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034-1033-50-000
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,WI 53707 BUREAU OF PLUMBING E:1 CONVENTIONAL El ALTERNATIVE [late Plan l.D Number El Tank ❑ In-Ground Pressure L'!TMound f assigned) NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DAT BENC ARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: JCSTREF.PT.ELEV.. (,«y�.la Name of Plumb MP/WRSW NSF County. Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAP ACITV TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED-. PROVIDED. OYES ONO DYES ❑NO BEDDING: VENT DIA.. VENT MAT! HIGH WATER NUMBER OF ROAD: PR DPERTV WELL BUILDING. JVENT TO FRESH ALARM FEET FROM LINE AIR INLET'. ❑YES ❑NO ❑YES ❑NO NEAREST` DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEI PUMP'SIPHON MANUE ACTOHEH EYE S F ONO BEL LOCKING COVER PROVIDED: ❑YES ONO ❑YES ❑NO GALLONS PER CYCLE: PUMP ANDLONIHOLSOPERATIONAL NMBER`OF PROPERTY BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FRAM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST-I► SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing N+,n+ uinME T111 MATE HInI AND n ARKwG or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH ±DISIR H NO OF DISTH PIPE SPACIN(; COVER MSIUE Dln SPITS LIQUID DIMENSIONS THE NCHES ATEHIAI' PIT DEPTH: GRAVEL DEPTH FILL DEPIPE DISTH PIPE DISTR.P IPE MATERIAL NO DISTR NUMBER OF " 'PRTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE CLF I ELEV.END PIPES J,ROPE INE AIR INLET: FEET FROM-- . 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- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOILCOVER TEXTURE 17,MANE N I MARK E RS [ISIIIVA TIGN WE LLS _ ❑YES ENO ❑YES El NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL j,1,j,O,O 1,,,DED MULCHED CENTER EDGES ❑YES. ONO ❑YES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTR UISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING "ELEV.. ELEV. DIA. ELEV. PIPES DIA ELEVATION AN11 DISTRIBUTION' INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECI LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1:1 YES ONO DYES ONO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF 1 PROPERTY WELL: BUILDING: FEETFROM LINE: k ❑YES ONO ❑Y"S ❑NO _ NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE: DILHR SBD 6710(R.01/82) Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Ra u°R 1�" �R i 1 TOWNSHIP 5JOO j V9 /�L c/ SEC. T N-R W ADDRESS At ST. CROIX COUNTY, WISCONSIN P 6 IL&N o d e i ry /,. T SUBDIVISION LOT LOT SIZE C/{e— PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SrA 1001 a 5- v+s � Iq 7y L Z INDIC.kTE NORTH ARROW BENCHMARK: Describe the vertical reference point used 'Zy- f DF L..IeLL Elevation of vertical reference point: /e z) Proposed slope at site: �� SEPTIC TANK: Manufacturer Iu/&SCR Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,©Side ,Q Rear, O 70 feet From nearest property line : Front 10 Side,Q Rear,0 feet Number of' feet from: well (�2, building: f/ f (Include this information of thhetabove plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Ao e. Liquid Capacity: j® O G Pump Model: Z Pump/Siphon Manufacturer: Zr C L C!a Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycler o1r3 Alarm Manufacturer: s���1 c d tA0 Alarm Switch Type: J1q e1q�f7 R y Number of feet from nearest property line: Front, Side, ©Rear,0 Ft. Number of feet from well: �/9 Number of feet from building: �r (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: ;�.. Number of Lines Area Built: Fill depth to top of pipe: 2-0 Number of feet from nearest property line: Front i O Side, O Rear, Pt .� Number of feet from well: 2f Number of feet from building: 9 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid the Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box0 been used on any o the above soil absorbtion sytems? (Check e). HOLDING TANK Manufacturer: Capacity. Number of rings used: El ation of ottom of tank: Elevation of inlet: Number of feet from nearest pro ty line: Front, 0 Side, O Rear, OFt. Number feet from well: Numb of feet from building: N r of feet from nearest road: Alarm nufacturer: Inspector: Dated: 6 e a- /-° � Plumber on job: License Number: �'� 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABM&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!,NfV%,S 15,T29N-R15W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town og S,pAinggietd S88-04415 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound l` /t : INSPEC D RobW FAick Route 1 Gtenwaad City, WI 54013 BENCH MARK(Permanent reference point)[DESCRIBE IF DIFFERENT FROM PLAN: REIF.PT.ELEV.: CST REF.PT.ELEV.: Na a of P mbe I MP/MPRSW No.: County: Sanitary Permit Number: Gate SnT th. 5690 St. ctoix 119368 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY- TANK INLET ELEV.: OUTLET ELEV.: WARNING LABEL LOCKING COVER (v0 0 P IDED: PROVIDED: YES ❑NO ❑YES ❑NO BEDDING: VEN�T(I�Vl HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING: VENT TO FRESH /, ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO 1 I ❑YES [--]NO NEAREST—► DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: E]YES ❑NO 06 ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES [__1 NO NEAREST---* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: ENF DISTR.PIPE SPACING: CO VER INSIDE DIA.: #PITS: LIQUID S: MATERIAL: PIT DEPTH:DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DI DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: EL PIPES: FEET FROM LINE: AIR INLET: 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 ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: [::]YES ❑NO ❑YES ❑NO NEAREST—► 11 ,f ✓ �C 1 Q%. � Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) 1 Zoning Adm-i nistAa ton —� SANITARY PERMIT APPLICATION COUN � DILHR 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 STATE PLAN I.D.NUMBER 8%x 11 inches in size. Sg$—Q /Sr -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES N NO PROPERTY OWNER PROPERTY LOCATION 96 6e t— _ je /✓ w % N4/ Y4, S 15- T,2 57, N, R 1,5- SKor)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME tl 0 CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK 11#lvDOcr( /� �1 . d�D / VILLAGE 11. TYPE OF BUILDING OR USE SERVED: AEG-�, Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 14 New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. Q A Sanitary Permit was previously issued. Permit## �.r:?(Fp Date Issued al' 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ❑Conventional b. jR Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ® Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A Tanks Tanks structed pp' Septic Tank or Holding Tank Y El El Lift Pump Tank/Siphon Chamber Z El [__1 ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MR APRSW No.: Business Phone Number: 6 7 l e, SM i � mac — �_7? Plumber's Address(Street,City,State,Zip Code): Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps_j Approved E-1 owner Given Initial S charge Fee Adverse Determination I W ` /�� Ranm � X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber A, INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION 1 TO THE APPLICANT; 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which yyisco 1ti'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaSif+"B is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. .a . The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) mmi I APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house") , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Eod e/� f' �,Ql4::= Location of Property '4 h141 ' , Section , T N - R 4-1' W Township /A"]a t°L4 - Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel f �� Date Parcel was Created Are all corners and lot lines identifiable? Yes ' No Is this property being developed for resale (spec house) ? Yes X Volume 3 C `3 'and Page Number 1P as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION I (We) ceAt 6y that a t statements on thin jonm ate tAue to the best ob my (ouA) hnowtedge; that 1 (we) am (are) the owner(s) o� the pnopeA-ty descAibed in .thus inbonmation �onm, by vixtue o� a wanAanty deed n conded in the 06j.ice ob the L)11( 142 County RegisteA o4 Deeds as Document No. an we ptesentty own the proposed site Am the sewage di,6pos system (on I (we) have obtained an easement, to nun with the above dedchibed pnopehty, 4on the const,tuction o� said system, and the same had been duty n conded in the 066ice o4 the County Regiz ten o4 Deeds, as Document No. LI) /( q Z SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) No-u-, 3- g� DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 j -- /�. THIS 8PAGE RrBERVED FOR RECORDING DATA ,) WARRANTY DEED I I REOIS7ERS OFFICE I This Deed, made between ...Dur-anA..Federal..S.avixlV.and.. ST. CROIX CO., WIS. -. ..----LoanA.92miatioJi I .................................. Rec'd. for Record this 7th ------------------------- - --•-...... -----••-•••--••--••---••-- r _ _ . ay of=A.D. 19j6-........... ......... i !' ...--•----•---•-•----•-•----•--•---•--•-•----....-.-•.---•-•---.._...__.., Grantor, and.....Roberi .A,__Frick,__ a single person 8:30 , J MA Ii .... ..............'..---•- ......................................................... •-•-----•••----••••-- ...... • ......... •. Grantee, Witnesseth, That the said Grantor, for a valuable consideration------ Thirt -Seven hundred dollars and no/100 ($3,700.00) i RETURN To conveys to Grantee the following described real estate in .... t,...CCOJ X......._._.. Ii 1 i County, State of Wisconsin: �I i I' Tax Parcel No: ............................ Part of NW' of NW' of Section 15-29-15, described as follows: i; Commencing on W Line 471 .5 feet S of NW corner, being centerline of Highway 11128 11; !' S on said W line 180 feet; E 250 feet; N 180 feet; W 250 feet to place of j beginning. r. SFW% EFX II - 11 �i I i i� II I� This i$..not 2------------- ------ homestead property. ` Or) l iS not) Together with all and singular the hereditaments and appurtenances thereunto belonging; I And...Darand_Federal _Savin s and Loan Association j warrants that the title is g.............imps..........._..- ...... li good, indefeasible in fee simple and free and clear of encumbrances except �i Easements and restrictions of record. II j! and will warrant and defend the same. I f Dated this .... --.17.th ..... ......... day of ...Ap.ril..........y•-• 9 -•-•- 1 ..8.. i DURAND FEDERAL SA N S LOAN SSOCIATION (SEAL) OAR f* ------------.................(SEAL) -•----...... (SEAL) • S ' L� * ....� --...-•--................... BY:- . -Ro a1d.:Hemmy:_-Pr. .ident..... .._....... .... ............................(SEAL) .. (SEAL) --......_. I " � ... ............................... BY:- __.-Linda__L.