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036-1021-20-100
\ ; / & o= = ? §) 2 � A 2m/ _ ca 7 °D \/3 � . \ 2§ § � . )k/ $ ( t ) o CL T_ cn W E_& 0 (D zen2 LL ) :5 _ e R a (D E / k/0 f L « w K z ; . o § 7 k k _ § / a 2 § � E z } k / f t E { m Cl) � } � \ 7 k 0 � .. k � _ = 2 \ 2 k > ~ ca / / kk ) \ §An k 2 � .0 \ \ k k k L � . : c � � z • t & m 2 m § 3 . 2 � v ' � CO CO o ) \ \ \ 2 c \ E _ \ ® r 2 ILIN .6 \ k \ ƒ ■ § / k § ) \ / o \ 0 \ 0 f -D ) § § d d - 2 6 R § » \ k { ] 7 g 2 $ I / ■ / ® / k (4J � \ 2 0 \ B C . 2 E / ' k § 0 a 2 0 k 0 . Parcel #: 036-1021-20-100 01/30/2006 03:05 PM PAGE 1 OF 1 Alt. Parcel#: 10.31.17.134B 036-TOWN OF STANTON 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-METZDORF, ROBERT G&KATHLEEN A ROBERT G&KATHLEEN A METZDORF 1761 CTY RD H DEER PARK WI 54007 Districts: SC=School SP=Special Property Address(es): =Primary Type Dist# Description ' 1761 CTY RD H SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 10 T31 N R1 7W NW NE 10AC LOT 1 CSM Block/Condo Bldg: 7/2009 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-31 N-1 7W I Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1023/59 WD 07/23/1997 821/104 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 125449 145,300 Valuations: Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 17,000 105,500 122,500 NO UNDEVELOPED G5 8.000 6,000 0 6,000 NO Totals for 2005: General Property 10.000 23,000 105,500 128,500 Woodland 0.000 0 0 Totals for 2004: General Property 10.000 23,000 105,500 128,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 c CERTIFIED SURVEY MAP NO. 2009 N%4 Located in part of the Northwest Quarter of the Northeast Quarter of CO R.SEC.10, T 31 N.,R. W Section 10, Township 31 North, Range 17 West, Town of Stanton, St. Croixo S 89°49'36" E 64 5.47'= -� -;S89°49'36"E 2005.85=, County, 1' isconsin. .' 1 PIFTRUNK HWY_ "� : BEGINNIgg°49E 645.47' M pNE CORNER DRIVEWAY Ki SEC.10 T.31N R.17W. +� U M NORTH LINE EAST- �1 M AAPREAO I OF NE 1/4 SEC.10 O Ln Cy) LINE ( I w \ (� ' DRAIN 1 4-4 o NE 1/414 l0 '_+POND rrr FIELD Go ''d O 0) ti 'r NORTH u \ U) BARN ti NI LEGEND � '" � U) SILO OUT 8LDGS. J1 0=PUB LIC LAND CORNER 1 w LOT I A 1 OF RECORD, ST.CROIX r, rJ 01 a ;� ti COUNTY MONUMENT, FOUND. t+ al INC UDING ACRES C.T.H 35RIG TS OF-WAY. W in °wl 0 ° 11/4"x 24"'IRON PIPE U � '_� c k WEIGHING 2.27 LBS./LIN. .0 tn FT., SET. o "=• 0 a WI 0 a 9.51 AC.= 414,300 SQ. FT z1 0 = I"x 24" IRON PIPE 4r I.H Z EXCLUDING R-O-W. o � � ►~-I i , I WEIGHING 1.13 LBS./LIN. �I 1 FT., SET. _ M f 4 rH of �� = FENCE LINE. ) 0 1 ` SCALE: 1"=200* t 1 OWNER: 0 50' IOV 200' 300' Larry Mickelson ' N89 049'36"W 645.47'-- 1- I Rt. 1 Deer Park, WI 54007 N/S 1/4 LINE UNPL_ATTED LANDS a SURVEYOR'S CERTIFICATE: v I, Ronal F. Johnson, a Registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped a parcel 1 S1/4-CORNER of land located in the Northwest Quarter of the Northeast `JSEC.10,T.31N.,R.I7W. Quarter of Section 10, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Wisconsin described as follows: Beginning at the North Quarter Corner of said Section 10; thence, on an assumed bearing referenced to the north line of the Northeast Quarter of said section, along said section line S89°49'36"E a. distance of 645.47 feet; thence S00 015147"W a distance of 674.86 feet; thence N89°49136 11AI a distance of 645.47 feet to the north/south quarter line of said section; thence, along said quarter line, N00°15'47"E a distance of .674.86 feet to the point of beginning. Containing 435,600 square feet (10.00 acres) more or less. Subject to County Trunk Highway "H" across the north 33 feet of the above described parcel. Also being subect to all easements, restrictions and covenants of record. I further certify that I have complied with the provisions of Chapter 236.34 o£ the Wisconsin State Statutes and the subdivision. regulations of the Town of Stanton and St. Croix County in surveying and mapping this parcel. Tji�r�2z 19,?,-Date R6nald F. Jo son R.L.S. 1186 Ron Johnson Land Surveying P. 0. Box 194 °i Amery, WI 54001 Tele. (715) 268-2601 tb Fit ED RONALD F. J4H`�dSON e 5-110 ate' V.. it w r Q- �• �aF,C� `�...m,,..•••' �0 Vol. 7 Page 2009 IV �A41. ''0@ APPROVED AVG 15 108&- ST.C.R0V COUN•IY ' COMRRI I*MVE PARKS PLAWNC; AND ZONING COMMI yL.E This instrument w ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 1`,y 911 FOURTH STREET • HUDSON,WI 54016 - (715)386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & r`emit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185. 00 Septic $25. 00 ,Water (Nitrate & Bacteria) 1 $35. 