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Parcel 018-1047-00-110 01/05/2006 08:14 AM
PAGE 1 OF 1
Alt. Parcel M 21.29.17.330A-10 018 - TOWN OF HAMMOND
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 - KEIMIG, LAWRENCE A & DIANNE C
LAWRENCE A & DIANNE C KEIMIG
845 170TH ST
HAMMOND WI 54015
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 845 170TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE
SEC 21 T29N R17W PT NW SW LOT 1 C.S.M. Block/Condo Bldg:
8/2162 4 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/03/1998 590689 1373/169 WD
07/23/1997 1052/546 WD
07/23/1997 856/241
2005 SUMMARY Bill Fair Market Value: Assessed with:
90452 268,900
Valuations: Last Changed: 10/19/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.000 33,600 188,700 222,300 NO
Totals for 2005:
General Property 4.000 33,600 188,700 222,300
Woodland 0.000 0 0
Totals for 2004:
General Property 4.000 33,600 188,700 222,300
Woodland 0.000 0 0
I
Lottery Credit: Claim Count: 1 Certification Date: Batch 117
i
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 60.00
Special Assessments Special Charges Delinquent Charges
Total 60.00 0.00 0.00
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER If~ CJ rG p/ Ne- Sa ij TOWNSHIP ~//-7 pm hK o h SEC. I T LN-RjW
ADDRESS 0, ST. CROIX COUNTY, WISCONSIN
i
SUBDIVISION L4- LOT LOT SIZE Lr Q C e_
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
*2
~/QL
iv T
,N r I
`y
0
a
CS.
~M
i
}
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ~X Z l~/m, 1l~d '
Elevation of vertical reference point: /(~l9 Proposed slope at site: 76
SEPTIC TANK: Manufacturer: 974 w.t, T tc,.►n Liquid Capacity: 000
Number of rings used: D Tank manhole cover elevation:
Tank Inlet Elevation: 0,6 Tank Outlet Elevation: Zoo, 13
Number of feet from nearest Road: Front,0 Side,(0 Rear, O feet
,.From nearest property line Front 10Side,~URear,0 feet
Number of feet from: well /\//4- , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
r
PUMP CHAMBER n
Manufacturer: w c, tc2h Liquid Capacity: (SOU
Pump Model: Pump/Siphon Manufacturer: z~ p_) I rZ Pump Size
Elevation of.inlet: Bottom of tank elevation: 16 l-/, 2
Pump off switch elevation: ~G 3~ 2 Gallons per cycle: /5-2
Alarm Manufacturer: Alarm Switch Type: -5-,e k e
Number of feet from nearest property line: Front, O Side, Rear, Q Ft.
Number of feet from well:(V &
Number of feet from building: 7
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: y Trench:
Width: Length: / Number of Lines: Area Built:
~e O
Fill depth to top of pipe: 411
Number of feet from nearest property line: Front, O Side, O Rear, ~t.
Number of feet from well: (b1 y
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
i
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
r G Inspector:
Dated: Plumber on job: o-f-
License Number : h1 fi 4( (o
3/84:mj
f 6E ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
DIVISION
LABOR & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
P.O. BOX 7969
A ISON 153707 State Plan I.D. Number:
I , WWI , Sec. 21,T29-R17 (If assigned)
CONVENTIONAL El ALTERATI E
E] Lit 1
Town of Hammond, L
h S u Holding Tank ❑ In-Ground Pressure Mound / Z
NAME OF PERMIT HOLDER: ADDRE S OF PERMIT HOLDER: INSPE TI DATE: 7
~s
~ -170th St. Hammond WI 54015 T LE
Br d Hel eson R V ST REF .ELEV ~T
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: 8~ S
J'Q. ii)Ci01. ! fC.r - !fl L~". i/~7. ~<✓l")+~I~ ~l..t. .7.
