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038-1142-70-200
0 3 0 O 60 p Ge M~ p4 O N a 4 o o ~ I O '0 C i co N O O rn~ I O CL E O ~G Cl) O d O L U lY 3 C 6 '0 y N ~ N y O E CL C c c Z c Z LL c Li c E ° ° E o O Eo 0 O a ca 0 Q U Q "0 N O O Z y z 4i E E 00 z m m a a~i I' IL co a m c') w U) c o i O z :!t c c v o !A H Y, N 0 0 z E E S E ` N N 7 N a co ISD) (D 'n CL (n •FV LO d Cn L Ln CL L L c -0 O C O O O N Q O Q r~ Z co Z Z H Z c c Z i+ O N ° M O E aci E aci N Cl) N U N £ J I, U y ~ J I IL a 'm m S a m c W z A Z T, N U~ Z y d (D N (7 O 0 0 a L - G O C. -U . 0 :3 (D Z N> 2 3 3 3 U) c~ 3 3 3 o z •rV ;j _0 a a a a a a a N (D a) C O CD 0 M O m y co O i Q 6i Oi Q Z r N N .-O w N E OO O O ?3 W E N m m y y L m y a Cl) d co N d N N d Q Y Q .f,. m I' `try y~ o o w o 3 Q i~ 00 3 C~ N C U~ N C c E (O O O O~ O N c 0 N C N U d 00 p f- :N E y f6 y E Y d C .O N N O c- is O 1-2 .2 = 2 =3 N 04 -0 z w.r co M a 3 N y o E 3 ~ O F c cfl M M E~ U ui 0) O U 0-, 0(n m • O M U) Z I- O Z N 2 I- Z O z y (n w E as ~a ° e a a w E y C C w 3 C "~1 A 0 at 0 U)Q Oinv FILED 2 91 C MAR 0 6 19910 3 46'`7021„ JAMESRegister0, ofC0",I" / Deeds g St Croix Co.. WI CD N O • 0 Bearings are referenced to the south line of the SW} of Section 35, ° c CO assumed to bear S8805013311E. f7 Cr r o o ~ v •o ro O Ln c v v r* CD A o N ~ = o F,.~ a r. b o o ~ rt H. W. c C 3 0 o a a o ' a IV 0 t~ H o °o Qa rr a 1 rt re I SQJ¢ S00°00' 0011E 0 0 rD rt N w. A = 120.001 cn a ° _ C ~ UZ 0 Vi z' NJ w 4- cl: CA 00 ° w ■ n05i '0 y 1i° ° cn a a ro a ~ ft 1"". K ,t, T O C a I-+ r* ° K 0 ti ro~M (it y~ N cn Pr r I UnPlatted Lands P. (D :x r"o o K 0 rD M ° P. 7v I (D N 0 e! -n 661 254.20' 0-4 I " N0205312811E 229.471 C+ Lnn ~t m 0104214011W 156.361 c d t n rt Cn ~ I 136.211 jJ o' N 0 w rD o --i f , • F- I d o►~.• iaC X z Cn m IA : ut r r ~O . 5, M inn 0 X! p~ 3 I a N ~ O / 4 7 OD Jd (j I N I 110 0 ~ r- rt x a a P. rt, "0 cn kc~ a t ' / Io 0 0 rt i rrM N M O z ~t y40oS0. m `Sl.l = 0 o T m s o 15711W G' o ? T `00.E 112.76 o /z rD . A1d 4 S40o / m o. l I Cl) 0. 0 LM 11 x Co -C 0 o J o c 00 -A p 0 a V r. ^ r. O O ,+t 'la'ir O ~ o m z c~ r+t v r n W r ~c " a v ,rte a a~ o a7z 717 17 . ( I I I +I 'I I .I IZ L T N 13.. O O O 1 Z r L H S +T `r••1 . O ~`r.~ T ro rt t rat ? Z ;Z Z' Z Z Z V1 N {Z N(N N N N Z Z' to `t r Ot Ot RO r 5 r r 00 O V Cn 3 O N O~ V V Cb i N Off m 7C 70 2 O 1-M IM N 00 O OD r-. yb V' O O v ti° 5~/ f1 T f1, O (n NLn r,) (.n ,V1 v, '-M Vt Vt r+° r h0 t!t Y O r r r,°i ~N 0 O O 3] z tD S X O O N N Gl O `O O V N ir+r; O N t0 Ot ,°t tC N K~1 = M X d O p A O 1N N N N O O O N r O 3, ru - 'O C H t z rt O (n to w O O O O O ~O e V O at N N :a (n D eb 0. CL o n a re 1rb rn at ac tae m m * rn nt m s 1 t: ?ac rn ri nt m at = MC > cC c C) 3C o a ■ c o A O N A ~ ~ r r W •'1 = r= Co c W N N 0 '.N N N N N rN r W r N (n a+ o N (Jt -rn r o N N r o a. oo, N rn of i P v ~0 V O W N O N O - lit CO W O V r r O W fV 1 r to W O W N 'O N W (n V rb O (Jt r vt V+ V CI W 2 VOLUME 8 PAGE 2323 LOT AREAS Lot 1 Including R/W 29,394 Sq. Ft. (0.67 Acres) Lot I Excluding R/W 27,005 Sq. Ft. (0,62 Acres) Lot 2 13,489 Sq. Ft. (0.31 Acres) Lot 3 38,891 Sq. Ft. (0.89 Acres) Outlot 1 8,429 Sq. Ft. (0.19 Acres) SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Thomas Doar and Gary Johnson, I have surveyed mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SA of the SWk and in part of the SE; of the SW;, all in Section 35, T31N, R18W, City of New Richmond and Town of Star Prairie, St. Croix County, Wisconsin; further described as follows; Commencing at the SW corner of said Section 35; thence S88050133"E, along the south line of the SWk of said section, 1329.41 feet to the point of beginning of this description; thence continuing S88050'33"E, along said south line, 114.34 feet; thence N4005010011E, 429.57 feet; thence N58008'23"W, 75.00 feet, thence S40o50'00"W, 115.00 feet; thence S11040'57"W, 112.76 feet; thence N65052125"W, 116.23 feet; thence N20042'56"W, 41.38 feet; thence N67019112"W, 46.87 feet; thence N79026'11"W, 112.45 feet; thence N02053'28"E, 229.47 feet; thence S82000100"W, 215.00 feet; thence S0000010011E, 120.00 feet; thence S62025148"E, 225.69 feet; thence S79026'11"E, 106.45 feet; thence S67019112"E, 26.14 feet; thence S20042156"E, 40.75. feet; thence SOOo00'00"E, 34.00 feet; thence S67054107"W, 45.38 feet; thence N79001100"W, 55.17 feet; thence S0104214011W, 156.36 feet to the point of beginning. Above described parcel is subject to town road right-of-way (Golf Course Road) as shown on this map and is subject to all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. ~'aQJ,✓ ~ 5 it R;~~~'~ % ESN G. " NY AC~Fr 1~7 f • HUDSON, VOLUME 8 PAGE 2323, WIS. ®~E~ N~. Parcel 038-1142-70-200 08/24/2007 04:33 PAGE 1 OF 1 F 1 Alt. Parcel 35.31.18.582F 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CITY OF NEW RICHMOND CITY OF NEW RICHMOND 156 E 1ST ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.310 Plat: N/A-NOT AVAILABLE SEC 35 T31N R1 8W PT SE SW BEING LOT 2 Block/Condo Bldg: CSM 8/2323 EXC PT TO CSM 14/3964 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 35-31N-18W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 909/254 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2006 Description Class Acres Land Improve Total State Reason OTHER X4 0.310 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 LV1L1 a~[~1Y11t1R1 aialL.r1 nt.rvtct OWNER ADDRESS 12- 72- 4j 18eq-6c AV 4 /C~~.SV IN.~Iywv ~Cy.~ • .S• q-o~ 7 SUBDIVISION / CSM# LOT AIA SECTION N-R__L6 W, Town of 451 ' 69yloy ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 26',lJ'' J 'v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~6ASfi F4 1co ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: (,Ql~ s - p • Liquid Capacity: J~ Setback from: Well ..S House other Pump: Manufacturer 74- Model# Size Float seperation Gallons/.cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~J t Length Number of trenches Ei4S~ Distance & Direction to nearest prop. line: ,,3p7 Setback from: well: So House a Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system; Existing Grade 5 S Final grade ~~8 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: Z INSPECTOR: 3/93:jt I,Q1 ~b''zTrl ip~rt j' i I RWIE 35.31.AMMEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 1999,10 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: igg Nyw RlrHMc)Nn A mTjmTr_TPLc;TAR PRATRTR CRT M ev.: Insp. BIVI Elev.'