRICIA P
ROBERT L & PATRICIA P JONES
2528 PIERCE/ST CROIX RD
SPRING VALLEY WI 54767
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2528 PIERCE/ST CROI RD
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 15.000 Plat: N/A-NOT AVAILABLE
SEC 35 T28N R1 6W 15A SE SW STRIP 30 RDS Block/Condo Bldg:
WD W SD ALSO DESC AS S 15 ACRES OF W 30
A OF E1/2 SW1A EZ-UT-1505/128 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
35-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/06/2006 817997 EZ-U
01/04/2000 616410 1481/526 WD
07/23/1997 1137/564
07/23/1997 876/405
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
171553 313,900
Valuations: Last Changed: 05/13/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 31,500 158,300 189,800 NO
PRODUCTIVE FORST LANDS G6 13.000 17,300 0 17,300 NO
Totals for 2006:
General Property 15.000 48,800 158,300 207,100
Woodland 0.000 0 0
I
Totals for 2005:
General Property 15.000 48,800 158,300 207,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 192.00
Special Assessments Special Charges Delinquent Charges
Total 192.00 0.00 0.00
.e'
STC - 104,
AS BUILT SANITARY SYSTEM REPORT
„ y
OWNER mot= -e „t ,L~rs ,4e 7LCVS~ cJ ,a►.:
ADDRESS
evec SrC~o,'x ~Gd ~
So z
SUBDIVISION / CSM# S^cLG~c
LOT #
SECTION T N-R W, Town o _
ST< CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
}s~o~
1
o
3 ~
~ T
O
a
ICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: -G 7`P Liquid Capacity: /mod d
`
Setback from: Well lo,o P House 20 Other
Pump: Manufacturer r _ Model# Size
Float seperation r)/Gallons/cycle:
Alarm Location
r~
f\U.SOIL ABSORPTION SYSTEM
G~
Width: Le~gkh Number of trenches
Distance & Dir ct~'on to nearest prop. line:
Setback from: we 1: House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: JyJ~ ~S'~2
INSPECTOR:
3/93:it
Wiscommn Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and H,wman Relations INSPECTION REPORT ST. CROIX
Safwoly and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No,:
Permit Holder's Name: ❑ City Village ❑ Town of: State PIA WP
PETERSON, BRUCE X /
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
rl
Septic NA Dt Bottom
Dosing NA Header/ Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. Dist. To Well
Fi
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches pIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Mode Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)'
LOCATION: Eau Galle.35.28.16W, SE, SW, County Line Road
i7-q.S
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
i
t
f _
hl-r-b~ CJ h b
k ,r 7
Safety and Buildings Division
v~G~riRi SANITARY PERMIT APPLICATION Bureau of Building Water System:
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 /en not less county
than 8 112 x 11 inches in size.
119-
• See reverse side for instructions for completing this State Sanit~aryyPPermit/ Nuummber
The information you provide maybe used by other government agenC] Checlt%(f Pevi6ion to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE T ALL INF RMATION
Property Owner Name e Proper ~ 1/4 S T -;2 F-, N, R if E (orW
Prop rty Owner's Mailing A dress Lot Number Block Number
1.9 B r~ X-1 ez_ I.O~~ C'_
City, State Zip Code Phone Number Subdivision Name or CSM Number
e- A-4-4 n Al jZ o a.3 ( - ) City
,41 II. TYPE F BUILDING: (check one) E] State Owned ll Nearest Road
❑ Vi age
Public 1 or 2 Family Dwelling No. of bedrooms s Town OF - f2
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 00 e- /j 9,?
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 p 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 ® 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 S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
N 5'0 11-7S- 1/17 4/ Feet / I • Z Feet
VII. TANK Capacity Site INFORMATION in gallons Total # of 's Name Prefab. Con- Fiber- Plastic Exper.
New Existing Gallons Tanks Manufacturer Concrete Steel glass App.
strutted
Tanks Tanks
Septic Tank or Holding Tank K f&4 d r ~4 mrC ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon chamber 2- ❑ ❑ ❑ ❑ ❑
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans-
Plumber's Name: (Print) Plumber's Signature: Stamps) lMPRSW No.: Business Phone Number:
J JJ/V`.ta ,n Sa ~i a. 41•t'cr - 7l s'- 3d'G - y/~ .
Plumber's Address (Street, City, State, Zip Code):
a ?d Allt D
IX. COUNTY/ DEPARTMEN USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Age t Signa re (No S mps)
AA/pproved ❑ M Surcharge fee) ,
Owner Given Initial 5 u VI/ w / CJ,d`_
Adverse Determination ~t" e(J
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.
G
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:
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 oxes that apply.
IV. Type of permit. Check only one on line A. Complete line B i permit is for tank replacement, reconnection, or repair-
V. Type of system. Check appropriate box depending on syste/ 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 exiting tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructe4and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental appr~val only if tanks received experimental product approval from
DILHR. f
VIII. Responsibility statement. Installing plumber is to fill i6 name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign appli,~ation form.
IX. County/ Department Use Only. J
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.
I SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry Ad Human Relations
August 8, 1995 226 Rose Street
P 4:• Crosse WI 54603
1 It
WEGERER SOIL TESTING.
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S95-40830 FEE RECEIVED: 180.00
PETERSON, BRUCE
SE,SW,35,28,16W
TOWN OF EAU GALLE COUNTY OF ST CR.OIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent, upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of j'
approval at the construction site. The installer shall notify the appropriate
inspector when i,aispections can be made.
All permits required by the city, village, township or county shall be
obtained priorlto installation.
Inquiries should be directed to me at, the number listed below. Please refer
to the plan number shown above.
Sincerely,
4Dei'
Sorenson
Plan Reviewer
Section of Private Sewage
(608) 785-9336
SBDA•7997 (K. 10194)
Page } of i-
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE -4083,0
LOCATED IN THE S~ 114 OF THE S►-k) 1/4 OF SECTION 35,T2-8 N, R 16 W,
TOWN OF Ei N COUNTY, WISCONSIN.
INDEX
BLOCS.
PAGE 1'of 6 TITLE SHEET SAFETY a DV.
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION.
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
C3RvC~ 4 LISA 1~~'TtQs'~
1Zp } ~I~ . ~-IZ~IVI-c Lt 1V
New Ul..wt, ~ rv s 603
PREPARED BY
WEGEE~EFt SQ I L TESTING `~~~~~.t~y,~`~~
AND as
DES = Gad SEF;zw ICE s° ACTH 4
O i WEGENE t
F.O. B01 74 421 K. 1SAIM ST. a~Sw%oaTH,
= wrs.
RIVES FALLS_ NI 54022 • •
715-4~.r-0165 •..,,..r
~~~0►~ S101 ahsetNN
8-V-4S
JOB NO. ~S-f 6S
'Sca1e - =-1. ~ - -
'95 -408,30
~~,X S CTS 4 7 °
J/ y I -
LO C.ll1~ S~tC~ ~4 i
0
V1
rc~ * s m
V-)
0C 50'r-It4l
o ~ n cn
8 -7g $-77 G
s ° n vu \,3,-i - ~7J GlA S'V« ~O Ble- QEI-I 0U etD .
~w tq_ t` t?t . q 6 S I lu s`1`~LL ~'PC~~FL~ S ))Q ET}U S *n"
e`4 33 ` ~ooo c~►tt , pC_Z-csT taiCR-eTG--.
DoT ~~~OC t3 3 -t~s' t s tt ~Yp.~1~ WI Y'1 f'(1l)1~(OL~ 1nJ1`CR1UrA7~
L-Lab5 B1. Fu \-`',f _
t25 - DF cor'1t~1 ~(ltiG.
