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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER L.
ADDRESS ; (o 9 S-0,*&tr
S yo 2
SUBDIVISION / CSM# Ile-
SECTION T 2,? N-R~~W, Town of ca" 60 / l e-
ST. #
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Goer 3 6& C4 VQ0rw1
l6 ~ f' l'f 014
n I
q2•
J' INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: /00
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION .
S;e,, c /~urrr h
Clrr~ be
Manufacturer: e_S Liquid Capacity: lerec, deco
Setback from: Well 0s-t House Other
Pump: Manufacturer 2 oellPY Model#?e Size
Float seperation 20 4r. Gallons//cycle: ;3 Go
Alarm Location lase "Ie-4;' Aw,(IW~-e kC0i-, 1
;SOIL ABSORPTION SYSTEM
2
Width: Length 0 Number of trenches
Distance & Direction to nearest prop. line: WPS~
Setback from: well:./60 House Other
ELEVATIONS
Building Sewer ST Inlet; 8 ST outlet g.
PC inlet„ PC bottom-/ . 6 3 Pump Off
Header/Manifold Bottom of system
Existing Grade S~ L) Final grade J
J
DATE OF INSTALLATION: r_ 2 y
PLUMBER ON JOB:
LICENSE NUMBER: ,A
INSPECTOR: Maq "je tf i h S
3/93:jt
r
a v
HEADICAPACITY CURVE
EFFLUENT & DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
5335
" 11 SERIES 3739 93 1371139 16114161 16314167 16514165 155/4135 15614156 I M41N 15914139
14
FT. M:' GAL 'LS'It GAL -LTR : GAL LYB GAL f LTA <GAL LTR GAL LYRGAL LTR GAL.:. GAL :9.ZLl. GAL I$TR:
1t 5 11SR u 169 72 273 104 394: 106 401 61 231 i. 61 231 60 .:s 166El2 155 ;872
12 105
10 3:4S 3< 129 61 r231 79 'r 350 f 100 373 7I 81 211:7 61 231:.1 6e 143 ~5. 151
' i OD 15 4:67 19 72 45 170 84 242. P 91 344 1'1 80 227 `s 60 227 ` 53 290'. 142 7951 145 .:SO
3tl 20 110 25 25 36 = 136 ` 82 310 s` S9 2 60 227 68 136 -t 140
4 95-
,5-- 25 7162 8 30 74 280 s 57 215 59 223 68 326'' 123 434 133 5032
'
90 30 9;44 6S 2+15: f SS 208 >i SS 220.'.'. 90 340 50 121 458 127 481
2640 12;19 46 174:'. 46 172.1 55 266 75 283 56 2901 105 .,392 114 431 f
85 50 15,24 21 30 33 125.;. 51 191 58 219 ' as 3Q090 .341 100 'rJ79's
24, 80 60 16:29 13 ST 43 161 : 36 136: Sa 226 71 269 85
75 70 21:34 30 it4 10 33 52 107: S1 193 70 -.20
22 41 B. 30 24.36 14 $3 45 4x0" 28 1 54 20.4
1166
70 90 c27f43 32 1 2 6I' 37
165. 100 30A6 18 63 21 79
20
65 1146155.
Ito U40 7 26: a 30
8'' 60 LOck Va lvv~: 19.25' 23' 26' S6' 66' 87' 73' 115' 91' 112'
5s 4667 WARNING: Model 185/4185 should not be subjected to
-1E 5D less than 30 feet TDH.
„ 45 NOTE: For Head Capacity on Model 112, Industrial
4D column-explosion proof pump, see FM0219.
12
185,41a5
35
t3.0-
115-
9B
5 42 4 53,55 137,139
57,59
G.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 SKB413
LrtERS '00 240 320 400 480 560 -SaO
U:.. FLOW PER MINUTE
w SEWAGE & DEWATERING TOTAL DYNAMIC HEADICAPACITY PER MINUTE
W w
75 SERIES 262 266 267 268 282/4292 2&114234 29214292 29314293 29414294 29614295
22 FT M, Gal. LIM Gal t tts:i Gal Lds r Gal. Lim Gal. 4tn Gal. L11s Gel.tgl.. Gal, L1R:. Gal ,L6 ! Gal. Lt.
!70 S 1,53 90 341128 484'. 118 484 128 1404 130 497 180 681, 140 530' 196 70 225 8'32
20 _ 10 3,08" 60 227 89 3371 89 337 89 337 9S 380 158 6981 124 469<. 181 658 205 776:
r 65 15 4,57' 22.5 8550 189: 50 IN 50 ' 189 61 2s8 135 Sit 106 4011 130 14U 165 6X 185 70W
60 20 4.10'. 10 38: 10 38 10 : 36 13 125 106 W 88 333: 119 4511 150 $M 168 633:
1B 25 ,7A2 76 238 68 257106 401 136 915 153 588;
155 30 9.1443 163 47 174 90 340 121 4$4 140 $30.
