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HomeMy WebLinkAbout024-1022-60-100 ti a o Q) ° o p cs~ o ~ ° I Q" p I r ~ O O N I V ui O O O ° r I Z o c c LL c o I I I. I 3 ~ ~ ~ Z H I I- co m w (L H Z ° o N c z O U O Z ~ .a ~ r fC O N H S j', w ~ Z 2 E •o o O ch `o ° I 6 • N W O O C M\ 0 U - O Q Q o Z Z o z N LO c 'D 041 c c ° LO E V LO O N tD N 06 CL la co L ` a > c °o a> a O G a t c o a> o (A fA M E E H H E d Z N O Z 0 0 0 ° O O O CL o 0 U) N 7 fn J V I. L O O } O O O) A~ O~ O W O CO, O O O j.,.y 7 c co co N Q - O N rn N O d o SO OC~Q+ to c U O es O O i-i (OO ~ (D m O C Q. _O O ] O ~ N N N E m° oo v W 04 N r_ c> W C N O -5 N r5 C, CO N Y co N Z~ O W ° • y' O r d (n N E ° O N F- 9 U) # E L EL L: CL 4) E 'c c FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER - , Z TOWNSHIP? 7 zrti r SECTION_ T N-R _W r ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION [f LOT N LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f ! fir.r $J01 -A ~9' of • 1 iA - v 111 rq:7. r a y.rx~ r 4 N INDICATE NORTH ARJOW BENCHMARK: Elevationi and descripAt~ ion /r ~i/~d c y ' r Alternate benchmark 'Id, SEPTIC TANK: Manufacturer: L) dc,,1 • f - a -Liquid Cap. Rings used:-LManhole cover elev:inal grade elev: r Tank inlet elev.:---/,. 1 Tank outlet elev.: IPO, L No. of feet from nearest road:Front , Side Rear Ft. GAL, From nearest prop. line : Front Side, Rear Ft . 1 g 9 No. of feet from: Well 7 7 , Building: 1 7 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER A : Manuf acturer . , cr a Liquid capacity: g' (V Pump Model: 1? 7 Pump/Siphon Manufact.:-' /.c Pump Size Elevation of inlet:! _Bottom of tank elevation Pump on elev.: a.Pump off elev.: 3> Gallons/cycle: Alarm: Man.: L y / Switch Type: Location Distance from nearest prop. line: Front!', Side-, Rear_Ft.;X-f$ i Distance from: Well t Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: i No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet, from nearest prop. line:Front Side Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE : PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NW 4 , SEE , Sec . 17 , T 2 8 - R17 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Pleasant Va.❑ Holding Tank ❑ In-Ground Pressure Mound 17 O UIT HOLDER: FADDRESS OF PERMIT HOLDER: INSPECTION DAT : -/7, - Luca d/G Vau hn Slick 3 Dell St. White Bear Lake, M BENCH MA K (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. E CST REF. PT. EL ; Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Henry Nechville 3258 St. Croix 12887 SEPTIC TANK/ .-to'_~o Ma Ce ( / 03 2', MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER / PROW 9 PROVIDED: t+✓; /CD. 1.~1 ~P ES ❑NO DYES ❑NO F ROAD: PROPERTY WEL : BUILDING: VENT TO FRESH BEDDING: MATL.: HIGH WATER NUMBER O ti YFAJ-F9rA:: VENT !7 , G, d ALARM: FEET FROM LINE: / AIR I E ❑ YES O ❑ YES NEAREST G / DOSING CHAMBER: ,S3' "nle Cr Pl P MODEL: PUP/S6M-MANUFACTURER: WARNING LABEL LOCKING COVER TU ER: BEDDING: LIQUID CAPACITY: PUM M MANUFAC PROVIDED: PROV DIED: El YES ~JOC''C l(3~' i=ce e C~'r`fS ❑ NO C~'P5S ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WE BUILDING: VENT TO FRESH DIFFERENCE BETWEEN _ FEET FROM LINE: / r AIR INLET: PUMP ON AND OFF L`I' S ❑ NO NEAREST 7 S 42 SOIL ABSORPTION SYSTEM. Check the soi moisture at the depth of plowing FORCE LENGTH: I DIAMETER: MATERIAL AND MARKING: Y or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN ?j it the soil is dry enough to continue.) v CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH -TRENCHES: MATERIAL: PIT DEPTH: DIMEN GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. FEET FROM F~ PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: NLET: ELEV.END: : LINE: AIR INLET: ABOVE COVER: ELEV. I PIPES ez_4V NEAREST ~ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thro~prn ur e!,i . SHOW u mound systems to make Certain tha it ON REVERSE SIDE