00 (Visual inspection) Owner:- hLn V\ -s An d D if�,,tw-, Requested by: (Y ' P �.VI `C& Addres : j j (� Address: City & State: (c.. W-' City & St. k Sb�,, f„}Z Zip Code: 540b 7 Zip Code: S Telephone N°: ( ) Telephone N4: t-IS) Property address (Fire N2 & Street) : 1-7l0) (,( k Location: , E � , Sec. _, T_.03' 1 N, R I W, Town of St. Croix Co. , WI. Tax ID N20%-jt4)-j&- Parcel ID N2 #OD House color: Wh;�2 Realty firm: Aln l e- Lock Box Combo: Water sample tap location: /Cj+dm,, S ►&% TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF S FORM Is the dwelling currently occupied? fflYes 0 No If vacant, date last occupied: 2�2� Septic system installed by: n1,)r n*• n-e& ) ,d&A, 2Qer( Ye r:_15��_ Septic tank last serviced by: Da e: Previous Owner's Name(s) : 1 Have any of the following been observed? ❑Y 4N Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. E�ErvEO a ❑Y ) N Sewage discharge to ground surface, c) road ditch or body of water. ❑Y ON Slow drainage from the dwelling. �T ,,ROix ❑Y RN Foul odors. ZONINGOF' � Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE:,�U �� DATE: eel -may_ j1 e u� Cto rw-�0 4J ��L e -� 2� Or OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION N �5 4 D , S 5Y� TO BE COMPLETED BY INSPEPTION AGENCY System design &/or permit on file? es ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd OAt-Grd - Approx. size ' X ❑Gravity ❑Dose Ft.2 ❑Bed ❑Trench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES O ther ❑U known Septic tank Setbacks: ❑House & �lJWel l Prop. line ther Dose tank Setbacks: ❑House ❑Well ❑Prop. a Other OLockin cover Warning label❑Pump/Floats `? ❑Alarmr(, ❑Elec. wiring 2. Soil Absorption System Setbacks: House�Wel�❑Prop. line ❑Other ❑Ponding: it 9k\.P ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY y WISCONSIN ry} ZONING OFFICE l ; �--i-r,.y=` `'•T '�' ' ��'' ST. CROIX COUNTY COURTHOUSE 1101- Carmichael Road • Hudson, WI 54016 (715) 386-4680 July 14, 1993 MidAmerica Bank 600 Second Street Hudson, WI 54016 An inspection of the septic system on the property of Dennis Anderson (now Metzdorf property) , located at 1761 County Road H, Deer Park, WI was conducted on July 14, 1993 . At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, James Thompson Assistant Zoning Administrator mij COMMERCIAL TESTING LABORATORY, INC. r5or14 Main Street, P.O. Box 526 -Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 -,5227 FAX - 715 - 962 - 4030 ST. CROIX COUNTY GOVERNMENT REPORT N04 4;013/01 PAGE 1 CENTER REPORT DATE: 7/19/93 1101 CARMICHAEL ROAD DATE RECEIVED: 7/15/93 HUDSON, WI 54016 ATTN'# THOMAS Co NELSON OWNER'# Dennis Anderson LOCATION: 1761 Co. Hwy H, Deer Park COLLECTOR: Jim Thomson DATE COLLECTED: 7-14-93 TIME COLLECTEM 1'#15pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED'#7-15-93 TIME ANALYZED*42100pm COLIFORM,WCC'# 0 /100 mt INTERPRETATION'# Bacteriologically SAFE NITRATE-N'# 7 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 1 9 LAB TECHNICIAN'# Pam Gana �.\NDEVEIypFNj � WI Approved Lab No. 19 s_ t Means "LESS THAN" Detectable Level Approved by. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 . '77�k- 'I Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. Z,�7— T 24N-R17 w ADDRESS ez ST. CROIX COUNTY, WISCONSIN --,iale / L/�/� �S Si�'I, /- 07- / 6I Cf l�-q j oZC/1� SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHIIIG WITHIN 1 0 FEET OF SYSTEM 0 7S'- 0 i a2 INDICATE NORTH ARROW LL BENCHMARK: Describe the vertical �eference of t used Elevation of vertical reference point: 21642 Proposed slope at site: SEPTIC TANK: Manufacturer Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: 977 Tank Inlet Elevation:--�/,'r/ Tank Outlet Elevation: Number of feet from nearest Road: Front Side,0 Rear, � f e e t From nearest property line Front,0 Side,Rear,O feet Number of feet from: well building: / � ,� _ (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER / Manufacturer: ' t Liquid Capacity: Pump/Siphon Manufacturer: Pump Size Pump Model: �L < Elevation of inlet: / / Bottom of tank elevation: Pump off switch elevation: 5 Gallons per cycle: Alarm Manufacturer: �4�. F_/��ir, ,,�,�.�C,Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear, FtYfia; Number of feet from well: /SS Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM 111;�OaAI7 Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 Pt .�_ Number of feet from well: 1 42 Number of feet from building: /7V (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: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: C Inspector- Dated: (�� / Plumber on job: License Number; � 3/84:mj A ?