. , B~Description: Parcel Tax No.: 14~d, oo z&e C" OIA-1142-70-000--l TANK INFORMATION ELEVATION DATA A9300337 A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark Septic C..? Ado M./- Dosing Aeration Bldg. Sewer Holding. _ St / JK Inlet TANK SETBACK INFORMATION St/ bI( Outlet 17 Verit TANK TO P/ L WELL BLDG. A irIto ntake ROAD Dt Inlet Septic 7/10 NA Dt Bottom r7 -7t t:ir_ - 01 Dosing NA Header- - 2< cJ Aeration Dist. Pipe S 7 Holding , Bot. System 9~1 5 PUMP/ SIPHON INFORMATION Grade Manufact~urer - Demand /'lid, ;gyp' Model Number GPM TDH Lift Friction ystem oss e Forcemain L Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width` } Lengthy j t No. Of Trenches PITT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / r.- DIMENSI 7t 11 SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM CHING MY facturer INFORMATION Type of ~c~ r I Number: System: yv.7G/C(~ 7 OR UNIT DISTRIBUTION SYSTEM Header / Manifol Distribution Pipe(s) ! / ~r x H ze _ x Hole Spacing Vent To Air Intake Length _ X. Length Dia. ? Spacing SCOVER x Pressure Systems Only xx Mound Or At-Grade Systems On Depth Over Depth Over rr rl xx Depth Of q '/Sodded xx ed „ram ~1 Trench Center 0,091 Trench Edges + Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION' STAR PRAILRF InE/✓[ s3531.1 1.c 82 J j c/ Plan revision required? ❑ Yes ®-W- Use other side for additional information. F// F// 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 COUNTY TY C / STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 9&_ _L/ / eq 9' r-Is 8% X 11 inches in size. L_J Check if revision to previous applica -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP r O ER PROPERTY LOCATION / (a Y. , 5 /a, S T 31, N, R ! ®~(or) W PROPERTY OWN R AILING ADDRESS LOT # BLOCK # Z ~ 8t9~` 9_ . W r4 yU e7 CITY, STAYII~ ZIP CODE PHONE NUMBER SUBDIVISIION NAME OR CSM NUMBER II.' TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD II~~~ I (J_ I3-Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX MBE ( ) Ill. BUILDING USE: (If buttdi~p type is public, check all that apply) t- 7C~ L^~~ /yJ~• 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car sh S 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 t4 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. RNew 2. ❑ Replacement 3. ❑ 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 ❑ 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) 5. ELEVATIgN --Feet 4~?`'eet Z -_:40 n G OZ/ 7 VII. TANK CAPACITY Site in gallons 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 00c) X1,wf #M ev° P.- 54 El n I Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): ' Plumb 's nature: (No Stamps #PfMPRSW No.: Business Phone Number: Plumber's Ad ress (Street, City, State, Zip Co IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No §tamps) Surcharge Fee) XApproved ❑ Owner Given Initial 7~ Adverse Determination ID 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. i> 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/;neater 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; close 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. Thp monies collected through these surcharges-are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. - S8 D-6398 (R.11/88) . STEEL'S SOIL SERVICE 1554 moth. Ave. Gary L. Steel ImmkWabonrome C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 Conventional system CP for City of New Richmond New Richmond Golf Club maintenance shop 935-THN-81817 City of New Richmond tom of Star Prarie pages #1-----------Review application #2----------- profect detail data sheet #3-----------soil evaluation A-----------worksheet #5-----------plot plan-plan view #6-----------cross section trench system C,ary L. Steel 10-13-93 • Wisconsin DPpartmont of Industry, PRIVATE SEWA{ E SYSTEM Safety and Buildings Division Bureau of Building Water Systems I abor and Human RPlations REVIEW fiffTACATION Itaywardoffice La Crosse Office Madiso%9fa Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 20 Ew1shington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P b~{pu 7469 P O. Box 434 Waukesha, WI 53188 liayward, WI 54843 Phone (608) 785-9334 on, WI 53707 Shawano, WI 54166 Phone (414) 548.8606 Phone (715) 634-4804 Fax (608) 785-9330 ne (608) 267-5119 Phone (715) 524-3626 Fax(414)548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633 1 11% INSTRUCTIONS: To save time, schedule your review We of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. ur brnittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call an j~ he listed offices if you need help filling out the form or have questions on what information to submit, PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number Tiov. 1, 1993 Jerry Swirl S93-41139 2. PROJECT INFORMA LION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Name City illage Town Of: County New n;j clu.lond wolf Club maintenance Sho r1~y1 / Project Location CC -54. (S 1/4 d C: 1/4 S3-5 T 3 1 N ,R I® or W GOVT. LOT5 0 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (Include new and existing tanks) n/''~ Up To 1,500 gallon septic tank . 5110.00 110.0 A ❑ At-Grade 1,501 - 2,500 gallon septic tank $120.00 H ❑ Holding Tank 2,501 - 5,000 gallon septic tank $160.00 . M ❑ Mound 5,001 - 9,000 gallon septic tank $200.00 N OXNon-PressuruedIn-Ground (conventional) 9.001-15,000 gallon septic tank $300.00 P ❑ Pressurized In Ground Over 15,000 gallon septic tank S 500.00 O ❑ Other, Up To 1.000 gallon dose chamber S 70.00 1,001-2,000 gallon dose chamber S 80.00 Building Type (check one): 2,001- 4,000gallon dose chamber $100.00 4,001 - 8,000 gallon dose chamber $120.00 "V D ❑ Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 ( P Public Building Over 12,000 gallon dose chamber $160.00 t S ❑ State-Owned Building Up To 5,000 gallon holding tank $ 60.00 120 5;001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow gpd Over 10,000 gallon holding tank $150.00 ❑ Check If Replacing Existing System Experimental System (additional one time fee) $300.00 Revisions To Approved Plan 2 $ 60.00 Petition For Variance: Setback $100.00 Site Evaluation $225.00 ❑ Petition For Variance Plumbing $225.00 Revision $ 75.00 ❑ Groundwater Monitoring Groundwater Monitoring - Per Site S 60.00 (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring S 60.00 Subtotal:......... 