YES ❑ rPo meets the criteria for medium sand/ ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; Cp tl u" I J / ES ❑ NO 01-ES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OFT SOIL: SODDED: SEEDED: - MULCHED: CENTER: It EDGES: p; ~j ❑ YES L~J'NO ItX~ES ❑ NO Id'YES ❑ NO L7 f u . r/ PRESSURIZED DISTRIBUTION SYSTEM: / WIDTH: LENGTH: NO. OF LATERAL SPA ING: GRAVEL DEPTH B OW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH /Q ` / / TRENCHES: /'2 /7 DIMENSIONS Q } MANIFOLD PUMP O MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO ELEVATION AND . DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: E V.: ELEV.: DIA.: , ELjV.:.. I PIPES: DIA.: DISTRIBUTION t tP1°`" HOLE SIZE .57 : HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION F I/ - APPROVED PLAN 5 / 0 YES ❑ NO `3 G:--- ES ❑ NO 5'S~ PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: } 901 COMMENTS: FEET FROM LINE: / CAGES ❑ NO ES ❑ NO NEAREST 4htn 10 //OC{~.c~ . f~ C~.1{. Sketch System on tain in county file for audit. Reverse Side. SIGNAT E: TITLE: SBD6710(R.06/88) 1 SANITARY PERMIT APPLICATION D„LHR In accord with ILHR 83.05, Wis. Adm. Code couN STATE SANITARY PER I -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 f ai~ 8i4 x 11 inches in SIZ@. 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. 5 - OO PROPERTY OWN L PROPERTY LOCATION a 1 Al c- n %~'/a.i_E S T~ , N, R / j E (o W PROPERTY OWNER'S MAILING ADDRESS ` LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CHS~A NJ~MBER CL~' X~•I~ Q r G v/ Z - OA T 11. TYPE OF BUILDING: (Check one) ❑ State Owned VC ILLAGE NEAREST R OWN Y: 7e2 ff .,a ❑ Public ❑ 1 or 2 Fam. Dwelling4 of bedrooms- PAR ELTAX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) '1;7- 1 ❑ Apt/Condo 10 El Outdoor Recreational Facility 2 ❑ Assembly Hall 6 ❑ ed a tyg 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF ERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 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) ELEVATION C f P SuC~ - • 0-4 f. Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structeA Septic Tank or Holdin Tank lac-o i Z' Ux ,,I 'L , ' ` _ r P~ I )F-W- F9 PT I Lift Pump Tank/Si hon Chamber G VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumbeer's Signature: (No Stamps) M PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPART ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuin Agent Signature (No Stamps) K Approved ❑ Owner Given Initial Surcharge Fee) n~~~ Adverse Determination O( l: 7_11 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 APPLICATION FOR SANITARY PSRMIT STC-100 This application form is to be completed in full and signed by the ownez(sl of the property being developed. Any inadequacies will only result in delays of the permit issuance. -Should this development be intended lot zesale by owner/contcactot,(spee 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. r c Owner of property U-, A/ Location of property LE X/4 /x, section T 'a- ,t~ Township Ati- Mailing address Address of site subdivision name. /V • Lot number - - Previous owner of property Total six* of parcel Date parcel was created Ata all cornets and lot lines Identifiable? ..Yes _ No 19 this property being developed for resale topee house)T__Yas o Vale" wand Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TITS FOLLOWINCs A WARRANTY DRRD which Includes a DOCUMIINT NUMBaR, VOLUMR AND PADS NUMltR, and the ORAL OF THR MISTER OF DRRD8. In addition, a certified survey, If available, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Cestlfled survey map, the Cettitled survey Map shall also be requited. PROPERTY OWNER CERTIFICATION I(VG) certify that all statements on this form are true to the best of my (out) knowledge) that I (wel am (are) the owner(s) of the ptopectY described In this Intotmatlon torm, by virtue of a warrant deed tecotdad in the Office of the County Register of Deeds as Document No. ~S /9i'~' 1 and that I (we) ptesantly own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to tun with the above described property, tot the conattuctlon of sold system, and the same has been duly recorded In the office of he County Regis er of Deeds, as Document No. 9 signs use of owner Signature of co-owner III Applicable) Date of Signature - Date of Signature .