��V 1,4 V, DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&.HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 t t ❑CONVENTIONAL ❑ALTERNATIVE Slate Plan I.D.Number: Ill—.nedl NG1�,NE�,S10,T31N-R17w []Holding Tank ❑In-Ground Pressure Mound Town o6 Stanton /. Co NAM ERMIT HOLDER ADDRESS OF PER�RE R INSPEC TION DATE Lwfty M-ick.eZson Route REF.PT.ELEV.: CST REF PT.ELE V BENCH MARK(Permanent reterence po 11 DESCRIBE IF DIFFERENT FROM PLAN: . .. Name of Plumber MP/MPRSW No.'. County: E Permit Number: Catvin Poweu J&. 1563 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. PROVIDED DLABEL PROVIDED OVER ❑YES ❑NO DYES -]NO PROP E RTV WELL. BUILDING. VENT TO FHESH BEDDING. VENT DIA.: VENT MAT(. HIGH WATER NUMBER OF ROAD: LINE: IAIR JNLET JALARM FEET FROM DYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MA NUF ACTIIRER WARNING LABEL PROVIDED OVER PROVIDED'. -]YES ❑NO DYES ONO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO EFHESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO NEAREST OCKING SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO OF IDISTR PIPE SPACING COVER NiIUE DIA PITS DEPTIH TRENCHES. MATERIAL' PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH.PIPF DISTR.PIPE DISTH,PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FHESH BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END. PIPES LINE'. AIR INLET FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE PERM ANENT MARKERS ]OBSE.11VA T ION WELLS❑YES ❑NO YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. JE.1E1 ❑YES ❑NO El YES El NO El YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR PIPE UISTHIBUTION PIPE MATEHIA L.&MARKING ELEV.. ELEV.. CIA.. ELEV.. PIPE; DIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE 512E HOLE SPACING. DRILLED COHR ECTLV COVER MATERIAL. PLANS ❑YES ❑NO ❑YES :J NO COMMENTS: PERMANENT MARKERS: OBS7ONO N WELLS'. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE. ❑YES ❑NO NEARE S T Sketch System on Retain in county file for audit. Reverse Side. TITLE SIGNATURE. y Zoning Administtraton I DILHR SBD 6710(R.01/82) SANITARY PERMIT APPLICATION COU TY. TDILHR In accord with ILHR 83.05,Wis.Adm. Code ST4TE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STAT PLAN I.D.NUM'B/E5 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES O PRO ERTY OWNER � �J✓14S PROPERTY LOCATION tx-cads. id) '/a& '/a, S T,3 , N, R 7 f,4oryg PROP/RT NER S MAILING ADDRESS LOT NU BER rBLOCK�WMBER SU�V�N NAME CIT ,STATE ZIP C DE PHONE NUMBER CITY NEAREST jiOAD OR f�DMARK PO TOWN OFO VILLAGE /f / II. TYPE OF BUILDING OR USE SERVED: `/W' Public Number of Bedrooms if 1 or 2 Family OR (S p ecif y) 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. 0 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.�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. ❑ Seepage Bed b. ®seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): NAIAIA Feet 4 Private ❑Joint ❑ Public CAPACITY Site in allons Total #of Prefab. Fiber- Exp VI. TANK Manufacturer's INFORMATION New xisting Gallons Tanks s Name Concrete strructed Steel glass Plastic App. Tanks I Tanks Septic Tank or Holding Tank "- l f" I El Lift Pump Tank/Siphon Chamber 1,16 L1 ❑ El I El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of! private sewage system shown on the attached plans. Pne/s ,me;,r i Plu s gnat e o tamps) MP/MPRSW No.: Business Phone Number: ZI S 3 -cS- 6 Plumbeffi Address)(Stt,City,Sta ,Zip Code. Name of Desig er: VIII. SOIL TEST INFORMATION CerWied qoil Tester T)Name CST# 4"'1 V � C T' DDRESS( reet,City, te,Zip Code) Phone Number: 3 w IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa�7,gry Permit Fee Groundwater Issuin gent Signature(No Stamp lyl Vf rge FeeApproved ❑ Owner Given Initial {��\0 rate / Adverse Determination t CJ I X. COMMENTS/REASONS FOR DISAPPROVAL: I SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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- G- 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 licend pumper whenever 'necessary, usually � ally 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; I1. 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; 111. 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'/s x 11 inches must be submitted to the county. The plans must include the following;A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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. ti 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 Grourid' tei a included the creation of surcharges (fees) for a number of regulated practices which Wisco iri'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaS4lCQ! ° 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. 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, ("spec Ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. er of Property �ar.Y• o�.