110.00 Priority Review: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 110.00 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code rl extension) Company Name Contact Person (715) 2146-1200 Steel's Soil Service Gary L. Steel No. b Street Address Or P.O. Box City, Town or Village, State, Zip Code 1554 200th. Pve., New ^ichmond, TJI. 54017 ' Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SOD-6748 (R. 03193) OVER -42_ G-' PI b. # 60 1/78 PROJECT D,kTAIL DATA SHEET NAME OF BUSINESS a lr"7T> , i 1 Z°~ub LEGAL DESCRIPTION OWNER 0;4,/ e:~ Cia pi"tnaqJ MAILING ADDRESS / Z Z e- 1 gDP- 1;41a- ~VL- ~ We-9mod zip 581 ARCHITECT, ENGINEER, AQV ADDRESS PLUMBER OR DESIGNER 00 'Apt / z-_© 4.A: Z I P S' Sze TELEPHONE NUMBER 7/s' • z Flo - loLO c~ 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building X~-- New building Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( )..Assembly hall . . . . . . . . . Seating capacity ( ) Bar • . . . . . . . . . . . . Seating capacity # of meals served ( Bowling alley . . . . . . . . . . Number of lanes ( ) With bar (=Campground and camping resorts . . . Number of sewered s tes Number of unsewered sites w Total number of sites ( ) Camps . . . . . . . . . . . . ) Day use only Number of persons - ) Day and night Number of persons ( ) Catchbas i n . . . . . . Number ( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall . . . . . Number of persons ( ) Dining hall Number of meals served daily ( ) Dog kennels Number of enclosures - ( ) Drive-in restaurant Inside seating capacity Car-service Number of car spaces Dump station . • . . . . . . . . . Number of dump stations Employees ( total of all shifts) Number of employees Hotel ( ) Motel ( ) Cottages Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . . . Number of beds Parks . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers Restaurant . . . . . . . . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service Retail store . . . . . . . . . . . . Total number of customers Schools . . . . . . . . . Number of classrooms __FT Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . . . Number of cars served dairy ( ) Swimming pool bathhouse . . . . . . Number of persons (~Q OTHER . . . (Specify) . . . . . . . L°ountr' COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. Floor drain yes no r4, Number of drains Food waste grinder yes no rC Dishwasher yes no Automatic clothes washer yes no X_ Number of clothes washers 3. Septic tank capacity Holding tank capacity Septic or holding tank manufacturer00, 4. SEEPAGE TRENCHES: tTi square feet -Z ®,a width of trenches -5' ' length of trenches //1 ' depth number of trenches SEEPAGE BEDS: total square feet width length of bed depth SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signatur person compl ting form: FOR DEPARTMENTAL USE ONLY Address !~/l?Dy7~! Gam. Z i p s/ 7 Tel ephone Number -6P zQ~~ Date Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 8ti0, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches'lysize. Plan must include, but not limited to vertical and horizontal reference point (BM), dir c0y,and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearelWad. APPLICANT INFORMATION-PLEASE PRINT A INFORMATION REVIEWED BY DATE PROPERTY OWNEP "60 PROPERTY LOCATION VV if rrL ~a I~C: Wb GOVT. LOT St,) 1/4$,6~ 1/4,S36 T 3 J N,R le jr(or) W PR TY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBP. AME OR CSM # I (a z z Bv'~ Rv~ /dr9 /Yrq IY CITY, STATE ZIP CODE PHONE NUMBER ITY (]VIL W NEAREST ROAD re.Amwtcl eqT. sir (7 '1-6, -seBs"o i Jeg-f #v g (A, New Construction Use ] ] Residential / Number of bedrooms P Addition to existing building j I Replacement K Public or commercial describe 6.0/1/w y! ie ~o/-/Z? 6 c4, b M.414 c_ S' h 0 P Code derived daily flow _1 Z.o gpd Recommended design loading rate , 5 bed,,gpd/ft2 , G trench, gpolft2 Absorption area required z 3`o bed, ft2 Z o o trench, ft2 Maximum design loading rate . 6- bed, gpd/ft2 -.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 9 G~ ft (as referred to site plan benchmark) Additional design / site considerations N14 Parent material _0( ">4("1-< h Z"-7 Flood plain elevation; if applicable s/,- ft S'= Suitable for system CONVENTIONAL ' MOUND IN-GROUND PRESSURE AT-GRADE S." SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem $Z S ❑ U EWS ❑ U L':2:S ❑ U 0S ❑ U ❑ S ❑ S ®J1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1-/6 D 3 0?rngr 6.35 /o Z- /2"o y G <S c / 44- Ground /O ytt o e---- st5 m54 /K M 14f_ Co' uJ b elev• 7rn 63 ft. Z, 5 o n ~(o IV 6 C kS Q S J ir/W J .g Depth to limiting factor " Remarks: Boring # as -1 Z- . . ,.S z v't Z Z-Zoo /0 4& 'f/ O G SG/ a M 5.0/4 tf, Ground 3 G' V1 p E S/ a mSAi~ s~iZ G'o l , .6 'Io lev/r 8~0 `ty ft. 0 "-d = S O nF .NIA ~ 14- , 18 Depth to III limiting factor r~ N Remarks: T Name:-Please Print ,,-Phone: - Address: S- of oe 4 Signature: , Date: CST Number: CS7 PROPERTY OWNER SOIL M-SbRIPTION REPORT Page-- of~ PARCEL I.D. # Boring # Horizon Depth Dominant C~ Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color GS z. Sh. Bed Tn3r~ch lvd) C Q C 3 3{ o Ground .4-y2 !y oir/G% S/ Z S© 5 elev. ft. Y,2, W12 /V 0 Depth to limiting factor Remarks: Or~i~d AArs Boring # F 'M F Ground 3 9, z /2 y% IVO S c 1 a I SAK 4t Co c~ AIX elev Depth to .J z 82 D a G .S D FYI vy /~f~ limiting factor Remarks: Boring O l~ 2 3 lU~ o? G!J S ~o Ground I/ o - d vim! S l•: Y`~ . -Y/ 4t /V Z ~eley,- ill6e /!l ft. Depth to limiting yfactor Remarks: Boring # r Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) l STEEL'S SOIL SERVICE Gary L. Steel 988 N. Shore Drive C.S.T. 2298 / New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 S I~ v 1'Y) r3 i'f E-n r9-r+C e- $gj y4 SL Y* VS--1--3/N R18J 0- ; 4 f lV L,7,(Dgi&,~ lov9s a 'C- 44- o o, ~~.t3 +25.1 -4a-M A l l A-Y^d-14-5 g 00 ~o Zoo+146,Y%As p®(~WE 1/ 6r ~i ~ ~q/1 c 2 1p o' I3' n~E~rES-F 307,' E,*4 pnev-wAY ~...,I L ~ L G M OPTIONAL WORKSHEET 1, MOUND SYSTEM if. IN-GROUND PRESSURE SYSTEM•Condnued- l, 10. Force Main: tn. 1. Wastewater Load, Total Daily Flow ■ 71% Minimum Dosing Rats Use s. ILHR 83.15 (3) (c) Diameter - i"' Adm. Code and PROVIDE A DETAILED . Total Oyna a Hssd: LIST OF SIZING ON PLANS. 1t System Head e I.S it. 2. Depth to Llmitktg Factor ft. 3. Landslops ' • 4. Distance from Dose Chamber to Friction Friction ■n lots f Distribution System ■ ft. S. Elevation Difference Between 12. Pump Selection: Pump will discharge at k tarn 1stribution S stem • tL Pump and Distribution st - T 1 ft. total d k hud. 6. Absorption Area Sizing: ._~p model and facturer: - Ana Required' sq. 1L Bed or Trench Length (B) • fl. Bed or Trench Width (A) • fL I • Dose Volume: Trench Spacing (C)' - tL 10 Times d Volume of 7. Mound Height: *l Distrib on Lines - Fill Depth (D) ■ ft. Dail astewatsr Volume 4- Fill Depth Downsiope ) • fL 7 3 uses In 24 hrs. • tai. • 8sd or Trench Ddpth f) • f L ackfiow W' Minimum Dose ■ ---ice W' Cap and Topsoil De th (G) • fL Cap and Topsoil Qipth (H) ■ fL I Dose Chamber: J S• 6. Mound Length: / Volume' End Slope (KV fL Total Moun ength (L) • fL 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM W 9. Mound Width: 1. Wastewater Load, Total Daily Flow ■ Upslow