~s_ r 1r.}n~yr•~ Tin . T 71 ;Nip idS Lamm now Mm it Bw•r O.aR CT IMAM IRA H. a.w~awLa.+u. 77- enw aaw i ~ 27th of ~ , 19_.x.-. betwaw b1ApB I= &y a idaob dnawi mpaeiw WNkA w CO IT• - t* 29 a, 011111111 5 tl AW" M • "ltit Wbob a/isas is P.O DOOt l!!, R m hataiagtr t dwell a • •M1~taaet: and wife kit* MEMO - J. 'am, Hi.+ sem 5S11Q lli9h1an6 Ai1Y1'Nila now s ttdian Is ChM. *ss survivorship taarital property 94 1. NOW AVOW Sloe of (a) U d ad a nny a haehatet W in the Coaety Of AWdWd w '1(1a Nbclh 660 fast of the Noeth Etalf (N*) of the Sotatheaat Belau O tpt eadfAn 'a1 Ml (17) TMWhip TWMtY-eight Nocth (28N) PAn" Smut-t m Nast (17N) Y4t widr at teocatests, dad ttppsmssaoas• tmckft MY ` t ` . bm"N fmt reined ton "the hlwt/." a ad « Pw~d6 hxaees, tildes. ttamntiam blinds. cumin rod:. storm wintdoays. Mona tlootr. screams. awip. amtr a the bred, tarbjed to my Voc" btsildmtt Mad use Ill and to ssY asarraios atixtimt tha lad' nul g, flewioat ad eaoepthlt ad teaeniaS to Sdkr all asinerW aed royalty r*bft. imoewewta. + ad tides hewtetmtots asolmoo 22. 19%. J day, INFO Iamb eeaeamab tat QC aaotPted Of tsooai by Tie itederd Laid aaat of 3" haul Prior u tuft. The forerist ewshtaisa. excepim ad lastratiee qpm aid ttaa of tataI as ow be ineiiaatal or rtxasary to use of such riSlr i• at trout dye above - doll belvds. bat not be IbNWd 0, sit oil, ps. bydtecatbon, cad amd other Woo is d wbtdoeva aswws Mot so as. ps ad other ntittewd, p.&,,d ad awed iaefrera. It it ealpou y uadenwod deaetltiai dI idol an royalty raletatts as of Minerals, or as to its two dtenw- fiat do lisr ar try =die W tassnatp as to the extent of its ownership ' Fiit~llfl Drl~ litre i ao/ten' (b) The to to coaaidnaoisa for is tttdr of the bud to Pwm men is: fir. d tehisir dye suer of d which is barely adm rayed. d 1 tlorwsa has btwVW to Staler Pi" oothe dtlvuy bsreof, the tttctrpt T" 21f01da Doilars 6 MOO 1e.mhe~ 1 dad ft a WUNd r d _ thereof at dry tiara trttpaid at the (ale Of ttoiea, iNailblddtr Bier. tsyith isoewswt liana ft thse d this corarad a any l any aoatptsul opmaay ratan e(ptimc~al PW0WV raawn aiiapWdlM is mat ladehok ad at the raced 12.0 !Ka Pa MIL" ad iaoetatt is Itld ` h in or iotsnt mow p" ahem torte iaimt do i~ of my th:faa pgymo. Bach addiooaal pMtdda iwistsa Npy ,'matte of 5107.47. ad • gjCaW tlpa sabr *MW Period" SWk PalianM to . (A/diliomel imreseat my be added to the fiat i.110MOM if the initial period n ismereat, however. must be Paid is flu on bs awed opm iatwast ad the baiaaoe am pwiacipsl• All of the pardrne money herein to the contrary notwidtstandit a'ffol!/e 1 199f~ . artytYat or bows mart in full of all wind, Ow* Irereoe, a Limited warranty deed ',Y (c) To etwame ad tidiru to pw mer or his assitms. Wm Pay ~gi but free from all aide b dye lmd. walled io abo O°s easements and to any that l a attatired nieopd mV- ed cocete " the date hereof tbrou6lr the 0"C" allow asambrs- i P - such as may be hernia set forth or shall have accnkA cxcW or ambliems of penorrs offer dm Seiler or his -signs. insurance or "TW.1 Of title H. either do owner's policy of title (d) scow I" upon J% ft provide as evidence Of title. at Seller's optm ra date of this cO.rac ~eniva Este of the ps y or ~ttifxawiowt dace of the dt+tije i is to be a ntrraact but y demand shall lend it ' . SNOW Ira hwe as ritMt to tsui /oremim of such evidewce of title dunn~ 7c life of this contract upon te It -on, r tgaa the lledti t of a rewoosbie Smutty 