-� Location of Property _/) k k, Section ! , T_ �N-R�W Township _ S�a,n tan. Mailing Address �O Address of Site D > 1 Subdivision Name , Lot dumber Previous Owner of Property VL air-S-w' Total Slue of Parcel 8 4 r*-*-s Date Parcel wes 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 —=�-L 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 ReRiater of Deeds. In addition, a certified survey, if available, would be helpful so an to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Hap, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i V010 Cow A6y that att S tdtement�s oil .tivi�s ohm ane thue to the but o m hncwCedge; that i (we) am (ahe) .the owneh.(.s¢ 06 the phopehty ducAi.bed6iny.tha � i"401mation 6o4m, by viA-tue 06 a waAAanty deed kecoAded in the 066ice o6 the County RegiAteA 06 Deedsah Document No. / ; and that I (We) awn 11:e proposed site bon .tile sewage. digs 0.5 d s em (0h. I phebemay eduement, to Run with the above ducni.bed pAope&ty, bon .the(con,6tAuction o6esaid system, and the came ha.s been duty hecohded to the 066•lee 06 the County Regia ten. 06 Veed6, ab Doc men.t No. 1 . SICNA Oh OWNER-1-112 SIGNATURE OF CO-OWNER (IF APPLICABLE) e�' ATS SIGNED DATE SIGNED o. 1 0..00K 1. 802 ?A`s'r217 11 DOCUMENT NO. S�' .E BAR OF WISCONSIN FORM 1 THIS SPACE RESERVED FOR RECORDING DATA i, WARRANTY DEED 434143 REGISTER'S OFFICE ST. CROIX CO., WI Jovce Belisle, This Deed, made between ........... ........................h-------------------- ------L.................P........h-------------------- Reed for Record William H. Larson and Lori S. Fischer, ------------------------------------------------------------------------------------ ----------------- as tenants in common- ----- ---------- --------------------------------- Feb. 2. 1988 --------- --------------------------------- ----------------- --- ------------------------------------------------- ---------------------------- --------------- Grantor, at 10:30 AM Ij and.... Larry 0. Plickelson and Laura C. --------------- -------------------------_ ------------------------- ------------------------- Mickelson, husband and wife, as survivor- .............. ---------------------------------------------- --------- ----------------------------------- rp.91ster of Deeds shin marita vropert .......... .................•..•....••... ....... -----------------------, Grantee, ......................................................................... Witnesseth, That the said Grantor, for a valuable consideration_.__.. --------------------------------- ------------------------------------ ............................ ------------- RETURN T conveys to Grantee the following described real estate in _qt_! C.ro.i..x.......... County, State of Wisconsin: Tax Parcel No: ----------------------------------- The West one—half of the Northeast auarter (W 1/2 of NE 1/4) of Section Ten (10).., Township Thirty—one 31) North, Range Seventeen (17) West. TRANSEER $ EED This ..i-s-- -no-t............ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And----—q--------------rantor--------------------- ---------------------------------------------------------------------------------------------------------------- warrants that the title is go od, indefeasible in fee simple and free and clear of encumbrances dXW ii and will warrant and defend the same. Datedthis .............a 0+�'--------------------- day of ---------------January------------------------------------ 19- 8-8-. IIII --------------- -- ---- ------ (SEAL) ... .. SEAL) William H. Larson ce --------_---------------- ......?-.r: M Be: isle ------------------- ........... ............................. ................... --(SEAL) ------------------------------------------- (SEAL) ........... .......... Lori S. Fischer ----------------------------------------------- --------------I---------------------------------------------- ----- AUTHENTICATION ACKNOWLEDGMENT of William H. Larson, STATE OF WISCONSIN Signature(s) ------------------------------------------------------------ Joyce M. Belisle and Lor i S. SS. ----------------------------------------------------------- _County.•authe7t tthis-�. ..day of-___- - ry 88 this _W.......day of nlxy� ..... ..Personally came before me '9 ..... ----------------- 19........ the above named ......