~ o DoT ~o~Phc-T
o lZ ~ \ s TvTLB 'titLS 1~'S~ ,
tZesr LUuIE- OF 771AAS 15 hz~~ Pty iZC~L ! S 700"$ ~tzau-1 ~,~ur~.
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (LL_ required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be hoop gallon capacity manufactured by
'EAV W ~'(Z►J ~'\c S i.~C - ~ i t3 r' 1F'~ ti`s S'~t 7sp QL. A~, _ -
5. Bench Mark FL, l p, ' Otv q G 31 01 PUC Plp W
C S OU E t'~ 1Z )3Bm I-.0 cam) U 1u
6_ Divert surface water around mound to prevent ponding at the uphill side.
Page 3 of b
Approved Synthetic Covering S95-40830
RST" C. 33 Distribution Pipe
Medium Sand
H _ G
Topsoil F Elev _ W3.7-
3 E "
`
b
g % Slope
Bed Of 2~- 2 Force Main Plowed
w k A' .r ' Aggregate From Pump Layer
D \-7 Ft.
E Z .3 Ft.
P* ss Section Of A Mound System Using
F c). B Ft.
} 28'tor The Absorption Area
G t_o Ft.
A $ Ft. H X-5 Ft.
Li l~ai L~, ,cijh'-T R e= 4•~ GPD/LN FT 6 ~ Ft.
Design Loading Rate= 0;38 GPD/SQ FT 1 l'7 Ft.
J 8 Ft.
K 13 Ft.
L Ft.
W 3:3 Ft.
L
Observation Pipe
J A
( -
• -~--------------Fo
rce Main
eDistribution Bed Of 2 - 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page 10
- -
Perforated Pipe Detail S95-40830
0
End View
Perforated
End Copt PVC Pipe Install permanent marker
f " ob~c ooS~a',
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
S I
PVC Force Main
.
I
T
PVC
Morufold Pipe
:a
Distri ution
Piee
Last Hole Should Be .
Next To End Cap
End Cop`: sr y l sr
P I4ZZ Ft.
Distribution Pipe- Layout
S 1)_ Ft.
X V b Inches
Y 4 `S, Inches
Hole Diameter Inch
Lateral Inch(es)
Manifold Z Inches
Force Main Inches
# of holes/pipe
Invert Elevation of Laterals V30--7 Ft.
6K U. -Iz -J.oLx 4 z 2-8. Lz GP"
Place lst hole Z4tlfrom center of manifold with succeeding holes
at 4$y intervals. Last hole to be next to the end cap.
-RUM{' CHAMBER CRO55 SECTION AMID SPECIFICATIOMS ' PAGE OF
v VE CAP S95-40 30
NIT
`'C.I. VENT PIPE WEATHER PROOF
APPROVED LOCKING MANHOLE
JUNCTIOU BOX COVER WITH WARNING LABEL
10' FROM DOOR, 12~MIU.
WIIJDOW OR FRESH I -
AIR IuTAKE
GRADE I
I ti" MI1J. ~.)L
a1-1 S,
16" AIM.
COWDUIT
18'MIAI.
PROVIDE I -
IAILET TA: ':"~,RTIGHT SEAL I III
i
APPROVED Joluarik itonstruct on shall comply I I i I APPROVED JOINTS
wkh ILHR. 8.3 1,54 and, LLHR 83.20 I I I
II ALARM
I I ON
SS.1Z--"' _
L L 1= V. F Yr PUMP OFF
~ ~L Q ` COAICRETE BLOCK
3" APPROVEr
RISER EXIT PERMITTED OIJLy IF TANK MAUUFACTURER HAS SUCH APPROVAL gEppINQ
SPECIFICATIOIIS __JJJJ____....
DOSE y~~ ~~Tg( Pt T
TANK MAIJUFACTURE;R: IJUMBER OF DOSES: 3' S PER DA4
TAWK SIZE: -1 S O GALLONS DOSE VOLUME
ALARM MANUFACTURER' SS, S`tST&ts INCLUDING 5ACKIFLOW: 6. CZ GAELOMS
MODEL NUMBER* b ~w CAPACITIES: A = IIJCHE5 OR 311" GALLOIJ3
SWITCH TYPE: SZ`d 8= Z' INCHES OR 39.0 4LLOIJ5
PUMP MANUFACTURER: ZO~L.l.L12 COM a MAJ C. = 7 INCHES OR `36' S CALLOUS
MODEL NUMBER: Q8 D. X31 ~ZIMCHES OR u'3' 3 GALLONS
tVT~CI. a - S f3. $
SWITCH TOPE: ~Z MOTE: PUMP AND ALARM ARE TO DE
MIUIMUM DISCHARGE RATE ~8' 08 GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEKEUCE 15ETWEELI PUMP OFF AUD.-DISTRIBUTION PIPE..\Z"S% FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . 2.50 FEET
S O FEET OF FORCE MAIN X FjOFJKICTIOM FACTOR. 0'81 FEET
TOTAL DIJUAMIG HEAD = 1 S $ FEET
DIAMETER
38,I~4
INTERNAL DIMLW510WJ OF TAWK: LF-MGTH ;WIDTH 'LIQUID DEPTH
BOTTOM AREA 231= - GAL/INCH
AS PER MANUFACTURER = 19•S GAL/INCH _
HEAD CAPACITY CURVE 3 7/13 s 1/a
30 MODEL "98" 4 5/8 -1
8 6
25
3 5/8
0
T 6 2D + +
U O
< X5 z .89
4 3/16
0 15-
4-
0
10
2.8. 08 1 1/2-11 1/2 NPT
2
5
0 S95-40830
U.S. GALLONS 10 20 30 40 50 60 70 80
LJTERS 80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 12
HEAD UNITS/MIN
FEET METERS GALS LTRS
5 1.52 72 273
10 3.05 61 231
15 4.57 45 170 3 5/16
20 6.10 25 95 - `
Lock Valve 23'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
e Electrical alternators, for duplex systems, are available and a Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
e Mechanical alternators, for duplex systems, are available with or a Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weiht 39 lbs. - YZ H.P. 2. Single piggyback mercury float switch or double piggyback mercury. float
98 Series Control Selection switch. Refer to FM0477.
Model Volts-Ph Mode Amps Simplex Duplex' 3. Mechanical alternator 10-0072 or 10-0075.
M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak".
N98 715 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify
D98 230 1 Auto 4.5 1 or 1 & 7 duplex (3) or (4) float system.
6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim-
E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by
a quali-
Piggyback Mercury Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ-
FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732- Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO., P.O. BOX 16347
Louisvflte, KY 40256-0347 Manufacturers of .
`o OELLE/~ O. SHIP ~svfle Mlftrs
n (502) 778-2731 a 1(800) 928-PUMP QU.f[/TY PUMPS ~NCE /9.
FAX (502) 774-3624
Wis o' nsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILrt6 A0
NTY
Attach complete site plan on paper not less than 81/2 x 11 inches not limited to vertical and horizontal reference point (BM), direction GEL I.D. #
dimensioned, north arrow, and location and distance to nearest roo 0 8 - 04 cj - 3 O
IEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFOR PROPERTY OWNER: _1iX 14 Tz, PrR M-f M FA ATIO N AW132.1 LtS A P z~' E t/ /4,S 3S T Z$ N R l 6
E( W
PROPERTY OWNER':S MAILING ADDRESS BLOC NAME OR CSM #
~zo) ►-1- , V:__t7A1.)1zt_.tN i
CITY, STATE ZIP CODE PHONE NUMBER ❑ MOWN NEAREST ROAD
I~L.Y'l ~ M'll~J S~pZ3 (5~'T) 3S~- S S L`Pcv G •Pt~R~-s'f'•CAAIx RA.