2. ftaittinas AP'e0s: (a) To pntcbaae the laid ad pay Seder the sum aforesaid. with interest then In as above provided. the Ind io accordance with an) And all huildings and use restrictions applicable thereto (b) To awe. mavum aryl occupy overnmental authority (c) i'o ketp die lied in accordance with all police. swttary or other regulations imposed by any t' To Iseep ad tsraMwrr die land and the buildings thereon in as good condiion as they are at the date hereof and not to commit waste (d) . thereon. or otherwise diminish the value of Seller's sectrnty, without the written cymscra of Scllcr renoove or demo" awry Yesaafler levied va the land hefine any penalty for n.V y.,eW Mucha) article. -and Bubo tit ( e) 'fo psly A tiros dad tpocial anawawta std also as all ironies M keep die buildimts now or bcmkr on the sroeipas to Shcw upon ts*wd, as evidemm d prpog t Utereof: to Seller , load saesd Who bias ad 46MW. a a anew toad air aMmmm epprored by Serer, and to deliver dtrpolrckt as Wit► dtr pwmimos iffy Pali " %2PAIP! Out) (f) That In Yes amiaad the lead and b satisfied with we physid condition of say strucme Oams. and hereby waives any ad all deim ole socouat of &W ismaosdreeea on the land or on any premna ad* m fhemo. (g) To saaiateie compble and socersee ffnnecid books said recoils for hirc isa's business: and provide anrnW fiaenciaf iafeatatifa (balance Am, operatittg selatiew, or cash flow) in a form prescribed by. or acceptable to Seller. 3. 3eNa and Fudlaser MuateYy Agree: ' (a) That if Befit h is nntle by purchaser m the payment of any tax or special aucument or irtntrancepranwmaor ie die delivery of inwtrmoe as above provided. Sella rosy pay such tu, "Mial assessment or premium or procure Nick meataaoe red pay the ptaaaietlas dtaefor, end say tusauet so paid shall be a farther lie on the land payable by Purchaser to Seller forthwith with interest at 12.0 peoatt per assent. This provision shall be effective only if Paragraph 2 (e) applies. (b) That during the existence of this contract, any proceeds received from a hazard insurance policy covering the laud shad at Seller's option first be and in repair die damage and restore the property. with the balance of such proceeds, if say, being dWrbuted to Seller and Purchaser. as their interests may appear. (c) That so aas4teess or conveyance by Purchaser shall create any liability whatsoever against Seta mew a reoordeble deplicsee thereof dnly ad adkilowbillI ad• a owing the residence address of the assignee, shall be delivered either pasoaaYy or by eaAified mail to Seta and moeipt tkador obtained. Purchaser's liability baeunder sWl not be released or affected its my'aW by delivery of such assipmtat. or by Seller's endorsement of receipt or acceptance thereon. (d) That Pwckoer doU have the right to possession of the land from and after the date hereof. unless odo at a herein par W A and be entitled to nNii possession dtaeof only so long as there is so default on his part in carrying out tie terms and coodiunea land. U the bed is vacant or aaimproved. Purchaser :hall be deemed to be in contnnxive possession Caly, whicb poasasaf i right *A ill Cease ad ter ieale Mer araw of a aotioe of forfeiture of this contract. Erection of signs by Purdtasa a vaeom or uamtpr a paoperty shall aft antedates actsel possession by him. (e) That if Nudieser fails to perform this contract or any part thereof. Seller immediately after such default shad have the right a declare 11da ooatata ffrfeta' and void, and retain whatever may have been paid hereon. and all improvements do may have been inside vpm the lead, togatlha with addhoos and accretion thereto. and consider and treat Purchaser as his teases bolding over withart pastissioe and may take isemediMe possession of the land. and Purchaser and each and every other occupant rmany and put alt. U sesvioe of a entice of forfeiture