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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,,61A,,, ADDRESS ~~lA~,;rJ 2(p ~d ke.
SUBDIVISION / CSM# 6~~oe Fa~+.yL LOT
SECTION (,va~ N-RZ~_W, Town of~ ~6 ~W:✓
ST. CROIX COTY;~ WISCgONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
0
0
d
0
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
B'ENCHMARK•
ALTERNATE BM•
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ~`~/,r/-P9ec~ sue- Liquid Capacity: jfo,50
Setback from: Well House Other
Pump: Manufacturer 24Zz,,;, Model#~ Size
Float seperation ld Gallons/cycle: 14~e
Alarm Location "5--e
SOIL ABSORPTION YSTEM
Width. Length Number of trenches
Distance & Direction to nearest prop. line: -Zz,
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: /e
AI
INSPECTOR:
3/93:jt
L `J4V artRiUPWXtry24.29.16 . WOOff T MV ~ffiEM County:
Labor and Hyman Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary ermit o.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village [1 Town of: State Plan o.:
-nWTM
v.: Insp. BM Elev.: BM Description. Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9300275 OS °f ,o,
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic GL/L~ ;3' 11 ®d Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Iy( Inlet / 5!( /OS
TANK SETBACK INFORMATION St/ )K Outlet 9
Xy
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet
Airlntake
Septic 70 NA Dt Bottom 3 2s
Dosing NA Uaadw/ Man.
Aeration NA Dist. Pipe z,&
Holding Bot. System
PUMP/ SIP -MFORMATION Final Grade
r
Manufacturer Demand`' 3
k
Model Number, {LAI GPM 3 !k ~ la, ZS ~
LorFcemaiftn LiFriction SysteTDH ~1 Ft
LOSS (e a d -'5
H Length w~
Dia. Dist. To Well >
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches P No. Of Pits Inside Dia. Liquid D th
DIMENSIONS 8 <17 DIMEN I
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEA jnu a r:
SETBACK
INFORMATION Type O CHAMBER & A ode Number:
System: iy'1 Gs,.,. > OR U
DISTRIBUTION SYSTEM
44%0 I Manyf Id Distribution Pipe(s), r x Hole Size x Hole Spacing Vent To Air Intake
Length Z Dia. C2 Length c;~P Dia. Spacing - ~X
r
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
r Depth Over Depth Over xx Depth Of „ xx Seeded/ Sodded xx Mulched
c , Bed / enter /'Z Bed /"fm,4_gb.E-dges Topsoil Lo f C] Yes ❑ No E] Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.)K-ks I~ ? ~~67
LOCATION: BALDWIN 24.29.16.356,NE,NW,90TH AVE. J._
f'2~~ Y-
f r
t<-
Plan revision required? Yes o WT / I ~j
Use other side for additional inform t' n. 1/0 /
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
DIR SANITARY PERMIT APPLICATION
_UILH In accord with ILHR 83.05, Wis. Adm. Code COUNTY _rCc0,'-~
~.s....y,..v.....,..,,,,„~
Emma
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1 T V90
8% x 11 inches in size. ❑ Check 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.
PROPERTY OWNER PROPERTY LOCATION
a e ,f/C- X 4''/4, S Z Y T 42 ef, N, R l E (or
PROPERTY O R'S MAILING ADDRESS LOT # BLOCK #
3 Old le_ I.
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE NEAREST ROAg
❑ Public Z4_or 2 Fam. Dwelling-# of bedrooms Y_ ~ Al
PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) ao2_ sr
1 ❑ Apt/Condo C tl
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 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.E1 New 2. 0 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 ❑ 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) l ear Q ELEVATION
,To 37,,,,- 37e alp Feet Q/• ~dFeet
VII. TANK CAPACITY 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
Septic Tank or Holdin Tank 0 NGeC1 '~-37'`
Lift Pump Tank/Si hon Chamber 75~ a eig-~ 1K El I El I F1
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system show ,on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) APA PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code): f
Zdr 719 114*
W. UNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa i ry Permit Fee (Includes Groundwater a e Issued Issuing Age t e S )
Approved F] Owner Given Initial m tO surcharge Fee) / Q
Adverse Determination ***777Dp~( T s
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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.
