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Home My WebLink About030-2088-30-000 r , STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, G l G A s'se ADDRESS /3G 's J)A4ee e. r,,, ~ 1 s,. ) GJ e' SUBDIVISION / CSMW /,47- 3 Age, ~FptX d LOT # 3 SECTION .,?f T 3j,':) N-R/f W, Town of sT 3'o,s~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM se R- /~e 4J Sa c~ '671 (r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 r , BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: 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: INSPECTOR: 3/93:jt WisconumDepartment of Industry, PRIVATE SEWAGE SYSTEM County: tabor and Human Relations S INSPECTION REPORT ST. CROIX a#ety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI LACASE, RICHARD X CST BM Elev.: Insp. BM Elev.: BM Description: ST- ffOSEPN Parcel T :r2088-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark J(~. C~ Dosing 14 L-., 0, rel. ~d' /v /9 Aera ' Bldg. Sewer ~p H St/JWnIet 16 9 fl72~ TANK SETBACK INFORMATION St/-W'Outlet //.OD, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet 9 3 i Air Intake /z Id Septic LZ) 1/1 NA Dt Bottom 5l~S' 90, ~fl Dosing } 3 Headed. Aeration NA Dist. Pipe S pS' Holdi Bot. System oar 5; 2 7' PUMP /5ttgWINFORMATION Final Grade nom. 'j~ d 3 /,qi Manufacturer Demand ~O d~S.T teeOlt. J, Ce Model Number e M TDH Lift;/" Friction System TDH Ft Forcemain Length /1) Dia.amead Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length i No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J lam"' DI N SYSTEM TO P / L BLDG WELL LAKE / STREAM CHING Ma durer. SETBACK INFORMATION TypeO z, , CHA Num er. System: yj v`, /,04. /a7 UNIT DISTRIBUTION SYSTEM Heade it Distribution Pipe(s)( Hx Hole Spacing Vent To Air Intake Length ~ Dia. Length Dia. _4 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst I Depth Over Depth Over xx Depth Of x Seeded/Sodded xx u c e _1+ Bed /yip enter Bed / Taes&FrEdges ~~}(p Topsoil C1 Yes El No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.)_-zAs 11 .2Cl!(>< LOCATION : ST. JOS PH . 3 4.3 0. 19W , NW , SE , LOT 3 , OAKWOOD Al" ~~~n~~ can mnj°► , Plan revision required?(Z) es ❑ rto\-./ n Use other side for additional information. r P 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION Bureasafetyu of and B uiildiinWater Systems g Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application state Sanitary Per it b r The information you provide may be used by other government agency programs heck if 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 Name Property Location A* Ij 1i4 1i4, S T~ , N, R , E (or& .re Property Owner's Mailing Ad ress Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number Ar6--.d.V0A-j 6.1 ♦ 0 ( ) 41r`6 jQ< Ill. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF a s o0 III. BUILDING USE: (If building type is public, check all thatapply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 63 1, 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. (4 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 5. Perc- Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. (Min./inch) Elevation /ad to (9, Feet 140-3, Feet VII. TANK Ca in haclt allo S Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ace ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ded [ E t ❑ ❑ ❑ ❑ ❑ 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) /MPRSW NO.: Business Phone Number: A.), Zli,~a. oft Plumber's Address (Street, City, State, zip Code): Id d a • 0.7" X04. d IX. CO NTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Ag nt Si ture (N Stam ) Surcharge Fee) pproved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHO-6398 (R. 05/94) DISTRIBUTION: Original to County; One copy To: Safety & Buildings Division, Owner, Plumber i 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- isto be installed- 11 . Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DM-R_ 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 8 112 x 11 inches m,st be submitted to the co.inty. The plans must inclr de the following: A) plot plan, drawn to scale or with complete dimensions, location o hclding tank(s), septic ~.ank(s) or other treatment tanks; building sewers; wells, water mains/water sc~ !,_e; stream-. an(i iaf;es; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system, area,, anti the to at!c- of the building served, B) hDrizontal and vertical elevation reference points; C) complete specifications for pumps <,nd controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump m<anu!~ ct_ -er; D) cross section of tt e soli absorption system if required by the county; E.) soil test data on a 1 1 form; and F all sizing information. - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can effect grcundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and estaLlishment of standards. ej al Ce S- 5 e=. h -Q- ~ f . ~ - J Ile d e-< A-r re `m 40 4- l 44 00 h 1 bpi J, ~ 0 Trr T 3 a A j,. 6 -Or HEAD/ 11S NAPA airy 32 ,10 . 32 106 30 CUR aE 100 - 95 28 90 26 95 I EFFLUENT 24 MODEL and p 76 MODEL 199 DEWATERING LLd=I 70 1'i V 20 a } 19 a 56 18 MODEL O 193 MODEL H /4 199 12 40_ 36 10 MODEL MODEL 137 139' „ 196 Ilk SEWAGE and 26 DE44/ATER/NG i so MODEL /5 MODEL ,i/ 4 7 2 MODEL - i 6 $3,56, `!u 57.69 0 GALLONS 10 20 30 40, 50 801 70 50.1 90 1001 10 24 LITERS 0 90 160 240 320 400 ' 79 29 FLOW PER MINUTE 70 20 ry G ,9 SR MODEL 296 T IS- M 60 11 u ODEL Z 294 J MODEL 36 293 O 10 MODE L H _ . _ 30 4 MODEL 0 20, 292 - zzt 16 ,0 MODEL - - - - 4 ZAff1FZ i. it /r/ r 2 6 267, 289 - - f 16 0 1 3280 Old MBlers Lane GALLONS 10 20 30 40 60 60 70, 90 90 100 110 120 130 140 "i5p 160 Iyo 190 160 P.O. BOX 18347 Loulsvl/91, Kentucky 40218' LITERS 0 80 160 240 320 400 490 560 640 720 (502) 778-2731 ' FLOW PER MINUTE Q . rqw 'W41 410 CAPACIII HEAD UNITS/MIN • Auliill ihC of Non-AUlamittiC. Few k4+Ws: Gal. LIlY 5 1.52 57 216 - • I LP., I Ph., 115V or 230V. 10 3.05 51 193 • Nun-Clugging vortex impeller Uesigl) 15 4.57 43 163 20 6 F'aSSeS SUIIQS (sphere) .10 27 104 • + Lock Valve: 24,5' 1 NPT discharyu o Float Uperated subnlarslble (NLMA 6) 2 POle muchanical switch. 97 SvllYc • Automatic reset then;till overload protection. listed 5C•2225 NN,11 t;u,utluss stuul >.cruws, guard, handle and arm and seal assambly. • Waiertiglll neopreno ring Detween motor and uln) Ilulislm . cane OShuWatax P l J A$*" Approval Yva4YL1Y N9%, Hart-uuwl)mfi0. :rvanavrv poahuyvu will) Y piBYYOack nwrcury /loaf swdch. w.r . +rrrrrrir~,rrurwrr.rrrrwrwrrri•rr+ PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VENT CAP 4'•C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING 25' FRCM DOOR, JUNCTION BOXMANHOLE COVER ~ WINDOW OR FRESH AIR INTAKE GRADE I 'i° MIN. IB"MIN L-- CONDUIT IB"MIN. PROVIDE I I~II F , AIRTIGHT SEAL I I I I III APPR.O`JEC JOINT A I III APPROVED JOINTS W/C.Z. PIPE. I III ~^//C.S. PIPE EXTENDIMC• 3' I (I ALARM EXTENDING 3' OQTO $0:.10 SC;:. B ( II ONTO SOLID SOIL I I ow C I I I PUMP ` ` OFF D CONCRETE BLOCK RISER EXIT PERMUTED OI ILy IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND DOSE TANKS MANUFACTURER: IJUMBER OF DOSES: PER DAB TANK SIZE : ~De GALLONS DOSE VOLUME ALARM MAAIUFACTURE.R; INCLUDING BACKFLOW: /GGGALLONS _ _ .r%r✓~GO~ ~~vl, MODEL NUMBER: CAPACITIES: A=A34 INCNES OR GALLONS SWITCH TYPE: A C'e C B = INCHES OR sd GA'-LONS PUMP MANUFACTURER: C =1[tL_INCHES OR GA'-LOWS MODEL NUMBER: D-INCHES OR GALLONS SWITCH TYPE: tweed NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHA.R`E RATE - Yd GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE B '1?WEEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , , . , , . , FEET + Ld_ FEET OF FORCE MAIN X -elt!