Sanitary Permit Number:
Name of Plumber: MP/MPRSw.No.: County:
Joe San 6646 St. oix 135535
SEPTIC TANK/ K: t, e. Gyli, = 77 f 51 NING LOCKING
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROVIDEDLABEL PROVIDE D:COVER e•f-. ~ 6M YES ❑ NO ❑ YES NO IZ3
VENT TO FRESH
BEDDING: Vc4ff'OIA.: YLpFT MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING:
/ LINE: / / AIR IN T:
ALARM: FEET FROM
❑ YES NO GGZS ❑ YES NO NEAREST
DOSING CHAMBER: ) 2-
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SFPh19N'76f NUFACTURER: WARN EDLABEL LOCKING OVER
c:1 YES NO 7Sv / El YES ❑ NO ❑ YES ❑ NO
PUMP AND CONTROLS OPERATIONA NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
GALLONS PER CYCLE: FEET FROM LINE: I AIR INLET: /
(DIFFERENCE BETWEEN ES ❑ NO NEAREST >I~ > V
PUMP ON AND OFF
LENGTH: DIAMETER: MA ERIAL AND MARKING:
SOIL ABSORPTION SYSTEM. Check the s it moisture at the depth of plowing FORCE h~f 2~/ /
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN p~ G/( P V,
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF ACING: COVER INSIDE DIA.: # PITS: LIQUID.
AL: TH:
BED/TRENCH HES: PIT DEP
DIMENSIONS
UMBER O PROPERTY WELL: BUILDING: VENT TO FRESH
. AIR INLET:
RAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR N
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM
G NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM`-~
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
meets the criteria for medium sand. ELEVATIONS MEASURED.
❑YES ❑NO 5t- rr
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
✓17~~ S~ EtIES F2g: ❑NO
DEPTH OVER TRENCH DEPTH OVER TREN HfBE9- DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: / I EDGES: ~p` l~ II
^ ❑ NO Eia'S ❑ NO
❑ YES L9I~U
i
PRESSURIZED DISTRIBUTION SYSTEM: ; o o S lam 5.72
WIDTH: LENGTH: NO. OF- LATE AL SPACING: GRAVEL DEPTH BELOW PIPE: FIL EPTH ABOVE COVER:
BED/TRENCH I I TRENCHES:
DIMENSIONS 'j S
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: / EL V : I DIA.: 11 ELEV.: T ~n PIPES: DIA.:~ I/ - I`^~,/~
ELEVATION AND , 17t~ i 72 II
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO p
INFORMATION 1/ I I i1 A VIED PLANS 3~0 s 7/ Si
E91 SO NO 2 ❑ YES E-i 113
PERMANENT MARKERS: OBSERVATION WELLS: NUMtROO PROPERTY WELL: BUILDING:
COMMENTS: ~ FEET LINE: S ❑ NO ❑ NO NEA~
e /4), S71
Re in in county file for audit.
Sketch System On (;SIGN URE: TITLE:
Reverse Side.
SBD-6710 (R. 06/88)
~HR SANITARY PERMIT APPLICATION couN
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~~j
8% x 11 inches in size. ❑ cn c revisl`~ n o previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
026 ` ZIA ell.
1'
1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION.
PROP RTY OWNER J / PROPERTY LOCATION
it ~7 ! DSO = lkl% ~lw Y., S 2 T N, R E (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
yel 7 - 1 ?6, St te t:~e't I
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISIO AME OR CSM NUMBER
H4 ~"M vh 4 Gr5` loil G - ilcs~-• -
11. TYPE OF BUILDING: (Check one) CITY N AR T ROAD
❑ State Owned VILLAGE / Ili G h a site
e ~
+
171 TOWN QF.
❑ Public or2Fam.Dwelling-#/ofbedrooms ~ A CELTAXNUMBER()
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ ApVCondo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 9 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 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLOLSPER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
/ `sREQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
1 2 3 ? S~ ~i 3 S~ 1061, Feet M,Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
- Steel Plastic
INFORMATION Manufacturer's Name Con glass
New istin Gallons Tanks Concrete structed App'
Tanks Tanks
Septic Tank or Holdin Tank / GGu , w t $t l.R n
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): Plu70--f- 's Signature: (No Stamps) /MPRSW No.: Business Phone Number:
c7~ S't4w G4 4( L l5' GQ~_224is
Plumber's Address (Stye , City, State, Zip Code):
k/,'s, b'4(GQ
IX. OUNTY/DEPARTMENT USE ONLY
E Issuing gent Si ture (No S
E.] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue R
.i Surcharge Fee) Approved ❑ Owner Given Initial Adv rse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8, Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by,the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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 6 `c
Location of property N w_1/4 1/9, Section , Tue.=.N-RLI_W
Township ~14/n nrorr c~
Mailing address ft?e e t-74 y+ ah d wi f y-Y~dlS'
Address of site Ste"' f-
Subdivision name
Lot number N A4
Previous owner of property 1-14~56 h
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? f Yes No
Is this property being developed for resale (spec house) ? Yes LNo
Volpme g-rG and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described In
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. tlS13 35' k ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
Y
of the County Register of Deeds, as Document No. /6-3 3 6-
Signature o Owner ignature o 06-Owner (If Applicable)
Date of Signature Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
453358 ~V,r,; 856PAGE24
- REGISTER'S OFFICE
This Deed, made between Annabelle- D,__ Hanson,________________ ST. CROIX CO., WI
a_ widoe,z Recd for Record
Nov 101989
I Grantor, of 10:25 A. M
and----- Bradley __T,---Helgeam-and..$renda. L,._ Helgu.Qa-------------------
_------husband..and..wife- -as-_survivorshi.p.-mari tal--proper ty..-- 0 l,arw. A
Re9lsterofDeeds
Grantee,
Witne,$seth, That the said Grantor, for a valuable consideration-.--..