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 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 filll 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'/s 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 sing 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.
SBD-6398 (R.11/88)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL Western Regional Office
2226 Rose Street
LaCrosse, Wisconsin 54603
WEGERER SOIL TESTING & DESIGN Owner: NANCY DAHLEN
BOX 74 2633 90TH AVE
RIVER FALLS WI 54022 WOODVILLE WI 54028
RE: Plan Number: S92-41207 Date Approved: December 3, 1992
Gallons Per Day: 450 Date Received: December 1, 1992
Project Name: DAHLEN, NANCY Location: NE,NW,24,29,16W
Town of BALDWIN County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- REPLACEMENT MOUND
Inquiries concerning this approval may be made by calling (608) 785- 9 1Q
cm
Cl) k d
iGERARD erely, 4 1 >
CO , -
2 Q c t'r`
F?
c
.f.
M. SWI Y:
Section of Private Sewage
Division of Safety and Buildings j
PPP039/0009n/28 / E Z+
cc: NANCY DAHLEN X Private Sewage Consultant
SBD.6423(R.01191)
Page of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
F
LOCATED IN THE NF 1/4 OF THE NW 1/4 OF SECTION 214, T 29 N, R 16 W,
TOWN OF p~L~W IN , ST. CCZ-U1K COUNTY, WISCONSIN.
INDEX
PAGE 1 • of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
~.?a0DV1LL~jW1 Sy;6z~
PREPARED BY
• ,eve®o~seen~r
WEGER:ER SO I L TEST I NG ♦f ~scoly
AND . o ••.....»..tiM 0 ~i
I3ES I C-sri! S1~R~J I CE s $S~
: ARTHUR L
N'eGEQ
P. 0. BOX 74 421 K. MIK ST_ o
S -sa P Z
GLLWORTH,
RIVE? F" wrs-
.ZLS. MI 54022 $
715-42`.r-016 i ~
O
~~~~B~OBKO~~
JOB NO. Z - Z~ Z
PLOT PLAN Page Z of G
- ~ D `(?t ~(,1 ~ - ~xc~T prs S t4oW ~v _ _ F~r_ ~ E, 4 i
E'vF¢E SSE. "A
r~s a
P .
• really i
C r
per. DIVISION OF
pE~GE S , o ~v
C~ ~a¢ ~L~
SEE
J~
O ~
C- G e
~lbo } 0 l O
fi a Co
~o q 'rte ~rA
4~ M ~ Je` •C~
12~ 4?
1.d V)
3~c j y tPU C 91 P C w/LtVT71
•
LEL tg
a.~ a,00 oo,
9~ G % A „0,,W
o J G°~ s7
\ ~ .~v ~`S.,~rN of ~
s
S°1o t ~~"~_qv4
ti 1.~e'~ = ~ l ST) nr 6 `MCA lrt~7'PCx/4t 5
r P ls~. C V~ E' ,
Du NuT- Co~~?R-eT utZ ill
~ ` u ~ slv Q9 'tit I S 1~ R.LM ~ 1
g. 3
NOTES: tFL 9',! ?
.1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Y required)
3. Install 4" observation pipes with approved caps. ( 7i --required)
4. Septic tank to be \%,~Op gallon capacityknufactured by
`M V D L-i tE S 7' E,J P l~ ~"Cn S r
5. Bench Mark s.e" fta0Ue
6. Divert surface water around,mound.to prevent ponding at the uphill side.
Page -3.Of
Approved Synthetic Covering
Distribution Pipe
Medium Sand
_ H _ G
Topsoil = F Elev 100.00
3
PRIVATE EEIIVAGE S g
Conditionally 6 % Slope
Bed Of 2~- 2.1;,-" (Force Main Plowed
® Aggregate From Pump Layer
LABOR & HUMAN RELATIONS
DEPT. Of INDUSTRY, ILDINGS D --Z-0 Ft.
DIVISION OF SAFW AN
ross Section Of A Mound System Using E 2.5 Ft.,
g ONDENGE A Bed For The Absorption Area F o•$ Ft.
SEE G G 1. Ft.