16 40 1219 5 1950 to 94 386 115 435:
t5 50 45,34 - 58 226 89 '339';
i 4 60 33.291 13 49 59 223:
I70 21,34'. 25 `.9EE
Lock Valve: 18' 21.5' 21.5' 21.6' 26' 35' 42' S0' 62' 7T
1Z:
WARNING: Model 293/4293 should not be subjected to
35 less than 15 feet TDH.
0
30
8 293,4293
2
6 120
282,4282
15
4 284,428
0
262 292,4292
Z 5
266,267,268 294,4294 295,4295
U.5 GALLONS r 10 201 30 40 50 601 70 60 90 100 110 120 1130 140 1150 160 11701801901 200 2101 220 230
L1Tt S 0 80 !50 24C 3{20 490 'i 480 560< 840 72Q 800
SKB1294
FLOW PER MINUTE
n
DOUBLE SEAL PUMPS
DOUBLE SEAL PUMPS WITH MOISTURE SENSORS
(1) Pumps with moisture sensors have a separate 18 SOW-A 2 conductor sensor cord in addition to the power cord and the control cord on XE models.
(2) Sensor cord conductors are connected to sensor probes in the lower seal cavity. The conductor wires are terminated in the control panel for activating an indicator
light when moisture is present in the lower seal cavity.
(3) When the moisture indicator light is activated, the lower seal has allowed leakage of water into the lower oil filled seal cavity. The pump should be serviced as soon
as possible to avoid damage to the motor and bearings.
(4) Oil in the motor housing and lower seal cavity must be changed when pump is serviced. If oil from the motor housing contains water or other contamination, both
seals should be replaced during maintenance. Always replace with new factory recommended oil and service parts. All repairs must be made by Zoeller Authorized
Service Stations.
DOUBLE SEAL PUMPS WITHOUT MOISTURE SENSORS
(1) Double seal pumps offer extra protection from damage caused by seal failure. Pumps are frequently installed without sensor probes.
(2) Pumps without sensor probes should be serviced on a periodic preventative maintenance schedule.
(3) Oil in the motor housing and lower seal cavity must be changed when pump is serviced. If oil from the motor housing contains water or other contamination, both
seals should be replaced during maintenance. Always replace with new factory recommended oil and service parts. All repairs must be made by Zoeller Authorized
Service Stations.
SERVICE CHECK LIST
WARNING: ELECTRICAL PRECAUTIONS- Before servicing a pump, always shut off the main power breaker and then unplug the pump - making sure you are not standing in water and
wearing insulated protective sole shoes. Under flooded conditions, contact your local electric company or a qualified licensed electrician for disconnecting electrical service
prior to pump
removal.
WARNING: Submersible pumps contain oils which becomes pressurized and hot under operating conditions - allow 2% hours after disconnecting before attemp rng service.
CONDITION COMMON CAUSES
A. Pump will not start or run. Check fuse, low voltage, overload open, open or incorrect wiring, open switch, impeller
or seal bound mechanically, defective capacitor or relay when used, motor or wiring
shorted. Float assembly held down. Switch defective, damaged, or out of adjustment.
B. Motor overheats and trips overload or blows fuse. Incorrect voltage, negative head (discharge open lower than normal) impeller or seal
bound mechanically, defective capacitor or relay, motor shorted.
C. Pump starts and stops too often. Float tight on rod, check valve stuck or none installed in long distance line, overload open,
level switch(s) defective, sump pit too small.
D. Pump will not shut off. Debris under float assembly, floatorfloat rod bound bypitsides orother, switch defective,
damaged or out of adjustment.
E. Pump operates but delivers little or no water. Check strainer housing, discharge pipe, or if check valve is used vent hole must be
open. Discharge head exceeds pump capacity. Low or incorrect voltage. Incorrect
motor rotation. Capacitor defective. Incoming water containing air or causing air to enter
pump.
F. Drop in head and/or capacity after a period of use. Increased pipe friction, clogged line or check valve. Abrasive material and adverse
chemicals could possibly deteriorate impeller and pump housing. Check line. Remove
base and inspect.