is relied upon by Seller to tenninate rights hereunder, a notice of intention of Forfeit this caatratx satrap Ewe been sleeved at leaf fifteen (15) days prior thereto. (f) That if proooediags are taken to enforce this contract by equitable action. after Purchaser shall have been in defaak fora period of forty-five (45) days or more, the entire amount owing hereon shall be due and payable forthwith. Anything herein contained to the contrary notwithstanding. (g) That upon commencement or during the pendency of any action of toreclosure of this :ontract, Purchaser consents to the appointment k of a receiver of the property. mciuding homestead merest. ro collect the rent, i,sues. and profits of the propePty during the pendency of such action. and such rents, issues. and profits when so collected shall he held and applied as the court shall direct. (k) That time shall be decrried to he of the essence of this contract. (i) 11isir ay declarations, notice. or paper ne,essar or proper to terminate, accelerate or enforce this contract shall be conclusively presumed to have been served upon PurRhaser it such instrument was cnrclo,cd to an envelope with postage fully prepaid. addressed to Purchaser at the address set forth in the heading: of this contract it it the latest other address which may have been specified by Purchaser std reicelpted for in writing by Seller and such envelope wa, dep.,,iwd in the United States government mail. (j) Purchaser hereby agrees to rehmhurw Seller when pursued to Igagatlon of all tint, and expenses, including reasonable attorney's fees. of Seller incurred to enforce ant remed% herewider to the client net prohihate `w law, and expenses of title evidence shall be added to principal and paid by Purchaser. a, in.uued, and shall tor' included to anv iudgment (let It is understood that sonic land n, luded in th., :ontrao -.i.% i-c o,crcd by the tede,al C'onservaleoaa Reserve Program. Buyer agrees net to violate any of the pros „ions t,r re,tr,. - um, under tad pr noun In the went that Royer Goes violate any provisions or restrictions under said program, Buyer shall indenuut. Scl lei I r am loos. Ix n.tltn ~,r re unhursement. that Seller must pay to the federal government as a result of said violation 4 Other Provisions (a) ' R>cctreeer shall -riot transfer, sell cr acrrvey any legal c r equitable _ inter eet in the PrR~m tY _ ~b _aeet3_Tmit a( any of Rrdhaa3erIs rigt is under this Orntract cr IN ciptiat, _lcng tun ]seen - - chr in east ether ti!1e1r) without the prior written omse lnt of Ve dx_ tnlew either the autstlwding balae cmmble_tidw this 03 tract is first paid in full cr the ir> mvst ccrhn is a Plate Cr canal matit of Plsd=W's intsest uider this 0311 ct solely as senritY far an uxbbbaxlhaaes - of Purdseer. In the_evert_ of anyaxh transfer, sale c r axmeya oe withottt Vendor's written b lance payable under this Ct ntract shall bea me imtediakreli the. ornaa>t,_ the aiklCe ot~tandin 9 and paplole in- full, at Varbr's cpticn wither t riotioe." Any individual parlacs hcrcu• ;i,u,ikr' t'- he ! hull .t}: \11\ , 'rp,rr.11: 1`.tttie, hereto repte,r tit theinselves to he existing corpo ran,-ns with their rhao Infl o t,.',t The pronouns and relative wool, hi t, tat u,„i 11-1 ,c !h; n,.rrulut: and ,inpjlut It. however. more than one person joins an the execution hereof as S,'ll, r ,r l'„t, h.i,rr r o , ! t, cuunr ex ,n , otp„ration, such words ,hall be read as if wrillen to plural te'numne or neut, r t, , ':n.' ;I, ht it, Ic,rune,. u-ve %or, and assign, of the respr,ttve nen~e•, a„a41,f~ . r+e for 1. k.., rVrfNBSfBS: PURCHASERS: t Va hn G. S1' REGISTER'S OFFICE - Sandra J. sl cic; ST. Ct~01X W., WI FARM BANK OF ST. PAUL' Reed for Record at SEP 2 01989 ey: " X8:30 A M r rtz Regional Yies Pers., Tide _ . _ Federal Land Bank Association of N0rthW48t Acting as Attorney-in-fact for Farm