A 8 Ft. H 1•S Ft.
Linear Loading Rate= O •Ja GPD/LN FT B 17 Ft.
Design Loading Rate= o.3 GPD/SQ FT I Z q Ft, .1
J 1o Ft.
K I Y_ Ft. '
Position L -7S Ft. ~
of
Force Main W -L Ft.
L
Observation Pipe
B ~ K
PA
w °
Distribution Bed Of 2M- 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
S z o 1= 6 ,
Plan View Of Mound Using A Bed For The Absorption Area
Page `1 Of
Perforated Pipe Detail
0
End View
Perforated
End Cap. PVC Pipe
as Install permanent marker
at end of each lateral
\ Holes Located On Bottom,
Are Equally Spaced
Q / \ S
Q
PVC
Manifold Pipe
* PVC Force Main
Distrn ution
Pipe
Last Hole Should Be
Next To End Cap
End Cop
P Z Z Ft.
Distribution Pipe. Layout S 14 Ft.
X 14 8 Inches
y _V8 Inches
Hole Diameter 1 !y Inch
Lateral Inch(es)
r
x Manifold Z Inches
DEM OF JN'!j~r Force Main Z Inches
# of holes/pipe 6
Invert Elevation of Laterals lob.so Ft.
SEE
u
Place lst hole Zy from center of manifold with succeeding holes
at qe intervals. Last hole to be next to the end cap.
' PUMP -CHAMBER CROS5 SECTIOU AND SPECIFICATIONS PAGE S OF 6
VCLIT CAP r
&j "C.1.. VENT PIPE
WEATHER PROOF APPROVED LOCKING MANHOLE
JNWCTIOW BOX COVER WITH WARNING LABEL
2S' FROM DOOR, I IV.
WINDOW OR FRESH I
AIR INTAKE
GRADE (
el- °19-0 I 4 MIN. 'ilk
I O' M11J.
COWDUIT
PROVIDE i
. IAILET ~ AIRTIGHT SEAL I III ~
PRIVATE SEWAGE SYSTEM 1 III v
APPROVED JOINTS
APPROVED JOIA►T A
I III
Conditionally
I I I ALARM
" % u
A r On V E I rl
ON
C DEPT. OF INDUSTRY, LABOR & HUM ELATIONS ( DtY1SI0N SAFETY AND 6 LDI S I
LLEV-91 FT. PUMP--.- Ilk
OFF
14Aq
0 SEE COR O ENCE
Ez- C13- S COUCRETE BLOCK
APPRWE
RISER EXIT PERMITfEC ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL gEOOiµG
SPECIFICATICIMS ~-LLLL
DOSE M1DWtSTL'RtJ PICRST
T 1,lUM9ER OF OoiES: PER D"
TANK MANUFACTURER:
TANK 5IZE: 1S0 GALLONS DOSE VOLUME
ALARM mANUFACTURLR' SkjS NS INCLUDING 5ACKFLOW: GALLONS
MODEL NUMBER 1 1 l~ CAPACITIES: A= 6 1NCHE5 OR GALLONS
SWITCH TUPIL: ~Y B IWCHES OR ' 2 4LLOL15
PUMP MAWUFACTURCR: Z•OIL- LEM C-0" 11~Y C= -7 J/Z'INCHES OR N410*3 GALLOWS
MODEL NUAbER: 9-7 D= \5 INCHES OR Zqz. 5 GALLOWS
SWITCH TYPE' 1-1~'~t~ V '`t MOTE: PUMP AND ALARM ARE TO 6L
MIWIMUM DISCHARGE RATE O$ GPM INSTALLED OIJ SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEW PUMP OFF AIJD..DISTRIBUTIOW PIPE.. S', S FEET
+ MINIMUM NETWORK SUPPLY PKESSURC~ . . 2.50 FEET
+ 30 FEET OF FORCE MAIN X x'31 F✓oopLFRICTIOU FACTOR. 2"41 FEET
TOTAL Oy1JAMIC HEAD = 66 FEET
DIAMETER - ,1
IIJTERAIAL OIME►JSION~i OF TANK: LENCsTH 6,1'~11P ~IIOTH LIQUID DEPTH _ L
S' 9'/i " air S' Lt" B47
BOTTOM AREA 231= GAL/INCH
AS PER MANUFACTURER =.t°L•.5... GAL/INCH
~AGt= of 6
CC W
WLL - -
' HEAD/CAPACITY CURVE 4% 6vA .