G. Pump seal sensor remains "on". Lower seal oil cavity contains moisture. Service pump and replace lower seal and oil in
seal cavity. If moisture is present in motor housing, the upper seal and oil must be
replaced.
If the above check list does not uncover the problem, consult the factory - Do not attempt to service or otherwise disassemble pump. Service
must be by Zoeller Authorized Service Stations.
Wisconsin, Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and 5 Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: City ❑ Village Town of: State Plan o.:
AABY, LARRY & SANDRA N -X
- EAU GAT 1 P4
CST BM Elev.: Insp. BM Elev.: BM Description
: Parcel Tax o.
/UCH /00 , Sao "ILt 46-1- g,,", _ .
I A94 0034.0
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
Vent
TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet
Air
Septic S I /9
C/ NA Dt Bottom J L
, 01
I e
Dosing o 0, s r NA Header / Man. j, q `1 q, 4 1 ,
Aeration NA Dist. Pipe ? G 3
Holding Bot. System of 3 a /
PUMP/ SIPHON INFORMATION Final Grade t;
Manufacturer Demand 11
l
Model Number i GPM
TDH Lift Friction System TDH Ft
i
Loss H
Forcemain Length a'ajI Dia. ail Dist. To Well >5
T7
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 Vo' 2 DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM
19
INFORMATION -Type Of
CHAMBER Model Numer:
System: yl,cw J`r / /oo Qd D OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
a
Length Dia. Length °02 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 2~ q Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center ✓ Bed /Trench Edges iTopsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: EAU GALLE 12.28.16.174C,NW,NW,50TH AVE.
r
Plan revision required? ❑ Yes ["No
Use other side for additional information. 1,7,3 l~ I J 4A~>.
SBD-6710 (R 05/91) Date I sp ct is Signature Cert No
ADDITIONAL COMMENTS AND SKETCH .
SANITARY PERMIT NUMBER: _ r`
SANITARY PERMIT APPLICATION
couNs~
'
In accord with ILHR 83.05, Wis. Adm. Code C-co X
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~j Q~
8% x 11 inches in size. ❑
Check if rUe islon to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
NW %4 NW S 12 T 28, N, R 16 E (or)
PROPERTY OWNER'S MAILING ADD SS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Woodville, WI. 54028 715 698-2963
11. TYPE OF BUILDING: (Check one) ❑ S Owned V TYi4GE NEAREST ROAD
7 :Eau Galle 50 th. ave.
❑ Public ®1 or 2 Fam. Dwellin of bedrooms J PARCEL TAX NUMBER( S)
III. BUILDING USE: (If building type is public, c _ at apply) Gs .0
1 ❑ Apt/Condo
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 in line A. Check line B if applicable)
A) 1. ❑ New 2. M 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 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 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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/. V
(
Min./inch) ELEVATION
450 563 600 . 93.5 Feet 96.5 Feet
VII. TANK CAPACITY Site
in gallons Total of Prefab. Fiber- Exper.
INFORMATION New fisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
b4i El
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature" (No Stamps) MP/MPRSW No.: Business Phone Number:
I mAeh AqAV I A S I 15 efid
- 2y67
Plumber's Address (Street, City, Stat , Zip Cc' e
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ing Agent Signature (No Stamps)
Surcharge Fee)
Approved ❑ Owner Given Initial
45
Adverse Determination
X. CONDITIONS OF APPROVAL/ZASTS FOR ISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To, Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at the 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 & 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 in 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 in #1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
water contamination investigations and establishment of standards.
t
SBD-6398 (R.11/88)
4 UGC - 2 G a f a t ti ~v~ I,~J~ d fps
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HVisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
labor and Human Relations
P? fision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
2 ust include, but SIT-. LK
Attach complete site plan on paper not less than 81/ PARCEL I.D. #
• not limited to vertical and horizontal reference poi , direc'on and % of scale or
dimensioned, north arrow, and location and dist neare 00 8- I CJ4 3 - 9S
~ REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE P ALL fl.MATIO.N
r
PROPERTY OWNER: PRO LOCATION
L_ NV-" 1/4 NW 1/4,S\2- T 2,fS .,N,R l6 E(a0W
PROPERTY OWNER':S MAILING ADDRESS L BLOCK # SUBD. NAME OR CSM # _
CITY, STATE ZIP CODE PHONj [3VILLAGE MOWN NEAREST ROAD
tAwbt>vLvW,Wl S,lozB (115) - 6 SO`f'tf hvE.