rection Use s. ILHR 83.15 (3) (c) , Wis. 11) Factor ft. Adm. Code and PROVIDE DETAILED pow ops Correction Factor ■ LIST OF SIZING ON PLANS. Do slope Width (1) ■ . fL 2. Required Septic Tank Capacity • I• Tq al Mound Width (W) ■ fL 3. Percolation Rate •41,0d'nb 2A& ' -%'21 minJi 10. B ( Area: 4. Absorption Area Sizing: Refer to Table 2 in ch ILHR 83 Infiltrative Capacity of. and PROVIDE A DETAILEI/Llst OF Natural Soll ■ gal./sq.ft./day Basal Rrea Required ■ sq. f . SIZING ON PLANS. ZOO Basal Ana Available ■ sq. ft• Required Are t sq• ft. Length ~ 2 fL 1, if Standard Tables from Chapter ILHR 83 Width Y +tf'~- it. j are' fused, Indicate Table # t Number of Trenches • --1- 12. For the Distribution Network, Uss Numbers S•141n Section I1. Trench Spadeg • tt. S. Dlstribution System: ft. 11. IN Gepth t PRESSURE SYSTEM ft Lateral Length • 1. D Depth W Limiting Factor ■ Number of Laterals 2. Landslope • Catsral Spacing ~ b' 3. Percolation Rate min./in. ' Distance from Sidewall to Pipe ~ ~ to. 4. Proposed System Elevation • ft' System Elevation ■ ft. i S. Wastewater Load, Tool Daily Flow: r Sal• Use s. ILHR 83.15 (3) (c) , wit. Adm. Code and PROVIDE A DETAILED 1 SYSTEM4N-FILL LIST OF SIZING ON•PLANS. Fill in All Items from Sectkn 111 Required Septic Tank Capacity • gal' 6. Absorption Area Sizing: V. 1. SEPTICTANK Capacity s Od 0 gal. PercolationRate■ min./in. ~~P'' Area Required - sq. ft. 2. Manufacturer: System Letegth - ft. 3. Show Site Constructed Tank Details on Plan System Width ■ ft. 7. Distribution Pipe Sizing: Vt. DOSING TANK 1. CapatltY • gal. Hole Sbe • in. Hole Spacing = h. 2. Manufacturer: Lateral Length' ft. 3. Pump Manufacturer. Lateral Sii In. 4. Pump t4+Kicl: I.atcral ti III ft. S. . Operatitill Head■ -w Sports. Uislau imm Shk watt •d+ Pilx in. b."aT1bw Rato ■ 11. Dharlh ten Plpc 01s harpe Ralr: 7. Show Site Constructe nk Details on Mans N ber ul I Wlcx I'rr Plix• - low Pet' Plltc t gt+m. VII. IIOLUING TAN gal. I Capa - 9; nifold Sfiittg: Z;` utN;ture"; fYPe (center or nn+l) Ste nstructed Tank Details on Plans Length ~ IL f Diameter in. s ' -SHOW ALL INFORMATION ON PLANS- ntlilR S8G•R?5i 1R G111S?V STEEL'S SOIL SERVICE Gary L. Steel OWN. 191-o a Ek2ve C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 rid/~L°lr,~.b I~Ainfe~,~.,ee Shoe Sw Y~ SL Y~c S 3~ - ~3/~/-•/r /BcXJ We'll 13rA a C 6,rnf vt-~- C3flsE ~ `y 18.1 4 1 ep (7 Ew `~n Rs-tes-,gym e~-z ~t~ ~y _ vdgA r 1 y~ w ►2~~ru,~ ~.►-►~-~5 1~ S7' log J3' J3?0 r P ^un itrclud~e 'sc;v%oidvrc oe.s n22ot 09 fitai tans SYSTEM } rtis ~s? 1i.3 Plan L,, y in ~eok ac ~i~~thec ~i,in~3• P r t~~ 1A 0 1 7, n `oz 01 'n r t ai r de to draaai~ d io qoval ,°x. bF III USTRY, LABOR & HUMA"11 „OFd6 4i ~ 303~,~Y el" OF 8;rA ~ /yob ~v Sa►~ l1= G z~ _ ~~4~_.:_ ~,J`~ 30 30" STEEL'S SOIL SERVICE /-..5yf ZDa Gary L. Steel e C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 t3 d rp 5.5 S~ c-t'~ v rz n e h ~ 58 So d~~ l r CL ~ ✓r ~ r~ i t C. 0-0 9 T f~( r y /L r 4 l7~ ~ r (~Cw' r n . Sb = 8 < s+r• b LJ, u-n C(1,5Arlb v-41 s~ P•/7~ 4* 0 P, Y4 44L- ~9s,r ya•l-~ F G s' C11 s ew t6 iwa/ g'*1 1~n cL 4 k e6S4 a0'' bd no Mme" ` h&,77 4z ~dl 86 u-) r'Qc4 A-X 1 m Lc ,~-l CI e F X a fv w4l e-,-i 4o w any'8 v1,41 °J N~9a~d * ' ` ~ `a a'uF+IS 4~~ SAr~~°d s4sr C" se SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/EtFYEER ADDRESS: -2 D i ~n FIRE NO: Z -z C. LOCATION: S uD 1/4, ,E 1/4, SEC. T & N-R_,I~W, TOWN OF: _.,5 V4-v, 60,0 -rL ST. CROIX COUNTY SUBDIVISION: 7F4Z _el LOT NO. k Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNE . I. DATE : St. Croix County Zoning office 911 4th St. Hudson, WI 54016 STC-100 'I'his apPlication form is to be completed i in full and signed by the otti ner (s ) of the will only result in del apestofbtheg developed, Any inadequacies development be intendedyfor resa pe bytowner/contrachtold this 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 f Location of property 1/4~S1/4, Section --_i T~ I _N-R~W Township Hailing address 1, e s Address of site Subdivision name Lot no. Other homes on property? yes_ 2~,_No Previous owner of property Total size of parcel zop-~ ~s Date parcel was created Are all cornors and lot lines identifiable? L--Yes No Is this property being developed for (spec house)?__Yes Volume-Q_2agnd Page Number of Deeds. as recorded. with the Register INCLUDE WITH THIS APPLICATION THE rOLLOWING: A WAIZttA ITY DEED which includes a DOCUMENT NunDER, VOLUME AND PAGE NUMBFUZ & THE SEAL Or THE. REGISTLI OF DEEDS. In addition, a Certified survey, if available; ;would be helpful so as delays of the reviewing process. to avoid references to a certified survey Map,Ithe 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 ny (our) knowledge that I (we) am the property described in this information form b e owner(s) of warranty deed recorded in the office of the County virtue r of of a Deeds as Document Ito. Zd and y Register ly own the proposed site for tl~e sewage disposal t system or I (we) obtained an easement, to run the above described ( ) presently the construction of said system, and the s property, for in the ame h office of Count as been duly recorded Register of deeds as Document Signature of a cant Co-appl cant Date ,7 ZS nature Date of s gnature 110 . Q-S A ~u«nrrmnty Decd , ~,o Corporation '.'(STATE OF ISCONSIN) Published by Eau Claire Book & Stationery Co.) Form NO. 4 I~ day ofAp;1 ~ , A. D. Z946 24 ~lr Alb ert. rs between€'~~~r;Sln ~f tho 'of `Star Prairie, fi~W iJMh tel. 4tI Crolx Cott Oris'12 x h prty, of the first part, and ` t ofNVr 'xzG --~-n`3 u alp - - 'ACogoratioiz duly ,organize u tng nder and vartue~f the laws of the State of Wisconsin, rfi1.. ~'2i ~3^'"'F•~'ep` '4'' 't'f.`;~,Y'."ia 'by` r•1'S~~= i to at d, t LT R~Ghm, riC~ Wisconsin, arty of4the second art. tftrie~et, That the said part t efirs arty' for and in consideration of the sum of Five t qusdndY.