1 MODEL 97 4%
m
$ 4%
25'-
- 1'r7-11'/7NPT
20' 43/16
= 6 e
z 15'-
o 4 y
:1-..~..
O 10'
.ZB . ~
5'
02
US 10 20 30 40 50 60 70
GALLONS
LITERS 0 80 160 240 11
10 /,s
FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 35/ 6
HEAD UNITSIMIN
FEET METERS GAL LTRS
5 1.52 56 212
10 3.05 46 174
15 4.57 35 133
20 6.10 15 57
Lock Valve 23.75'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
e Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling
and supplied with an alarm. single and three phase systems.
e Mechanical alternators, for duplex systems, are avail- a Double piggyback mercury float switches are available
able with or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard All Models - Weight 33 lbs. -1h HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury
float switch. Refer to FM0477.
87 Series Control Selection 3. Mechanical alternator 10-0072 or 10-0075.
Model Volts-Ph Mode Amps simplex Duplex 4. See FMO712 for correct model of Electrical Alternator, "E-Pak".
M97 115 1 Auto 12.0 1 or 1 & 7 - 5. Mercury sensor float switch 10.0225 used as a control activator, specify duplex (3)
N97 115 1 Non 12.0 2 or 2 & 6 3 or 4 & 5 or (4) float system.
D97 230 1 Auto 6.0 1or1&7 - 6. Four (4)hole '•J-Pak-. junction box, forwatertight connection or wired-in simplex or
E97 230 1 Non 6.0 2o r 2&6 3 or 4 & 5 2 pump operation. 10-0002.
7. Two (2) hole "J-Pak for watertight connection or splice. 10-0003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices and wiring should be done by a
Starter, FMO514: Piggyback Mercury Float Switches, FMO477: Electrical Alternator, qualified licensed electrician. All electrical and safety codes should be followed
FM-0486; Mechanical Alternator, FM0495; Alarm Package, FM0513: and Sump/- including the most recent National Electric Code (NEC) and the Occupational
Sewage Basins, FM0487. Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
3280 Old Millers Lane Manufacturers of
® OZ ~LLE~ 01 P.O. Box 16341 a Louisville, Kentucky 40216
(502)778-2731 FAX (502)714 3624 ~Quez1rr At",-g AlNCr IffF
II
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER rjPrt-3C`l (yl° dA1i1AL-jEt`J
ADDRESS Z' 3 ~O ~iJE - FIRE NUMBER c~-(o-33
CITY/STATEN C,1000QV (L--L-C_- LJ ! ZIP 5L10 2-8
W II z. oC Nt~) ~Iy Oc n1E `k AOD e- 7Z oC
PROPERTY LOCATION: 1/4; 1/4, SECTION T_.2_9_N-R....1_(0__W
OF LOc,J ~.1 , St. Croix County,
7pwNswl P
SUBDIV151ON , LOT NUMBER
Im roper use and maintenance of your septic system could
result in, its premature failure to handle. wastes. Proper
maintenance consists of pumping out the septic tank every three
years or sooner, if needed by a licensed septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix county residents may be eligible to receive a grant
for a maximum of 600 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,
)ourneyman! plumber, restricted plumber or a licensed pumper
,erifying 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
idompleted and returned to the St. Croix Co. Zoning Officer within
~,0 days o'the three year expiration date.
SIGNED: ~ol~►'~etr. m ~c1~-lcl~~
DATE : ! / ZZ 19,3
St. Croix co. Zoning Office
1!511 4th' St.
HudsonWI:54016
i
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
W 1/2, or ►-jw'1y cc NE Ify nNa E'Iz oc rJwI y
Location of property 1/4 _1/4, Section 7 `l ; T--)q N-RW
Township
Mal iling address A-vE-•
c,~oO~c~r F w t Syo 2-8
Address of site 5,4 M F
Subdivision name Lot no.