•.Weber.,..Vice President AUTHENTICATION ' ACKNOWLEDGMENT SiLr,Rt,nre(e1 .. ..... STATE OF WJSCONSIN ii pun..•-•.............•-•--County. authenticated this ........day of........................... 19...... Personally came before me this 1.7tr1....day of ---- .................................... ......Apr U-------------------------- 19.86.. the above named --------------- F3flnald..Helolt>,y.,--�re_S.ide.0t._aCld. 'IT -• : - •---- ----- Weber.,..Vice_.P>'es.�_d�. t.�.._Qf.Durand__Federal TJTLE: MEMBER STATE BAR OF WISCONSIN ,SaVings...arad_Loan_Association_on behalf of (It uut, behalf --A b _the_.GAr-pQxat................................................. y § 70fi.06, Wis. Stats.) ---- to me kno to be the person .A. .. who executed the j foregoing strum, ackn wledge the same.THIS INSTRUMENT WAS DRAFTED aY C� 7 --------•---.Association.... bJs rm _.. .� , to tl?uh Pepin --------------County, Wi . (Signatures may be authenticated or acknowledge Jsok� 1 �C ' are not necessary.) g I w iniV n: is permanent. If not state expiration � 'AatC � r�.tobe_r..5------------------ 4 , -Names of persons signing in any capacity should be LYPe•1 or prinle.tJGGYIow their sir�na��e� R.CMdiercorn; STATE IIAR OF WI.SrONRIN FORM No. 1-19tl2 Stock No. 13001 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/29W /`I D p G R 7` z /;?'� ROUTE/B*X=#VNVzr&L FIRE NO. CITY/STATE ZIP SL/o /3 PROPERTY LOCATION: 1/41/4, Section Town of SP,Riy4�FieLd , 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. W ('_� A SIGNED DATE-No-u— -3 ` O15 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 State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 GALE SMITH Owner: ROBERT ('=RICK ROUTE 2 BOX 149 ROU"rE 1, (,i._F:.MOOD CITY, WI 54013 GLENWOOD CITY, WI 54013 RE: Plan Number: SOS-04415 Fate Approved October 18, 1988 Gallons Per Day: 300 Date Received: October 3, 1988 Project Name: F"RICK, R013E12T — RESIDENCE Location: NW,NW, 15,29, 15W Town of SPRINGFIELD County: ST CROIX The plumbing Plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based an 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 rioted 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 ILJ1R 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the followi:nq components only: -- NEW MOUND Inquiries concerning this approval may be made by calling (608) 266-.6952. Sincerely, ALLEN WELDORF Section of Private e age Division of Safety a Buildings PPa3020/0009n/64 cc: ROBERT' PRICK Private Sewage Consultant County ___ UW--SSWMP --.---.Plumbing Consultant __Private Owner Plumber Environmental Health SBD-6423(R.10/87) DFPARTM,ENT OF REPORT ON SOIL BORINGS _A_ SAFETY& BUILDINGS INDUSTRY, LABOR AND PERCOLATION LA N� DIVISION HUMAN RELATIONS TION TESTS (115) MADISON WI 53707 & (ILHR 83.09(1) Chapter 145) TO SHIP/MUNICI ALIT LOT :BLK. O.: SUBDIVISI N ME: '% 4 SI cT !T N/Rr�E(o LINTY: 0 NE 'S BU E 'S NAME MAIL AD(:iR S USE ,.-,/ NO.B DRMS.: COMM I S R PTION: ��/ DATES OBSERVATIONS MADE L1GResidence LKNew ❑Replace f, `'7r Q RATING:S-Site suitable for system U=Sije unsuitable for system OElS Ij ' MO,r U'_ND�o (IN'q�pUN PR, ESS;°i : �S EM-IN HOLDIcN (TA .RECOMMENDED SYSTEM: ptional) S l=J N ----- I S UV�fV �S7 �` u J LJ Y If Percolation Tests:are)NOT required DESIGN RATE:under s. ILHR 83.0Ib►,indicate: If any portion of the tested area is in the Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH T GROUNDWATER• INCHES CHARACTER O SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH f6 n MP NUMBER DEPTH IN, ELEVATION OBSERVED HE TO EDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- %-33 Oy '39 �, 7 B- p B B 0 3 58 s •33 B- s bA f t . 9 B- JB- dcv PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME D P W L VE N NUMBER INCHES AFTERSWELLING INTERVAL-MI •I HE RATE MINUTES P' 30 P RI D t PER INCH P- Q 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. SYS i E ELEVATION ;4 �I do I _ z Orn I i - IN TH ! ' v t7VYO•-undersigned,hereby certify that the soil tests reported on this form were made by me,1h411ccord 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 th6"bbit of my knowledge and belief. NAME print►: AJC TESTS WERE C OM➢ ETED ON: ADDRESS: ty /a CtHJIPiICAT ON NUMBER: PH gNE NUMBERloptio aq: CST S TU t O� ' .. DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DI"LHR 5(R. 10183) —OVER— Smith Plumbing & Heating PHONE (715) 265-4838 )?odey GLENWOOD CITY, WISCONSIN 54013 Ly. & NAD 6°� QPgtM�����so11 Ile 1Uc� 'pF, ' oR �s pe E 5EE Sao ry 1e ©- - - - - - o — - - - — - © - ,. of Hwy 1�RAwN Iv 9- k- p�/7 M P.3-d 90 Page — Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil ---,-�=- F -J NS E p % Slope ` Bed 0 2 ' arG�jbn Plowed �` rom Pump oyer � 1VIStON , S ysrt�'iW r-l-e v,' 97,. 31 ° /� � �gpONpENO� D 6' Cross ction 0 o nd System Using E � A Bed For The Absorption Area F ,� A �' Ft. Signed: - LJ B ,Z Ft. License Number: N p�`6 90 I1,; Ft. Date: q 7 J Ft. K 9✓ 9 Ft. Alternate Position L _6-�2— Ft. of Force Main W Ft. L j Observation Pipe B K A ��---------------------- -----------------------I __ _�� Force Main W ° --------- K------- From Pump M M Distribution Bed Of 2 — 2 i Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page _ Of— O'VS17E S eWAE SYSTEM bPaT - , �t OF OJ1V��r t 1 t=a Perforated Pipe Detail RELAT <•,% INGS 1015 ORR�Sp End View Perforated End Cop) eye iE PVC Pipe Ja��a,acc Des Holes Located On Bottom, S Are Equally Spaced . � S P *� PVC Force Main x w � • Q/ PVC Manifold Pipe Distribution Alternate Position Of Pipe Force Main Last Hole Should Be Next To End Cap End Cap ,.. Distribution Pipe Layout P Ft. R 3.Q S 3. S X � Ra Y _ 5 Signed: ���� r Hole Diameter Inch �/�.S6y�? Lateral Inches) License Number:* Manifold Inches Date: Force Main .Z Inches # of holes/pi pew Invert Elevation of Laterals97 Ft. 3s -116- PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COYER -15' FROM DOOR, WINDOW OR FRESH 12"MIl1. AIR INTAKE GRADE I 'i°MIIJ.