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HomeMy WebLinkAbout042-1069-90-000 F q STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Q l ~ ADDRESS SUBDIVISION / CSM#_ (IL j~LOT ~r SECTION 0(~ T C? N-R_ W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM mot( SPP ao R3 ?so a pug ~a /004"o), "701 L) INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~6d T612 ! C he, U 6^r ALTERNATE BM: SEPTIC TANK-)/ R / HOLDING TANK INFORMATION Manufacturer c`y1,J~S P~PC~~S ( Liquid Capacity:)De'o 1 56 Setback from: Well >f00 ' House ao f Other ti Pump: Manufacturer-cem ld Model# r0 3) Size A Float seperation Gallons/cycle: Alarm Location ~~QJ~ 6-r SOIL ABSORPTION SYSTEM Width: 3 ~ Length /Q Number of trenches a4~C°.S IGj N i Distance & Direction to nearest prop. line: C~ J S• Setback from: well: ~060' House Other ELEVATIONS Building Sewer 1 ,J ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLAT/~ PLUMBER ON JOB: c~ LICENSE NUMBER: n INSPECTOR: 3/93:jt T.0M(~T0W0ar. ARJ"usR5.29.1.$.39M%vWE9XWArW ISM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar rmi GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P X Insp. BM Elev.: BM Descriptio Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400123 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 33 Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe /.(oD /•(v~ Holding Bot. System 2 3p 2.51 PUMP/ SIPHON INFORMATION Final Grade Manufacturer < Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well 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 Manu ac SETBACK turer: INFORMATION TypeO 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.) LOCATTON:'WARREN 25.29.19.393A,SW,SW.70TH AVE.. 'j 4 Ll ri, r 1 a 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: 7 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN ..A...,,,..e,. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than pd-~OWZI 8% x 11 inches in size. ❑ chec c if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. . ~a a1 ~T~ Is 9 IV PRO TY WN PROPERTY LOCATION OL y( '/a T ~9, N, R E (or) W PROPEF31Y OWNER'S MAILING ADD ESS LOT # BLOCK CI ,DSiTATE mil' f a vZIP CODS PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: Check one) CITY NEARESTROA0.Q ( ❑ State Owned VILLAGE : i ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms A : J (S) 111. BUILDING USE: (If building type is public, check all that apply) --AC)- /4' C/~ 1 El Apt/Condo 20 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 ❑ Off ice/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.E1 Replacement of 4. ❑ 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 Di Mound 30 El Specify Type 41 ❑ Holding Tank 12 El 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 q66 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/da /sq. ft.) (Min./inch) ELEVATION 76 t 0 D Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION Tanks Tanks structed Septic Tank or Holdin Tank K Co * r t Lift Pump Tank/Si hon Chamber ~d F-1 F-I F1 I [I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbs 's Name (Print): PI mb r Signature: (No to MP/ W Business Phone Number: it, S X Lim 1 a 42, l M,? Plumber's Ad 5(Street,- Ci State, Zip Co e): `~4 D e) rt I "V A V- - 4 . W F U `IV IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater [ate ssue ssuing Agen atu ps) Surcharge Fee) Approved ❑ Owner Given Initial O Adverse Determination y X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: h ; S its ; &f-"t C b u CAAL fem. b co (formerly Plb-67) (R. 11/88) DISTRIBUTI0Nr0riglnal to County; Qr],e Copy o fe Y&Mtriffi-nYs i ion, er, Plum r Old (1 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 F ransfer/Renewal Fcr~ r 6399) to be submitted to the county prior to installation. 