One__dollar_.-1-,00)-_or-_other._good- &__valuable consideration n
conveys to Grantee the following described real estate in _..St...CrQiX------------- RETURN To~jPAQ~~'y /7tLGFSOAI
County, State of Wisconsin: i°4- Bo.► /a/
~/.9.e~.ya.✓!7, verse, SS~o~,s
Tax Parcel" No ------------------------------------I
Part of the NW-4 of SW4 of Section 21, Township 29 north, Range 17 west,
Town of Hammond, St. Croix County, Wisconsin, more particularly
described as:
Lot 1 of Certified Survey Map, recorded in Vol. 8, at page 2162
of Certified Survey Maps, St. Croix County Register of Deeds
Office as Document No. 452669.
I'f V
$4
FED
This i.S-_-11Q.t...... homestead property.
ltrj (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And. a--•----nto-r
- - - - - -
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions, reservations, and covenants if any of record, and
highway rights of way,
and will warrant and defend the same.
L//
Dated this day of 1989---..
- (SEAL) XU~..P11-..4"-!C(SEAL)
* Annabelle D. Hanson
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Annabelle- D. _ Hanson STATE OF WISCONSIN
ss.
-
------------------------------County.
authentica d s -..day o A&I 19.89_ Personally came before me this ................day of
- 19 the above named
Edward F. Vlack
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- -
authorized by § 706.06, Wis. Stats.)
to me known to be the person w o executed the
foregoing instrument and acknowledge the e.
THIS INSTRUMENT WAS DRAFTED BY
DAVISON & VLACK
River Falls t WI 54022
- Notary Public -------..County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date:
•Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 1-1982 rlilwankee, Wis.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 4 r C 1I e-lOtq
ROUTE/BOX NUMBER kY? - r ? 6 r? L~ FIRE NO. ,
S'
CITY/STATE u4 I.Mme' u k/' 'S ZIP 5- Y61
PROPERTY LOCATION: r WW1/4 5 IV 1/4, Section T 2'j N, R 17 W,
Town of H G rn h" c, St. Croix County,
Subdivision , Lot No.
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 for a MAXIMUM of
$3000 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 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 form 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 Department 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.
SIGNED
DATE "'T -M
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
LABO All 115l P.O. BOX 7969
HUMAN LABOR RELATIONS PERCOLATION TESTS MADISON, WI 53707
(ILFiR 83.09(1) 8i Chapter 145)
LOCATION: SECTION: TOWNSH UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
Nw~/ sw Z1 /TZ9N R~~E(or ~1A~-I~o~lb _
BUYER' ME: MAILING ADDRESS: p_ aUX ! Zf
COUNTY: OWNER'S A
ST,eRv l x 8u1~-o 'Irk C LG CS ON VA-1h h o~ O w ! SVO) S
USE DATES OBSERVATIONS MADE
X .Residence COMMERCIAL DESCRIPTION: IPROFIL D RIP 10 S: A N ESTS:
X.Residence 3 _ .TNew ❑Replace L S - 3 - ~9 s-10-89
o>u s t ~ ~ ~ T0~ N ~t,su~ S - 4- 8 9
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAFFYi IN-GROUNDPRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM:(optional)
DS ®U ❑U DS ®U DS L7U DS ®U f1QQ~ W1TM S'u ~S'
zs'tl Y. R S' wN c
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
Floodplain, indicate Floodplain elevation: Al
under s. ILHR 83.09(5)(b), indicate:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T TU WAND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) t
'3 q.