Other homes on property? yes_ __y No
Previous owner of property C~OnJA72p (~cc nJl]E,Q,>~
Total size of parcel X00 A•CR-C,5
Date parce~ was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes _2~_No
Volumev,3 and Page Number -52455~ 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 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 o fice of the County Register of
Deeds as Document No. llyl?11:7S76, ~ 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
Signature f applicant Co-applicant
9lz193
Date of Sign ature
Date
of Signature
i
Vo ' 973na 36
- ( DOCUMENT NO. WARRANTY DEED THIS s►AC: .11ES[HV[D ►oet~tcoRDl O DATA
i STATE BAR OF WISCONSIN FORM 2-1982
Y 489505
REGISTER'S OFFICE
Leonard 0. Gunderson and Lenore E. Gunderson, ST CROIX Col, W1 l
hush id and wife Recd for R#cad
OCT C 51992
conveys and warrnnta to ??zCy.1K.--I>~hlen, a single person d 9:50 A. M
e_
1
OIOYOds
i'. Lr TO
.
'
- the following described real estate in .._St...-CIVIX count,
,
State of Wisconsin:
77
Tax Parcel No:..-•-•
E'~N4J~
Sec. 24-T29N-Rl6w. ~
FEE
This ...__i3 homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way of record, if any.
L? Dated this day of October , 19 ...92.
x'{i"""ce'~'. L09-`((SEAL) XL1~LQi.C.... (SEAT,)
• ie-onard-Q._--Gunderson • Lenore-... F., Gunderson..
...........................(SEAL) - (SEAL)
AUTSBNTICATION ACHNOWLBDOMBNT
Signature(s) GU11dGt'SOTI,............... STATE OF WISCONSIN
LemM..&_ Gi.mderson---------------------------••--•- as.
_ County.
authenticated this _ --.-day of...... 9~tOber 19.92_ personally came before me this day of - rA,, , 19 the above named
j~rjgtj4)q__0 land
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- authorized b
by 708.06. Wis. Stata.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0gland
a ttoiiney-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.........)
sNamm of persons signing in any capacity, should be typed or printed below their signatures.
1
WARRANT! DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. a- i9s2 Milwaukee, Wisconsin
011111- Elm - s
-
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
t,. ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
PI MAILS (715) 386-4680
November 30, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite soil investigation of the Nancy Dahlen property, located
in the NE1/4 of the NW1/4, Sec. 24, T29N, R16W, Town of Baldwin, St.
Croix County, WI., has been conducted with the assistance of Art
Wegerer, CST# 576.
This onsite revealed suitable soil for onsite sewage disposal to a
depth of 13" while meeting the requirements of the A + 4" rule.
This site should be suitable for new construction utilizing a mound
septic system having 23" of sand fill.
Should you have any questions, please feel free to contact me at
this office.
Since ely,
mes K. T mpson
Assistant Zoning Administrator
cc: file
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labof and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. ao Z - l0 S13 -60
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
: ~Me_s `>l bkiPS,Iu 11-m-a 2
PROPERTY OWNER: PROPERTY LOCATION
1113 K IJ CC~y b k l~k L J-N GOVT. LOT N3 tZ 1/4 N W 1/4,S 214 T Z9 N,R 16 E (ol2
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
2 b 3 90 ant n ti
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
woof Vtl~l= ICI SWo2-8 (-)IS) 698- 2.780 Zst~\_Ity ~ V'3 °l0 Trt Rt> E .
[ J New Construction Use [xJ Residential / Number of bedrooms 3 [ J Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow ~-L SIo gpd Recommended design loading rate Z l- "Abed, gpd/ft2 0 -1 trench, gpd/ft2
Absorption area required 3) S bed, ft2 3_71 S trench, ft2 Maximum design loading rate o. S bed, gpd/ft2 a- 6 trench, gpd/ft2
Recommended infiltration surface elevation(s) %oo. oo ft (as referred to site plan benchmark)
Additional design / site considerations `Zt-r-oMM I_Njb vlbv" w/S k~l7 ' e e;z~ $ W1 YU trl UM 2' of= S>\k/fi~, Ft L L- .