5. Onsite systems must be proper:4? maintained. The sep i,- tank(s) must he t . a licensed pumpe, whenever necessary, usually every 2 to 3 years. 6. It you i ave questions concerning your onsite sewage system, contract your local code :4drr'~oistrator 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 nu•nber(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 Farr.ily Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in fine A. Complete line B if permit is for tank replacen•rerit, 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, =somber of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. ComplMe for all septic, pump/siphon and holding tanks for this system. Check experimental approval only it ranks received experimental product approval from Dil_.HR VIII. Responsibility statement. Installing plumber is to fill in name, license number wilh appropriaie 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 131/2 X 11 inches must be submitted to the county. The plans must include the followi7g: A) plot plan, drawr to scale or with complete dimensions, location of holding tani.(s), septic tank(s) or other treatment tanks; building :;ewe s; wells; water rr.& ;"si e,ate-r service; streams and lakes; pump or siphon tanks; distribution boxes; so, fa,`: s~ /;lion sys-erns; re,,i~c nrnent system areas; and the location of th+ :iuilding served; B) horizontal and ,,,:a; .:levation reference ooint3; C) complete specifications f(;r pumps and controls; dose volume; e! vat ,.)n dMerences; 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 numb _rr of regulated practices which can effect ct'ortndwn Pr. The monies colierted through th~se surcha ge.s are jsed for monitorin Qrfi~_ dv~ater rt~r.; u water ;,o:citamjnation investigations and establishmp.,r of stanr„irds. ,N . ~y i . _ • - _ 96D-6398 (R.117$8) ~~and~r S94 0 4028 2 s~ ~2~, -raQ~C~ I g~ 3 0 31 as uw Twnskep ~j a. q s q q- yd A-z oo.o bm. To ~ele, tox+ 209 q 9oi'C t, Y s y oi $1r ~"€'~r cr u s e to b e y, P,rese~ta~m + Mew ~esidev~ce~315ed. , o~, Burn °°n °`vr b bui It 1v~ Same L►DCa~~d~ O1Mq~Ka~toYl tank f~000~b~jU ©x ~Sfi►h we Il RECEIVED MAY - SAFETY i oLOGS. DIV. 1 ~a3 Ear ed S 5. `fiv e y ga e o A b ov\ l do e d t0~.1.N at g.yn.loo.~ o tle ~ioX dge loth Ave. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION 7969 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS R 83.09(1) & Chapter 145) LOCATION: SECT ON: OWNSHI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: W 4S toy /TJj N/R E for ~ - C l •Y~I d I iC Pad- (Je la er MAMILING ADDRF~SD/~ l USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R A TS: l Residence ❑New ®Replace Al~ RATING: S= Site suitable for system U= Site unsuitable for system o ON~VEN S TI®AL: MOUND: ❑U JISYSTEM L I G®Y : REC 1'Q D ySYSTEMaoptional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: - I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 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.) B- ~ a'' 99'►5~? o~te 3 a„ a~la'' l s; ~ -3b" ~ s ~ ~ ~6.,_~~"w~l` e ,he B- I9ttXt~ W o~awlC ~s~ /&Ir ~gnc~S B- 36" o~~a"gI s' 1.? +3Ait 05 36-7.)