B- z 5 >J A• NoN 1 q "
\-1 t
3 u 7-
7_0
B U t18 ° y
S SZ 9 _
B- 5Z M v 3~
B- 8 S) q9.5 N _Z~ S PhG 3 ai- 3
B- itip\C `T~ S eb N ss Sv I t3L.1e 7-01L Plk tiD 'WSTSM
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P I D P RI D2 ---PERIOD 3
P. } ZZ NAG 30 it/!b S/8 5/6 L,18
P- Z zz rao 30 3/y It//L 3/ 4vo
P- 3 zZ P40 30 s/(3 u//b
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. EL100•Z'COSUFy oQMjk(;o(-Zs)l ?PI F:~R/.i
SYSTEM ELEVATION (n ►N t' 05 S fwol
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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): TESTS WERE COMPLETED ON:
W~6 ~1Z SIS II.TE1S-r/A1G IQ" SGRU)cE 5-1~-89
ADDRESS: ~,p. Uk 7y CERTIFICATION NUMBER: PHONE NUMBER (optional):
2) UDR FN 10 S(4D 2., 2. C_ ST 0005 6 ~1S-42S-0165
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. fC i~t L OF 3
DILHR-SBO-6395 (R. 10/83) -OVER -
SOLI DESCRIPTION FORM
(Attach Soil Profile Location Map On a Suparate Sheet)
CLIENT' BRAS rtE~~~o~ LINEAR LOADING RATE/:.
PURPOSE: GVNLVA-O(1 SCOL- SOF-PnW S-1S SLOPE: L4 blo
DESCRIPTION BY: lam- STN V [Z L - w E6~z ~R ASPECT: N3DZTH
DATI.: M R 3 g 9 CURRENT LAND USE: C7I~~-"1~1 -
COUNTY/STATE: ST• L-CZO 1)( 010QAJ i J VEGETATIVE COVER: GLZ.hSS
LOT DESCRIPTION: TAT • OF -C 'I`E Ww I/y- SL-J)/(/ SEC-Z), T -L-N), X J-PJDRAINAGE CLASS: M6b E'.A-M LY 1A
LOCATION: wtJ OF Cyvt" GALLONS PER Sp. FT. PER DAY: -C3 • 0
PARENT MATERIAL s /DEPTH: SOIL SERIES: SR O p►rvt~
P.til!S TO, , AP QIL QLAS~IEIQAIIQ~'
HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS
in. mist Gr. Sz, Shp. COATINGS
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OTHER SITE FEATURES/NOTES:
LIMITING FACTORS/DEPTH: Signature Date CST #
BOUNDARY REMARKS
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ure Date CST #
State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
PRIVATE SEWAGE PLAN APPROVAL
Western Regional Office
2226 Rose Street
LaCrosse, Wisconsin 54603
WEGERER SOIL TESTING & DESIGN Owner: BRAD HELGESON
P.O. BOX 74 P.O. BOX 121
RIVER FALLS, WI 54022 RIVER FALLS, WI 54022
RE: Plan Number: S90-40264 Date Approved: June 7, 1990
Gallons Per Day: 450 Date Received: May 24, 1990
Project Name: HELGESON, BRAD - RESIDENCE Location: NW,SW,21,29,17W
Town of HAMMOND 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 "785-9348.' >4r^;,
Sincerely,
GERARD M. SWIM
Section of Private Sewage
Division of Safety and Buildings
4PP039/0009n/30
cc: BRAD HELGESON X Private Sewage Consultant
SBD-6423 (R. 08/88)
Pa ge 1 of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
ItSF OF SECTION Z , T Zq N, R 17 W,
LOCATED IN THE NW1IY OF THE
TOWN OF `r~yji~j nv~ , s'r . c lX COUNTY, WISCONSIN.
INDEX
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
'53~~ 1~ ~-C.GESOt~I
PoC3ox 12.)
l~ tok1~7 , w1 s~~lS
PREPARED BY 'too' %sc
WE~~1f ~CE~CQ = TEST I 1VfG 4~
AND
Y G INJ '.3K= FR ,.v I ARTHUR L.
]E> E'E3 O
C E 0 WED-37GERER i
o 5 P 6LISWORTH,
WIS.