Parent material %I Ti. L Flood plain elevation, if applicable to - A . ft
S = Suitable for System CONVENTIONAL MOUND 70S ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system ❑ S IM U ®S ❑ U ®U ❑ S O U ❑ S o u ❑ S I~ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoLtrtdary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
Fz-O -S 10-9.12. ~ti U.. S e.8-16 loiQ 'L//3 - S t 1 Z ~'sd~ r~'fr cS o,S o-L
3 ) b- Z2 l0`1 c. z S1 ) Sl~k M - 03
- -
Ground 2
Y/3 I O`t b lz /L
elev.
36 7•S4 2 3J t~ s ~ ZlLL, vw, rvf v`F1^
Depth to
limiting
factor
)6"
.Remarks:
Boring #
O-8 1'C~~1Q 3/3 S 1 Z`F5 6k vvt'F~ a_S o•S n. L
L- Z $_1S loHtZ /3 - st I 2`Ps~>~ mph es o-S o-L
3 1 S-I $ 7
Ground •S ` e- 3/ - 9, `i~c 1~ ti`Ft- e S b. '1 i
elev. y ) F-3 7• S yR 3/Y cZ•s y>z y/8 S 1 ~Lt. CJ~ Yn U W 1"I ! r
qAA ft t ,
Depth to S~l~
limiting
factor
N la t 2 3
cz)
ST
Remarks: ~nl /cu
T Name:-Please Print Phone: ZON ING OFF CE"
Arthur L. We erer 25-019
egerer Soil Testing & Design Service-P.O. Box 74 River t l/ ,Wj 22
Signature: Date: CST Number:
°1Z_ 26Z 1- 19-9 2 M 00576
PROPERTY OWNER ~ ~ LAN SOIL DESCRIPTION REPORT Page?-.or-3
PARCEL I.D.# OOZ- IbS~i -60 .
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bound3y Bed Trerxh
vx'
o-a vom tz 313 - si z'-Sbk ~-s n, s 0•6
3 v
F2- $-\3 M4V- Y/3 - S Z"FsblZ v►Z C S o, s a• ie
Ground kLL41 13-16 ti0`1R Y/3 dt`~~tlyz .Syb/ZS M c s `
elev.
aJq ft. SyR yI~ `nil C>>~► h1U`!1.
Depth to S h \ S 6
limiting
factor
,
Remarks:
Boring #
~F
y Z 8 - ~3 Io yt2 v/3 - s f Z`f's bk 1nn c S o, s
3 ~3-17 10 yR y13 aZ z.Sy Sj) Z`~ Sbk lYt' 1- ~S
Ground I~ y P- b/1 /i
elev. 1~_3Z ~.SyR y/6 ihu"F~ - ,
01'1 • Z ft.
Depth to ~ S Ar `[U~Z - S G L
limiting
factor
13
Remarks:
Boring #
U
i:~ 4:h\4:tSing.
U Z O OUAJ S
Ground S S U 1 L S ~v\ 1 iu As
elev. s ~I V k.J ~t 1 Z
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
PLOT PLAN Page 3 of 3
l_ L fl = 3O 1
S C/IN
Exc~-p~- prs s t}a,~ ~v
o. 3 M j ~-n Z 6 0 714 ST.
r
I
Y ~ eo~Z.w~
7
~I
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~y
61
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8
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t FL qq
9Z-Z6 Z
LIZ'S_ 0)6s MtOS76
CST Signature 6~' Date Signed Telephone No. CST #
Wsconsin Department of I ndustry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
'S's . C. ~Zz t,-
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 0o Z - 10 SB -60
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
.Mmes `f M1IP1se" 11-18-a2
PROPERTY OWNER: PROPERTY LOCATION
1V I-, 1J C4 i~-' 'rk L-Q--}J GOVT. LOT N tiZ 1/4 N W 1/4,S 2Y T Z9 N,R 16 E (or&
PROPERTY OWNER':S MAILING ADDRESS 1_01 # BLOCK # SUBD. NAME OR CSM #
26 'IS 3 9(3 `I•x t)Ur_ . - -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OfOWN NEAREST ROAD
wooDvt~~t; I wl S4o-Z-8 (-)rS► 698_Z78o 'is1N ~1,v11,4 of C) T" RUC .