- n q, no 7 0 04~ ' Mars - ~ >h~', yW ~•ti~t~ fit,-I~~~z- t A -.F ~ t ~ ~ o hl" in'han ~.P. t P , t b he sad e' and i~arf the r ce' t when of is hereby confessed i a a e_ ged; 'ven ran ed° bai emise released :aliened,, conveyed and con- g , firmed and these., gsents d,, gs c, grant, ba ise, release"alien; convey and conform a untorthe said ally the,s cond,part,,Jts suc estate, situated in the Countynof~ St j Cr of Wisconsin, to-wit: {1111 h4 spurt of t t eA hwest quarter h. h h f, of,' u - (EofSVti ofSect o ; r't e' ($5) Township K Num eVa`.,-T . ne r th af,- RAxige Number~Eighteen. F (18)W`es 4,lyi ds South of old Wisconsin Central sr Wright -o wa •ti 3 zComlencI ouiheast~:corner'-"of Southwest quarter of Seoon' ve -x(35)';'~in"" ToWnship'}Numbe.r Thirty-one (.31) North 'ighteen'',1a);West; thence East Eleven (11) ~,rods`,i- nt'r..of Willow,-,R ver; thence in .a Northwesterly °;point.,on the ;',line ruar4ixjg°;'North and South`. De eSouthwest quarter` W ) , and the Southeast quarter ! Said SectionFTriiicty-five I ` tYi t' is thirty-f e North~ of ace- ' of'., begsxining; thence;;South to place f w{ ; A` f of ginning, ybeing ;;a' part of SW of SEA,'; of Section 35, in Township Number'31 North of 'Range Eighteen (18) W"est. µ{7z t t ~fllvi lr l a~. • .f ti - - r~CpQtoee with all and singular the ,hereditaments a~ng~d :appurtenances thereunto belonging or in any- ;:,~„i px"~~,~ wise appertaipr and all, the estate, right, title, interest, claim or demand whatsoever, of the said part y of the first' p in, law` or equity, either in possession or expectancy of, in and to the above, bargain- ` ~ ~r ~"~^4~Yi" ~3 `qt °5 wG'JA'~~n `"c, A . .vft~n fr{ '~~.''Yy A{ j } ~''t • : „ ed prgmises,~a editaments and appurtenances' ? r f co babe ario t aid premises as above described with the hereditaments and appurtenances, F unto the said party"o art,"and to its successors and assigns FOREVER. 4rib~tbe Oaf D Albertell,`'a single' man z p _ 6~ u for h~n~~eYz hiss tutors ,and,, administrators, does covenant, grant, bargain, and agree to and with the'said part nd part, its'successors and assigns that at the time of the ensealing~ and delivery pf `these 'prese S:y will 'seized of the premises above described, L `r as of a g od, sure, perfect;"absolute and in State o . inhQritance in the law, in fee simple, and ' %thkih:e same are free and `clear from all into Lever, . ~a n "WM 41 f' sand that the above bargained premises in the q ossesslon of the said party of the second I essors and asst ns a part, is suco alnst all a rsoL persons lawfully claiming the whole or g g e an` r rhhereof he` will fo AN thesaid t DDEFEIVD. h p ^~~riftrie~ r'~d~CrCOf~ of e firs r a hereunto set his. hand and s al ,ti this t+i 24th. < ' A ri L A D., z946 (Seal) yr rI igned and Sea ce ofA °?~i Albert M. Campbell j j rt (Seal) aJ Hu (Seal) r (Seal) } a a n..1 titY ri t 1 Eve. ' h,r t~ 1~ lE 4 V 1 w: Y e I S~ e yr, ~~5fi a ,f VII ,4 u ~'°"4Po y` }~15' 4 r~ t M tyt ~ t 'a ~~.~ktl +,`~;~'r r ~ It"', ~v. r - %tate of foconofn, .......................St Crbix County. SS. Personally came bekore n e, this 24th. day of April A. D., xg 46. the above named Aibert A4. Campbell., a Single man to me known to be the person who executed the foregoing instrument and acknowledged the same. 74 J E. Hu ghe l" No y Public .t.......C.rQJ X......_•......._County, Wis. My, Commission expires...N_OV. 28 _......A, D. r948. ff„y. r•T w: t ~ f ed 01 'd: 0 i rI Cfj 1 U O 3 O .M 4)'• i ti p <1 0! U o 1 O 1 c e o 1 ;4 Er I I , I O ~sl ti-i I W r4 ate, ! i II Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT SEC.-35 T_N-R_W OWNER &,12- pl&l~ TOWNSHIP :24:2^ Pr ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION 10 1A4- LOT T1 2 LOT SIZE 0/9 PLAN VIEW Distances and dimensions to meet requirements of I•LHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Jcg M'~ ) INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ez~ ;d Aaao"~Z'~D,~'~'~(~, 1__ Elevation of vertical reference point: Proposed slope at site: _ SEPTIC TANK: Manufacturer: Liquid Capacity: 1 ~o Number of rings used: Q Tank manhole cover elevation: Tank Inlet Elevation: zl -t Tank Outlet Elevation: 7 8 Number of feet from nearest Road: Front, Side, Rear, O aD feet From nearest property line Front ,0Side 10 Rear, O 5 t~ feet Number of feet from: well, building: e~J`r~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Manufacturer: L id Capacity: Pump Model: Pump/S on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch el tion: Gallons per cycle: Alarm Manufa rer: Alarm Switch Type: Number feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: `j Length: :2 - Number of Lines: Area Built: _ Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,O Pt ^ Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: N er of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built Has eithe a drop box O or distribution box O been used on any of the above soil absorb on sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used* Elevation of bottom of tank: Elevation of in t: Number of f t from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: tp ^p?.S-' 8 4 Plumber on job• '11~~Ctej~ License Number : — 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 KXCONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number: assigned) 1:1 Holding Tank ❑ In-Ground Pressure ❑ Mound COMMERCIAL COMMERCIAL NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER: INSPECTION DATE. New Richmond Gott Ctu.b 156 E. 1.st, New Richmond, WI 54017 (-,2,5-84 P:30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SE SW. Sect, on 35, T31N-R18W, Town of Stan Pna Aie Name of Plumber: IMP/MPRSW No Cnunty Sanitary Permit Number: Gan L. Stee.2 3254 S Cnoix 79206 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LCAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: j/CL4_9 > YES ONO OYES NO BEDDING: VENT DIA.. VENT MATI J HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING.IVENT TO FRESH . ALARM FEET FROM LINF~ AIR INLET OYES ~ ~ NO C, OYES NO NEAREST ~~U c1(J DOSING HAMBER: MANUFACTURER 7INGS LIQUID CAPACITY PUMP MODE(JPUMPSIPHON MANUI A(THHLH WARNING LABEL LOCKING COVER PROVIDED PROVIDEDONO OYES ONO OYES ONO GALLONS PER CYCLE: PUM P AND CONTROLS OPERATIONAL NUMBER OF PHOPERTV JWELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) OYES ONO NEAREST-11, SOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IN(,TI IIIIA111TEF IIIATI HIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: _ WIDTH. LENGTH NO OFHES DISTH PIPE SPACING, COVER INSIDE Dln SPITS LIQUID TRENC Mn RIAL PIT DEPTH BE DIMENSIONS a,a '9, GRAVEL DEPTH FILL DEPTH UIST H. PI 'F DISTR PIPE DISTR. PIPE MATERIAL NO 'Y-01' NUMBER OF PROPERTY WELL. BUILDING. VENTTOFRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV„END PIPES FEET FROM LINE.,y .ten AIR INLET. G ~v c t t( 1 A NEAREST 0 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE 1111111ANI NT MAHKII'S UHSEHVATIQN WELLS DY S ONO OYES ONO DEPTH OVER TRENCH BED DEPTH OVIR TRENCH RED JIIIPTII QF TOPSOIL IS1111111 11 IFFDFD MULCHED CENTER EDGES OYES ONO ❑Y"ES. JNO LJYES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATEHAL SPACING [HAVE DEPTH HE OW PI F FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE IMANIFCFLD MATERIAL 11,O UISTH DISTR. PIPE DISTHIBU LION PIPE MATERIAL & MARKING ELEV. ELEV.' CIA. ELEV. PIPES DIR.