•.... -------- ----------------------------------------------------- -------------------------- ------------------------------------- -------------------------------------------------------------------------------- TITLE: -------------------------------------------------------------------------------- (if not, Notarv--Public ------------------ -------------------------------------------------------------------------------- ........... ---------------- authorizwd'by 9 706jq6�.,.V to me known to be the person ------------ who executed the (,I qftn"n!7,il foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY BAKKE, NORliAN & SCHUMACHER, S. C- -------------------------------------------------------------------------------- -------I-20iD---ITer-itpx --------------------------- -------- .... .je- Drive ---------------------------------------- .......... .............. -------------------- Notary Public ..... ------- New..Ri-chimjid'i'M11� =-------------------------------------County, Wis. (Signatures may bQ authen�atod or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) 4 r• date: ---------------------------------------------------------- 19--------- •Names of persons signing ir,f.,.vy eapaij P1,%1d be typed or printed below their signatures. WARRANTY DEED FORM No. I STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. —1982 Milwaukee, Wis. H 'G N r-j a r ST C - 105 r" a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z cy 9 1` H OWNER/BUYER �ckr V1__f ROUTE/BOX NUMBER 1�1� Fire Number CITY/STATE r ZIP—,5•j��o 7 PROPERTY LOCATION:__#k) k, _14, Section�0 T __j' N , R W, Town of 5 St . Croix County , Subdivision Lot number-7 • Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper • What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system., which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration . 0 E •L I/WE, the undersigned , have read the above requirements and agree v, to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- 'b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . \ rO 116- SIGNED V: 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 . ST. CROIX COUNTY WISCONSIN { i � 'f �f-F .S•; 1 '`' }1 ,.^^rJ ,, `... ZONING OFFICE ST.CROIX COUNTY COURTHOUSE ' to 911 FOURTH-STREET • HUDSON,WI 54016 _ - (715)386-4680 June 20, 1988 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Larry Mickelson property located in the NW 1/4 of the NE 1/4 of Section 10, T31N-R17W, Town of Stanton, revealed suitable soils at a depth of 1.65 feet, below which high groundwater was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, -T�Nc)vy c-r) Thomas C. Nelson Zoning Administrator rc PRIVATE SEWAGE SYSTEMS STATE SIONOFSAFETY BUIL BUREAU OF SAFETY A BUILDINGS IMILHR BUREAU OF PLUMBMN¢ 201E.Washington Avenue,Rm 141 PLAN APPROVAL APPLICATION P.O.sox 7868,Madkwh WI 53767 808-266.3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales,202 South Thornton Ave.,P.O.Box 7840,Madison,Wisconsin 53707,Telephone(608)266-3358. 1. PROJECT INFORMATION(Type or print clearly) Revision To Plan Number. Naga of Submitting rt ians returned to same) Project Na"}e ` j Street&No ,,Rural Foute Project Location_Str et&No.or Legal�acrl tIon 1 P JD o y I ,i; 4Q V- ar K.W CityorVillage State Zip City M County 1\tG�vYY�x.+l Village OF. 54. C V`© 8 y W, .SiG3 r Town Telephone No (nclude area code) -51 3'.,.5" Designer Telephone No.(Include area code) Owners Name Telephone No.(Include area code)4 G r+ t^$ /S'-J y` / kA it r Street&No. Street&No. 99.3 � ' Cltyor Village Slate Zip City or�Village S�talto c!� xiP Wt F. Replacement LICATION FOR: New Mound System(3a) O Groundwater Monitorinig(7) onventional System-Public Building(1) Replacement Mound(4a) Holding Tank(2) Pressurized System(4b) ❑System in Fill (1) Petition For Variance(B) New Pressurized System(3b) ❑System in Flood Fringd(1) Other Alternatives(5) 3, FEE COMPUTATIONS(Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank - 50.00 4a. P 3b. 1,501 - 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 - 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 - 9,000 gallon septic tank -100.00 4d. 3e. 9,001'-15,000 gallon septic tank -.150.00 4e. #. Over 15,000 gallon septic tank 250.00 4f. 500 1,000 gallon dose chamber - 30.00 4g. Jo � 1,001- 2,000 gallon dose chamber - 50.00 4h. 2,001 - 4,000 gallon dos8 chamber - 70.00 4i. RECEIVED tr ` 41001 8,000 gallon dose chamber - 90.00 4j. JUN 3 019 $k. 8,001 - 12,000 gallon dose chamber - 110.00 4k. »-.T-.. ). Over 12,000 gallon dose chamber -150.00 41. fJf )JVl" 1 E 3m. 500- 5,000 gallon holding tank - 30.00 4m. 3n, 5,001 -10,000 gallon holding tank - 55.00 4n. _ 3o. Over 10,000 gallon holding tank -100.00 4o. Sp. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. - -- (other than a proposed subdivision) Subtotal Sr. Priority plan review:walk through 4r. Submittal of plans in person, by appointment,with double fee " s. Petition for variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee NOTE:Fees pursuant to Wis.Adm.Code,Chapter Ind.69 may be sub)ect to change annually -OVER 196D-6748(R.8/85) Epaetive July 1,1284 eat s:o STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS .� DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING ;. P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM tooc ikIon: Township/Municipality Nr k S /O IT :5;1 N or)W S �. t et Address: Subdivision: County: "' RAG/!YT?GYt ql j t SC Si rea 1 , n Landowners Name: Mailing Address: g r r k R R r R.r K W1 5-Y00 O 7 - ; ..ai o I (Me) , the undersigned, hereby make application for an alternative-arrstem on the above ad premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I � b agree to have the ,system installed in conformance with the Bureau'a approval > of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into g; use. I` agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have F access to the above described premises at any reasonablp time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or 'by my agent contact the proper county official to arrange the time and date to begin construction of the system. r i I understand that this application does not permit me (the applicant) or m agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes* construction of the alternative system after all necessary permitaA. hairs bean obtained. X #. a, I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the promises are served by an alternative System and further agree to give the buyer a eopy, 4> thi% application. F The Bur e au accepts this application' subject to this understanding and subject to all the conditions and obligations set out in this application. 4 A36 Signat a of Applicant Date STATE OF WISCONSIN RECEIVED Subscribed and sworn to before me SS. JUN 3 01988 COUNTY 0l' S t. Croix OFFICE of DIVISION�N This 21 cwt day o f June 198$ 4 11ot y Publ c, State f Wisconsin Jai licl+ Ann J. Peterson My C(Immission Expires: Feb. 2, 19922_,._ DILHR-SBp-6413 (N. 05/81) { t o (Ok so - 8 8 ST. CROIX CCUINITIf ZONING OFFICE ST.CROIX COUNTY COURT14OUSE FLLU 411 FOURTH STREET r HUDSON,W154016 (715)3%4 June 20, 1988 Division of Safety and Buildings Bureau of Plumbing P. o. sox 7969 Madison, WI 53707' Dear Sir: An on site investigation for the Latiry Mickelson property located in the NW 1/4 of ,the NE 1/4 of Section 10, T31N-R17W, Tow o Stanton, revealed suitable soils at- a depth of 1.65 fe4ti Alow which high groundtmter was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, Phrase feel free to contact this office. t Sincerely, Thomas C. Nelson Zoning Administrator re RECEIVED JUN 3 0.198 9 OFFICE OF DIVISION COP;-:19 AIM �'.""11rkT!04 4w Ep3RT ON SOIL B RING A ` TMENT OF 1I1fE)UtTRY, ` BORINGS AND � �9�i��'fiY$exB�14t7lJ 1_A ENO PRCQLAT`ION TWISTS 15w��srl y REI;ATioNs t P 1. OX 'x$89 f, (1463.0911)&Chapter 148:Q45)" MAd15dN `W1 53107. Y4 SE �� ( OWNSHIP/MU ICIPALITY: OT LK. : SUBDI ION NAME: Y ER'S BUYE A AI D R I 10,BE DATE OBSERVATION�tIWIADE M R PTIQ .i LXTI dance 1 QNew Replace M / r RATING:S=Site suitaWO for system U-Sits unstfltable for system N''I AL MOUND: IN- ND- T -FILL OLDIN TANK:RECOMMENDED SYSTEM:(pptipnall r. U INS ©u as a os cis If Percolation Tests are NOT requite DESIGN- ATE: If any portion of the tested area is in the If s,H63.09(5)(b),indicate: Flo odplain, indicate Floodplain elevation: 4. �r PROFILE DESCRIPTIONS BORING TOT �t� ELEVATION P R N TER-INC E ARA S IL WITH ICKNE. S,C L T X RE,AN DEPTH DEpTI1 OB VE 1 TO BEDROCK IF OBSERVED(WE ABBRV,..ON BACK.) Alo pp / PERCOLATION TESTS 1 TEST DEPTH ATERINHOLE TES .TIME— E LEVEL-INCHES RA`E MINUTES NUMBER fNCH€S AFTER SWELLING INTER AL-MIN, R _ PER INCH P- *AAIC 31b 714 P Ra. PILg1f-' r N: Show locations of percolation tests, sidil borings and ths',dimensions of suitabk9 soil areas. Indicates . ibe at are the ll gIk. y zo i�vertical elevation reference points and show Their location on the plot plan. Shoal the surface elevation borings ahe ire n end peresiat of tend 9Nopa. SYSTEM ELEVATION , t - k l g 1. - _ r E IVE REC s uF�►. ., 'x'a . . . __ , JUN, 95 y _ ._ • _ . or z r t r J. {{ r L- J, I_"undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods spaCified 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. NA ,. rl TESTS W RE COMPLETED ON:' e CERTIFICATION NUMBER: HONE,)YUMB€Rloptionat: C VGNAIU DISTRff1UTION:Original aml ne cony to Local Authority,Property Owner and Soil Tester. )ILHR SBD-633b (R.02/82) —.OVER -. c Palo ,;F4�, ;Y �'�• I ' 41. is w' WQfIKSHEET - MOUND SYSTEM DESIGN leior "aa t, At 1 11 a mw11d $ysteo for a 24 + ' ' t 'T1ie Kite characteristics are: { rr al Depth ,to groundtter or bedrock a lAndsiope % Y Si Percolation rate R. D sta a fOom dolse Ch er-to distribution system f y ' E'1evaLion iffeieltc+eetr and +distribwti s sib " ac # -.T k sr b ' r SIZ "SHE �bRPTION WA Mireo . © ✓�'/ . ��O!f�� f��. 