[ j New Construction Use [ bq Residential / Number of bedrooms 3 [ j Addifign to existing building
jpQ Replacement [ I Public or commercial describe
Code derived daily flow SO gpd Recommended design loading rate O -3 a bed, gpd/ft2 - trench, gpd/ft2
Absorption area required '~N1 S bed, ft2 315 trench, ft2 Maximum design loading rate 0 . S bed, gpd/ft2 0. b trench, gpd/112
Recommended infiltration surface elevation(s) o O . L' ft (as referred to site plan benchmark)
Additional design / site considerations fksyvk~ w/ 8 ~X ~l1' Bl'~ • wtiuv 11" )u h-r 2 O" o S l'1•n.r , t=-1 L. t- .
Parent material o-\ Flood plain elevation, if applicable N ~ A - ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK
U = Unsuitable fors stem El S ® U ®S ❑ U ❑ S O U El S ®U ❑ S ®U ❑ S PffU
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 Tmnch
SEE
Z. wk b-6 -t 1'z_ 31Z S1, Z`ESd~C Yn a-S
Z -7A -t V__ 3/(0 - s11 Z'Fs~k V14 cS - o.S o•.6
Ground 3 2.0 Z9 kr),Lt Z 414 S`1R Slg 0-`
elev.
Otb.S ft
Depth to
limiting
factor
ZO''
Remarks:
Boring #
o-•S tb`1.R 31z - Sl} ~-T'Sbk ~►~l'~h c~.s - r,.s ~u.~
Z Z S-lb ~O`t1~-Yl3 sit 2`~'s~k wt~'b eg - o.s c.b
3 16-3~ log-f,2 ~Fly~ ~.s~c2 s1~ cl c~~-t ►-►-,'E~ - - -
Ground
elev.
I_ ft•
Depth to
limiting
factor
Iby
Remarks:
CST Name:-Please Print Phone:
Arthur L. We erer 715-425-01.65
Address:
egerer Soil Testing Design Service-P.O. Box 74 River Falls,WI 54022
ate GSTti[umb~ -
r.. ~S-~~13 - - °jS A0057-6
PROPERTYOOWWNER~tERS \ --rZ1?SO1J SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D.# 00 $ - x.09.9 - 3D `
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
(pin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T
a.s - o.S
1.v~-1R 3!6 - sl l Z'sbvc wI'(V cg o•s
Ground 3 Z2 3Z LO`'(i2 yf C'-)•SL1►2 .18 c f3 vK f-►-
elev. '
96.Sft.
Depth to
limiting
factor
Remarks:
Boring #
'i
Ground
elev.
ft.
L I.
Depth to
limiting
factor
Remarks:
Boring #
:v}}~ 1 III ~;,,r l I'1
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
111
Depth to
limiting II
factor
Remarks:
PLOT PLAN Page 3 of 3
SCALE 1"= L40 '
x s
y
~ PL~Z.G.C, ST`, Cl~lx \Zp~-b
Lo G11~ Uly S lz,~-j' c l1
i
DI
N
i
$o (n $ Z . m ~,~3 X17
73
5
L c~ b5
`cv
o ti o 1 s Tv'R.t~ 'nt ~s ► ,
f~~~T_ LLN~ Or `'C13.1 S ~ S ~-IZ,E C='r~R. ~ C:'~- 1 S x,0.0 ' _1-1z(1M__ N7_ t~ V!~p
e.• LUU. 0' oftj qk ~ 1Gl~i, 3 )q" b1f~, PvC PIPE wl L_AT] ,
q S~ t68
_
(715 ) -4 2, 5-016 5 _ 140056
CST Signature _ Date5igned' Telephone No CST #
VALstonsin Departrnent of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper, not less than 81/2 x 11 inches in size. Plan must include, but
_-nom limitedto-ver6cal and horizontal reference point-(121M), direction and of sb ,scale. or PARCEL I.D. #
. _
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: -12(1,4 TZ~* *rR.Q "M PROPERTY LOCATION
%k)qE 1S Z%U cU- ig W A Ptr_ Trj N Gew-k(y 5 EF 1/4 Sk) 114,S 3S T Z$ AR 1 b E( W
PROPERTY OWNER`-S MAIUNG ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
ZZ o I fv, PR Vk)kuN -
CITY, STATE ZIP CODE PHONE NUMBER E]CITY EIVILLAGE FROWN NEAREST ROAD
I~LII~I, ?'~►Pv Sl,p-13 (S-67) 35t{- X,5 S L v G ~4 LLB Pt~RCts-ST•CAAIX RD.
[ J New Construdon Use [ Jq Residential / Number of bedrooms 3 Addition to existing build'mg
jpQ Replacement [ J Public or commercial describe
Code derived daily flow 'kSO gpd Recommended design loading rate .o -3 8 bed, gpdtft2 - trench, gpd12.
Absorption area required ~"1 S bed, ft2 3-1 S trench, ft2 Matomum design loading rate o - S bed, gpiW 0.6 trench,
Recommended infiltration surface elevation(s) 1 b D . Z ft (as referred to site plan benchmark)
Additional design / site considerations *'NbuxAZ~ 8 ~K~l1' t3l'A . Wtiuv r rav 1I-r Z o" 01= S 1 ►p H LL. .
Parent material C \ ~L Flood plain elevation, if applicable V--) • A - it
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK
4 U= Unsuitable for stem ❑ S ® u 10S O U 0S RlU ❑ S ®U O S ® U O S Pau
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color
MoUles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed w&
0-6 1oy231z - sil Z.~'sb~c yn a.-s - o-s o.6
I`
Z &--?n lb`1tZ 31,` - Sj 1 Z'~Sbk Y►t'~. S o •S o,d
Ground 3 Zo-z-`J W-m 41V c -S~tQ sly o `"N ti►~'~'t _ - _
elev. -
°i6.5
Depth to
limiting
facia
~O4
Remarks:
Boring #
0-S ib `tR 31 Z - Sl~ Z~sbk ~-S p.g o. ~
Z Z S-1b ~p`-[R-Yl~ _ sit 2`s~k y►~~'h e,g - u.S o.b
3 Zb-3~ lkw- - 4ly --l-s4vt slf3 C_ tl~t vn'~ - - -
Ground
elev.
Depth to
limiting
(actor
X1.
Remarks:
T Name.-Please Print Phone:
Arthur L. We erer 715-425-01.65 -
ress: _
_er_ 5~3.Testin & Design =Service-P.O_ Box 74-River-Falls-,WI 54022
PROPERTY OWNER ~ ' ~1ZSON SOIL DESCRIPTION REPORT -Page?- of 3 i1 ,LI
PARCEL I.D.#I C) O 8 - LO9.CI - 3D
i.,
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T
: xk o_~ ~~`~11Z 3! Z 5L } Z ~'-Sb ~y a.,3 - 0.5 0 6;
~,~~v,...~..•~r~, z ~ -ii .1. ~~R. j!6 - s i 1 Z~s b1~ wL ~ cg o. S o. 6'~
Ground 3 ZZ 3Z LU`[.12 y~ C-~•S~tR 518 c~ v vn f-~' - ;i
elev.
96.Sft.
Depth to
limiting
factor
Remarks:
Boring #
i;
nw,
I;
Ground
elev,
ft.
Depth to
limiting
factor
I;
Remarks:
Boring #
hhkh i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor i, j
ji!
Remarks: - - - - -
• PLOT PLAN Page 3 of 3
SCALE 1"= -{O
.p
p l LS,1tC _ Vr. Cl~Jlx \Z1I N D
Lo C-?M o Sh0~1 c H
D
N
yc. v-~eT1..L
K '
V cl o ~1oT Co"- , vc-T'
C'Z 'b1s1X31L}3 'nttS 11R* ,
T Ll►v~ or LS \S ~elZE ~C:r` lS oo 1 R(~M 1°_?_u_vAAD.