[ J New Construction Use [ACJ Residential I Number of bedrooms 3 [ j Addttgn to ekisting building
j}Q Replacement [ j Public or commercial describe
Code derived daily flow kA SO gpa Recommended design loading rate o- bed, gpol(t~ __-:__trench, gpol112
Absorption area required bq3 bed, 0, S <6 3 trench, ft2 Waitim design loading rate a - -1 bed, gpolft2 0, a 1 .9P
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations o S F Qy K P R zQ y t R LIZ (sef k3m 'Co uuslat t L W % . 3
Parent material g6tt -t OV`TW A SN Flood plain elevation, if applicable °t. 3. S t R
S = Suitable for system ~ MOIM•ID IN-GROUND PRESSURE AT-GRADE SYSTEM IN FLL. HOLDM TANK
~
U= Unsuitable for stem ® S 11 u ®S ❑ U [ s O U S D U [aS ❑ U ❑ S f$U
SOIL DESCRIPTION REPORT
Depth Dominant Color. Mottles Texture Structure. Cortsistiertce Bancf3y Roots GPD/ftBoring # Horizon in. Munsell Qu. Sz. Conit COlor Gr. Sz. Sh.
Bed fertctt
I
Z ~Z-36 10.1 ~ Sly _ S I Z~ 3b'Ivt - cS - o. -S %1-6
vz'
3 3 `t `l16
Ground 8° _ S g G1h O S~ wt - o o• 8
6- w~,.~z3 6
elev.
Depth to
limiting
factor:
>
Remarks:
Boring #
?--)-Vol Z tit-z7 ~v 4/!y - s t 2w, S~~c w► ~H cs - o.S l0, 6
[3-
3 m%i R y/'~ = S o S9 ~ ~ cS - o•~ o•g
Ground _ v
~elev.
s It Flo-8b lob 2 3i~ _ S 1 GI, o s5 wt I
Depth to
limiting
wtor y
Remarks:
T Name:-Please Print Phone: 715-425-0165
Arthur L. We erer
egerer Soil Testing & Design ..Service-P.O. Box 74 River Fa11s,WI_..54022
Signature: /f % u ~ L)(1- Date: CST Number:
C~~ c~_ lc{a 7.-zZ_4~ M00576
PROPERTY OWNER ~PChY SOIL DESCRIPTION REPORT Page Z of 3:
PARCEL I.D.# C~ 0f3- tOS3- °f5
Boring # Horizon Depth Dominant Color Mottles ` Texture . Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3 ` o-LO bu`~LR zl Z - S' Z~sb12 m t+ Gw - 0-s o. b
Z tin-Z.6 to-m- 316 Sl~ Ztin s1sk ~~M ~S - o S o•b
Lo`1 tz 3/6
Ground -~8 ~O`tR Yl6 S 6"b O Sg t,;r 0,7 0.8
elev.
°t6 S ft.
i
Depth to
limiting '
E
factor
Remarks:
Boring,#
' I
13
;
Ground
elev.
ft.
Depth to
limiting
'factor
Remarks:
Boring #
Ground 1
elev.
ft.
Depth to
limiting
factor '
r
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
Page 3 of 3 PLOT PLAN
Soon SCALE 1"= ,"30 ' f
c.T. tL: 8" So -v-1 NNE".
tibo•
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= eaZ'Nrh of
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it.
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av TT R't.l, t.11Utr' ~
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t-'13 ~wu fl P~.Mfv : L►u'ttT b ~ oU w Sot'- - S~'c:-vim Flv~ ow~@2S ~~i3o~1~-c. ~Wl1wl.~6E ,
q~-1~ta
(715 ) 4L-0165 - M00576
CST Signature Date Signed Telephone No. CST
at~r"~naHu iao.1Ind15ty' SOIL AND SITE EVALUATION REPORT Page k d 3 Division ofsatety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY.
Attach complete site plan on paper not less than 81/2 z 11 inches in size. Plan mast include, but ~12A'Lx
not limited to vertical and horizontal reference point (BN), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road Op' B_ 103 3 - 9S
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER PROPERTY LOCATION
I- NV-" P(A~$~1' 6AIl~{81; NW 1/4 -1W 1/4$'X?- T. ~ ;N,R L6' E(o~W
PROPERTY OWNER'S MAILING` ADDRESS LOT # BLOCK # 'SUBD. NAME-OR CSM # -
zb Oo► 50 `T1}- !A'Ue.