4 �" N xJt ;'' ; i ` +s r .t r } �d al etnc to 'h, #. 0 4: r'I.►1{r. �7 f;f s '}�. �# i #3 j Wv I. '4 2 r7M } .,G gQl,# ` I d9y } r} § {. ^ & k;, ':~ re ' i?1� HE IGAT 'FR t a) t I i aptn (a) x r , B) Fill depth (E) ■ p i` slope (A ) f t• ' E$ed o trench dearth:,,(F) ' D) Ci p ail to soil th G RECEIVES t }� JON 3 01988 t, E P top'soil +dapth (H) s y15101� t' _ ' OFFrICE 0 F Ajin , a � ;f 4 MOUND LENGTH r m A). End slope (K) . p + E) + F + H x 3 ,,, f � �-. Bj Total pound length, (L' g + 2(K) 8 #t*y S. MOUND WIDTH AI) Upslope correction factor A2) �Mpslope width (J). (D + F + G)(3)(factor) Et•�- �`,�" « , 4 awns'i pe correction factor • t = `;l Downslope width (1) * (E {+ ++G)(3)(►actar�1l` t� � ) Total a and widt4,, (Wj for bed, « J + A 41 C2? Ti�talourud w1dtM►. (M) for tronahes « �y < , + (l10 t�r!eMyChes •lc} + + y6 ° ^ : ► b. BAS AREA y� . InfiItrativ cap ity of nat ra soil ur s } joo ;are& to quid *► wastewater flow natu, sail nf' trative cAparcity ■ �` � , 'x , off I vF C1) nasal urea available for bed for sloping sites « C2) B*s ,are avail le for trench for sloping sites ■ rr ft . 5 3X9 3 � ) AI ;�. 4 3 r C3 Basal urea eva�ila le for tre +th or bed for level , . {� v f t xa x ,, 1!21 MAW 41; 4 `� s se1e17 . _ ` 5 DISTRIBUTION SYSTEM � yA) SIZE DISTRIBUTION SYSTEM + ry r: Hole size j HO'�e SpaC#ng • i11. 3) Distribution pipe length +� yi�.Pca 4) Distribution pipe diameter 5) Spacing between distribution pipes .. xef , ; Fy L 6) Distance from sidewall to distribution pipe 4 `, 0) CII5TRI MUTION PIPE DISCIIARGE AAT t. 1) hu06er of hcI'Ies per pipe's .. _' ) F 1qw per pipe • 4 _.�. ..,: GPM 7D. SIZE M .D . 3, I`) Mifold is central/ ..--,�. 4' 3 ) Manifold length,* 3 Number of di*triibution° tines a 4) Manifold dieter {' .. .. 7b SIZE FORCE MAIN x k 1) Minimum dos#fng rate �► r .. ; � frdree may i in 41 emeter ' 3) ricti+an loss . .3r3,�-�- l,l " ^ . � 1. f# r . . 1Da �Go , r J ; 7E} TOTAL, ,,DYNAMIC HEAD 1) Vertical lift . .�,. ft• 2) Friction tots _ REEVE �8 ft. System head 2.5. ft. ��N 3 ft. y.,. c�c 4) Total dynamic bead rp �� ' ft , - r U cer"te 3 tk +•„ i Al t A " r 7 (4/t xk wp r i w 'Aso h ° ELECTION ff b t" } ptrt+p selected will discha rge GPM at ft. otal dyn amti head. 1 d manufacturer YM" +L dz .• t {AO istr bution lines *► 9 ' 1 ;� O times vo l virlw r h 2j lily was r ume . rs,24 hrs. *' r lininu+�-dash` vOliJme • � }}t k `;0'eWY Ate* /*wr ." �/• }} ' V�_ F Gap4 i ty requi tied v NJ *' St lam +1 era ' r$S 3� �^T^"^""^`r' {fir loss RECEIVED % a r i c CO'P I (�lSWM k % I "r A g 'R n �. l s; 3 xa. Sr Irli ± { NI � InITAi lei. �,�.Icl 1�.��ck'-,cSa,�,•9 0�s•.b;U9 s,Et�c�,rc��r-,�..C,t�.c9 AM e�xo ro Av /w o0ex �leL Jo r ,• i As�Y El i 4 } hf } ' RECEIVID M. JUN 3 0 ON .e Fi ��°re ". Papa 00 All,cie'elAp w, Marsh Hay, Or Synthetic Covering . Medium Sand Distribution Pipe H - �G Topsoil sx� �.= _==:=.s,..�,.�, __ F 3 t E 0 Force Main % Slope Trench 0# -2 Plowed -Aggregate Loyer Undisturbed D Ft. Sail E 7 Ft. R Cross Section Of A Mound System Using F AT Ft. 2 Trenches For The Absorption Area G' / Ft. A 3 Ft. H /,,9-_ Ft. B Ft Signed: C z41, 9' Ft:. License Number: L 1'2 _3 .�.._.,_. K - s -"Ft. Date: 7 Ft. Ft. Alternate Position of Force Main zml 5,3 K r Ca U" Force" W Observation "`� Permanent Main Pipes Markers -- -- -- -�---- - -- --:' w Distribution Trench Of 2 — 2 � �VEID f Pipe Aggregate .JON 01988 pf�ic� Mound Using 3 Trenches For Absorption Area y � of :A... s � 'err► w 'rrr►r MM rrrrr W W Syr►r► rrrrrr�►rr _ ►►rrr~� � t 5' Ri Ilk b e� U IA CZ4:�., ti .. .� J;CEIVE J0 3' 01988 a w OFFICE OF DIVISION . ' Cn Afln A0"!IfiAT!6N. , � R � d` ��� ��,�t n rr ..�,,.:;,� A � y� ii 1, .y u � ,.. �. .. � /c , !Nib -� .... . �1�.: fi wd Efi . $g a r PAg 3M C . : •rfgrated PI Jun VIOW, End c4 P pvt Pipd Sep- J � . ` v u Y it . Nal�• t 1 `x } x S k� Bg4AliY pf1d • t s , RECEIVED �- i PVC force mew JUN 3 0198 P PVC 7 E4 AR"! r!1�1�M , "# )POa,itaa Pitt, - .- �'�- _ 016trip1Ilon° - Alternate 1�,piitipn Of { farce Mqn 1 +� ..�l1 {I Td CHOP Fy+ E 940 c ict►ibufion Pipd.. Lop y ., .. ......, .,, _ p lk t � r hr ; '" X In li y SM Inches signed: ' �„ Hole Diameter Inch .!crease NOmber Lateral tt Inch(i� ) ,..,...,,_ a.. . Manifold " S Inche), - ! R' Main, .......__ _ # of holes/p#pe; t� Invert Elevation of Lateral d N f 41 ao + RAP. ��•' ^3t' ej a J PAGE 9 PIJMP�CF ►,MBER CROSS SECTION AND $PECIFIGATIOkIS jeeff '(C.I. VENT PIPC ZS' FROM DOOR, WEATHER PROOF APPROVED LOCKING JUQCTION 9OX MANHOLE COVER WINDOW OR FRESH II!"MILI. AIR. INTAKE ' GRADE I 'i"M11J. CONDUIT- `,. _ 71 8"MItJ. ---------- ; itJt�ET .. 