#& 7t B- ark B kart $nd Y t4-j ``no 41 -go" B- 3 7911 I O. a 36 b bn fg-~Vll & B- ecl l,~a~er C, -f 7,9 o .n 3e" PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER D 1 P OD2 P PER INCH P- T_ LF .30 f7lb b P P- 3 Y 6 6 P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /D OxQ f = i I ell E k I i t t j j! TT i ll° ~a I 4 I E i i i ~ [ ! I I ~ E$ E ~ ~d~E 7~f~ five 1, the undersigned, hereby certify that the soil tests reported on this f m 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 (prin : TESTS WER CO PLETED ON: aS ADDRESS t CERTI ATI N NUMBER: PHONE NUMBER( ptional): l~ ~r As, - D~ ~'6 7K mss1-fYs- CST SIG RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; & PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols at - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sI - Loamy Sand < - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION 707 LABOR AND PERCOLATION TESTS (115) P.O. MADISON, WI BOX 537969 HUMAN RELATIONS 1 / 3707 R 83.09(1) & Chapter 145) LOCATION: ON: r!!MICIPALITY: LOT NO.:BLK. NO,: SUBDIVISION NAME: V4 S l~~/SECT /Tai N/R E cor e C N Y MAILING ADD S : :t.~rerx Pol,t Oe/a der 17LI)IX 1J. USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ❑ IL DE IONS: ERCJOILATIJON T TS: Residence New ®Replace RATING: S= Site suitable for system U= Site unsuitable for system Z v ' , `3y3/~ ONVENTIONAL: MOUND: IN- UND-PRESSURE: ISYST E M-1 N-F I L LIH OLD ING TANK: RECO ENDE SYS EM:loptional) ~S ®U S Du CIS U EIS U OS ®u ~y If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: - Floodplain, indicate Floodplain elevation: i PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST, IGHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ante 30 Ixe w daP B- ~2'' 99th 3Dl' a.~a"g15' -3d'` hsl 3~-~a"w1~~~ 11 B- ar iB Ar j &Js 1, t4 .3 Ao l`s .41 -70 B- / 0,4 7j,, B- ec1 &)afer^ a et 3v PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAT R LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P R D 1 P RIOD PER INCH P a 3O 11110 b P- 3 Y 6 6 P- 7W46 P_ I P_ . P- T= 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 /D D off, ~(t ox # o 1 _ ' 1_ TN I ~ i _ _ - I o...._ pale 70th iq ve I, the undersigned, hereby certify that the soil tests reported on this f m 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 (prin : TESTS WER CO PLETED ON: aS ADDRESS- t CERTI ATI N NUMBER: PHONE NUMBERI ptionat CST SIG RE: BUTTON: Original and one copy to Local Authority, Property Owner and Soil Tester. D-6395 (R. 10/83) - OVER - _ S94-40282 Page of Perforated Pipe Detail n n View Patoregd End Cop PVC Pipe Holes Located On Bettor", Are Eauolly Spaced A PVC For "I" f y, .1 M F' e Distribution Pipe Lost Hole Sbouid Be ~E 0 s Nest To End Cep Distribution Pipe Layout P Ft. R S_ X R& Inches Y 34 Inches Signed: Hole Diameter Inch -41 - Lateral I$ I YL Inch(es) License Number: 3/ Manifold " Inches Date: Force Main " 2. Inches # of holes/pi pe_L Invert Elevation of Laterals)4./5 Ft. Page 894 - 4028 2 Strow, Marsh Hoy, Or Synthetic Covaring\ Distribution Pipe M6,lum Sand Topsoil--l E 0 A I.' • 3 ~ slope 1' Bad Of 2 ~ (Force Main Plowed Aggregate Ftcrn Pump Layer 0 1.0 Cross Section Of A Mound' S st;:in U E y sing A Bod For The Absorption Area F .75 L G i,v ' A 8 Ft. H - s Signed: B y7 Ft License Nuu-ber: _ 3a 1 _ I " Ft. 15.94 Date: 51 J Ft. K 0 Ft. Ir1=Ee r'~,.:;e Pos i t•i on L L 7 Ft. of V Force Main's W _ Ft.J;,Z,94 7' ..`.'.r-- J Observation Pipe--,,,, a - - K -------.J. I Fbece Wn From dump CDIs;ribulion Der1 Of 2 - 2 i . Pipe , ObsurvGliGn Pipe P' Omonenl Markers Plan Viea Of MoUfjAPVVfinl U AST IAWT Absorption Area 11t1 t ' a SE.C~. , P. ),wo c-A l Septi'Q-+ 65690 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEnsNT ~e CAP S94-40282 srchea ~ - APPROVED LOCKIN WEATHER PROOF MANHOLE COVER W~ Jukicylow our. 25' FROM DOOR, , 04rn i(i »ttbt~ WINDOW OR FRESH 12 MIU. I AIR INTAKE f I GRADE I ti"MIM. 19"MIN. COWDUIT-- ,P OVIDE IAILE T AIR IGHT SEAL I I 1 ' I I i APPROVED JOINTS APPROVED JOINT A I I i W/C.I. PIPE W/C.I. PIPE V_ x f: lt3 S I I I EXTENDING 3' EXTENDING 3' ALARM ONTO SOLID SOIL ONTO 501.10 SOIL' ~tv~s~ot+ ~f I I ON God xnc ~ C J I CLEV. z' FT. SSE GOR PUMP--- ` OFF D CO R TE BLOCK RISER EXIT PERMITTED Ly IF TANK MANUFACTURER HAS SUCH APPROVAL SF. SEPTIC E SPECppIFICATIOU DOSEtdiN~S'~'YI !