Credit Bank of St. Patti. or: Production Credit Association of T16 STATE OF Wisconsin COUNTY OF St. Croix On this a,~ da of _ September 89 Vaughn G. Slick y 19 _ before me appeared__ and Sandra J. Slick to me known to be the person(s) described in and who executed the foregoing instrument and acknowledged that hdsbe►(doy) executed the same as his(her)(their) free act and deed. b►ic D 3: c. y` tie LAL) ss Count. , state ? ~S ;a STATE OF Wisconsin 1 3f COUNTY OF St. Croix 1 The foregoing iaistrttmeW was a, wlcdged before me on _ Septeffbe: 27, 1989 by Jerry Lehnertz Regional Vice President of the Federal W Oat • . of Northwest Wisconsin - - a, Anorne%-m-tact on behalf Farm Cref Ystat My commission expires --11--90 NmarN Ribli. ry Lou Vi 7W- Pierce - - Wisconsin Count% state STATE OF COUNTY OF 1 The foregoing instrument was aekmowledged tviore me on t>.r by - - - - - of the Prodnctio1111 C7rW! AstaaLl! tll~ - - - . _ - - _ _ _ - - - ~M beitaff Of am > My Commission cxpirc% \otan Public Cortm. - State Drafted By : FCS-NW Wisconsin - --0 P.O. Box 199 Riyer Falk, WI L4W f ^ v-r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT l~~I w St. Croix County ~ OWNER/ BUYER oNumber 0 ROUTE /BOX NUMBER / 9 7 Fire 3.~ ti - ! I b CITY/STATE ZIP Gt l~.~i / 7~~.',.~~ M PROPERTY LOCATION: k, k, Section, TAN, R )2 W Town oSt. Croix County, gwtsf 0" Lot number Improper use and maintenance of vour 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 'sept'ic tank um er. What you put into the system can affect the .unct on of the-septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents may be eligible to recieve a grant for a maximum of 60% of the cost-of replacement of a failing system, whit 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 sys't'ems agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system 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. y 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration. date. w SIGNED DATE 10 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. s ~ I.L.H.R. 83.08(2) PROJECT INDEX SHEET Owner: l xV ,S/i6v(I- Address: fit// A61f, Gf,(Z- Site Location: //0 i&W.; N E J- $ E Y~ SFG / 7-,.IRnJ 17 GtJ . TOGv-v D/'° /E~4S~t.~ 7'_ Project Description: //,f /~C y S T- 4A0 i K Cpv0 Ty ~~OM E , ~vF~~~e o~~~ y ~sr%~rrFo ~tsrEio~t~ : Goa ~s . T SESo~v~t//y S~-T e r n r9 T L 01 J ~ ~Sp Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOUI~ Page 4. DOSING CHAMBER CROSS SECTION Page 5. PUMP PERFROMANCF. SPECS 31991 siot+ PLUMBER: ~o r D Ym ~ J tJ w,E rn N m T r1 -S C.nr`P M1 S91-00009 DATE: SITE EVALUATER/ DES I GPIER SIGNATURE HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT r-ST ,9e-L2 yp, VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. -MINN. INSTALLER & DESIGNER LIC. NO. 00663 . r1S ~ C>Gi M 'O a N u CA- v - F h eo ~ ~ M tu y CL- U) O M I ~ ci ~ ~ o P4 a b T ci If\ VM o r Cho 'trz v~X i pp •J h ^n z~zw P4 a W. v N ~~CEI~E~ W Sl~ 1991 t•--~aCa~, `n z la. p;FitE Or rfvrl p F Cog S LO 4 w~ W S91-00 Q 6 9 v~ n W cr A Page z Of S Synthetic Covering Distribution Pipe Medium Sand S Y STEM H = ~a flEV,~no~ Topsoil F y(Q. SCE ' _J E p /0 % Slope Bed Of it Force Main Plowed Aggregate Layer D Ft. 5 Z Ca E Ft. ~r S'~A P, Cross Section Of A Mound System Using sg ~ F .75 Ft. O Bed , r The Absorption Area Ft. A /0 Ft. H 5 Ft. w , ~~Fa B f0 Ft. K Ft. ~ G L 72- Ft R P Ft. G ~ T l8 Ft. Force Main w .35 Ft, L Observation Pipe A 01 -1\ Distribution Bed Of -12-" I Pipe Aggregate Observation Pipe Permanent Markers y ~ PvG c~j~~E~ S~E~L ,005 Plan View Of Mound Using A Bed For The Absorption Area RECEIVED JAM 2 3 1991 OFFiCEFOF^Ui41~iO ~N " cnrt S91-.00069 X Of Page 3 s ~ - vO/ L7 11o /utif E ~o R 3 FT o f 2- s 6.0 ~oRcF . Y4,6 Y44F /As r Perforated Pipe Delall Ztpl aA T Ak !