[ j New Construction Use [XI Residential / Number of bedrooms a [ ] Addition to existing building
Replacement [ j Public or commercial describe
Code derived daily flow L SO gpd Recommended design loading rate • 3 bed, gpi:W 0 - 3 trench, gpd/ft2
Absorption area required 3l5 bed, ft2 31 S trench, ft2 MaAmum design loading rate 0, S bed, gpd/ft2 2 - 6 trench, gpcW
Recommended infiltration surface elevation(s) `'oo - oo ft (as referred to site plan benchmark)
Additional design/ site considerations `Zt~T-'O"m "t-v" 4 " vj im k.Nm 2' ot= S POro FILL_
Parent material S1 T't ~L Flood plain elevation, if applicable M - A ft
S = StAtablB for System CONVEW04AL MOUND IN GROUND PRESSURE AT-GRADE SYSTBA IN FlLL HOLDING TANK
U = Unsuitable for stem ❑ S IM U ® S El U ❑ S [N U ❑ S ®U ❑ S I ❑ S 2ri I
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Coke Gr. Sz. Sh. Bed rench
c0-S 1b`t2 51 J Z `F r rn'~~. CS o, S o.t.
1 13
Z 8 -I 6 10 `t Q Y13 - s i t 2 'F s b~ wt `Fr C S o. 5 0- 6
G ~.S y
~z y/G Ground y/3 S1 ) 2 +sl~->t W\ 03
3 ) b-•Z..Z ~O`12 rv~f ~Z ~!Z `
elev.
q 9 . L ft. y ZZ 36 7 •S y 3l s ~ rL>, hn v `~H _
Depth to S is 617,
limiting
factor
)6"
Remarks:
Boring #
j 13-8 vfw-lq_t 3/3 s 1 -Z~56k a.S o•S :(3. L
Z 2- is 104tZ Y/3 z f'SbvK M eS n-s o-L
-3 1S-I~ ~.S `11L 3Jy - 9, ~1LL 0In MU'f t- c S b. 3
Ground
elev. y )-3 7•SyQ 3/y ci.sytz y/8 S 1 `nt.f.
CTk-j ft
L( S ai1t 1Z - S 5
Depth to
limiting E
ftcw
~1~ \A
E
Remarks:
CST Name-Please Print Phone: Arthur L. We erer 7'x'5.-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls Wj _541022
Signataue: Date: CST Number:
~-Z- z6Z 11-~9-9 2 M 00576
PROPERTYOWNEN t,% JA L~N SOIL DESCRIPTION REPORT rage _L of*
PARCEL LD.# (::~OZ- ~bSf3 -60 "Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trends
6
:Z 8-~3 1otit2 yls s I Z~ Sbk m c s o. s o. :
s Z,'FSbrc 1n~ C S
Ground 3 13-16 ~01R Y/3 etItilliz
elev.
q~ft. CJ hIU`Fv.
Depth to
S ~ .
\ G
limiting
factor
Remarks:
Boring #
Q 3/3 51 5bv[ ni`Fl- oc S b•S ~•6
4 2 8-~3 loytz Y/3 - s 1 Z~sbk rn cS o.s o•b
3 ~3-17 10 4lZ y/3 a2 z.Sy¢y/d S~ 1 Z~ Sbk 1►~'~1- eS
Ground ►o 40-10/2
elev. 17-3 Z -I. S* y/6 S 11L~ D M y iL
~'1 • Z ft.
elz\ GL
Depth to S
limiting
fait
Remarks:
Boring #
N t)
)N L 1 j Pkv
1 ti Z O Uuly L> S
Ground S1 Z S U L S VV\ 1 lu Aa
-)A 2`12 1
elev. L S ~r rl 1
ft.
Depth to
limiting
factor
Remarks:
Boring #
tk$ 4i'I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
PLOT PLAN Page of
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9 Z- z6 Z,
(`CIS) U1S-0165 MOOS7b
CST Signature Date Signed Telephone No. CST #