0-- Mul0I ON qk 1~lGl~i, 3lyr wl , pVC p[PF w/ LATH,
q S~ 168
- 1 2 4-f11 r'LS 1,100576
CST#
Dated rted = Telephone Nb_ :
CST Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER D2wCe + L: ,S& Pe,+.e✓SC? A
MAILING ADDRESS -4 4-5 4Z An
c>
PROPERTY ADDRESS Pi O (location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 56 1/4, S W 1/4, Section J3 S_ , T 0r N-R W
TOWN OF lf44., G*tf l2 , ST. CROIX COUNTY, WI
F"L 4"al : $ ITA,",e-S aJ W 30Acr-e-s at f V2 Se /y T35•, fZ4 a1, s+ ►Cf-ou Ga.
6 LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME - 'PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible~o 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:
DATE: P'•? ' 9S
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
• ' r
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. _B2vAce + L: s* -wuis e e,_
Location of property SE 1/4 S&) 1/4, Section 3S ,T 2d'N-R 6 W
Township_ jFAtt / /A-Ile, Mailing address
5503 Cj'
Address of site
Subdivision name Lot no. -
other homes on property? Yes k No
Previous owner of property ~ e4L a)_ i Z✓t 4*Vk -
Total size of property _15 Total size of parcel S,¢G
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes X No
Volume 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 ppt ounty Register of
Deeds as Document No. 5 33 t eal VO1 113;7 afic ~fi t 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 33 K 137 P, ~ q
natu e of Applicant o-Applicant
L/~ v
/ 2-8 J
Date of Signature Date of Signature
State Bar of Wisconsin Form 2 - 1982
133183 i s VOL + I PAD
DOCUMENT NO. ii rte- Y
a r II r,~CC
F - -divord a and- yrn ed1 La JParnhan.-_ - - - I'
-e-d-- un-r_e-n Avv 2 9 I9S5
i
said Cynthia J Parnhatn 'VAJa- C'n- this J. loltnes
-
it
cotncys and warrants to _Br r-e L. Petersen and Lisa M ` ' •
Petersen 1_husband_and wife - -~-=3
Petersen - _ - - - i - - - -
THIS SPACE RESERVED FOR RECORDING DATA
r
NAME AND RETURN ADDRESS
k_ { the following described real estate in -Sty-Croix-
County, State of Wisconsin:
00d-1099-30 = - -
~n (Parcel Identification Number)
X+. The South 15 acres of the West 30 acres of the E 1/2 of the SW 1/4 of
Section 35, Township 28, Range 16, St. Croix County, Wisconsin.
t~ •
t}'ut it
•1 Y li
I!
i'
This -lS-nQt- homestead property.
{ (is not)
r Exception to warranties: Easements restrictions and rights-of-way of record1 if an
y'
tY / w Au us t 19. 95 .
Dated this _ day of
(SEAL) - - - (SEAL) 11
, Gerald Parnham
a (SEAL) ,4ParrVnhea _.s AvLj ~ (SEAL) i
Cynthia J. m n/k /a ~G nthfa J. Holmes
s !51.
'k AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
Signature(s)
ss
- - - County.
k authenticated this day of _ , 19 Personally came before me this 7 day red
{ _Au9U0t , 199_ the above na
- Gerald Parnham
h4
Divorced and unre_married
;q TITLE: MEMBER STATE BAR OF WISCONSIN - - -
i " (If not. - - - -
authorized by §706.06, Wis. Stats.) to me to be the person - who executed the
foregoin mstrumeit and ,,{{nowt grthe same.
A l THIS INSTRUMENT WAS DRAFTED BY
Kristina_9Blanc,-----------------___._--
_ Attorney at _Law Notary Public - 1" ---r unty. Wis.
r,
(Signatures may be authenticated or acknowledged. Both are not My commission is er anent. (If not, sta piratic hate:
necessary.) _ ? ' 1 .17-
'Names of penons+igning in any capacity chtnild be typed or printed below,heir signatures.
W:ARR.AN"tY DEED SLATE BAR OF WISCONSIN Wiscons.n Legai Blank Co.. Inc. -
- 982 Milwaukee. Wi^! -
-Department of Industry, PRIVATE SEWAGE SYSTEM County:
uman Relations INSPECTION REPORT ST. CROIX
y and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
PeFP&i i ; -dERALD ❑ City ❑ Village [ R Town of: State Plan I No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
- A9500234
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 16VO Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANKTO P/L WELL BLDG. A
iritc ntake ROAD Dt Inlet
Ar
Septic Al4 /V& Nq' NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift ILric ' n System TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengt o. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO / BLDG WELL LAKE/STREAM LEACHING Manu acturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Eau Ga11e.35.28.16W, SE, SW, Pierce-St. Croix Road
PJ1n.U t.~ lr-S V 411 T
eLA~
J
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Dat Inspector's Signature Cert. No.
l
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
'I
I,
I
I
i
Safety and Buildings Division
L•=~Xn 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 onlyLfor the system, on paper not less County&n
than 8 112 x 11 inches in size. '
• See reverse side for instructions for completing this application state sa ^aryoerm'tNum er
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner N Property Location
eonl- am a E 1145- 4j 114, S 3S' T oZ F, N, R l E (or) 40
Property O ner's ailing Address/ Lot Number Block Number
y a e-/ C 7`-4/6x 7` `d-~ l -
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYP F BUILDING: (check one) ❑ State Owned !tr Nearest Road
vila,
Public 1 or 2 Family Dwelling - No. of bedrooms 3 ❑ Town OF 44 G' ST fY•c" /Q
Ill. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 60 8`J Q f,?
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 online B, if applicable)
A) 1. ® New 2. ❑ Replacement 3. Q Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an
------System ___System_____________TankOnly______________ Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12E] Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy
13E] 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
Feet Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ,%t'a 0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
V111. 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 S amps) MP PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip ode):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa ar Permit Fee (includes Groundwater E41RIe slue Issuing Ag t Si nature( t s)
(Approved ❑ Owner Given Initial ~j~ -D u Surcharge Fee) 3
t/` Adverse Determination H
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
'398 (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, recorcjion, 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.
PLOT PLAN Page 3 of 3
\ SCALE 1"= ~[O '
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A)
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9 S-M
(715 ) 42,5-n1 r=i5 1100576
CST Signature Date Signed Telephone No. CST #
o'ww ~z GZ~ S S - S ~ UN
"a,7/w"waw 11JS'T'hL~. V ►~W-1 UU
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`~PC~u w f Rt FFLLS F~0ufj
~ 1rvL~-'T NK.p ovZ- ~T t~~u~ sc~
I
Owner's name San. Permit No.
H63.05 PLOT PLAN
Show:
G~I Location of building served NA Dosing chamber
NA Septic tank NH Vertical/horizontal reference point
NA Building sewer N~ System elevation is
E Effluent system C hRl V'~l~ Well
RAI Replacement system area Property lines w/in 50' of system
t~1Ac Distribution boxes Scale = 1'~=Zoo , or dimensioned
►.iq - Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
t
a~
~I o
wEL~- M
Al
J
jJ' tih
? ~.>5, p
--1 ~ J
J /rt~uy p
- U
Sw Q~1 fJL~Z
o f SE/ry_ Sw lly ~l ~C - ST-~~lyc R u►~q
SEC35,TZ`dtl, m6k!