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING: FEET FROM LINE: OYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE ,r DILHR SBD 6710 (R. 01/82) - wisconson APPLICATION FOR SANITARY PERMIT / COUNTY 'Z~ DILHR (PLB 67) UNIFORM SANITARY PERMIT # - OEPRRTTErIT OF Ir10USTRV, LRBOR 6 HUMRn RELRTIOl15 D -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instr cti ns for co leting ap lication. PLEASE PRINT PROPERTY O pt 6A od-4 & g"n,.A J'Ld ER t j MAILING ADDRESS 11- PROPERTY LOCATION .64XY: ri1~mE: c r SC 1/4 S(.t) A S . , Tj N, R (or) W TOWN OF: Y C LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD K R LANDMARK STATE PLAN I.D. NUMBER ,V O/ b f-t TYPE OF BUILDING OR USE SERVED ❑ 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): 126&1- r2d e- 7s THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed 1CI'1,eepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: t"I'Peds. IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): c7 'Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installatio of the private sewage system shown on the attached plans. Namp.ejPlumber (Print): j Signature /MPRSW No.: Phone Number: C~J 3 d S P7Z ►2 kzon) Plu be 's A ress: Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved &0 rt~ ~ (y) ❑ Owner Given Initial d,,a J p( U to Approved Adverse Determination Reason for Dis pro I: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 1 INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i a ~v . i m i 44 t 0 A t~(j 'A. e 1 anti 41 loll 3 p`uMe 0 co 1 ;peas ~ 5~ . , ~ ~ I ~1 Uy~ Las0 F SPFE~V CE RECEIVED Ct~SP 0`APR 2.-519;; PLUMBING BUREAU ~,3 u 3 of 4. 7~`` a~ . ro , j \v t 1 s v., .f~ pLutAWt4G { - s---~ Cnjit~naQAe 01 q` 641 I~ YATiONS S t F VE `TV V L F ,J a: NU P vt) ~1tA{J t.AC~OR pEFART~tt~ ` VtSIGN Or ~N~ tl'{ A~~U 43U1LGiNGS ONDLNCD RECEIVED APR 2 51K: PLUMBING "EAU ' {J i~. r PAGE. OF CROSS SECTIOW OF A BED SyS.TEM $OIL F L. DI31fRiBUTlO PIPE APPROVED SyIWTHETIC CO oo "---MATERIAL OR 9" OF STR 2" OF AGGREGATE J OR MARSH HA'zi ~I vam (o'OF%p Z/ -AGGREGATE ELEV. OF~JFEET_,~ I P~~Mg~N4 ! BUTIO E AT LEAST lMef i'E3 BELOW Of71GIMAL GRADE A A 5 B,,TSNO MORE THAN' 42 IAICHES. BELOW FINAL GRADE s~R~ `~~oa P gu~LC1 36016 l SAFETY ANA 7. G OEF' AXI 0 , 7<~_SXCAVATION FROM ORIGIWAL GRADE. WILL' BE TH OF EXCAVATION FROM ORIGINAL GRADE' WILL 'ar- RECEIVED SIGNED APR 2 519:; LIC EM SE UUMBE R: PLUMBING BUREAU DATE : i / % CrJ t~a co n v d, op ~.eev r 4wy j I A19 Yl /G ey-,5 /~UG? J~' .S rv, .35 LA) FS f15 0 4 1 RECEIVED APR 2 5 J PLUMBING BU STATE OF WISCONSIN DILHR D~~~~ DIVISION OF SAFETY & BUILDINGS PRIVATE SEWAGE SYSTEMS ~ BUREAU OF PLUMBING 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.o: Box 7969, Madison, WI 53707 608.266.3815 ~ INSTRUCTIONS: Please fill in all,applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this fo(m describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. 1. PROJECT INFORMATION Type Or Print CI@arly) Revision To Plan Number: 8601641 Name of Su mitring Party (Plans returned to same) Project Name l1 G~ F i fl r ~ . . Street & No. or Rural l Route roject Location . Street& No 'or Legal Descritp_tion Y City or Village State Zip City ❑ County Village • ❑ OF~ ~I ~ ~ ,~~'T"~•~ ~ 7 Town 1~- er~1 Telephone No. (Include area code) Designer Telephone No. (Include area code) Owne Nam hon No. (Include area code) Street & N Street & No. ity or Village State Zip ~ City r Village //yy State s Zip C~..f t ~ ~ ~ . ! 2. APPLICATION FOR: ❑-New Mound System (3a) ❑ Groundwater Monitoring (7) ❑ t4-Conventional System -Public Building (1,) El Replacement Mound (4a) Holding Tank (2) ❑ Petition For Modification (6) F-1 Replacement Pressurized System Ell ow` ~ System in Fill (1) C `fir ❑ System in Flood Fringe (1) ED Other Alternatives (5) New Pressurize~d'~yste El 3. FEE COMPUTATIONS (Include _exiistttinlitinlt1~a10 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TOJ"R (u 3a. 750- 1,500 gallon s-, - tank 000 4a. 3b. 1,501 - 2,500 gallon septic t 60,00 4b. 3c. 2,501 5,000 gallon sep$N11t - 80.00 4c. 3d. 5,001 9,000 gallon septic tank,_ -100,00 4d. 3e. 9,001 - 15,000 gallon septic tank -150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500- 1,000 gallon dose chamber - 30.00 4g. 3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h. RE 3i. 2,001 4,000 gallon dose,chamber - 70.00 41. 3j. 4,001 8,000 gallon dose chamber - 90.00 4j. Ap 3k. 8,001 - 12,000 gallon dose chamber -110.00 4k. F+r 31 Over 12, 000 gallon dose chamber - 150.00 41. 3m. 500 - 5,000 gallon holding tank 30,00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal - 3r. Priority plan review: walk through) 4r. Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 c I Total Fee Note: Fees pursuant to Wis. Adm: Code, Chapter' may be subject to change annually -OVER DILHR-SBDZ748 (R. 03184) Effective July 1, 1984 `/LsJJ P1 b. = 60 .1 /78 F PROJECT DETAIL DATA SHEET NAME OF BUSINESS to DESCRIPTION VA4 S. 36 f»9/ A). OWNER ( i 4,/ t7' ~Nt~ Q"jV&'71k.8_ MAILING ADDRESS l ZIP !tre,-U l 9 AtRC_yII CT, ENGINEER ADDRESS ~09 K), L h 0_~ br N LUMBER)OR DESIGNER ~ V Adz IP _,i !z Jrj TELEPHONE NUMBER ? '~D 7~UC1 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition ( ) Apartments and condominiums . , . Number of bedrooms 4 ( ) Assembly hall . . . . . . . . . . . Seating capacity { ( ) Bar Seating capacity A of meals. served, ( ) Bowling alley Number of lanes ( ) With bar ( ) Campground and 'camping resorts Numher of.sewered sites Number of unsewered sites Total number of,site s ( ) ramps ( ) Day use only Number of persons ( ) Day'and night Number of persons ( ) Catchbasin . . . . . . . . . Number ( ) Church No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall Number of persons ( ) Dining hall , . . . . . . Number of meals served daily ( ) Doa kennels . . . . . . . . . . Number of enclosures ( ) Drive-in restaurant . . . , . . . Inside seating capacity Car-service Number of car spaces ( ) Dump station . . . . . , . . . . . Number of dump stations ( ) Employees ( total of all shifts) Number'of employ~~ I ( ) Hotel ( ) Motel ( ) Cottages . . Number of unit1~Yi'th,vku 2 eons ppy, unit Number of uni wii e r nit ( )Medical and dental office bldg i s. N umber of doc o nu D Number of offi n~R~ Number* ( ) Mobile home-parks . . . . . . . . Number of e APR 6 9; ( ) Nursing homes . . . . . . . . Number ds,~~C'~~ MBING BUREAU j`.