� 18"MIiJ. COIJDUIT -- _—_- 18"MIN. \��\\\ ---------- INLET PROVIDE I. – --- AIRTIGHT s EAL ONSITE SEWAGE SYSTEM I I APPROVED JOINT A I III APPROVED JOIIJTS LJ/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3' B ry. ,,, +r �' ��`' TI SOLID SOIL OVITO SOLID SOIL I oDEPARTM,ENT OFINMUSTRY.. ! .,`,�M :E',' i,•: ;.: R1•:�,"::' I i oN D Vi$ION OF 6AFr(-Y Al 0"W Oi GS � ELEV. FT. --� /// PUMP–� OFF D SEE CoffifeSPONDIEENCE CONCRETE BLOCK RISER EXIT PEP_MITfED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL CDM� 'AIAtfeN ,F 1000 5-e-pri�, SPEC,IFICATIC)NS DOSE .roc' oo se t-*mk' TANKS MANUFACTURER: o..X=9-s NUMBER OF DOSES: PER DAy TANK SIZE : ,,-kr1 GALLONS DOSE VOLUME ALARM MANUFACTURER: S ELjscT n INCLUDING BACKFLOW: 8%3Rfi2l' GALLONS MODEL NUMBER= jmu CAPACITIES: A=. n—MCNES ORIlgLlGALLONS SWITCH TYPE: A 1h Lr9C4R 0 5= UUa INCHES OR 19. 7 GALLONS PUMP MANUFACTURER: 2'a is Q C= O IkJr_HESORF-?'r9f GALLONS MODEL NUMBER: ? D=INCHES OR A GALLONS SWITCH TyPE:ST ELEC7W6 19,060 A1iACQQMOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE�,'f� GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.._J90 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET + S FEET OF FORCE MAIN X'Z"S� FYoFT.FRICTIOM FACTOR. — FEET TOTAL 09MAMIC. HEAD = ��'75 FEET // // INTERNAL OIMEIJSIOIJS OF TAUK: LENGTH ;WIDTH �/ 5. ;LIQUID DEPTH SIGNED:-� �' " `L' • Ll� LICENSE IJUMBER: ��-���� DATE: HEAD/CAPACITY CURVE EFFLUENT and DEWATER I NG WARNING: Model 185 should not be subjected to less than 30etioi. Q W TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE W W. EFFLUENT AND DEWATERING W r > ?✓ 53-55 X15`` SERIES 57-59 97 137-138 181 183 185 185 188 t89 ° FT. °M=: , Gal w Gal Gal. Gal. ,'tta. Gal. Gal. Gal. Gal. Gel. 34 N�• . �� 5 p^'1.52 43 8' 57 7 104 F 1061b1 61 ln: 61 1 155 FM 155 10 -3.05 34 '129 51 193` 79 300 100 1378 61 2231.' 61 PTKI 148 151 15 4,57, 19 i 72,1 43 ,1 64 p242' 91 -344 60 27: 60 7 s: 142 145 Yr49 32 105 20 6.10 27 ✓ 36 L13e1' 82 P3'10' 59 60 136 140 �:. 25 8 0@0 74 57 59 128 133 3€ 30 9.74 z 65 '446- 55 O 7 58 90 121 127 1 30 ao as 14"' 46 ss 75 105 114 �R 50 i&1 21 33 51 58 90 100 80 15 43 36 71 85 26 70 30 . 10 51 70 80 ' 14 28 54 90 NO NOW 2 37 26 100 30A8;' 21 110 32 Do- +fir -,� Lock Valve, 19' 24.5' 1 26' 1 56' 66' 87' 73' 91' 110' 24 MODEL 22, 89 D Q W = 20 V Q 11;5 Z 18 O a 16 NSMOEEL \163 MODE1 f- 188 14 12 M DDEL 10 185 1% VULL 8 1 17, 1 9 6 NOD EL 161 4 7 7 1 2 'k 53, 5 , �5 0 GALLONS 10 20 30 40 50 60 70 80 90 100 1110 120 130 140 150 160 �''UTERS 0 °` 80 '160 240 320 400 480 560 40 FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. 3 Smith Plumbing & bleating PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 p� R-L A-xV PR Ae'4 G� g hoc (d �) SAO ry �j''Jyl, loo ' toPof=i✓��-G qo 0 OF Hwy PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE 4"MIN. / L. I B"M 11,1. COQDUIT -- _ INLET PROVIDE I. ----- AIRTIGHT SEAL j . _T APPROVED JOINT A I III APPROVED JOINTS W/C.T. PIPE I III W/C.I. PIPE EXTENDING 3' I 111 ALARM EXTENDING 3' ONTO SOLID SOIL B I II ONTO SOLID SOIL I I I I ON � I 1 I ELEV. FT. PUMP -_j r OFF D CONCRETE BLOCK RISER EXIT PERMITED GfJLy IF TANK MANUFACTURER HAS SUCH APPROVAL Mh fA/gr7e/y SPECIFICATIONS DOSE �r-�� pc+s nk Al TANKS MANUFACTURER: kl)-r&A 9-A NUMBER OF DOSES: PER DAY TANK SIZE : �:!rbri GALLOIJS DOSE VOLUME ALARM MANUFACTURER: S EL j;T .(2 INCLUDING BACKFLOW: 8349 GALLONS MODEL HUMBER: CAPACITIES: A= n INCHES OR���GALLONS SWITCH TYPE: /79LrL�C4R B= INCHES OR IT-7 GALLONS PUMP MANUFACTURER: '1 in 164.4 49 je C= INCHES OR ?1 GALLONS MODEL NUMBER: - ?7 D=IN d CHES OR 1 GALLONS SWITCH TJPE: 5:''Et1E'C7Wd 4CAEd n►iNCKKYMOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE XQ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . , . , , . , , . 2.5 FEET + _ �(J FEET OF FORCE MAIN 0 rw F X Z' YoFTFRICTION FACTOR.1AC FEET TOTAL DUNAMIC HEAD = x'75 FEET IMTERNAL DIMF-WSIONS OF TANK: LENGTH ;WIDTH ; LIQUID DEPTH �CL— SIGNE LICENSE DUMBER: liflo-4-11ela DATE: Page _ Of Perforated Pipe Detail End View \ Perforated End Cop) PVC Pipe f (\ab�ice �• J o Holes Located On Bottom, S Are Equally Spaced S P *4 PVC Force Main Q PVC Manifold Pipe Distribution Alternate Position Of Pipe Force Main Last Hole Should Be Next To End Cap End Cap Distribution Pipe Layout P / .S Ft. R 3:d X Y AS ids Signed: � �`J� Hole Diameter Inch License Number: Lateral Inch(es) / �Yl? Manifold Inches Date: Force Main Inches # of holes/pipe _ Invert Elevation of Lateral sQjf3 Ft. -116- Page — Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil _J D E ; 3 � . % Slope Bed Of 2M– 2 %2 Force Main Plowed Aggregate From Pump Layer D i s O Cross Section Of A Mound System Using E / A Bed For The Absorption Area F G 40 Signed: B 3 Z Ft. License Number: Al P'3-0/ /C/O I -,���Ft. Date: d 7,76 Ft. K 9 Ft. Alternate Position L S-;2- Ft. of Force Main W � Ft. L Observation Pipe B K A (----------------------- -----------------------I