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St.CroixCounty and theSt.GroixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
DEPARTMIENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
lNDUSTR'Y, DIVISION
LA80R AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSH UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
1/ sv3 3S 11L /l E (or ,
COUNTY: OWNER' BUY AME:
IMAIEE= MAILING ADD ESS: ~Ou fl~ S )
ST• CZO lX ~ER~Z`T ~F~ iJ I°o1~1 IUE'R F-ArLJLS~ wi►V S 6 7L-:I, )
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence Z N• A ® New ❑ Replace I 1 1 1
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENT(IOONN1A'L: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) Vp\.D1U 6 'IPt7Jh
■ S ILV U ❑ ®U ❑ ®U ❑ S 2JU ❑ Wou SSW L1J ~~eRuk16 n xTulZ~
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the N
under s. ILHR 83.09(5)(b), indicate: N • N , Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-tfa:OM:Ps CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
3 1 tv.~, No)J~ N'y%6- Cd' O-Z'blil STS ;e.6'YJS-~72.3'G4 73.1\
B- Z.. • _ _ mei i o. o •Z'Utc G Ens' T - 1, ' $>t c
3•2-
' 'I Mrn Ta_I.3' b.y• ; 2.$' `1 _s_i ~ -
B- L4 1 14'
3• +I nibT~ 0,7 o.z, I~ ;o7'GYSiI~ z.5"t $r,Cl
-S 'E.4_'_ I r O.-Z, .8h5) YS;o.S'GySi
! ; Z•z'
B- 6 2• 1rn6T~ 1.'Z I 8.6' D\tB' Si 1o-V'LT 15151 S') 8 'LT. bh v S -
7 Z.-7' ~I 1Mo1o I. 2,' S.I/` 5' E'YSL-i~ Gy Bl v-(\sl
B- Z. 6' moT a I-3' 0- ' e, O y f 1 8, 78+1 C,
o- 3'D\c-K 6n S l TS 1. S 1 `t $_t ) S tuff y C S PoT 4
Eu*~c1 CIS /voT ~"TN-R~'~1tN- ~S MbI'nuJArL C,L)ST w0Q~,QL__3E_1Nc&R-1tM
B- w v E W'00 - tl - s u ~ ,
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH
P- 1v S U `11V Sc~l L O
P- V Z 101 'SCAL $ TEP?
P- Il) N
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. ~ P, q 5 \-Z~ ~y \j A, vk,) ftx, TTybe 1
SYSTEM ELEVATION
;zl W~TL.h'^~ 5 ?S'[~.LaP s t..uPES •h~b
-A) tt
TN
~ l.D v S C~'TCt-I
10 ~c~+E
1
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a
3
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3
T. Wit" tx b
S E- 3S
ttI- SW~~yl S CI ! tI_ ZOU' PL sE. !IT caoi~t ~A•
I, the undersigned, hereby cer5 y /that thesoil 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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
AZT v1~, L. W SC, 0ZeZ '11\_
ADDRESS: u k_ ~ L/ rsl~x ?-Z CERTIFICATION NUMBER: PHONE NUMBER (optional):
LLSw z s o)I S-)6 JS-1415-(3) ~y
CST SIGNAT RE:
3UTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
-6395 (R, 10/83) - OVER -
C TV 11
HE
i "OIL
r,..
,
ti
T C s )V.
This soil test report is he first step in securin a ~ary pefmit. co y ~ L
verification of this soil test in the field prior t , permit issue z'e
sewage system and a permit application must b' mitted orE_.~r to
obtain a permit. The sanitary permit must he Ohl 'Id
>truc-Barr.
i
r
TC_
5 - V0!_ PAGE
PRIVY INSTALLATION AGREEMENT
St. Croix County, Wisconsin
PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION.
Property-Owner(s):
Reserved For Recording Data
ZIEM'-i
Mailing Address:
ly,oc4 (I-WZ-s mUr oa,
Location: Ui
3F 15W) S:35, T_68 N R 1.6 E or ow fiac'd for City. Village, Township Of:
J U f 1
L 1.3 1995
Parcel Tax Number:
bog_ 109 4 - 30
Legal Description:
S \Sstc 61= 1.J 3o RC of C j1`Z0F StOItty
mot. 8~6 l'S yo7 u6o66~ do0
1. No plumbing will be installed in the privy.
2_ No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or
holding tank exists, or a valid sanitary permit to install such a system has been issued.
3. A privy vault/ pit shall maintain minimum setbacks as specified in Table 1.
Tablet Well Building Lake/Stream Additional County Setbacks
Open Pit 50 Ft 25 Ft Min. 75 Ft
Sealed Vault .25 Ft 25 Ft Min. 75 Ft
4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code.
5. Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and
other vermin. Doors should be self-closing and vault ventilators should terminate at least one foot above the roof.
6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall
comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes
and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code.
7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR
113, Wis. Adm. Code.
8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the
register of deeds in a manner which allows its existence to be determined by reference to the property where the
privy is installed.
Printed ner s Name s
Subscribed and sworn to before me on this date:
Owners Signature:
Nota
~ M3fIN601J►
` • l:1
my c xpires U1ENN
~M1IMII My~
NOTE: This document was drafted by the State DWOMm: of industry. Labor and Human Relations,
Bureau of Building Water Systems.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERR ~e~C2-LL- ~`St-R ►'jl
I LL b'4
MAILING ADDRESS L-nN \~lZ lc~R1 ~ ca, S,3 X41
PROPERTY ADDRESS Z~6 - CJ's- Y a,
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, SW 1/4, Section 3 T _2'f3 N-R W
TOWN OFy C> ~=l ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE - , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and re umed to the St. Croix
County Zoning Officer within 30 days of the three year ex it lion date
SIGNED:
DATE: Q
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
Location of property S~ 1/4 SL A3 1/4, Section 3 IT '~!-S N-R W
Township )~U G LLL Mailing address
Address of site
~~ag' ~,'L'✓G ` STEro i 1t
Subdivision name - Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property S 1
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes L-*'~ No
Volume 8--)G and Page Number W)-7 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. q k)66 8 , 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.
S atu Applicant Co-Applicant
D
Date o Sig ature Date of Signature
07/12; 4
^~i d30CUM61VT Nt7. ii5fllT£ BAR OF WI!R'9f9'ki)M 1--><gggri--FP-" asACE eszrYco %ew'ikGo,leI,+a DATA WARRANTY DEED
ii 460668 y~ 876FXSE407
- r=_ - . - 1► REGISTER'S OFFICE
f' This Dead made bclwuCn Jack L. Palumbo and
a 94ren,L...Palumbo. husband and 1We..an.d $T. CRQIX W
each in
„
I~ their, ow,rA •right RCC d for Record
.
t,
Grantor. JtJL 2 4 iV0
M
CIS
1 and Gerald Parr►haw. and.. C nthia J :.Parnham..... 11-00
husband and wifQ .as survivorship, marital.,property,...... I'
1 O~+w e+f p
, Grantee
witneSSeth, That the said Granter, far a valuable consideration.,.... !i
. , ~
One Dollar.. and other.. valuable. consideration
......~.....r ._._--_.__...--1
conveys to Grantee the follt%wina described reel estate in ,5;, . Cr•• 17G-,• i atcTUgn ro II'
County, Stale of Wisconain: I
I
The South fifteen (15) acres of the West i i _ - ~ - -
fi ;I Thirty (30) acres of the East Half of the TotParcel Noe...................................
Southwest Quarter (E$ of SWD of Section
Thirty-five (35) Township Twenty-eight (28)
North Range Sixteen (18) West.
This deed is given in consuamlation of that certain land contract by and between
the parties dated May 31, 1989 and recorded on June 27, 1988, in vol. 814, sage
608, document number 438805.
This •.:13 npt.......••. homestead property,
GO (is not)
Together with all and singular the hereditxments and appurtenances thereunto helouging;
And .