CITY, STATE ZIRCODE PHONE NUMBER []CITY []VILLAGE OrOWN NEAREST ROAD wdo~v~~~F, wl S~1o8 (?t5) 648- z~6 3 GR-~-~F 50 '1'tt t~uF
[ j New Construction Use [IKj Residential / Number of bedrooms 3 [ ] Acidt' ri bekS1ing buikWig
j}Q Replacement [ ] Public or commerdai desaibe
Code derived da11y flow ' 50 gpd Recommended design loading rate o= bed,.gpdffl WW
4- Absarp5on area regtiUed.. b3 t>ed;t?..S 6 3..:t~endt, Ili M~amum design bar5ng rate a '1 bed; p t~rtd~,ft2
Rkorrlfrtended infiltration surface elevation(s) q i - S ft (as refefred to site plan bendtntadQ .
A&0 nal design /site considerations-," O S _11~_. IF:,U 1"t P R~Q U L t2 L'~ . ESQ U61E'to-t+u31 Qq - _3
Pa mt material Snn.-aB v AS YJ Flood DWn elevation, if applicable O.3. S t It
S = Suitable for System . , CONVENTIONk_1 _ MOUNb N~RO M PRESSURE AT-GRADE SYSTB_ rl N F111 HMbM TANK . U -t)nsttifable for 138 ❑ u ® : S 00' IRS
❑ U ~ $ _ ❑ U T$S ❑ U O's 4$C) ;
SOIL-DESCRIPTION -REPORT
Depth Dominant for - __'_AAotdes Structure: GPD/ft._. Boring # Horizon Texture Constslanoe Bpndaly Roots terld1
in. Munsell Qu. Sz. 0,61 Color Gr. Sz. Sh. BOW
Z - o-t2 1>b~L1Z _Z, _ S Z~Sbtic w•'F~. G.c, . ! - a.5 ov b
Z tZ-36 o`-f ' . iy 0-S a. 6
Ground 3 36-8° %-t %a- 3 - S dG1, 0 S-j m 0-7 0.8
elev. q!6-~ ft.
Depth to
limiting tacror.
> S0
Remarks: .
Boring #
-tl LO'i2 `24 Z o.S 0.6
rrt ~t~ - c - o.S o. 6 13 Z tit-27 XA0-I 2 qly s~ l Zw, Svk
o.$
Ground 3 Z7-VO twl R y>.. - S D S9 ~-S 0.-1
qeW. fL 14"6 l6`1 R ,4/0 4 G1, O S9 r►.t I 6.1 to.
1)" to Z
uniting
factor g
Remarks:
T Name.-Please Print Phone: Arthur L' We erer 715-425-0165 '
Vg rer' Soil`Testing-V.-:,.Desi.gn :.Service-P..O. Box 74 River' Falls 2,VJ ---5-4022 -7A
Sionature: /1 0 n _ nZ.- . rer si=...i. -
4~ M00576
Y
SOIL DESCRIPTION REPORT Page Z w,- PROPERTY OWNER
PARCEL I.D. # t~ O 8 - t0 3 - at'S
structure GPD/ft Depth Dominant Color Mottles y Texture Consistence Boundary Roots Bed Ti
Boring # Horizon in Munsell Qu. Sz. Com Color Gr. Sz. $•h. rerL
::>t. _ Z~f sbn m Gw - O. S o. 6 S' o-LO tio~t.R z 1 Z
3 si) Z~ s~k w►'F~' ~s - o.S o.b Z 1q-'Z.lo <.O `1,tZ 316 - .
wtoL 316 fi S ~ GM O sg ~ t, - 0,7 0.6
Ground -76 vz)'m b
elev. i
q b. S ft.
Depth to i
limiting `
factor Remarks: i
Boring.p► ol;
; s
Lim
Ground
elev.
ft.
pepth to
limiting
'factor
Remarks:
Boring #
; F
Ground
elev. ft: !
Depth to !
limiting factor i
Remarks:
Boring # '
p
Ground elev.
ft.
Depth to` limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLM Page 3 of 3
_SU o' SCALE 1"= ,30 -
YN e.
Lbo•
tJ y`1~ r -
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a
(715 ) 425-0165 M00576
CSTSignature Date Signed Telephone No. CST#
``M-4oOra nDepaatmentoons usby' SOIL AND SITE EVALUATION REPORT Page of 3
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 m6st include, but
not limited to vertical and horizontal reference point (BN), direction and % of slope, scale or PARCEL I .D. #
dimensioned, north arrow, and location and distance to nearest road. a.= 11313- qS
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
~~~R-~{ ~ ~1' 6AV 91- ivW 1./4 IVk11/4 Z T,, . NR 16` E(a W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK -SUBD. NAME OR CSM #
z6 d°1. 50 `C11~ !A11~- - -
CRY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
w1 SktoB ("?1.5)648-24'63 Gfrt.t.E SO'rW pWE..:.