L----- --------------- ----------------- ---•I Force Main W — --- ---_—_ From Pump Distribution Bed Of 2"_ 2 2N Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area << ROBERT A. FRICK 715-772-4770 RELCO COMPANY ROUTE 1 GLENWOOD CITY, WISCONSIN 54013 0 `op^— � r ��5c> G G �� DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS y PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 MADISON,WI 53707 BUREAU OF PLUMBING XW!4,NW3a,SS15,T29N—R15W 1:1 CONVENTIONAL ALTERNATIVE State PlanLD.Number (lf assigned) 'Town of Springfield ❑Holding Tank ❑ In-Ground Pressure MMound Hwy 128 NAME 6F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bob Fricke Route 1, Glenwood City, WI 54013 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: Lyle J. Myers 6219 St. Croix 95988 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED DYES 0 N DYES ONO BEDDING: VENT DI N.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: DYES ❑NO ❑YES El NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES NO Ill R EST' SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: °° WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER I DIA.. #PITS: LIQUID Ey�i y� TRENC HES MATERIAL: PIT. DEPTH: � ii4 T. GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER QF PROPERTY 7711ILDING.1VENT TO FRESH BELOW PIPES- ABOVE COVER: ELEV.INLET.ELEV.ENO. PIPES. FEET FROM ''.LINE: AIR INLET: NEAREST. 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES El IDYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED: CENTER. EDGES. 1:1 YES ONO DYES ❑NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: g� yy�� :WIDTH. LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. TRENCHES: ? `!MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. JDISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. � I N ELEV.: ELEV. DIA.. ELEV.: PIPES. DIA.: HOLE SIZE HOLE SPACING- DRILLED CORRECTLY. COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO } .s ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: N `Tf�fT PROPERTY WELL: BUILDING: FEET FROM LINE: El YES 0 N ❑YES 1:1 NO INEAR'JEST Sketch System on Retain in county file for audit. Reverse Side. GNATURE: TITLE DILHR SBD 6710 (R.01/82) SI Zoning Administrator �ILHR SANIT RY PERMIT APPLICATION COUNTY Ina cord 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 STATE PLAN I.D.NUMBER 8%x 11 inches in size. 7e, —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT LL INFORMATION. FOR VARIANCE ❑YES E� NO PROPER Y OWNER PR P TY L C TION <D ` .ZZ� ! /a '/a, S T , N, R j E (o W PROP (iTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Cl Y,STATE i . ZIP CODE PHONE UMBER CITY NEAR ST ROAD,.LAKE OR LANDMARK VILLAGE ti II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 472 &�- /Ldr3t1rt5OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one n#1. Check#2,3 or 4,if applicable) 1. a. New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one.owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional b. WAlternati I e c. El Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e.*$ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION ARE A, 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Fe t): PROPOSED(Square Feet): S -0-r- Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ciallons Total #of Prefab. Con- Steel Fiber- plastic Exper. Manufacturer's Name INFORMATION New xisting Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank L+_ ff ".V/ El F-1 Lift Pump Tank/Siphon Chamber r"?— ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' Signature:(No Stamps) P/ PRSW No.: Business Phone Number: G yl-rr l Plu beAddress(Street,City,State,Zip Coe Name of Designer: �� �L Z Gf'/Co.,si VIII. SOIL TEST INFORMA I Ivin Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 2 &2 G - �3Z. .;2- IX. COUNTY/DEPARTMENTAJSE ONLY ❑ Disapproved S itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Sur arge Fee Adverse Determination ��� Od C ,-7 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber f-- INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained,The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department,Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 3'/z x 11 inches must be submitted to the county. The plans must include the following; A) plot plan, drawn to scale or ith complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building $31wers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution bo*es; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model an d'pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground atE included the creation of surcharges (fees) for a number of regulated practices which Wisco in`s ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re BSt ee is used in your building is returned to the groundwater through your soil absorption o system or the disposal site,used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- ° tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION INDUSTRY, PO BOX LABOR AND PERCOLATION TESTS (115) 3707 HUMAN RELATIONS P.O.MADISON,WI 53707 0 LHR 83.0911) &Chapter 145) LOCATION: SECTION: TO SHIP/MUNICI LIT X: LOT O.:Bl y�hO::TSU_BDIVISI ME: 0/ '/a I /T OUSE (o A IV LINTY: O NE 'S/BU E 'S NAME: MAIL ADDRESS: DATES OBSERVATIONS MADE USE NO. MM I PRO D/,?-'7 S R PTIONS: PER AT I `N TESTS: D E B � / / �N �esidence ❑Reple � a1 RATING:S=Site suitable for system U=Site unsuitable for system rONEV ES N T[�1 MOUN .