~_aF31/oofT.FgICTIOU FACTOR.. 2 FEET fit = TOTAL DYNAMIC. HEAD = ? FEET INTERNAL DIMEWSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH OK LICEOSE MUMBER: j:;g~ ~ DATE: -117- SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Cou . G STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ l k r ~b1 8% x 11 inches in size. c ec i erosion 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 f ' A d Ao Caps-e %_%F t/4, S3 T.? 4, N, R ~ E (or) N~ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0,0 C vl X-I'Cl el s. a.tJ_ Lci CJlG II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) State Owned VILLAGE T~ asp ~ O ~uxa ~ TOWN OF: ❑ Public K1 or 2 Fam. Dwelling,# of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 030 44 f 3 d 1 El 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. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 M 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/day/sq. ft.) (Min./inch) ek ELEVATION G Gd 16G r _;:3 Feet 4 3i Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed -7- F-1 R F-1 Septic Tank or Holdin Tank ado m i ,Ww 2 s e Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show "n the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) &EaPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): ,0 c' IX. C UNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani1&ry Permit Fee (Includes Groundwater [Date ssue Issuing Ag t Signa a (No S charge Approved ❑ Owner Given Initial Af/r Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 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 may be 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. I SBD-6398 (R.11/88) !I i I S 3 e elW s~`cTos 0,4 k aoo aC S i+ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX HUMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 539069 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: T WNSHIP/M Y: LOT NO.: BL NO. : SUBDIVISION NAME: NW 1/4SL1/4 34 /T30-N/R19 (or)w SSt. Josep 3 n1a Deerfield COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Henning & Norell 665 Walsh Rd., hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/ a UNew ❑ Replace 7-9-92 in/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) us ❑U x~s ❑U ®S ❑U ❑S ~ ❑S DV I conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: class 2 J I Floodplain, indicate Floodplainelevation: n/a deciaml' PROFILE DESCRIPTIONS page 42 JsB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0-12, 10yr4/2, L.; 12-32, yr , si B- 1 86 103.75 none >86 32-86 7.5yr 4/4, ls. & gr. 102.75 0-8, 10yr , L.; - yr , s 1 . ; - B-2 84 none >84 34-84, 10yr4/4, ls. &gr. 3 84 103.25 none >84 0-9, 10yr4 / 2 , L. ; 9-35, 10yr5/4, sil. B 35-84 1 4/4 ls. &g r. 4 80 102.85 none -10, 10yr 2, L.; 10- , si B- >80 31-80 1 4/4+ ls.& r. B- 5 80 102.05 none >80 0-13, 10yr4 2, L.; 13-40, 10yr , si 40-80 1 r4 4 ls. & gr. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P-see design rate 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. SYSTEM ELEVATION 99.60 e If % E E i.v~ X17 1 tN I t 3 7 i ~ f 7 7 , B 9~ I F f i 4 N' G y r E E --+I +l\ 71 `I Q [ j I, the undersigned, hereby certify that the soil tests repo a this form were ma in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the to ests ar r c he best of my knowledge and belief. ~ Z NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 7-9-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., PTew Richmond, Wi. 54017 2298 