[ ] New Construction Use [)I Residential / Number of bedrooms 3 [ ] Add r1. to e**V buil*V _
UQ Replacement [ l Public or commercial describe
Code derived dally flow - -
9Pd Recanunended design loading rate . 'bed 9PdlftI fttdr 9PdVft2
Abs&ption 8W regtared _6(t3 be(t.61,S 6 3 trends, ft? Maximum a
design ktadn9 rate ~-bed ' D4, Vendf.9P
Rkommended KtfilGation surbee elevation(s) 4 3 . S It (as referred to site plan bendtrnark)
Additidtal desagis7 site O S " PU 1 1.P R %J,
R 1._'D CSC &ME 1%- VU91% M W Qg ..3
Parentfrraterial _%,nn. t j Ow1w A sli Food pW elevation, ff appkc" 3. S; t It
S=Suitable ftxSystem !t► NIOIS0 N-GROljr1DPRESSl1RE AT-GRADE _ . SYSTBU IN FLL. FIOL-D TANK
U =Unsti►labte for S ❑ U ®S ❑ U [as ❑ U S ❑ U 19-S ` o l ❑ S 1W
SOIL-DESCRIPTION `REPORT
r •
Depth Dominant Color. -----Mottles Structure: - Gpotft:,:.
Boring # Horizon Texture cons~ Boirft Roots Bed ttatdt
in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh.
I o_ ~2 >~~-t z z-(Z _ S Z`FSb~c wok cj j - a. S o;. b
: Z 1Z-3~ VA-t.R. 31Y SO Zwf sbk W`Fl+ cs O. s 13-16
Ground 3 36. go w`1. R ~tl b _ .
elev.
q . It
Depth to
limiting
hactor
Soo
Remarks: .
Boring # ;
~ 0-1.l tb`i2 2=12 ~ si ~ Z'f-sbk ~,,,L~~, - Ct,,~., o, s o• 6
Z: Z > t-z~ - s t 1
6
- . Y 2►~► sbk ~h cs o. S 10.
Ground Z7-Slo 1~`2R yIb = S O sg 1^'1, CS o.~ o.g
q eNev. 40_86 101 2 ,3% S G1- 0s,)
h1 - a• Z
5 ft
Depth to
limiting
ihm
Remarks:
CST Name:-Please Print - Phone:
Arthur L.:We erer 715-425-0165
eg rer Soil"Testing -&:::Design:-:.Service-P_.0. Box 74 River ~ Falls,WI:,.5.4022 _A
Signature: Date: CST Number
7. LZ_q~t M00576
Page
PROPERTY OWNER SOIL DESCRIPTION REPORT `
# t~ O S - to 3 3 - °I'S
PARCEL IM.
G P ,
Depth Dominant Color Motffes Texture Structure Consistence Bwidary Roots Bed Trey
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
o~ 6
4~`h. "x' - Z~ sb12 m Gw - 0.S
sit , S 0• b
3 si) Z~ s~k ~~t. C-s
tio~t.tz 316 it $ 6M O s.g ►n a o,7 0,6
Ground
elev.
~lbSft.
Depth to i
limiting
factorS „ E
Remarks:
BoringlA
E
E
,
Ground '
elev•
ft.
Depth to
limiting
'factor
Remarks:
Boring #
~ I
E
Ground '
elev.
ft.
i
Depth to
FP
limiting i
factor !
Remarks:
.Boring # i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
1
PLOT PLA Page S of 3
SCALE 1"= ,30 -
S O Tl1 l~v
L6p•
W CkTft two 4, 1vW OF $.Z
_ 3 4ARJ~y ~,e3LD~c.E _
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~~V~t Pi,v~ o~.vNlS2S ~~3on~~-c; ~WUwlk~6E .