„-arrant that the title is good, indefeasible in fee simple and free and olear of encurnbragCcs except
all casements, restrictions and rights of way of record.
a,nd will warrant and defend the same.
Raced this .26th day of June . 19.90
i
(SEAL)c.•-~.Y?f~- ..Lr•~\o.~m,~.X-`{}.(SEAL)
. Jack L. Palumbo
(SZAL) ~~'C:.Gdt, CLrL11L.L` ,(SEAL,
Karen L. Palumbo
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ..,-lac,k..L..,...~3It1>nbb•.and...... STATE OF WISCONSIN
Aud..7Kaxen......Pa?.u~b
County.
to TUrIB........ 14•. Personidly came before me this day of
- 19........ the above earned
RQkd3r J „Richardson
,
TITLE; 1i M P. STATE BA ft 0~ WISCONSIN
(If not .
cut orizp by ib6.96, Nis. Ststa.) to 'r a known to he the person n•hn exewited the
for, zoinic inkrument and aesnowledge the same.
THIS ,NSTRUW.tNT WAS ORAFYEO 9Y
ROBERT J. RICHARDSON
Attoriieq 'aE' L•aw
Spring... Va.lley.,_WLAU7$7••.... \nen~1 Pu1,1ir I",ilnr:, R'i•.
(`iir,naturra may he authenticated or ncknnwh,dce+l, Anch i'nmuli=;inn is rcrm;ln ,c• 1i? nnc, srue rxn rmir•,
are not necessary,)
date: ) 1 1
•N~mti nr Ftr ns .4n-nz ,n'nr rkr-ov ph'...1d 1- •••I rinrn•1 1F•a u~ ,h•,r uzn~. c•: r••i.
~FltrTVllAr ar.l'rFORM If.. 1 11912 Stock No. 13001
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
rs!
~796-2239 (HAMMOND)
w 425-8383 (RIVER FALLS)
HAMMOND, WI 54015
March 29, 1988
Division of Safety and Buildings
Bureau of Plumbing
P. O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Jack L. Palumbo property located
in the SE 1/4 of the SW 1/4 of Section 35, T28N-R16W, Town of Eau
Galle, revealed suitable soils at a depth of 1.2 feet, below
which high groundwater was noted.
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
' kc, MC 0 _ I ~-C )tv,, I
Thomas C. Nelson
Zoning Administrator
rc
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
ION
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVIS
BUREAU OF PLUMBING
P.O. BOX 7969
MADISON, WI 53707
SE4,SW4,S35,T28N-R16W LXXXCONVENTIONAL OALTERNATIVE State Plan I.D. Number:
(If assigned)
Town of Eau Galle D Holding Tank ❑ In-Ground Pressure D Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
JACK L. PALUMBO Spring Valley, WI 54767
BENCH MARK (Permanent reference po..0 DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV..
Name of Plumber MP/MPRSW No.. JCounty: Sanitary Permit Number
Jack L. Palumbo St. Croix 106056
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES ONO OYES ONO
BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH
ALARM FEET FROM LINE AIR INLET
OYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL ING COVER
NO]PROVIYDED
PROVIDED: OYES ONO OYES O
G VENT ES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL OFRE SH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST 30
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING,
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH NO. OF DISTR. PIPE SPACING COVER INSIDE DIA -PITS LIOUIU
BED/TRENCH TRENCHES MATERIALt PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH IDISTR PIPFTE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PR OPER TV WELL r7l VENT TO FHESH
BELOW PIPES ABOVE COVER ELEV. INLELEV. END'. PIPES FEET FROM LINE AIR INLET
NEAREST--►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WE LLS
DYES ONO DYES ONO
DEPTH OVER TRENCH!BED DEPTH OVER TRENCH/BED =111111 SODDED IS EDEU MULCHED
CENTER EDGES.
DYES ONO DYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE IMAN11OLDMATERIAL
ELEVATION AND NO DI STR DISTR. PIPE DISTHIBUTION PIPE MATERIAL & MAHKIN(,
ELEV.. ELEV.. CIA.. ELEV. PIPES OI A..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLAR TS CAL LIFT CORRESPONDS TO APPROVED
DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING
FEET FROM LINE
DYES ONO DYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE.
DILHR SBD 6710 (R. 01/82) Zoning Administrator
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""5CO"j"' SANITARY PERMIT
D' L H R County
00 GROUNDWATER SURCHARGE Ord
§1~ 'NIOUSTR%%LABOR 6 HLKrw l F EL PM IS
Sanitary Permit No.
U& O-TG
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com-
monly known as the groundwater protection law. This change in statutes was the result of over
2 years of steady negotiation and public debate. The groundwater bill included the creation of
surcharges (fees) for a number of regulated practices which can effect groundwater. The
surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to
the groundwater through your soil absorption system or the disposal site used by your holding
tank pumper.
The monies collected through these surcharges are ciedited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
Ground.
Sign re of Issuing A,gent:~ `r undwater Fee: ate: Wisco
' i
~I~ .liter 6v y- ~ buried.'
DILHR SBD-7289 N. 05/84 •
t
APPLICATION FOR SANITARY PERMIT c i
L H R > hC I - COUNTY
(PLB 67) UNIFORM SANITARY PERMIT #
DEPiiRTTEnT OF
/0606-6
STRV.LRBOF6MUTRn PELFiTIOr15 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
ZT\C_Vt L a ~PA LUJ-I JbC) S i> i.,i AJ G U H LL ~~i ~v / 5 17 6-1
PROPERTY LOCATION CITY: VW E 1/4 SW 1/4, S 35 , T 2f~ N, R l6 E (or W N of
LOT NUMBER IBLOCKI\UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
11Ze~ - ST': C'a2otk tZJAO
TYPE OF BUILDING OR USE SERVED
9 1 or 2 Family Number of Bedrooms: Z ❑ Public (Specify):
THIS PERMIT IS FOR A:
[q New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ® Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On Fite, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
a~
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
i
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
kloidiw-T capacity 7ZlU ~o GC,
Manufacturer: LS <!0)0 G2E E ~l?l` l~l~c 7 S
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
❑ Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of No A-er (Print): Signature: MP/MPRSW No.: Phone Number:
P1vrMbers Address: Name of Designer:
j PiZl~i G V ~ LL~'y , w1 sy76-~ THIytZ. L. ~ E6~ZEl`Z
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
n j;~ ❑ Owner Given Initial
f-iao, oo Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
•
DILHRSBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
o o the 115 soil test report,
4. Indicate the design percolation rate listed the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
~I
i
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
s
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of Property Sz- h; Sw hr, Section S5~ , T__,~' N-R 14, W
Township
Mailing Address ~p //Uir
Address of Site
Subdivision N"e
.Lot Number
Previous Amer of Property rfr~ci c~ (Ro4, 4
Total Size of Parcel 15- Gnees
Date Parcel was Created ~J'ICvi~h 7 /5' ~i
Are all corners and lot lines identifiable? Yes r/ No
Is this property being developed for resale (spec house) ? Yes No
Volume S20 ' and Page Number 3_ 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 refer-
ences to s Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (Wel cv.ti.6y that a t statemen" on .thus onm ane tlcue to the but o6 my (oun)
hnowtedge; that I (we) am (rice) tile ownen(~5g o6 the phopenty dese i.bed in ,thin
in4almation 6oAm, by viAtue 06 a waAAanty deed kecoAded in the 066.ice o6 the
Collutt RegiAten. o6 Deeds ah Document No. 3170-) / ; and that i (we) pnehen ty
avn I p1toposed site bon the aewage duspo4 eya em (on. I (we) have obtained an
Qa.6 ement, to dun with the above de!s CA i,bed pkopen ty, bon the eonhthuction o6 ea.id
eye.tem, and the came ha.e been duty hecohded to the 066.tce o6 the County Reg.iAteh o6
Veeda, da Voement No. ,3 y 7U aj 1.
SIGNAfURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 3
QUIT CLAIM DEED
347421 THIS SPACE RESERVED FOR RECORDING DATA
VOL 57R,. PACE 374
RJEG!STERS OFMCE
BY THIS DEED, PATRICIA A. CROCKETT, formerly known as sT. atoix 401, Wis.
Patricia A. Palumbo, a single woman.
Grantor, Reed. for Remrd this__Z&b__
Quit-claims to JACK L. PALUMBO, a single man, day of March _A.D. 1978
f
Grantee , for a valuable consideration
~ Oa~al,
the following described real estate in St. Croix County, State of Wisconsin:
RET RN TO
The South 15 acres of the West 30 acres of the East Half
(E'k) of the Southwest Quarter (SWk), Section 35, Town-
ship 28 North, Range 16 West, St. Croix County, Wisconsin.
Tax Key #
This is homestead property.
(This deed is given pursuant to that certain judgment of
Annulment dated the 18th day of February, 1977 by the
Honorable John G. Bartholomew, Circuit Judge for Pierce
County, Wisconsin.)
FEE
EXEI~+fPT
Executed at this day of January 191A-.
SIGNED AND SEALED IN PRESENCE OF AL7_L1L'_ .4_) t v' 04 (SEAL)
Patricia A. Crockett
(SEAL)
(SEAL)
(SEAL)
Signatures of
authenticated this day of 19 .
Title: Member State Bar of Wisconsin or Other Party
- Authorized under Sec. 706.06 viz.
'TAT OF iilfl,NC
County. ss,
Personally came before me, this 20th day of January 19 78,
the above named Patricia A. Crockett, formerly known as Patricia A. Palumbo, a single woman,
to me known to be the person who executed the foregoing instrument and acknowledge a same.
This instrument was drafted by Donald J. Parker
Phillip M. Steans - SOLBERG & STEANS Notary Public
i'Co~y,?Wii7f;_
Menomonie, r,..
The use of witnesses is optional. My Commission (Expires)
Namen of persons signing in any capacity -_Luuid be typed or printed below their signatures.
GRAPHIC PRINTING CO., [AY CLAIR[, WIR
QUIT CLAIM DERr 'If'ANSIN, FORM NO. 3 - V"
L
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ri i n Gz ~l~~l~
ROUTE/BOX NUMBER L 21LZC6&2 /)LLe FIRE NO.
CITY/STATE ZIP
PROPERTY LOCATION: 1/4 11/4, Section 3S , TAN, R / W,
Town of Z-Gw St. Croix County,
Subdivision , Lot No.
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 a 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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
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 Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGNED
DATE
ff k
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
(715) 796-2239 or (715) 425-8363
Sign, Date, and Return to above address
DEPAR**--NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, - DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSHI MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
SE'a Sw'/4 s T 3N/R !6 E to ~ v Grp L-u -
COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS:
S'S• C-ZOIA S~NCVz- L. ~AUQMBO 51---21NG VAL-LIS`f, W► Sy767
DATES OBSERVATIONS MADE
USE (PROFILE DESCRIPTIONS: E CATION TESTS:
NO. BEDRMS.: COMMER IAL DESCRIPTION:
~Fiesidence A• ❑New RfRepfuce
ZZ Y
c-~x~NTy ciu- s~ TE 8b 7i .L~4..Sdu °N 3 - 2!- 8 8
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: 0_1 M-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑S ®U ®S ❑U ❑S QU ~ CAS ❑U "W&Jb-~Al6tf GRoc~~Dwk"'12
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
N Floodplain, indicate Floodplain elevation:
under s. ILHR 83.09(5) (b), indicate:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-Its CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 119. ELEVATION OBSERVED EST_ HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1.3 WQ, m6T@1.~.` (D. V,Tr-6icrBhS1)7-S; l''-'Ry,S I; `-f8"cj
B- 1 Z.8' \00.OI
2.y' 98.5 it 111o'r@ ) 3' 0-V1 1•bl 1r p' /I
B- 2
B- 3 3•Z' 9M07-LI
B- _ B3 s SK"E NS 83 aAJ L RePULT 8YAIG~ DNiTID 1) - 12•-S7 FOR
B- PK Vw Z " . S 1~T 1~ C N Z ~1~O 1ZT Fri 2
B- l 0yv Pc L SO) L -t:i TA
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- 1 \S NorvE 3 0 Slg 5/8 911b S1
P- 7- \ S 30 S/16 -V8 3
P- 3 %S k ac) W 3 2
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
~oT'1o~1 OFI2b )o) • 3' p•95 LNsN7y st'J
of land slope.
SYSTEM ELEVATION
_ _ , - Sol SST OF__NUUNU _
WSoI*' N, Or 'T~i~ SW LbR~J~`R
of T 1It SESw y
"ILIX h
~ 8 (7 ~ ~ - 1~CA ~ Std-TCN
cJ„ PRIVY
fg^
)o 51 Y3 f33 SITE -T0
Br,>rZ rd''~° RJZl'LFlCeZ sy MDV~D _
EL .IOC • b'oN Yy S o~ \ SLf ST'E kJ
1~tx w0op O
w/ STN
_ SEC 3
SG^ 1 _ ((O' Pl -:Rc - ST. Cfi w R.p_
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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
2`C1-iV~ L _ wECZ 3- Z3- S8
ADDRESS: ' Zou-Tl; l1l $py~ ZZ6 CERTIFICATION NUMBER: PHONE NUMBER (optional):
F-L-.c_SkJORTM t sv S76 71S-t4ZS- 016Y
CST SIGNAT RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
LkBOR AND 7 PERCOLATION TESTS (115) P.O. BOX 7969
f~.BO MADISON, WI 53707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSH UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
0 _''T s 1/4 3S /TZ 1 R f6E (or v Gr~~L
MAILING ADDRESS: S
COUNTY:: OWNER' /BUY AME: 1-7 NJ 5 1 u )
j~'C'~~ tX ~E~-~~ ` 21U^ ~ DATES BSERVATIONSMADE
USE EDRMS.: COMMER I L PROFILE DESCRIPTIONS: PER OLATION TESTS:
DESCRIPTION:
NO. BA
Residence Z N , A, ® New D Replace 1 1 Z _ gj"] N -
RATING: S= Site suitable for system U= Site unsuitable for system
MV21.j AL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) VpLD)IJ 6 1"3)11
U D S ®U D S ®U DS ~U S DU NCO EFRuauG) xTulk u2i
tv? P coo urff_
DESIGN RATE: I If any portion of the tested area is in the
It Percolation Tests are NOT required Il N _
under s. ILHR 83.09(5)(b), indicate: A . Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GROUNDWATER-f CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
MBER DEPTHT=Z ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
' o.Z'~ltBh Isis ;6.6'Y1SJz _3'6Kn_S~-_
1 3.1 ~ 1~.___ Na1J~ ~nno'T•O~.5 - ~
1. - - - - « - X03 0.7 ' o •2 'Ist6 Bns•) IS "'I - 1. Rh c
NU MbT
B Z 3
B- 3 3•Z - - ~I
I- %I - rn b-- Q CS 0111 It ; 0Gy si 1; Z • S "t $y, cl
• I
_S -0-4 ` 11 1rioT.(2 1. 1 ` O.ZI" t 'th5~ YS_;o_.S 6'.f s;
B- 6 2, 16' WIS 0- 1 6.6' Dk 8n -o-N'LTl~, 5-~- ).a'LT.Bvt v S I
Z . VV C l e I. Z ' b • y r ii ; D_, 5 ' 6 `1 SJ~_ _ 1. $ ! Gy v -4's 1
- - ►naT a 1-3' n• a. y' !-g' Bri C')
Z. 6
B- 8
rnoi (2 a-y' 0.3"D\r-If Bn S~ TS; 1.S"-f )S cv/Gf C SP'eTS
~m 'LEv+c`z7 ~1 S 1JOT C`~-E2 ~')ta1- ;4\S M`ti `T 0Q A L C-C ST w~v~t~_ S3 E . 1NGVIZ ED
B- h_i v u u E WOOL-~ (ii~ s u~
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER OD 3 P N_-_ S \I S L o
P v Z A 4 L 5 M
P Evv 1~1 N
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation tUvborriggsann the Tecti~ajdpercent
of land slope. , A /rim ~~y L ~fyM V Ll` 5~'f`~
SYSTEM ELEVATION
G G µ`+SE
w~C Lfth~ 5 I STZ'~ SLOPES 'SITE
I tN
L~ ca'r o~ S K.~`Tc~l
~t_'Rr LIS
85 86 _ - 00
_ yq XT
eote.of5 1r- S►v/~y PteecE-ST.cZOt)c~•
I, the undersigned, hereby certr y t at the soil tests reported on this form were made by me in sccord-tvith the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
print): TESTS WERE COMPLETED ON:
NAME (
ADDRESS: Z-2- CERTIFICATION NUMBER: PHONE NUMBER (optional):
b{
L LSw e~-_SyU)I _ 5--)6 p) ) 01
CST SIGNAT RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10183) - OVER -
• `'~~~'-~r~ ~ ~ Own e r ' s n ame San. Permit No.