/"PCdS?' TANKS MANUFACTURER: NUMBER OF DOSES: PER DJ GALLONS DOSE VOLUME ad (6~`~~' ~ &#0) TANK SIZE ALARM MANUFACTURER: 74p ` lei, } INCLUDING BACKFLOW: GALLONS A. JI 302.'4 MODEL NUMBCR: CAPACITIES: A=INCHES OR GALLONS 1~.~5 8 c INCHES OR 341.2 GALLONS SWITCH TYPE: ere 14 y ¢ 77 PUMP MANUFACTURER: Goa ti C=INCHES OR a3 GA O~tJ~ MODEL AIUMBER: Eo D= INCHES OR 1310 VALLONS SWITCH TYPE' elreull MOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE RATE 3GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET ♦ MINIMUM NETWORK SUPPLY PrR~ESSURE . . . . . . 2 5 FEET ♦ ~L'r EET OF FORCE MAIN X C F O FtFRICTION FAC•fOR.. A FEET TOTAL DYNAMIC HEAD = )SN FEET INTERNAL. D NS►ONS OF TANK: LENGTH L ;WIDTH ;LIQUID DEPTH E NUMBER: DATE: Ld-Q U~~ SIG1~,1ED: LICEIJS SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations I May 6, 1994 2226 Rose Street La Crosse WI 54603 ~I III WANG EXCAVATING THOMAS WANG W9672 770 AVE RIVER FALLS WI 54022 I i RE: PLAN S94-40282 FEE RECEIVED: 180.00 DELANDER, PAT SW,SW,25,29,18W TOWN OF WARREN COUNTY OF ST CROIX 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 approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Gerard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 3686R/ 1 SBD-6423 (R. 01/81) L3' I( gC e t k` St. Croix County OWNEktBUYER t w V 1 kOU"TE/BOX NUMBER Tom( Fire Number - d -9 CITY STATE -PaS...~.._.. "y ZIP ✓ V& ` W q PROPERTY LOCATION:' 510 k, Section ~ T42~ N, X~f W, i Town of n ' YY ~'y1 sit Croix County, + Subdivision J Lot numbs Improper use and maintenance of your septic system could result in its,,,,gt mature failure to handle wastes.''Proper maintenance con- stiti-of pumping out the septic tank every, three years o~ sooner, ` I iUiAieded, by a licelis'ed'•se t'ic t'ank' pumper. What you pu# into the'4's!ystem can affect thi function ox the septic tank as a treat- f meat°4tage in' the waste disposal system. St. Croix Count residents'-maY be eligible to recieve a grant for x a maximum of "60K of the-cost-of replacement of a failing ,!system, whic was in operation prior to-July 1, 1978. St'. Croix iiCounty accepted this. program in August of 1980, with the requirement that .C owners of all hew'sys'tems agree to keep their system properly j maintained. The property owner agrees to-submit to St. Croix County Zoning a certification form. signed by the owner and by a mater plumber, journeyman plumber,, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system isain proper operating condition and .(2)-.after inspection and pumpingl(if nec- essary), the septic-.tank is less than 113 full of sludge and scum.' Certification form will be sent approximately 30 days pr or to three ,year 'expiration. ' y _ I/WEi' the undersigned have read the above requirements and agree .to maintain the. private sewage disposal system in accordance with the standards set forth, hefein,.as..set by the Wisconsin Depart- 4 completed Natural Resources. Certification form must be completed .d and-returned to the St. Croix County oning Office within 30 days of the three year expiration.date. i SIGNED 5 DATE. St. `-:Croix County -Zoning Office 91L 4th St Hudson, W1 54016+, 386=4680 4f. Sign, date and return to the above address. ;r ii 1 - N' lryM' l 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 GC-{ C( Y~~ l/` Location of property A) 1/4 '31J 1/4, Section , T12'y _R/9 W Township y 1i -eyl Mailing address U Address of site Z~Z Subdivision name Lot no. Other homes on property? yes__ No Previous owner of property Total size of parcel ( S Date