%
°s
F.O. BOX 74 421 N. MAIN ST. ~
RIVER FALLS NI 54022 d '
715-425.0165 SIG14
hNNtNw
Job # ~a-49
PLOT PLAN
Page ~ of ~
'
Scale 1"=I0
LOT t-IAJ
351-37'
qo~
Qom- eL. 48, f ~ a:> >'xz'~
`wo0~ ST14kE' W/~AfiJI - -
1 8.9
tbo Y-JGT CA r1 P rt --r o m
'h ~taT~~B T)tis r'cR~A
NNI
r I ~
r
N N
qS,
w`o~til STtt►z.~ w /~A77! 41
rJ
3o'oF "pvc Fop-ce P1%1Aj
•P
SEV~ p,G~
p OC1~~,~1 ss or= y pvc
~O ~~~P~`pNS
W ~ ~v~~CJ~ S
0 IFS
~ J O SEA ~4 zs'oF 4"eve
3tJU : LJB,t_ `p $E RT IJ~RST Scar °"SE
Su~`T}1 OF i70~ 1~p RT
~ .sr ZS' F-f_Qr-1 Tr t~ s.
3sy_ 3 tAz- mauve
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be tDoo gallon capacity manufactured by
f-AVZ7wES.Tt Q- J !Au C.
5. Bench Mark S t;~aoV E
6. Divert surface water around mound to prevent Ponding at the uphill side.
• ' narvE 3 of ~ -
S°oP UtVCOwtPP<CTL=p SZRAW OR HARSH Ffl~l .y,3T)W,i PIPE
bR PcPpR.ovE.O S`-tF.1TH~TlC cAVERIIJG
~Otl,."-Fi:LL - -
v~PRo~/EA 1-+c~~o~H SH+vD t1 G
13,
3 - a 11- b -
`yo SLOPE QV C-'FORCE n A 1 N .
TAEr.►cl~ of iiz"-2~~z`~ i2r`6Ara \t=(~AY'1 DOM P
6 'BEww PIPE - Z" OVER Pr PE D p
fi•T _
E i. Z r-T .
F S `r-.
FT.
SYSTEM
~GE 'S Fl,
1~ES1G L ~N` 0-3S G?D/SO • FTC ►3 ~1 S 1=r.
P ROVED
AN RELATIONS Fr
RY ,6l1R I\Nn GS t X O FT,
LF
OFPP.RftENT IUN QF SA L Q S FT.
~q~ES ~Pdv~ W ZS ~
SCE C.Y
Pve ~oR.aE Y-tii~ u~
S pNC ~\STZ\sunosJ P~'R1vA1q
cyeseRvAT,Oto Pl'~E
w PIPE
1 (ZQ~JCl1 of I/Zu - 2It
I~G GtZ ELATE
L _L_
PL1lN V~~vJ
` ~hGE 7 pF_ (o
PER.FoRA'TEb Pt PE _DE-T=~R7 t.
PERFaRATE~
<-PUC h1PE
E?~a CAP.
q~ o~ °-~1J5TA LL {~EIZMAIJOUT F?ARfCb~Ft'
AT EuD OF EACH LI M-SE LAt,
BUD tJiP..
Q
. ,live-E4 WC.ATL■O 01.1 $OT?'py CF
+ _?LS?e. RUD /4Re t'~uRL~Y SPAG ,
+
Q
4-ToRCE t~ R t aJ
E=Ra1-t tau r1 A
PVC LATERALS
31-t-NO-E LAST
"ex.T TO ELL CRP
~J1SZR.1$uTlp11_ PE 1.A4uvT- _ -
EvJ AGE SY S
~~551-~E S P 3S .15 ~r.
p~tO
ac1~
pFt ~
O~,pa~~~' 10N ~,OE L~'cEt~L z tN _
Ir- OF 41LE~/Pl PE
IM%J, ELEV. OF L4NM R.AL-S 1D0 .'70 ;
P~r'~CE I ST HUt-E 13'l FRO+I TS-1 WITH Su CC-4-- )A )G HOLES /`}T Z6" 1 JJT~'RU cS.
I.,.PcST t'~pLE TO I3E J~IEXT' TO ~?tE LSD CA-P•
r
' PUMP CHAMBER CROSS SECTIOM AKJD SPECIFICATIOUS ' h E S of
VENT CAP
4"C.I. VENT PIPC frT WEATHER PROOF APPROVED LOCKING
,
7 JUUCTION BOX MMINGLE COVER WITH
25' FROM DOOR, WRRNINE, LABEL
WINDOW OR FRESH IYMILI.
AIR INTAKE pi
GRADE I
LL, 1.00.5 ~ I 'I" MIN.
I0' MIN.