li ( 715 ) 42.5-0165 M00576
,ESTSignature Date Signed Telephone No. CST#
-WisoonsinDepartmentoflndustry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relat,ons
DiVision of Safety r£ Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan mtt include, but e'' tx
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL 1 D #
-dimensioned, north arrow, and location and dstance to nearest road. 00'8-- l0~3 - q5
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
P(PC$lf' 68V 8~- Nw 1/4 °N W 1/4,S`\Z T , Z-b . ;NR L6' E066
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
Zb Oq Sly !PYU~•
CITY, STATE ZIP CODE PHONE NUMBER ❑GTY ❑VILLAGE )MOWN NEARESTROAD
wdo~vIvW,wl SVoi8 01.5)618- 7-g6 3 v (SPrt _1q SQ Tif "I e. :
[ ] New Construdon Use [M Residential /Number of bedrooms 3 [ I Addikn to existing buillimg
()Q Replacement [ ] Public or commercial desaibe
Code derived daily fl&r _'A SO °gpd Recommended design load•Ing rate O ) 'bed, gpolft2 _ ~ `trench; gpolft2
Abso - ltendi 9Pdlft~
olion area.fegtrired,. . french, n? M~dmum design loafing fate a = ""t. bedr9polft2 O•
63 bed,.ft2~=
Recut twded infiltration surface elevation(s) q3. S It (as referred to site plan bemhmarlg .
- SLR- tJtSTE ''CO W31l11:1~t ~?q .
(2 L~ . ~
Additional desagri7 /site aonsideratians ~ o`S-E_ V KP R. V l OK3 3
Parent maternal Sty ~~t g1j1 J Asti Rood plain elevation, I applicable 0Q. S.* ft
S = Suitable for system . CONVefnONAL . _MOl#JD. NGROUND PRESSURE AT-GRADE SYSTEM N FILL. H001110 TANK
U=1lfustfitable Iof tem 110S ❑ U pa S ❑ U 0S ❑ U S❑ U ~S ❑ U ❑ S INU,
..SOIL-DESCRIPTION-REPORT
Depth Dominant Color.. ---.Mottles Structure. GPD/ft, .
Boring # Horizon Texture Corsbertce 9oundaly Roots
in. Munsell Qu. S.Z. Coat Coto Gr. Sz. Sh. Bed rt~tdt
A 1 2 to`-blZ =i.(2 - S~ Z`FSb1c w~'~h Cw
Z 1'L-36 1o~-LQ 3iy _ sl S Zw, sbk ~5 0-S a. 6
Ground 3 36 - 8 o wit ti I G
S 6~. 3 OS-3
elev.
- aft -
Depth to
limiting
facto,
Remarks: .
Boring #
0 - ~ 1 1w-m- Z4 -z - S L ~ Z FS r~'f C(ti o. S 0 6
Z Z 1l-Z7 ~v`~-t 12 ~!!y S-11 2w, s~k o. 6
3 Z~-S(o Loy R y1G - S o sg M es - o•~ o.
Grotmd '
q-). y 110-86 16 V R 31L - S ~ o S.) h7
tintiting
a~
Remarks:
T Name:-Please Print Phone: '
Arthur L.-:We erer 715-425-0165
eg rer Soil Testing -1' Design._Se rvice-P.O. Box 74 River F_alls,Wl-.5.4022 -A.
Sgnatwe: Date: CST Ntxn_ber;
gV - RIB 1400576
PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D.# C~68- NtS%a_ OILS
Depth Dominant Color Mottles Texture . Structure Consistence Bourclary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Inch
0-10 b2`-1.R Z f Z - S . Z'1= 5b12 m Gu1 - o-S
11-12 Z tin-Zf- 10`m- 316 _ ISO Z>~, s'~k ~n f b C-s o.S o, b
1.p`i~Z 3!6 fi o•~
Ground U--26 0•13
t0`ttz ~ll6 S >~6M O sg ►,.r 1
elev.
X1,6• S ft.
Depth to
limiting
factor „
? 'Z 8
Remarks:
Boring.*
i
..M t
Ground
elev.
ft.
Depth to
limiting
'factor
Remarks:
Boring # I
Ground !
elev. I
ft.
Depth to
limiting '
factor
i
Remarks:
Boring #
g%
s
t
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-e330(R.05/92)
PLOT PLAN Page 3 of 3
SuoSCALE 1"=, 30 ' -
l.bp•
X,J`u- LW GATft ttb # taw OF- %.z
0
o
m
3 eDR,r~ ~,es~,cE =
ON (Z bo q S O 'r~F t~r<lE~ -
S~fl»u 6 Lj
Ste. `i►C
et 9.15 co
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S r►vt4; 8Q"ro "I of 8pp i s
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o
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. c-~z-lZ- ~-~-C~1,•t
.o~ . (715-) 42.5-0165 M00576
,CSTSignature Date Signed Telephone No. CSt
I
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Larry Aaby
MAILING ADDRESS 2609 50th. ave.