parcel was created Are all corners and lot lines identifiable? Yes No is this property being developed for (spec house)? Yes ,,-k_No volume 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 & THE SEAL OF THE REGIST>R 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 n office of the County Register of Deeds as Document No.f , 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 record office of County Register of deeds as Document No. Ag j~ n ature of ap¢l cant Co-applicant Date o Signature Date of Signature 1067FA,E 617 • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 -1962 TNis SPACE RESERVED FOR RECORDING DATA LAND CONTRACT Individual and Corp" " 513832 $21 1'E S USED FINANCED FOR ALL TRANSACTIONS WHERE -CONOVER ^ (TO 1 IS AND IN A,HP:R NON-CONSUMER ! ACT TRANSACTIONSI ST. CR04X CO.. %V1 p;'dft P=^~~1 it ({OIlt1'dCt by and between Leon M. Delander -and Marilyn Delander, .husband and wife ("Vendor", MAR 7 1994 r 1.00 ~P• whether one or more) nd _.natrick L. Delander and Deborah E. DeIantler,__?lus?~an~?-and.wife,__holdingsury_kmuhip....... marital-- ro rt ("Purchaser", whether one or more). i ? . Vendor sells.. and agrees to convey to Purchaser, upon the prompt and full per- ;I formance of tl.is contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), I~ - jl in-------- St.:---C.ro.i_x County, State of Wisconsin: I RETURN To I See Exhi!,)it A attached hereto and made a part ,hereof. ~I Tax Parcel No - II I - 0 This _ 1.8............... homestead property. (is) XUX01 3 a lace desi nated-• by__-vendor ees to purchase the Property and to pay to Vendor at ....P... Purchaser agr - the sum of i 47,_D.QO in the following manner: (a) $-15.,.-66.7_.=6.7 at at the execution of this Contract; and (b) the balance of $.-31_,.33.3x3.3 together with interest from date hereof on the balance outstanding from time to time at the rate of..*See..be_1o----------------- per cent per annum until paid in full, as follows: annual payments of $15,667.67 principal, together with interest as hereafter stated, commencing one year from date hereof, and on the same date of each year thereafter. Interest shall accrue at a rate equal to the average annual interest rate received by Purchaser on Purchaser money market account at the First National Bank of Baldwin, Wisconsin, for 'the twelve months preceding the annual payment date. In the event no such account exists on said date, interest shall accrue at the average annual ' rate for said bank's money market deposit account for said period. P ovided, however, the entire outstanding balance shall be paid in full on or before the.2..year.. f... AXXk date hereof . PdX--__ ( the maturity date). II Following any default in payment, interest shall accrue at the rate of per annum on the entire amount II in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). I~ i Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, . Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after.- January..l Ig 95 ) II ' ]lN6s?4X>lId[J7C9~JG36yC~E'1~1L~Ye8>tCBfX~3~6DA75~15~fiK~~~61CXDt7it~D~2t' In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. II Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser has elected to forgo examination of an abstract) ,of title to the premises. I li Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. i Purchaser shall beentitledto take possession of the Property on___S~>~tQ_ .of ._closing 1+8K..--. 