❑U IN-GROUND-PRESWRE: SYSaTEM-IN-FIL HOLDING TA .RECOMMENDED SYSTEM: ptional) DESIGN RATE: If an portion of the tested area is in the / If Percolation Tests are NOT required y p N 1�•/l under s. ILHR 83.0915)lb),indicate: Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO EDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- / V6 .33 3 9 6n '28 -. l B s l 8 30 q8n L s,.IS 8 S B-3 B- •� t „-- e # d f.%*-#N C'+ B- B- 447 �] - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PER LOU 2 P RI P_ 3� a a P / P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION q 7,33 E� a' , qa` _ 13 9 , , , �0 • F , , , _ s , 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 WEl COM��ETED ON: ADDRESS: Rilcl -ka-rA CER I IC /NUMBER: PH NE NUMBERIo do al): to ba - ��� �3�a/d CST TU c DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 SR - 6395 . To be a Coml lete Find J,CCUfate Soii t0s",,yo;.rr report #T'w t iii dude, 1. Complete legal description,; 2. The use section must clearly indicate whether this is a residence or cornmesrcial project; 3. MAX IMUNAI number of bedrooms car commercial use planned, 4, Is this a new or replacement systern; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS= F. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan, 7, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8, Make sure your be rich mark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate: boxes as to dates, names,addresses,flood plain data,percolation test exemp- tion,if appropriate; 10. If the information (s ach as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and place your Current address and your certification number; 12. Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIES} SOIL TESTERS Soil Separates and Textures Other Symbols St — Stone (over 10") BR — Bedrock cob Cobble (3- 10") SS Sandstone gr Gravel (under 3") LS — Limestone s Sand HC3W ... High Grounds=rater cs Coarse Sand Parr, — Percolation Rate med s Medium Sand yet — Well f Fin:^Sand Bldg -- Building Is Loamy Sand > — Greater Than sI -- Sandy Loam < ..... Less Than "I —� Loam Bn -.-. Brown sil — Silt Loam Bl — Black si — Silt Uy -.... Gray cI — Clay Loam Y — yellow scl -- San:Jy Clay Loam R ..-- Red sicl — Siltv Clay Loam illot — Mottles sc - Sandy Clay w.•' -_.. 'm ell ` sic, — Silty Clay fff — few, fide, faint *c Clay cc __ cornrnon, coarse pt per€ rmn — Many, medium Muck d -- distinct P prominent HWL - High. vrater ir�Vei, m Six general Soil textures s(.irfaCE'. vvntP.r or liquid vi�aste disposr,l BI`v1 --- Bench l`+Jlark `ARP .. Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 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 ,0 * 0 /,-, Location of Property -42 (LIt 'fi r Section -!�i , T N-R� W Township �� / T, C'Z Nailing Address l ' LAI00Cs) , ICY Address of Site Subdivision Name Lot Number ,(,f Previous Owner of Property Total Size of Parcel 'A (� Date Parcel was Created Are all corners and lot lines identifiable? ` Yes No Is this property being developed for resale (spec house) ? Yes No Volume �� and Page Number �— g 1� 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) centti6y that att statements on th,i6 aAe tAue to the beat o6 my (owc) knowledge; that I (we) am (ane) the owneA(,for the pnopehty de6cA bed in thiA .in6onmati,.on 6on.m, by vi tue o6 a waAAant deed neconded in the O66ice o6 the County Regi,6teA 06 Deeds ass Document No. ; and that I (we) phebentty own the pnopob ed d c.te bon the sewage d i,a Nob a yb em (on I (we)) have obtained n¢d an easement, to hurt with the above de•�e/%ibed pnopehty, bon the eowatAucti.on o6 said system, and the tame has been duty neconded in the 066.ice 06 the County Re9.i4te% o6 Deedb, ab Doewnent No. ) SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 4 9 � DJUE SIGNED DATE SIGNED 1 A; DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS 8PACIE RVSERVEO FOR RECORDING DATA �I WARRANTY DEED REGISTERS OFFICE I This Deed, made between ---?lrSnS__keder�al._:S.avings__�nc _. T. CROIX CO.,CO. WIS. i :LQan_.AssQC�atio0 ................................... ......................... Recd. for Record this 7th �i i ay of irtay A.D. 19j6 •----------- -------------- ----•-----•---•-•-•-•----•--•----.----------.-----.-----•----•--•--•--• Grantor, and-..._Robert.A,_--Frick,-• a single person 8:30 A fI) ...... --••---•---•---- -----------------•--•- •----•-••--•-•-•-------.........•---...---•-----•--.... s ......................... ----'---•---------........._.................. , Grantee, I; Witnesseth That the said Grantor, for a valuable consideration .._...Thirty-Seven hundred dollars and no/100 ($3,700.00) - - -_. ---------------•-•--••-••••-•----•----•.... conveys to Grantee the following described real estate in ....St. .Cr0]X_......_._.. RETURN To County, State of Wisconsin: I i Tax Parcel No: i4 f Part of NWr of NW4 of Section 15-29-15, described as follows: j Commencing on W Line 471 .5 feet S of NW corner, being centerline of Highway 11128 11; S on said W line 180 feet; E 250 feet; N 180 feet; W 250 feet to place of j' beginning. I '1 SFfi i! I This ...i n ....:........ homestead property. OWN) `(is'not) lTogether with all and singular the hereditaments and appurtenances thereunto belonging; And...Durand•.Federal•-Savings• and Loan Association warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except ii Easements and restrictions of record. I III I' and will warrant and defend the same. l I Dated this .........1 Tth_------------------------------- day of ...April 19..86... •V y ' DURAND FEDERAL SA N S LOAN SSOCIATION (SEAL) I (SEAL) �,- - ...............-------•----...__...._ --- -- - : . . . Cident _....._....---(SEAL) BY:* Ronald-•Hemmyx..Pr .............. • t 1 (SEAL) �ltk�Ot,�.. r }................................. (SEAL) II V............. r'�c... ............................... BY:* ....Linda-.L-..Weber.t..Vice. President. �! AUTHENTICATION ACKNOWLEDGMENT ,I SitrnRtvre(el _ ... . ............ STATE OF WISCONSIN sa. I I PeA D............. .County. I authenticated this ........day of........................... 19-__. - Personally came before me this ----1.7.tkL.-_day of ......Apr-i-1-.......................... 19—M.- the above named II Ronald Hem fixes-tde.rxt..atZd.Linda L� .---•• - x es.ident, off_Dursnd-.Federal ..Weber., _V1ce._P TITLE: MEMBER STATE BAR OF WISCONSIN ,Sa�tpgs ,mod LQan_Aaociation•on behalf of I (If nut, -- ................................ ---tbe__ 0XVQC'?U.90.r... authorized b Y § 700,.06, Wis. Stats.) to me kno to be the person .-q........ who executed the foregoing strument al ackn wledge the same. l THIS INSTRUMENT WAS DRAFTED BY ;f Durand_Federal Savings•and•Loan ,N /:._...:;, C�Awaf/...................... b s ...................................... Association , ----•--- J... ;t' to .Pu1��{ Pepin --------------County, Wis. (Signatures may lie authenticated or acknowledged. BA yl;' inii1$en: is permanent. ([f not, state expiration are not necessary.) ? a Aat*:_ tobex..5-----•----------•--••---••---... , 19..8.. - > *Names of persons signing in any capacity shuuld be typtO or ,riute gr� #�4 I .tJGpluw tl�e�r d�cq�4y1�'elCl N.G MdIer Carrywry M STA'I'N: RAR OF WISCONSIN «._...... ........ 1•YIItM No. 1-1982 Stock No. 13001 IL • Ha ST C - 105 r r a • H SEPTIC TANK MAINTENANCE ACREEMEN'1 0 St . Croix County z d y OWNER/BUYER .4*- Ir f � c_� M ROUTE/BOX NUMBER /` R, / /5�> Fire Number CITY/STATE �( C Z1P`5�0/3 PROPERTY LOCATION : &) Iz, JVW !4, Section /5 , T �9 N , R /- W, Town of -5 vi 01 , St . Croix County , Subdivision Lot number I 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 , I 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 . H 0 F, I/WE, the undersigned,, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth , herein , as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning ffice withlrA30 days of the three year expiration date . SIGNED / 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 . i i • o� r cke. s C�F% s 8703366 Zak ../.11 _ _ o 4 I 6 Q Sr 63 c C�o s 3, C� to I /� 6IF9 7oP 100 /� 0 d CA e, p rb t MLUII��I� i , n' 011 ` AP Tt NS DEPARTMENT OF D ,Fd �.�S �A 0 Di1'IS!O's� py�Lti'��C)S � E.. , SEE Oiiht:.F:J�vLiETvCE� r - Page — Of _ s ` 0336 6 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil p - '- F 3 E " D X Slope Bed Of �"– 2 %2 (Force Main Plowed Aggregate From Pump Layer ' Cross Section Of A Mound System Using E A Bed For The Absorption Area F . 75 G A Ft. H I .5 Signed: B -4-7 Ft. License Number: I 12, Ft. Date: �_ J �_ Ft. K Ft. Alternate Position L Ft. of Force Main W .19 Ft. L J Observation Pipe--- K A I.-------a------------- ----------------------I I0----- --------------- ----------------------•) Force Main W --------- --- ----- From Pump Distribution Bed ' " 2 -" Pipe P9(NQ I q regal Observation Pipe per a t�A TMENgiv 5,�IJOF OAFti1 DEPAI7 � Plan View Of Mound Using A Be 1v' @iB S Page _ 8703366 Perforated Pipe DetalI End View Per for aI8d End Cop PVC Pipe Nolen Located On Bottom, mss\ Are Equally Spaced PVC Force Main ♦ From Pump C • .7 /Q PVC Manifold Pipe OrNr bu UOn Alternate Position Of l Pipe Force Main From Pump Lost Note Should Be Next To End Cap End Cop Distribution Pips Layout P �3 R �� S 32" Y I Oki, Signed: Hole Diameter Inch Lateral Inch(es) License Numbe : Manifold Z- Inches/ Date: Force Main 3 Inches P um"a Cafth&- ro DEPARTMENT Of IMUSTRY. LH��)R ,�i:' i� rs.::.' ',N riti.AT;r,• D VISION OF SAFETY AND BUiLDINW.S SEE MRRESPONDENCE PAGE_— OF�- ' PII�MP CHAMBER CROSS SECTION ARID SPECIFICATIONS � VENT CAP �_, i,)� 366 C.Z. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER 2S' FROM DOOR, It•MIU. WDOW OR FRESH I iR INTAKE GRADE ( y'MIN. CONDUIT -- ------ PROVIDE ---- . ,ML'E T Alkfi&H T SEAL I .PPROVED JOINT A I I APPROVED JOINTS 4/c.z. PIPE W/C.=. PIPE .XTENDIWG 3' I ALARM EXTENDING 3' iIJTO 601.10 SOIL B ( ONTO 501.10 &OIL I ON C .LEV. $� FT PUTA --J � Off D 0 3 — CONCRETE BLOCK . RISER EXIT PERMITrEO OWLtl IF TAWK MANUFACTURLR HAS SUCH APPROVAL J �►PPRcvtt:o �oo�NC, SEPTIC E SPEC.IFICATIOUS DOSE TAWAS MAUUFACTURER: NUMBER OF DOSES: 3 PER DAU TAWK 51ZE: C GALLONS DOSE VOLUME 1'7.G 1 \SO �(p0 ALARM MANUFACTUtr 9i R' '� ( INCLUDING BACKIFLOW:.,......�. GA�LOt�IS A MODEL MUMBCR: N4 CAPACITIES: A= 1 IUCHCSOR z 1'$ .9�QGALLON3 SWITCH TYPE: INCHES OR GALLOUS PUMP MANUFACTURER: Z� — C�—!1—INCHES OR WALLOWS MODEL NUMBER: D- INCHES OR GALLON& 5WITC14 TYPE: SQL PUMP. AMD ALARM ARE TO BL MINIMUM DISCHARGE RATE9GPM INST ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTION PIPE.. 1 7 ' y H -1- MIIJIMUM NETWORK SUPPLY PR�ESSSURTE/. . . . . . . . . . . F ET 5 FEET OF FORCE MAIN X --'L=—F/ooftFRICT1oU E ♦' D LA .= TOTAL Oy1JAMIC HEAD F�:j� T OF i �� S,�iLvlcauS EPAR7N+ YIS1014 OF SA�� IUTERNAL DIMEIJSIOWZ OF TANK: LENGTH 7 0 6 El µRE51'p�D � q SIGIJEO: LICEWSE M M5ER:—I'''� ! 