5- 6-6200 CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - 'NSTRUCTIONS FOR COMPLETING FORM 116 - SBD - 6396 I To be a lete and accurate soil test, your report must include: 1 . Comp` I description; 2. Tl- on must clearly indicate t?is is a residence or commercial project; 3, MV, _ number of t -drooms or corn rcial use planned; 4, Is _ =vv or rer nt system; 5. Co the suitabi, rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL t''.a"i_HER SYSTEMS A. RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completingthe plot plan; T -,KE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A to sheet may be used if desired; W. -ire your benchmark and vertical elevation reference point are cleark si ovvn, e :permanent; 0. C 7 ~lele all appropriate boxes as to dates, names, addresses, flood lpl< it exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, ~ rx; 11. Sign the form and place your current address and your certificatio.; n 12. Make legible copies and distribute as required. ALL SOIL TES'_~ ST BE FILED ''ITH THE Lt3CAL. AUTHORITY 1,VITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Syr )Is st - Stone (over 10") BR - Bedr.,..,, cot) Cobble (3 - 10") SS - Sandstone gr Gravel (under 3") LS Limestone .s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate rnlrl s Modiurn sand tail V'Je11 fs Bldg - Buildinq Is - I > Greater Than sl - L-ss Than *I - L Bn - t, .a,... 0 L(, im B1 :k si - Gy - f cl - Clay Loam Y - .(lover set - Sandy Clay Loam R - I< sicl- Silty Clay Loam mot sc - Sandv Clay sic - Silty Clay _ fff nt e _ Clay CC c ;arse pt Plat milt rip - Muck d - p Six gen <tures ;for liquid . ~posal BM B VRP 4 TO I C JNER: =e first strip in secrrrirrg a sartitary { ~ init. The coun~ Ca ~<tuest a >f ^st in the field prior to'jpermil ate -/C c- private 71it application must be Sul, ler to r9. y permit must be obtairtE cti n. I aD Si ' N011TM LINE of I"[ SEM4 of SECTION 34 IWt rt MI sB9.27.3TE 1321.14' I ao.w' QI al " 66.00' 4sa.oo W C 3►1.49' ) yl TIMROPAR'T 30 FOOT RADIUS UI 3.a.oo' T- 0. SCALE IN LOT 8 131.2,7 SO. FT• LOT. -7 f \ "-CENTER 3.01' ACRCS o LOT 6 s ! CuL-o SAC . $ 130.977 sa. FT . % ° . n 135.320 $o, FT- 3.00 ACRES \ I .I I I 3.12 ACRES N> PLA JJO. I [tscm( S39•27•37.E LOT, 9. '1.3.[3• S0. iT. 3..1 ACRES LOT . 5 135.237 30- fT. LOT , 3.13 ACRES 131.290 50..FT. 33.01 ACRES .7 v. awOO' S39•t7'37•[ ' 396.34 •11..2• 71 01 ~ ^ 100• 100' ~ 1 w l M; r1 r; TRE• N rl J' n St O., 2" I Z1 t, I 19'3 ~I 1 LOT 14 0 o1l L LOT 4 ? g LOT I I " %'ti 00.961 s0, rr.~r J S g 130.971.50. fT. _ 139.241 $0. FT- n •j 3.00. ACRES 3.00 ACRES 3,13 ACRES O C 0 Le CA, N S a 1, N ° Ss9•27•a7•t 306.03'- 364 '"O I' I 2 O Ss ' p 411..2' 9 I Y r.` 19.34 ; ?r 0 ^ 7 Go* 12 L& 13 + Iw R x C.... ' " • g r LOT _ 3, L % w 30..T.• _ t I • ~ 130, i79 30. -FT. S,OV AMCS ~ Y LOT 3 1 n~ 130,p9 S0. FT. 3.00 ACRES • 3.00 ACRES - I ) I 33.1 33' I ~ i $ I 8 .471 21 42 NIR g .v. ar 7.L .1~ _ 113 .11.,2'- 3] 8 ' of ELI -1 N39.2T p•W ^ 3YS. )4• 3.00• .89.27.37•- ---ROAD - -3a.4 }I 8 •-WALSH - x 52..9 w1 623.00• I WI • MI N09•2T37•W 1237.34• a< ° I B53.a9' >I a1 d31 ~I • . ~I 464.34' N89. 27-37-W 39i. ]4• 66.00• 1 I F..I cn: 1(31 ..Q3i I _ I MI l33•, 70 wI 1 p~ I ~rfNG- a~S~ I I I o; Z1, LOT 2 ~o0= N I `W31 zl ^ J-^ N N ' 131.207 $0. F fT. 9 ]N M ON I , i 3.01 ACRES R ro i 1989 E • s " f Y MAP. IN VOLUME 7 , PAG_ . SURV _ _ CE R71 FIED _ _ • ••3s.ot- -».oo•589.2T37•E 416.90'. 19n AI' Se3.2T)TL 449.90• sQg-41'33•W 43 r. s2' DOC. NO: 438728 it N "Oj4 j N P 14 R SMALL TRACT' b m 4a 3LOT $o. rr. o ACRES .34 NB9.27.37' W RculsE sII4 coRNER of LOT 2 ...C~~~~. 3LCTION 34 LOT' 1 , bNOv{~ DOC. S, P~StE L4L@ CERTIEIEQ SURVEY LAN! IN VQLV GIZ 1G • ,~/1/~~/Y•~ ~ N0. 