'Cross Out One. II STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. LAND CONTRACT - IDdlvldual and FORM No. 11 - 1982 milwaukee, Win. Corporate Vendor to pay all 1993 real estate taxes when due. Purchaser and Vendor 3 to pay 1994 taxes as per Closing Statement of even date. Purchaser promises to pay n when due all taxes and assessments levied on the or Mendor's interest in it and to deliver to Vendor dernand receipts showing such payment. ~'1i ~,,.,gia Purchaser shall keep the imp-ovements on the Property- insured against loss or damage ocLaaioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of #fU I Insurable valtje , but Vendor shall not require coverage in an amount more than the balance owed under- this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restorv.-ion or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances an~ regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the f m. ea and In the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except : • Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest whim continues for a period of ....6-9. days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of .....6Q days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waived, ai,d Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to t..ose provided bylaw or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, ith interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, ti ith interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency- or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. ! Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigaa of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated is - - day of ../n 42 - - . - - 1994.... ...(SEAL) - ----------(SEAL) -on__ D Lander------ Patrick--L - -D - ..a der_ - -------(SEAL) (SEAL) Ma lyn Delander Deborah E. Delander AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. St. Croix ty am Cools the above named u authenl:sated this day of........ 19 Per onallcame before mriilyri _ Leo Md n M. Delander, y_.. a Delander, PatriCk _L. Delander, TITLE: MEMBER STATE BAR OF WISCONSIN and Deborah E. Delander t (If not- 0--- authorized by § 706.06, Wis. State.) S -1 i to me known to be the person ho, exefuted the foregoing i ument and acknowle same. THIS INSTRUMENT WAS DRAFTED BY r r• Thomas-_A, McCormack &aldW.ln_,.._W-I5.4D.02............................ Notary Public Sto%te.-6 cam, Wis. (Signatures maybe authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration r are not necessary.) date: -Names of persons signing in any capaeity should be typed or printed below their signatures. LAND CONTRACT-individual and Corporate - State Bar of Wisconsin. 'Form No. iiT i9s2 10 WpAa 619 EXHIBIT A Southeast Quarter of Southwest Quarter (SE 1/4 of SW 1/4), and Southwest Quarter of Southwest Quarter (SW 1/4 of SW 1/4), EXCEPT that certain parcel of land located in the Southwest Quarter of the Southwest Quarter (SW 1/4 of SW 1/4) of Section Twenty-five (25), Township Twenty-nine (29) North, Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin, more particularly described as follows: Commencing at the Southwest corner of said Section 25, the POINT OF BEGINNING, of the parcel to be herein described; thence N 00000118"W 1325.14' on the West line of the Southwest Quarter (SW 1/4) of said Section 25; thence S 89053153"E 328.80' on the North line of the Southwest Quarter of the Southwest Quarter (SW 1/4 of SW 1/4); thence S 00000'18"E 1324.551; thence N 90000'00"W (assumed bearing on the South line of the Southwest Quarter (SW 1/4) of said Section 25) a distance of 328.80' to the POINT OF BEGINNING, containing 10.000 acres, being subject to easement over the Westerly and Southerly 33.0' thereof for town road purposes and also being subject to easements of record. AND FURTHER EXCEPTING part of the Southeast Quarter of the Southwest Quarter (SE 1/4 of SW 1/4) more particularly described