1 DATE:" k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 September 26, 1988 Division o6 Satiety and Bu.itding Buheau o� P.P_u.mbing P.D. Box 7969 Mad.i,6on, WZ 53707 Dear Sit: An on site .invati.gation 6or the Bob l kicke prapeA.ty, .located in the NA o6 the .'VW% ob Section 15, T29N-R15W, Town of SpAing6ie.2d, St. Croix County, teveaf-ed 6u.ctabte soitz .at a depth. o6 27 .inche6, below which zea6onabte high ground wateA wa6 noted. This site showed be .6u,i table 6or a mound -sy.6tem. Shou.ed you have any questions, ptea-se jeet 6ree to contact thi,6 o66.ice. S.in cenety, ill�,C����� r►�s Thom" C. Nets on Zoning Administrator TCN:rm6 Department of Induatry, GROUNDWATER Safety & Buildings Division Labor and Human Relations MONITORING P.O. Box 7969 Bureau of Plumbing REPORT Madison, Wisconsin 53707 Note: Show de the in inches. Location: Lot No• Block No. DEPTH FROM SURF CE TO WATER/NONE 14 14S /T N/R E(or)W OBSERVATION WELL WELL WELL WELL Township Municipality: DATE # # # County: Owner is Name: Mailing Address: WELL NUMBER: WELL DEPTH: PROPOSED O INDIVIDUAL SUBDIVISION LOT Rainfall Data Obtained From: MONTHLY DATA Sept Oct Nov Dec Jan Feb Total(8.5 ) March April May Total (Need 7,611) Provide daily rainfall data on a separate sheet for March, April and May. `- Write total rainfall for March, April and May in the above boxes. ARTIFICIAL DRAINAGE Check the site for artificial drainage. If the site is affected by such - drainage, submit complete details for the drainage system. Indiciate wh will be responsible for maintenance of the drainage system. CHECK ONE: 0 No artificial drainage o Information regarding artificial drainage affecting this site. affecting this site is attached. Attach a SBD-6395(115) or SBD-6309 (if a proposed subdivision), for soil information and estimated depth to high groundwater using mottling. Submi 2 copies of the Groundwater Monitoring Report to the Bureau of Plumbing, P.O. Box 7969, Madison, Wi 53707 and submit 1 copy to the local authority. INDIVIDUAL LOT PLAN-Provide a diagram showing accurate locations and surface elevations of all monitoring wells. SUBDIVISION-Attach a scaled map showing well locations and relative elevations (1 in. 100 feet preferred) . N I, the undersigned, hereby certify that the data recorded and location of tests reported on this form are correct to the best of my knowledge and belief. Date: T o: gnature: DILHR SBD-6412(N.05/81) epartment of Industry, GROUNDWATER Safety & Buildings Division abor and Human Relations MONITORING P.O. Box 7969 jureau of Plumbing REPORT Madison, Wisconsin 53707 Note: how� de the In vocation: Lot No. Block No. DEPTH F OM SURFACE TO WATER/NONE ;4 14S /T N/R E(or)W OBSERVATION WELL WELL WELL WELL Township Municipality: DATE # # 4t County: Owner s Name: Mailing Address: WELL NUMBER: �. _.... . WELL DEPTH: PROPOSED INDIVIDU SUBDIVISION LOT Rainfall Data Obtained From: -- -- MONTHLY DATA Sept_ Oct Nov Dec Jan Feb ITotal(8.5' ) March April May Total (Need 7,6") `— - - Provide daily rainfall data on a separate sheet for March, April and May. Write total rainfall for March, April and May in the above boxes. ARTIFICIAL DRAINAGE Check the site for artificial drainage. If the site is affected by such drainage, submit complete details for the drainage system. Indiciate wh will be responsible for maintenance of the drainage system. CHECK ONE: 0 No artificial drainage 0 Information regarding artificial drainage affecting this site. affecting this site is attached. Attach a SBD-6395(115) or SBD-6309 (if a proposed subdivision), for soil "— - information and estimated depth to high groundwater using mottling. Submf 2 copies of the Groundwater Monitoring Report to the Bureau of Plumbing, P.O. Box 7969, Madison, Wi 53707 and submit 1 copy to the local authority. INDIVIDUAL LOT PLAN-Provide a diagram showing accurate locations and surface elevations of all monitoring wells. SUBDIVISION-Attach a scaled map showing well locations and relative elevations (1 in. 100 feet preferred) . EFT H+ N I, the undersigned, hereby certify that the data recorded and location of tests reported on this form are correct to the best of my knowledge and belief. Date: T o: gnature: DILHR SBD-6412(N.05/81) ---------._...._...._...___-_-..- ......._ . Parcel #: 034-1033-50-000 01/31/2006 0328 PM PAGE 1 OF 1 Alt. Parcel#: 15.29.15.230B 034-TOWN OF SPRINGFIELD 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-FRICK, ROBERT A ROBERT A FRICK 985 HWY 128 GLENWOOD CITY WI 54013 Districts: SC=School SP=Special Property Address(es): •=Primary Type Dist# Description 985 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 15 T29N R15W 1 A IN NW NW COM ON W Block/Condo Bldg: LINE 471.5'S OF NW CORNER, BEING CENTERLINE OF HIGHWAY"128"S ON SAID W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LINE 180'E 250'N 180'W 250'TO POB 15-29N-15W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 739/84 07/23/1997 732/251 07/23/1997 717/528 2005 SUMMARY Bill M Fair Market Value: Assessed with: 82100 201,600 Valuations: Last Changed: 05/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 6,450 167,650 174,100 NO Totals for 2005: General Property 1.000 6,450 167,650 174,1000 Woodland 0.000 0 Totals for 2004: General Property 1.000 6,450 158,750 165,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00