393031 r~'l F~*~.~'i.) • F eue W B~tSKACfK ! . THIS WfTRYMCNT ORAI7LD by i IA6 Bass i. H Hunting ton L Jr q r /o I Jj -9 d a n II i. Pine L a 12 g o Sta Prairi ' `.S MER SET ►~-"1 a I 13 Is k p ` TAR L -31 Johannesbur K i Strand" 9Q~ •1 I? IRIE A Tu25 L I'. 30 ! w z K i, f~.l ~l- a LLL U. omer ict t o 64 - w 11 , f- a p N 3564 s~ R 11 C q Li6 1 ` Ily Bros Mound 12 N. BSss 1 P 65 04 U.a u and ' 13, 18 l o 1,3 CH OND 24 ~Brigh~~ enmil rnrl 24 r oulton - - Boar man - - IIw E it Penh L. L~~ C 23 aJ b4 ' S T. ; t 31 i 0 E I P q 31 Three 36 I J I kes'~ 11 E E E ILLOW Dn I 6 - 1 Dam L j ! • 12 - 12 I I W' REN1,0 12 13 1 L L I IF HU 50 C.-, I . _j 1-111 A ,naheu - - ~Y A U 12 24 I 1 R prk usn ; - llU p . ✓ I'~ H U D S O N'• ,25°U I 30 Twin 65 'I Q 1 94 w d v kes 0 12 5 ' w N 94 ~ ~ I N I LL. Lake -L w f C)OLV 12 ;ill') 13 I J ~C~ K N I JJ U ~ ss K I N X24 TRO Jai _ I 65 b4~~ l 25 o s v ~ I JJ 31 M M M It M ° 35 River Falls ..li:~: l++r Y'.. ....'..iLZL'1:lrLLlEiIIYI'~Iardld .l r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT t. Croix County OWNER/BUYER LA2 tAj MAILING ADDRESS PROPERTY ADDRESS 7 DX ( M (location of septic system) Please obtain from the Planning Dept. CITY/STATE /AD PROPERTY LOCATION 1V bj 1/4, ~5_ 1/4, Section 7 l T 3C) N-R_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~.~r\_~ 1 LOT NUMBER CERTIFIED SURVEY MAP , VOLUME 3, , 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. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: i o l~ DATE: o ~ 2 ~ y 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 c Z' I L)CA S S-~- Location of property, 1/41/4 , Section 351 , T 30 N-R_I_E_W Township - c Mailing address Address of site 15 Subdivision name Lot no. 73 Other homes on property? Yes No Previous owner of property ~r-Q~ L~ Total size of property 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 k_ No I Volume 66 and Page Number l`/~~ 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. , 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. Signature f Applicant Co-Applicant /o/ Z_ ~Fy Date of Signature Date of Signature [DOCUMENT NO. WARRANTY DEED TI41S SPACE RESERVED FOR RECORDING DATA • ' STATE BAR OF WISCONSIN FORM 2-1982 520021 V . . VOL Pa~f R`G STttt°S UFFICE 1 Donald E. Norell, a/k/a Donald Norell, and Beatrice Ann ST. Ree'dfor CROIX CO., Record WI Norell, aJk/a Beatrice A: Norell;-- a/k~a Beatrice ~ - _ Norell---as joint--tenants AUG 9 1994 - - - - - 830 A. M conveys and warrants to -.-Richard W. LaCasse at /A• C LT Reglstei of Deeds - - - - - ETURN TO ----------..t Ghprc, Lt,.CZtb,SG. )3&.s 1 the following described real estate in St.._-CroiX------------------------ County, 4~kor~ WL _ (IVAo State of Wisconsin: Tax Parcel No Lot 3, Plat of Deerfield in the Town of St. Joseph, St. Croix County, Wisconsin. I This _ 1S-not - - homestead property. = (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. 19.94 Dated this day of August --(SEAL) -(SEAL) - - - - Do E. Nor 11, a/ /a Dona d Norell - - - - (SEAL) _ . - - - (SEAL) Beatrice Ann Norel , a k/a Beatrice A. * * - -Norel-l-,--a/k/a--Beatrice--Norell.-- AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donald E. Norell, ak-a Donald STATE OF WISCONSIN Norell, Beatrice Ann Norell, a/k/a Beatrice A. ss. Norell; --a/k/a--Beatri-ce--Norell------------------------ County. authenticated I day of August 19_94 Personally came before me this ----------------day of ~ l 19 the above named . Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Attorney at Law Notary Public ------------------------.County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: , 19...... •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. , Ff)UM No. 2- 1992 Milwaukee, Wisconsin •°z°wE°:°~ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit N tuber / The information you provide may be used by other government agency programs eck 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 Name Property Location 'C- / U) 1/4 114, S -2 T N, R E (or) f Property Owner's Mailing Address Lot Number Block Number G s /44flc 7~- City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ VII(age E] Public 1 or 2 Family Dwellin - No. of bedrooms Town of a -e III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ 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 box on line A. Check box on line B, if applicable) A) 1. 0 New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Recnection of 5. ❑ Repair of an System System _ __TankOnly - Exist gSystem _________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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ~GG ~Grl f Feet /1-0/ Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank Q U / ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, u~ ! ❑ ❑ ❑ ❑ ❑ 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) MPRSW No.: Business Phone Number: ,Plumber's Address (Street, City, State, Zip Code): 0 c ° I' cif IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue ]Issuing A anrSiture ( Sty s) Approved ❑ Owner Given Initial Surcnargeree) _ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: e SHD-6398 (K. 05/94) DISTRIBUTION: Original. to Courtly. One copy To: Safety & Buildings Diw.ion, Owner, Plumber - h INSTRUCTIONS c_ .1ni','y permit is vah,. :wc (2) years. 2 our ssin;tary perrr)i' 171,o b=_ rer awF.d before the expiration date, and a' a of e of renewal any new criteria in the Wiscox sir Adrom;strativ e Cc de vill '-)e applicable. 3. All revisions to this permit must )e 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 thissanitary permit application must include: 1. Property owner's name and nailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being servec . 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 o ie online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check approl +riate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7- V11. Tank information. Fill in the apacity of every new/or existing tank, list the total gallons, number of tanks and marufacturer'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 Ins ailing 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 specifica ions not smaller than 8 1/2 x 11 inches must be submitted to the Minty. The plans must include the following: Al plat plan, drawn to scale or with complete dimensions, location of holding tank(s), septic. tank(s) or other treatment ta; iks,- building sewers,- wells,- water mains/water service; streams anc lakes; pump or siphon tanks; distribution boxes; soi' absorption systems; replacement system areas; and the location of the building served; B) l-orizontal and vertical elevation reference points; Cl complete specifications for pumps and -ontrols; dose volume; elevation differences; friction loss,- pump performance curve; pump model and pump manufacturer; D) cross section of the soi! absorption system f required by the county; f_) soil test data on a 115 form,- and F) all sizing information. - I GROUNDWATER SURCHARGE 1983 `u on a d _ e creaJo,n Cf surcharges '`ees` for a nt~;robe" a` reg'llated r rcacl.,--.: which can effect groundwate- Thr_- 'Tti i ~ F qw., ~ e' St C~ ld'J2; , _ jseu for r GL~ Z~Y.'8tE ` ,:on am+'.,a'. Qn ? f;Ves'!gatlOnS and P' t~Pir:` o ita,,.- arC` L 'o y dc.,{ X47- 7i'in { Sri ~.e ~o rra (y~ ~.lf~r7''gJ~Cafo~ ~C„GaAia84 ~l~U/T 6v6.'+q ~jC r ~ r X` r h►j 40 k I ~ I ado ~ 'Q i ~t d1 Y1 S 3 IkL 1