4,rwx PR OVIQ f '" EAL w t APURO'JED JOINT A S t + c., I I APPRO� .101Aty3 w ' W/C.i. PIPC E6; , r� s I I M W/c. . P PE XTCNDMJO 3' I I (( ALARM 0*4TO 541.10 $C':. ° _r�' ,'��� ( I ONTO 30Lip fi0$ . OIJ ' I f ' -r:pUMP-� - Off ' CONCRETE BLOCK RISER EXIT PERMITtED ONL4 IF TANK MANUFACTURCR HAS SUCH APPROVAL. _CC FICATIOWS U 24 61v 6crriE AND NKS MANUFACTURER: NUMBER OF DOSES: PER PAS TAAIK ;,IZE: f/x GALLOWS, DOSE VOLUME y ALARM MANUFACTURER: �S�J /��Arf�w ccicfi 9 1%/e INCLUV!!:;. vinCI FLOW: lK GALLONS, ,,,�/ MODEL MUMBEK: CAPACITIES: A= �7 IWCHCS OR .-lrb�.�GALLONS SWITCH TYPE: B= INCH91,0A CALLOUS UMP MANUFACTURER:._ a C= /G _IAILHES OR LLpkjs , MODEL NUMBER,. �, 5�NUMBER,. , hl+ MI' D=-Z_INCHES OR 6ALLONfi,r `y SWITCH TYPE: ' A TE:. PUMP AMD ALARM ARE TO BE PUMP DISCHAR4E KATL .,� PtA /S� INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCt Dilr-Owera1 PUMP OFF AND Dh$TRIBUTIOM PIPE.. III- FEET RECEIVED {► MIAIIMUM NETWORK SUPPLY PR�E�S�SJURT,E,�. . . . . . . 2.5 FEET , 1 FEET OF FORCE MAIN X _,�CaLZ._F/pp JUN o A9� ftFRICT1o1.1 FACTOR.. FEET t --- OFFICE OF 01VISION TOTAL OtIMAMIC HEAD = a Y' �J FEET clor!0 Ate 1!t� I_!P,Afi!ON ,AITERIJAL QIMEIJSIOIJ Qf TAiJK: LEKIGTH -;WIDTH .��..�LIQUID DP6PTH $IGA3E C% LICEMSE NUMBER DATE: A �2A -117- rp 30o".7rl able E ftflu nt P;1,,`.'1-�� ! lA WY /�,�/ S ��- t� i,pit c4:✓ 1 f -a4` )• .y` ; _ r, rf' N _o° 100 � 'cr 1� v gMgt -• fA' y.,j e; "` r t' e 3 40 t El p MA L i VIII v1 M.P. bk 20 Q1 r f 7 f' Yr �aM „ H P OrON NO. Vottf PhMN Amps ar,r t WPO311E 115 94 xk°5 WPM0311E 1t50 ?,. wPO312E : "1 y: 4 j:': sa WPM0312E t WPH051IE t -189 t . RECEI h _ At • a WPW632E 208!130 34 JUN 3 O 177 Q9AA wPH0534E 490 90 WPH071;E 230 1♦ WPFW732E 2 /M 54'_ OFFICE OF DIVISION WPM734E " 4!00 • 2.t To CC1�r C ltA)tt "'lCAT1tIN WPNtOt2E 20. lid 116 9460 ..' 1 w 11032E 2obl w" 3* ..... .. WPH1034E yf60 3.2 '+ WPHIS12E tf�,.t3� WPH 1532E 2CB + 4.6 r }{rt 1 M1 y{fPHt534E Y a'/ • wPHH15129 2;w 1p 13,1` ` WPNH153 206/2. f" 3< 9E SPE ifICATtONS MiE U8J CT fT t,+ State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION ���� 201 E.Washington Avenue July LU, l acs :' P.O.Box 7969 Madison,Wisconsin 53707 0000 Larry U. i icf el son Route I cA Go Deer Pan,, VA �4UU/ 6-1 "Petition itiU. Dear i(r. 6ici(el son: Re: Larry U. Hickelson - Residence Private Sewage System lown of Stanton, St. Croix CGUntj, II Section ! .L4 ( i ) , A scorisi n Statutes, anti s. i:ai scunsi n Administrative Co6e, al i o.r file 01,-,r,e r to pet'i ti ulr for a variance to the installation for, a. private se6(.i-e systei;i to t,er i ace an existing private se4lage system, dt a site eviliCh is not in full cur,ipiialicy bditta the siting stancar6s in the adriii ni strati ve rule. l ne sJ stet( desi S ri proposeu should protect the waters of tale stale frotr�i contaralna000. i' this systeri uecoraes a failing syster,i or• contar.,i hates tt& raat(:r•s of ilije state, this variance shall be r`scinceu. Ttie petition for a variance requester to s. ll-hk 61.L t1 ) ( u) of the Wis. jLJ ( re Petition ,as been Adi Code eras considered on Jul l J, conui ti onal ly dppr uveu. The conch ti on bci n�, that i ri tsie evert of failure, tare Houli(j sy ster;; dial l Le replaced aced v i tlh a iial di nc< tat-IK or other off-101" system. Tile rule requires ti`at a ouuna sys terir iiavL W rai ni,iur: of L4 inches of sui tatil e natural soil . The vat,i arice requesteo was to install a rep i acetier,t il;aund system) on a site wito `U inche:�> of suitdule natural soil . All of tire: data and sta towerits suiaia1 tteu uri i>e+ra i f ui the petitioner were consi(,iereo. This s variance is specific to tore subject petition anG cannot be used for any auditiunal iriodifieatiuns. Sinwr"ely, ii hard i ieyer, Arch,i tect; Director, Gfficc-, of Division Coles and Application (uUu) 2w-:3UbU k1k:PEP: i14 ,i cc: Leroy Jurisq, Private Sewdv e Consultant - ;is`tr°i( t: 0, kiiippewu Falls Thoi,,las Ilea sun, Zoning Adi,-Ii ni strator - St. Croix County Calvin Posers, Jr. , Pl ut,oer `- SBD-8928(R.10/87) ., State of Wisconsin ` Department of Industry, Labor and Human Relations PR'TvA1V PI, {1111 PrIp,<1,Al SAFETY&BUILDINGS DIVISION RF: PLa'!i7 IEA{R1#�t '` 08 02460 (i 1 (C,l f�'. ;',P{..l��it +,.ie `�ik; �.3<:,i�� .; :-: ' � t.;: ti! �. ,. ,. ,• .,.. �., ...r Li i�+ . }"'t'. ,{i ,3"s--�i !.ti.?.' i{, ir; , 'r ;�'_, I;i{! ,lt: i , ,• i i{t ,, , ,aF i ."�{ } •�'�� r I.17 I t t' t-., � 1 It+, , ( .. .. f{{ I t��.{-. t . I i I if SBD-6423(R.10/87) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION 'j f J, it SBD-6423(R.10/87) ----------------- ------------- ---------