\ p. @► ( } Showers ( ) Parks . . . , . , . . , . . Number ( ) Restaurant SeebO . cap ( ) Dishwa P disposal? ( ) 24- se ice ( ) Retail store . . . . . . . , . . Tota number of customers ( ) Schools . . . . . . . . Number of classrooms _ T7 Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station Number of cars served daily. ( ) Swimming pool bathhouse . . . . Numb r of. persons (Y OTHER . . . (Specify) •~.d,~~Uri~ y COMPLETE OTHER SIDE 1 r'S 4 Par r~ tj vN-y 2. -Indicate whether the following facilities are present. Floor drain yes no Number of drains Food waste grinder yes no Dishwasher yes,no Automatic clothes washer yes, no._y__ Number of clothes washers 3. Septic tank capacity ) 0 0 0 fy A Holding tank capacity Septic or holding tank manufacturer 5u 4. SEEPAGE TRENCHES: total square. feet width of trenches length of. trenches depth •.3--~ number of trenches SEEPAGE BEDS: total square feet width length of bed _ depth SEEPAGE PITS: total square feet outside diameter depth below inlet . total depth from top to bottom of pit signature of person completing form: FOR DEPARTMENTAL USE ONLY Address ~ r 86 Z i i • 0 16 4 1' Telephone Number 4/ ` ~,o zvo Date- °w ONMAECEIVED I '"o A 2 5 a~ t PLUMBING BUREAU • Ode P~-~N1'i ~ ~ l~~ ~ ~~10 Off`` OPTIONAL WORKSHEET 11. IN-GROUND PRESSURE SYSTEM-continued- UND SYSTEM L MO gal, 10. Force Main: 1. Wastewater Load, Total Daily Flows Minimum Dosing RA U.se s. ILHR 83.15 (3) (c) Adm. Code and PROVIDE A DETAILED ine LIST OF SIZING ON PLANS. 11. Total Dynamic Head: e' Y 2. Depth to Limiting Factor= t' S stemVerticalHad = 3. Landslope Lift: - - x ft = 4. Distance from DcsE Chamber to Friction TDH.= Loss Distribution Systemft. S. Elevation Difference Between 12. Pump Selection: Pump and Distribution Systemft. Pump will dischar___--ft. to6. Absorption Area Sizing: at pump model and mArea Required s4• ft. Bed or Trench Length (8) _ ft. Bed or Trench Width (A) ft. 1/D Trench Spacing (C) ft, lume of s g 7, Mound Height: Voluma+ F!II Depth (D) _ ft. = g Fill Depth Downslope (E)'= ft.. g Bed or Trench Depth (F) ft. g Cap and Topsoil Depth ft. Cap and Topsoil Dept H) = ft. Volume g s 8. Mound Length: End Slope (K) = ft. Total Mound.le th (L) s ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Dally Flow- Upslope Corr tion Factor= Use s. ILHR 83.15 (3) (c) , Wis. Upslope Wi h (1) s ft. Adm. Code and PROVIDE DETAILED Downslop Correction Factor = LIST OF SIZING ON PLANS. g Downsl a Width (1) _ ft. 2. Required Septic Tank Capacity = Total ound Width (W) _ ft. 3. Percolation Rate s 10. Basal A a: 4. Absorption Area Sizing: Refer to Table•2 in ch. ILHR 83 tunl Soil era Soil Capacity of q.ft./day and'PROVIDE A DETAILED LIST OF asal Area Required ed = s q. . ft ft. SIZING ON PLANS. ft Required Area = -st Basal Area Available'- sq Length = f 11. f Standard Tables from Chapter ILHR 83 are used, Indicate Table • # Number Width = of Trenches= -L, f 1 . For the Distribution Network, Use Numbers 5-14 in Section 1 . Trench Spacing = f ll. IN-GROUND PRESSURE SYSTEM S. Distribution System: O 1. T ft. Lateral Length - -•Z. 1 f i. Depth to Limiting Factors Number of Laterals= -•1--- 2. Landslope = ~ = 3. Percolation Rates min'/in' Lateral Spacing i Distance from Sidewall to Pipe = i 4, Proposed System Elevation = ft System Elevation = 5, Wastewater Load, Total Daily Flow: gal. Use s. ILHR 83. 15 (3) (c) Wis. 860 A Adm. Code and PROVIDE A DIET ED IV. SYSTEM-IN-FILL 16 LIST OF SIZING ONTLANS. Fill in All Items from Section Ill Required Septic Tank Capacit gal. j OOC~ 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rates min./in. 1. Capacity = Tl n P i" Area Required $q. ft. 001611G 2• Manufacturer: System Length = ft. ~ 3 Show Site Constructed Tank Details on Plan System Width = ft. e0jalonaffil Distribution Pipe S ng: VI, D 7. Hole Size A ft. i Hole SDaci = let t nufacturer: Lale6tl Klh .t Q'I,.:1V41~i , uJel: Later. ize atinK Head t Lal .11 Spacing U' .utcc I'rmn tiiJcw.dllo Pipe , S\Q ~ c H. Di rihution Pipe Discharge Raw pEpP ~ ~ ylte constructs ank Details on Plans Number of l Jules Per Plpe ~N low Per Phle pR~ IKN.uiNG TA= Manifold ame: 12. . ~i capnufacturlr:, fens (ccntei tar end) - Length 7% = ft, Shaw Site Constructed Tank 6wQ;s"® Diameter = in. APR Z 5 19c -SHOW ALL INFORMATION ON PLANS .-7' BUREAU ~ DILHR SOD-6761 (R.03/82) v r rn x x m N e ,,.F CD c W viw a~~ °'~ccN3O imm ~00ID ° ~9 mo 3 ~~co o eo v cD o am D p? m Dap o °ca wv m Cn a 7 ~4 0m;12 ElFC=D CD D n O 0 ~ m ~ 00 w 0 C CD D a s too owo of° w0'-N =00 ° oc=. y-•mwwu, 0 ~p m w~ m c CCO N (cc sr~ v m N C - ° 0 10 O `ra~CS wa i °mCaD~ Q a ..~p(a o -aQm w m 0~~ c0na~~'- v, C CO) cn -i 0 m Z n ~ 7 m fD m a► A ~ C'D ~ Z CA. (D 0 3-4 m m ~a y -i CD r 0 CO a ~w =.o =0 fT1 o tnN ~..A = w m y w =r 0. ?m0 CF0*0mmm~ C f~Tl v CD C CAD D a m o y n w o ago w 3 m aw _ Ki ca (a N O 7 c -.0 CD n N aoF Mcca~o 1f1 o. a a m a cr cr M- =r FA* c 1 C to m H a° o ca a 0 N M 0 N 0 c a C -4 w C .mi m c m = o e~ acn =c mm o As L 0 n o o -p r"' wa0 _am 003 93 3 N. ' a 1 O CO m e 0 z ( 1 D I L H R Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 D' Private Sewage Plans r- Telephone: (608)266-3815 Plan Identification No. Y ly~s GaRcin9 Per I:?aY v f PRIORITY PEA1W' REVM.%U Y Plan Review Fee ReceivW Petitjo For VarianCv fry ReL. Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village 12' Town of: - 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. 2 w FOR PRIVATE SEWAGE PLANS: ((1).: (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By. James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ . cc: D' Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health D' County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other SBD 6678 (R. 08/83) (PIb 100a) (Wis Stats. S. 145.02) fps STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form WI 7BUREAU OF PLUMBING ` 201 E. WASHINGTON AVE. RM 141 Any Return Correspo ce4 P.O. BOX 7969 'l,_ MADISON, W153707 608-266-3815 DATE: PROJECT: ~W ~G3 I 1 J ~ -Its 5i=ur` ;~rair°ic i -7 r.] PLAN ID. # ,-s)1 1 DETACH HERE PROJECT NAME PLAN ID. This is to acknowledge receipt of your plans and specifications for the above-indicated pproject. Preliminary review indicates the required fee is t ` Fee Received is $ r Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance: Plans being returned. ❑ Overpayment- Refund forthcoming. Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed, ❑ Holding tank agreement signed by owner and local IL Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed): ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification to Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. )EPARTMtNTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NCUSTRY, DIVISION _ABOR AND PERCOLATION TESTS (115) P.O. Box 7969 -IUMAN RELATIONS l / MADISON, WI 53707 H 3.