COWDUIT
SEW n
INLET QNcJ~TE Ir~ PROVIDE I -
. ~ ~ajy' 4RTIGHT SEAL
c I
APPROVED JOINT A I I (I APPROVED ;JOINTS
l~ I
W/C.I. PIPE W/C.I. PIPE bRPVC
'+IW tA~~4 I
EXTENDINt. 3' D f1+J ~ I I) ALARM
OWTO $0610 TOIL b cj~tY 1 A3a't ' ( 1
J I
QA~TNENZ OF SP~E ( I ON
~~3~ ~clcE . i I
CLCV.93.33FT. SF FOR
PUMP-,_ OFF
0
clZ pV COLICKETE BLOCK
RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURCR HAS SUCH APPROVAL APPROVED
SPEC.IFICATIOUS
oosE
MA . M~DwEMT~t.1 ~PI~c}sT', wc- NUMBER 3.o
T A K
NUFACTURER. OF DOSES: PLR DAU
TANK 51ZE: ~ 50 GALLOWS DOSE VOLUME ~ SZ. (o
ALARM MANUFACTURER' 's 'X' TRO S` 1ST ?'1 S INCLUDING OACKF6OW: GALLONS
MOOCL NUMBER: I icy CAPACITIES: A=? INCHES OR 366- GALLONS
SWITCH TYPE: -~Q B = Z INCHES Olt J'S 0,►LLOW5
PUMP MANUFACTURER: ZV e L6-ell 5 • Ca 1O IIJCHE5 OR GALLOWS
MODEL NUMBER: q O s «O INCHES OR WV- CALLOUS
SWITCH TUPE: ~1ZY MOTE: PUMP AMD ALARM ARE TO OE
M1101A JM DISCHARGE RATE 3Q•'$ GpM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEREKICE DETWEEU PUMP OFF AAJO..DISTRIBUTIOW PIPE.. 21_ FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . 2.50 FLET
♦ 11'3 FEET OF FORCE MAIN X l ' F j o - 62
Ioo FtFRIG7IO1.1 FACTOR.. FEET
TOTAL DtJWAMIC. HEAD = S) FEET
D\ P11`'I eTER 6 y
tI
MITERNAL DIMEWWOW~ OF TAWK: LEWCsTH - ;WIDTH =...;LIQUID DEPTH
~o-r'tvh i°t2~'A 35z6 :-2.31 = XG-- c,R~ /INc>1
AS P E52 M R 1J U FA C~'V (t~12 = _ G R / I 'ki c- M
10 n~6E 6 of 6
to -
W w HEAD/CAPACITY CURVE TOTAL DYNAMIC HEAD FEET/
I.. W W U. METERS
2 30' MODEL 97 CAPACITY GALLONS/LITERS
CAPACITY
HEAD UNITS/MIN
8 FEET METERS GAL LTRS
25' 5 1.52 65 248
10 3.05 57 216
Q 15 4.57 43 163
= 6 20' 20 6.10 27 104
U Lock Valve 24.5'
a
yZ. 15'-
4-
10,
2 I
5' 39 -)8
0
US 10 20 30 40 50 60 70 80 90 100 110
GALLONS
LITERS 0 80 160 240 320 400
CONSULT FACTORY FOR SPECIAL APPLICATIONS
e High water alarms available.
e Electrical alternators for duplex systems available with mercury float switches.
e Long cords available.
a Mechanical alternators available for duplex systems.
e Over 140°F. - 60°C. special quotation required.
a Variable level long cycle systems available.
Zoeller Co. can provide complete packaged systems or combination of components
including controls, pumps, polyethylene and fiberglass basins.
SINGLE PHASE UNITS
Cast Iron Model Ph H.P. Volts Amps Wt.
M97 Automatic 1 .5 115 12.6 33 lbs.
D97 Automatic 1 .5 230 6.3 33 1 bs.
N97 Non-Automatic 1 .5 115 12.6 33 lbs.
E97 Non-Automatic 1 .5 230 6.3 33 1 bs.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is an engineered/design part of every Zoeller pump.
3280 Old Miller Lane Manufacturers of .
P.O. Box 16347
Kentucky 40216
ZZ71Z-,1Zj-ff O. ILoulsvNe,
(502) 778-2731 , "L/rr A"W'_g SNCE IS39
ST. CROIX COUNTY
WISCONSIN
{nom{, ; ~ ~ i ~j_•
2
' ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
June 4, 1990
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Brad Helgeson property,
located at the NW4 of the SW4 of Section 21, T29N-R17W,
Town of Hammond, 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,
Thomas C. Nelson
Zoning Administrator
cj