/ill v~rE End View )Perforated End Cop 'a. PVC Pipe ~o~~oo once as Holes Located On Bottom, Are Equally Spaced R P * PVC Force Main .7 PVC Manifold Pipe Alternate Position Of Distribution Force Main Pipe Lost Hole Should Be Next To End Cap End Cap Distribution Pipe Layout P l Ft , R SEWAGE SYSTEM ' l pNS11CE X 7 Inches y Y 1y Inches Signed: Hole Diameter Inch f m :-eWh 1~~- y 0S Lateral Inch(es) License Numbs _ t - G Manifold z Inches DEppR`~Na~c~~ Date: DlVt°; . Force Main " Z Inches EE ~~5 .?pJ v~= SCE # Of': es/pi pe 7 $ Invert Elevation of Laterals 770 Ft. d/S T/'?il,3uT/OAJ pl*5Gl/1', 6- ~fll7r AOR C 4cA, /47,641A/ s~- 2- 4~7 T i • ?~o f4/ ewsrnlaurioa Z)iSCA AR(E R,176- rvR lj( O~ek 32,f 1410 1991 (~i1r iiiU S91-00069 ,rP\Tl C0E~,~~...... 4 Fii PAGE OF PUMP CHAMBER CROSS SECTION AIVD SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE T WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE I ~•GRAD `I" MIN. o4pe C~ / NS~~~ F I r I B" MIN. r I - D V rs AA I I' ~ INLET CAL I I I 0 ~ O I APPROVED JOINT APPIkOVED JOINTS O~P~ 0 Q1~5P ►~1 0 ) III W/C.x. PIPE W/C.I. PIPE '~0~o G~Q'~ I III ALARM EXTENDING 3' EXTENDING 3' SF. ~K~~ / ! I I ( ONTO SOLID SOIL ONTO SOLID SOIL B aSI Af1oa I I NN " ~ ~ ►~IFy • ~ i ow o 3 G I 1991 ELEV. 1/35 FT C PUMP OFF Sd 11 ti. (}I~,IJI17T1(1P~ 07-- ZE a 4A)i K D DOIA) / Q5 CONCRETE BLOCK C ti qo,l RISER EXIT PERMITTED OWL4 IF TAIJK MANUFACTURCK HAS SUCH APPROVAL SEPTIC E SPECIFICATIOPIS DOSE ' TANKS MANUFACTURER: C~~ T WMBER OF DOSES: PER DAS TAWK, 51ZE. 90 GALLOWS DOSE VOLUME L L~GEL */24"q • INCLUDING BACKFLOW: GALLONS j ALARM MANUFACTURER: 150 MODELAIUMBER: 2),L."y• CAPACITIES: A= Z INCHES OF. 07O GALLONS SWITCH TYPE: ~ERwA°r FID A T B= z INCHES OR GALLONS PUMP MANUFACTURER: C- S'& INCHES OR GALLONS 7 yZ D INCHES OR 0 GALLONS MODEL NUMBER: 7 SWITCH T9PE:-pIQ5y'84K1t MOTE: PUMP AMD ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE-GPM VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. S,-7 FEET -rAok SpIECS + MINIMUM NETWORK SUPPL9 PRESSURE . . . . . . . 2.5 FEET EAC4. I of PltL 1 + -LE-- FEET OF FORCE MAIN X d F/oo FFRICTIOM FACTOR.. <O 3 FEET ~40A TOTAL DIJUAMIC. HEAD = 9' L3 FEET 717 RO MOD ~fy AO' INTERNAL. DIMEWSIONS OF TAWK: LENG ;WIDTH - ;LIQUID DEPTH 4 SIGUED: LICENSE MUMSER: DATE: Oc,ti~D A.ed yr r-t'icTio,,> r-W'704 -2 " oI0111 /a D 3- S9 1-000 6 9 0 5 fad 3S ~ race ~ Q W HEAD/ 15 115- 34 110- CAPA CITY 21 05 CURVE 30 100 - 85 I 28 90 26 85 I I EFFLUENT 24 80 - - MODEL and Q 75 MODEL 188 DEWATERING = ,0 165 I V 20 65 Q Z 18 ~ 55 _ ~ 16 50 MODEL 0 183 t- 14 45 188 12 40_ 35 r_- MODEL 10 MODEL 137, 139 MODEL 185 SEWAGE and 6 25 DEWATERING 6 20 MODEL 161 r EL 4 ~ 1 15 101 1 0 - W F MODEL u¢i uW+ 2 5 53, 55, - 57.59 0 p 50 70 80 90 100 110 I ~ GALLONS 10 20 30 40, 60 24 75 LITERS 0 80 160 240 20 400 t 22 FLOW PER MINUTE 70 20 85 - t7 18 - - I ODEL - ----I-- - 295 ' UJI x 18 55 - V 50 Q 14 45 MODEL ( 1~ 3 1991 Z 294 1 L 12 40_ p - OF t}141~10~ Q 35 MODEL _ I OP5, ,..,•,rnT1nN 293 1t No'!) 0 10 MODEL 30 - 281 - - - t" 8 25 - - - - MODEL 8 20- 282 i 4 15 10 MODEL - - - df~ir. f/ t Oi I 2 5 267, 268 0 3280 Old MAIM Lane GALLONS 10 20 30 40, 50 60 70 80 90 100 110 120 130 140 i50 160 170 180 190 P.O. Box 16347 I Lou/sW RA Kentucky 40216 I LITERS 0 60 160 240 320 400 480 No 640 720 (502) 778-2731 FLOW PER MINUTE S91-00069 I "97" Cast iron Series HEAD CAPACITY • Automatic or Non-Automatic. Feel Meters Ga ITS/AI; s • ! H.P., 1 Ph., 115V or 230V. 5 1.52 s7 21s • Non-clogging vortex impeller design. 