H63.05 PLOT PLAN
Show:
to Location of building served NA Dosing chamber
NA Septic tank NA Vertical/horizontal reference point
(76 System elevation is
NA Building sewer
Effluent system (ZIP?,) Well
Replacement system area ~yq Property lines w/in 50' of system
t.1Pc Distribution boxes Scale = ~11=-2-00 1 , or dimensioned
Nq Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
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By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued,St.CroixCounty and theSt.CroixCounty Zoning Administrator, does
not assume or 1e for any defects in plans or specifications, plan
if liable hold itself
omission, examination oversight, construction, or any damage that may result in or
after installation.
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DEP 0 F ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
_IN.-JUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) 7969
MADP.O.ISON, WI BOX 53707
HUMAN RELATIONS 3707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSHI MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
5E'/ Sw'/a s T 2.qN/R IG E (o ~M~ GA
COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS:
!&-r. C.RAIX sack L. ~~L~~ eo s ►~2►NG vFll.l W1 S1F7 67
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ~❑New Rne~UY 3-2/-$$ 3-Z3-SS
c our ry cw- SI ZTE 8b Tai Sdu av 3 -2J-85
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
EIS ®U ®S ❑u DS Z OS CCU ZS ❑U "oo&& -,ik«)f GPw%j&&wAwe
i~F l l~U '-UI~. M O t F I CA ~~`L`~U t 1?. U
DESIGN RATE: A
If Percolation Tests are NOT required If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INKS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ia. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
I lv p>J Y)76 blz6rBn S i) T-s ; ~-t Bn s i ~ ; I .3'
B- 10b~0 ~-t B k C4
1 Z.8
B- Z 2 y' 98• S~ 'I 1no~@ 1. 3' (3.V 1 1•b' ; 1, p'
B-
B- = g3 Z s s rc~-r E r rs oAj L Repu r RY YIE 2DPmm, 1) - I Z_ 8`~ Fo)2
S AT CH L=1~ -R.LvItIOR-1 Fbit
B- T-I'Dpl 0YU PC L SCE) L _'ti TA .
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 -PERIOD PER INCH
P_ 1 15 No1vE 30 S/g S/8 9/!b S 3
P_ Z 5 30 WA 1 S/e6 1351
P- 3 t S 4 3 0 W 32
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. %QTT01`9 OF ) 0) • 3 ' Q• 9 S v L-M mTY S I'll
SYSTEM ELEVATION ) 8' or- sAAj
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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 the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
ADDRESS: ~ZpU'T1E 4[ ~C1X. ZZ6 CERTIFICATION NUMBER: PHONE NUMBER (optional):
kil Sy S_)6 1-)) S- Q Z S 0/6y
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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TO THE OWNER:
This sail test report is the first ste) rir cx r y request
verification of thi- sc" in t! e private
selvage system any € I ii, order to
obtain a permit. T7 =,r , r f a t r-t of any co ,truct:ion.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
I AMOK AN.D PERCOLATION TESTS (115) P.O. BOX 7969
'dOR AN MADISON, WI 53707
HUMAN RELATIONS OLHR 83.090) & Chapter 145)
LOCATION: SECTION: TOWNSH UNICIPALITY: LOT NO.:BLK-NO.: SUBDIVISION NAME:
~~'/sw'/ 3S /Tzl R 16E for t-_~ G>t~~ I
MAILING ADDRESS: Ou1~ 3 Box S )
COUNTY: OWNER' /BUY AME: I.7~ SG-)131
J 1 • C.Z~ ~X -JrC~Z~ ~1~C 2NGIL LL.~
DATES OBSERVATIONS MADE
NO. PROFILE DESCRI TIONS: IrtH OLATION TESTS:
USE
BEDRMS.: COMMER IAL DES
L Residence Z N , A• 771:~New ❑Replace } `i \ Z_
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) Vo.,blU 6 1f jyt
DS ®U ❑S ®U DS ®U DS MU 0S DU `i'ris ` ~c~u,6 FlxTultt
C~vu`r'Y t'ct' P Ro unt
DESIGN RATE: If any portion of the tested area is in the
If Percolation Tests are NOT required
under s. ILHR 83.09(5)(b), indicate: A . Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-tfs CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTiiTmr OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON Is BACK.)
o_z_bgh;6_6'YIsJ~_3'6Y>15~--
} `!hoI- Q_ ZS TS
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B- Z o •Z'Dh.G Bns•) T - f`-f Bn c
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B= 3. - mcTa 0.7' 2-S"i$y,CA
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5 *1 cA 1.1~ o•z~ott8hs1 Z's;o.G1GySi Sj) TS -0-y'd1!1 s-)• ).8'LT.w,-~ 5~-
B- ( Z• r ,t n~o1 C° l-Z' b,y` i, ;.D.Sr 6ysl- ;l.$! ~y F3>, VS I
B B Z• 61 ~r ►noT 1.3
3'9`~Y 6n S J TS 1. S"t s w/Gy C S PeT s
~m = tEU" /,15 NoT ~"5"ClZ!'11~- ~S Mbl` IJAL GDST
B f1►•~ v u u E I.t)ovL-Z~) L S urn
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R D
P ~ S viv S c- oT
P- Q5 •EvU tJ A tJ S M
P_
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevvaatiioon tov rri ggss awn'' tth ,drecti`na; C`Y~nL V-A I\ of
land slope. r' q 5 A" c-n y Lli" ar
V S~-ry
SYSTEM ELEVATION -
i 'Cbra -rm)u S _ ua~SQ 1`C7t8~-E_ Sint-s
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1, the undersigned, hereby certi y t at the soil tests reported on this form were made by me in-aceord vvith the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
AR- UR L . W i L-F G SIZE 1Z-S-,
ADDRESS: L/ j3px Z? CC, CERTIFICATION NUMBER: PHONE NUMBER (optional):
_-fit S a o i2 `T?~ 1 ~v 1 S y I- - S 7 6• 1 S- U Z S- 01 6{
CST SIGNAT RE:
DISTRIBUTION: 0, iginal and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R, 10183) -OVER -