PROPERTY ADDRESS same
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Woodville, WI. 54208
PROPERTY LOCATION NW 1/4, NW1/4, Section 12 T 28 N-R 16 W
TOWN OF Eau Galle ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP 9 VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
LAW
DATE: 9-26- W
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
lludson, Wl 54016 11/93
5TC-100
This application :Corm is to be completed in full and signed by
the ot;!ner(;;) 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 Larry Aaby
Location of property, NW 1/4 NW 1/4, section' 12 , T '28 N-R ,1`6 W
Township Eau Galle
flailing address 2609 50 th. ave.
Woodville, WI. 54208
Address of ' site Sli n, 'e-
Subdivision name Lot no.
other homes on property? yes, X No
Previous owner of property _ ZT --7/ ~ IC7 w
\,►Total size of parcel
\J,Date parcel was created / ,0 - / 27
Are all corners and lot lines identifiable? Yes No
is this property_boing developed for (spec house)? Yes x o
volume and Page Number yes as recorded, with the Register
of Dee s.
114CLUDE WITH THIS APPLICATION THE FOLLOWING:
A IIAIUIU\11'ry DLED which includes a DOCUHENT NUtwER, VOLUME TEND PAGE.
NUMBER & THE SELL OF THE REGISTEII 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
referencos to a certified survey Map, the certified survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(wc) certify that all statements on this form are true to the
best of ny (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
DccdG as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
No.
Sign to of ap caht. Co-appl cant
Date of Signature Date of Signature
c 1. • STATE BAR OF WISCONSIN-FORM 1
DOCUMENT NO, WA"A.&ITf DEED
56 z~l 48 J TMiS SPACE RESERVED FOR RECORDING DATA
' 896
iJ[ T 0 1 1 C E
THIS DEED, made between Bette A. Hagen. a marrie~L-_ _ ~V!$•
woman _ -
.1''iis 17th
----Grantor COQ ---Oct -A.D. I 9 77
and _---Ia rv Aabv dntl . Sandra ~.ablc-, husband-end-- ~s•--B-+~U` A. , M.
wife -_aS--jo i nt_-tenant G
_ Grantee, James O'Connell
Witnesseth, That the said Grantor for a valuable cons iderationorl-e_dolla - V .u`?JOV of De "t
j %pF 1$1.401_-and-o_ther_-goodLand -valuabLe_ cnnside_ra_tinn-
conveys to Grantee the following described real estate in_-St -.__rLQ1X_-County, RETURN TO
State of Wisconsin: T,'ort-"iwest M.r and Realty II
I
Part of the NW 1/4 of NW 1/4 of Section 12-28-16, -
described as follows: Commencing at the NW Taxx.yiUng- 1033-5~
corner of said NW 1/4 of NW 1/4; thence E 25 1/2 This is homestead property.
rods to point of beginning, thence E 160 feet; thence S 348 feet; thence
Nally 160 feet, more or less, to a point 300 feet S of point of beginning;
thence N 300 feet, more or less to point of beginning, together with
certain well and water rights as described in that certain agreement dated i~
August 10, 1964 and recorded August 13, 1964 in "406", page 166 as Instru-
ment No. 277233 (no. 66), Register of Deeds Office, St. Croix County. ii
i ~
This Deed is given in satisfaction of that certain Land Contract dated
September 27, 1976, and recorded September 30, 1976, at 8:30 a.m. in
Volume 543, page 337, Document No. 335757.
{ j Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaininSS • D it
fI And GLaL1t4r_ r i. v
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except - -
j and will warrant and defend the same.
"f
13~
k Executed at - Woodville, Wisconsin this- day of October 1977
.I
SIGNED AND SEALED IN PRESENCE OF r _ (SEAL)
BettyyA. Hagen
(:,EAL)
f '
~i
{
' ~ (SEAL)
- - (SEAL)
..A
Signatures of _
authenticated this day of I9-•
,y Title: Member State Bar of Wisconsin or Other Party
'.F I) Authorized under Sec. 706.06 viz.
STATE OF WISCONSIN 1
St. Croix_-county, a.-
Personally came before me, this ----.-13 day o[_ -October 19?7•
the above named
-_--.-$ett_.- H~~Q7:------
-
t to me known to be the person _ who executed the foregoing instrument and acknow ad the same
I
This instrument was drafted by L • 3-_-
-ROBERT 1eI County, Wis.
! - ( ALT E Pyblic
F~ s
' _ P V2Coip' scion (Expires) (TA
The use of witnesses is optional.
i tom.. Q I @ •tA - -
Names of persons signing in any capacity should be typed or prlpt~¢~be ow tl~ff si,p.~ -e s.
WARRANTY DEED-STATE BAR OF WISCONSIN. FORM NO 1 - 1971"•,,,, •~S,`N
♦