10 3.05 61 193 t-PaSSes"!Y._ 15 4.57 43 163 • 1 sphere). ~ zo s.1o z7 104 NPT discharge. Lock Valve: 24.5' • FlQat operated submersible (Nema 6) mech- anical switch. • Automatic reset thermal overload protection. V~ listed 97 S.r1ea • Stainless steel screws, guard, handle and arm and sc-222s seal assembly. _a_ • Watertight neoprene "17" ring between motor and pump housing. Canadian Standards N97, non-automatic, available 511) ASSOC. Approval /lost switch. Packaged with a piggyback mercury ava /able a------'Y & BUILDINGS DIVISION Tomm„~ G. Thompson Goverhor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC PLUMBING COMPANY Owner: VAUGHN SLICK ROBERT ULBRICHT 655 O'NEIL ROAD 1893 DELL STREET HUDSON, WI 54016 WHITE BEAR LAKE, MN 55110 RE: Plan Number: S91-00069 Date Approved: January 23, 1991 Gallons Per Day: 600 Date Received: January 23, 1991 Project Name: SLICK, VAUGHN - RESIDENCE Location: NE,SE,17,28,17W Town of PLEASANT VALLEY 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: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 266-2889. SBD-6123 1 H. 07/801 SAFETY & BUILDINGS DIVISION Tommy G. Thompson Gover[ior Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations HOMESITE SEPTIC PLUMBING COMPANY Page 2 Since ePAGEL PE ER ESection of Private Sewage Division of Safety and Buildings PPP013/0009n/ 6 cc: VAUGHN SLICK Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health I SMD-6423 i H. 07/900 ST. CROIX COUNTY e ~y WISCONSIN ' ZONING OFFICE •l t zs3 ..~5T. CROIX COUNTY COURTHOUSE L STREET • HUDSON, WI 54016 - Y 911 FOURTH (715) 386-4680 Jan. 17, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for Vaughn Slick, located at the NE 1/4 of the SE 1/4 of Section 17, T28N-R17W, Town of Pleasant Valley, St. Croix County, revealed suitable soils at a depth of 24 inches below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. sincerely, i ~Ovz r ,?ames K. Thompson Assistant Zoning Administrator cj i a A DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ OT NO.:BLK. NO.: SUBDIVISION NAME: 4/51/4 s£ 1/ 7 /TZt2 N/R 11 E Wits ~a VA COUNTY: MAILING ADDRESS: 57-, Cle&x ffF11 sr Gvti fE TAE USE DATES OBSERVATIONS MADE NO.BEDRMS.: 1COMMERCIAL DESCRIPTION: 4 ROFILE DESCRIPTIONS: New TESTS: WResidence 'If. 4 , 4New ❑Replace I vepv, _ 1 17 / 1 0 Aj00 14-. 770 RATING: S= Site suitable for system U= Site unsuitable for system 5C S (if-) S°4 t'~T A(15--o ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI G TANK: RECOMMENDED SYSTEM: (optional) os ou as au as Bu as ©u as ©u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C-L Is s -11:- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. EST TO BEDROCK IF OBSERV (SEE ABBRV. ON BACK.) Z~D 9 ~N y 13 B- Coo 3-35/ Z~o Ok-&o_ SO8•ANSocA'iZ Sloe K 5/ 3 8.J. 131'00 5 / w/ •f/E WA/74d- 6.4Av0 co rTi v~S a-~ l 42s B- w1-e, l . rD(STlacT oR- yt//ow .Aqa"/s " L~. Q++ z 9" aN. Gy./orf,~I P/ow6o~ 3~, . lo~,.t 10 B_Z (-PQ f7' A0 ~o Gy/, SUB •A.J ,)FAQ 91ocFcV 5~ IC7 OR. S (&-u M,}aI/. ~t'ST. OB~Gy./MOTS Zy" toR ~rt.at9~ B- CIAy /0 4-1 w~ nN,t,ay I g. PRv?_1 . op-&y. A16 rS 3 J)) i, 8 3a-SY P/ow~o) /o TM CIPU~t$Ly) S 101P_~y J 7to B- 70 CS 13 '~O Su6-A,a ot_AR 131ocK St Z1 " 0P-9 $t~g• ~aS. %locky $ w/,-,4&,y fST. V -y y. B- -Al (2 'I j- 0R cL,4t 10AtA 4, l rfA.~y )eOM . o R- U•/• ~-t c~T S PERCOLATION TESTS P } EST DEPTH , WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH P_ 1 f, d 30 '/C. 1 8/(, 2C) P- 2- z0 7_L1T_ 30 1 / / z P- 3 Z0 /4 I 4 2- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. I T-7 s I T I I J S/ 7- /Crg Tio•✓ 0 'A- I I A-1 4), 1 f , I I . I i e E 3 ~ ~-~4 I, the undersigned, hereby certify that the soil tests reported 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 location of the tests are correct to the best of my knowledge and belief. NAME (print): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON:Q 465 O'NEIL RD., HUDSON, WIS. 54016 #av 0 15 ~ f! l 70 ADDRESS: 1GflT CERTIFIC f{TIOZUMBER: JPHOU NUMBER optional NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. LL~I A 3P6 l (?5 CST SIGNATURE: 16660- Zee& DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - - - - V --S M M X - cif ~ Y i1 u CL r O O ~r h t 2 M w v lz W 2 w ci 0 W ti 4 o0 ~ • `mss a= ~ !v ~ o Q~ b to rll zx ri U m3~occ PQM z S2c~ arz N' S2 cc 0, o~g3cc LU -j0CL rnz ac~ p _Lo Q~ n W