as Lot One (1) of Certified Survey Maps filed January 26, 1994, in Volume 10 of Certified Survey Maps, Page 2724, as Document No. 512303, office of the Register of Deeds for St. Croix County, Wisconsin. All in Section Twenty-five (25), Township Twenty-nine (29) North, Range Eighteen (18) West. f 1a n d ~ r /~~a,a Pad ~ S 94 m 445 9 4 SLU 3 031 axyw Twnsket a q A 51 l a S q q- yo u 8'a e v is L a i 9y r'ro,* 3 4e~rA r toy e d room fes. ~ =well ~~n. Toi c le . gox 1969 RECEIVED A-z)mo o Core Jul, 18 X94 o' ere SAFEN a 8~. OW, 1V tf H 4 mew Res idev~ce-- fed Li It i V~ S a kit e l~ 6 ext a S~ nktP)l we-11 .goo p/ septic 75n~a(pu~~, as Fa►le~ S 5.`fi~~t r ~a o A o~~ ~n e d ~0l. . a WI too . c- l e fox F dye 704 Ave. Page _ Of - S94 - 4059 4 1 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ --G _ H G 6" Topsoil - ;r=- F PAOE de 6 Con Bed Of 2 Force Main Plowed : Layer NUOAAti Rsoo 1g r e g o t e 0 INDUSTNY. 0 gt}►1,Ot1 ~ (6' Be 1 ow Pipe) D Ft. 0 ~ OfVi ~ E I .2- Ft. pONDEt,(D%ss Section Of A Mound System Using F .15 Ft. E 13 A Bed For The Absorption Area G p Ft. A 10 Ft. H 1, 5 Ft. Signed: 'A , B ~ Ft. -7 Ft. License Number: 3 D ~3 L K 10 L Ft. Date: Ft. Alternate Position I Ft. of W.~ Ft. Force Main L - Observation Pipe J K A Force Main z '2 Distribution Bed of 2 Pipe Aggregate 'I Observation Pipe Permanent Markers Plan View of Mound Using A Bed For The Absorption Area Page Of Distribution Pipe Detail For A Four Lateral Network S94-40534 Alternate Position Of End Cap Force Main P % PVC Force Main PVC Distribution Pipe P '*,Holes Equally Spaced PVC Manifold Pipe On Bottom I ~X S X X 1k ,~=iksi muc_ I,j Ifs Lft(-gf=e> 'FACM Wdv- 1FCL D * Last Hole Should Be Next To End Cap * 1Y P aZ~{ Ft. S L Ft. X-I~L-lnches % Yinches Signed: c. ~ ~ l ~ Hole Diameter Inch PR4L I c&n iWSTEI~A .7 Lateral Diameter ~ Inch(es) w ~I 3/9Y ttr~. O' - Manifold Diameter 2 Inches is an 11 Force Main Diameter Inches Wffilh look APr nov ohm "i DEPT. Of IHDUStitY, LABOR & HU H RELATIONS IFdGS RELATIONS N Holes Per P i pe FE11f AK tHL DIVISION OF Invert Elevation Of Laterals W&SFt. S CORRE N L-,%,GE PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS S94 - 4059 4 VENT CAP PE APPROVED LOCKIK1 y"C.I. VENT PI WEATHER PROOF MANHOLE COVER W/ JUNCTION Sox WCbr fsi1~ l.Qbr-l 2S' FROM DOOT U. WINDOW OR FRESH I AIR INTAKE I GRADE i y"MIN. IB"MIN. CONDUIT-/ INLET ~ -rj~V~I SY~T~~iRT GH DE TSEAL I III APPROVED JOIN A corlditioncl I I I APPROVED JOINTS I I I W/C.I. PIPE W/C.I. PIPE T + I I (I ALARM EXTENDING 3' EXTENDING 3' pNS ONTO SOLID SOIL ONTO SOLID SOIL pN RE ( I I B , pDSZR`l, ~,g04 pu•U %vx _ I I ON C pmt. pp 1N Of ES'I i I p1V►S~ ELEV. C~ FT. / t4v)L ~C PUMP OR OFF D SEE CONCRETE BLOCK 3" APPRO RISER EXIT PERMITTED Ly IF TAWK MANUFACTURER HAS SUCH APPROVAL 8ED01NG SEPTIC SPECIFICATIOKIS E ? -f- DOSE TANKS MANUFACTURER: d }t~~J 7 l t iAk"~ f NUMBER OF DOSES, PER DAy TANK SIZE: ~y GALLONS DOSE VOLUME INCLUDING BACKFLOW:GALLONS ALARM MAI,IUFACTURCR: ~+L" 1 ~ n "~,-~Ic~ 2 , r. MODEL NUMBER: ft CAPACITIES: A0 MINCHES OR -,!l ALLONS SWITCH TYPE' A Z2>' I INCHES OR GALLOWS PUMP MANUFACTURER: C1IJCHES OR GALLOWS it NUMBER: ? Q -t D ° INCHES OR G'A LOAIS SWITCH TYPE: g NOTE: PUMP AWD ALARM ARE TO BE MINIMUM DISCHARGE RATE-_ 6PM INSTALLED OIJ SEPARATE CIRCUITS a dd~~++Z 1Z t<~ - M 0v : " D FEET VERTICAL DIFFERENCE BETWEEN PUMIP OFF AN OISTRIBUTIOW PIPE.. ♦ MIE~N//IIMUM NETWORK SUPPLY PRESSURE . . . . . . . 265' FEET ♦ _ Y-Q-'r EET OF FORCE MAIN X a'V? F/oo FTFRICTION FACTOR.. 7 FEET TOTAL DYNAMIC HEAD = FEET ~I'''') U I, II IAITERNAL DIM LW IONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGNED: ' LICEAISE NUMBER: F~ ( DATE: u C~ X;6 Q.3~