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ NICIP TY: LOT O.: BL NO.: SUB/DIV/ ION NAME: St= 1/ 5 3 c _ T~31 N/R 14(or) W w (J CO NT WNE BUY NAME: AIL N DRESS' / i JSE DATES OBSERVATIONS MADE MER IAL DES RIPTION: PROFI D C IPT ONS: E A ION TESTS: I '7' /lGa - Yo S~-44"esidence New ❑R /~/T J l~~" ~~ST / 1~17lI7nS eplace, r - , SATING: S- Site suitable for system U= Site unsuitable for system 860164 1 ~ONVENTI NAL MOUND: IN-GROUND R URE: rYSTEM-I N-Fl LLIHQLDING TANK: RECOMMENDED SYSTEM: (optional) US ou I ❑u S ❑u a s;®u E Is Iku , If Percolation Tests are NOT required DESIGN F1T : If any portion of the tested area is in the under s.H63:09(5)(b), indicate: Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS rx 30RING TOTAL D PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO R,.T XTURE, AND DEPTH NUMBER 594441N, ELEVATION OBSERVED EST. HI HEST TO BEDROCK IF OBSERVED (SEE'ABBRV. ON BACK.) 17 (e ' 7 1 W, B- yj Q z 7 A) Q A) B 03 ` 47 EL j7 B 2-, B_ - ~ - - - a- RECEIVED 06'_~iW) AI PERCOLATION TESTS' APR 2 5 lKi TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES P NUMBER We"ES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P D 2 PERIO P_ 3 © 3 / .3 P_ - A)o 3 3/ /z, A~ P. IJ o G w P- ^P P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• )ntal 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 f land slope, i rl/ L 10 0 iYSTEM ELEVATION ~''.5 \ YJ4 r 0 - r O r J I . Q to -Bpi) I,~As_h~ x_00 Sit' y E , J 36 Po 01 ~v \ 7Z ~0 8rn , ti the undersigned, hereby certify that the soil tests rep rted on this form were made by me in accord with the procedures and methods specified in the Wisconsin administrative Code, and that the data recorded and the cation of the tests are correct to the best of my knowledge and belief. DAME (print): TESTS WERE COMPLETED ON: aDDRES CERTIFICATION NUMBER: PHONE NUMBER(o.ptional): CST SIGN TU )ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. JILHR-SBD-6395 (R. 02/82) - OVER r H 9 STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z a 9 H OWNER/BUYER r~ M ROUTE/BOX NUMBER Fire Number / CITY/STATE_ ZIP V PROPERTY LOCATION 6 34 Section T N, R W, Town of•- St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho I/WE, the undersigned, have read the above requirements and agree vi to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►o ment of Natural Resources. Certificaon form must b o .leted and returned to the St. Croix County th 30 days of the three year expiration date. SIGN DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property , aucb Location of Property 14, Section T_a_LN-R 9 W Township 'AQ~ A_ ~~_1~'l^1 Mailing Address Address of Site PAZ AL)Z) Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ~.4 Date Parcel was Created C.~ f Are all corners and lot lines identifiable? C--Yes No Is this property being developed for resale (spec house) ? Yes No Volume o7913 and Page Number 1507 6 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) ee ti6y that att etatement6 on this bo&m cute thue to the beat o6 my (oun) knowledge; that I (we) am ( cute) the owneh (a) o6 the pu pen ty du eh i.bed in thiA in6oAmati,on 6o4m, by viAtue ob a wauvcanty deed neconded in the 066ice o6 the County Register o6 Deedb as Document No.o21V-ea33 ; and that I (We) pnesentty own the pnopoaed z to bon the .6ewage diapod .aye em (on I (we) have obtained an easement, to nun w.cth the above debct bed ptopehty, bon the constnucti.on o6 said .system, and the eame has en duty neconded in the 046ice o6 the County Regi6ten og Deeds, eument SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED v ~ a ? n ;co O ic, o ;cr 9 ;ter o z y A • O fD }'i in I J A tt- O b vii 77 ~ • • HI V , • •Il , • 0 i ~Ap ^ :ct d ~w n V/ m d , ~ 1 • 1 1f-y ~Ui O I-a z • • 'q . J v • a i s ~ QUIT CLAIM DEED. STATE OF WISCONSIN-FORM No. 11 r. C. roue co.. ruwAua99 s•ae This Indenture, Made this .............!.4 ........................day of..... . A. D., 19...5? between John ...D o ......part.-y......... of the first part, and................................................................ 0-ity.... Of ...hew ...Rlo. hmmd...................................---------•--............-•-•--.............................. ........... part...Y...........of the second part. WITNESSETH, That the said part..,V ......of the first part, for and in consideration of the sum of...... olle....~1 it ---a,lid.... other...ualuable.... considera-tion Dollars, to.... in hand paid by the said part..y....... of the second part, the receipt whereof is hereby confessed and acknowledged, ha. S....... given, granted, bargained; sold, remised, released and quit-claimed, and by these presents do.-.CS...give, grant, bargain, sell, remise, release and quit-claim unto the said part y...... of the second part, and to J..t8............................. heirs and assigns forever, the following described real estate, situated in the County of ..............S.t..-.-.~ x'Qj.X............ State of Wisconsin, to-wit: The South 33 rods of all that part of the Southeast Quarter of the Southwest Quarter of 35-31-18 lying; North of the Town Road which is presently the entrance road to the New Richmond Golf Course, and lying East of the West line of the old railroad right-of-way, being one and a half acres of land more or less. „ TO HAVE AND TO HOLD the same, together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the said part..Y of the first part, either in law or equity, either in possession or expectancy of, to the only proper use, benefit and behoof of the said part ...y-..... of the second part i ta.......................heirs and assigns forever. IN WITNESS WHEREOF, the said part Y...... of the first part ha...5...... hereunto set .....................h S...........--......hand. and seal this ~.t r~...................-..........-........day of....................... . _ _ 1u:1 ^ A. D. ,19..5.4-... 59 Iled and Sealed in Presence of (SEAL) + J John Doar GO--..""'.... .(SFAL) r EA David I ope _ ...................................................................(SEAL) STATE OF WISCONSIN, ss. S.t... _Groix ...............County. Personally came before me, this_ 1.0. h ..........day of.... Jun.............................., A. D., 19j.4...... the above named..- ,Tohn..-D.oar.................................................................................................._............._..._..........---- to me known to be the person........ who executed the foregoing instrument and acknowledged the same. L~- 4~? Notary Public St.....C My Commission expires.... Notary Pu!;li... 6t. ''Nis. My Comirus_:on tom. ircc .•I~rci; a, 1956 (Section 51.51 (1) of the Wisconsin Statutes provides that all hsstrasnests to be rsoora shall have plainly printed or typewritten thereon the names of the granters. grantees, witnesses and notary).