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010-1053-10-100
n N O 3'o n t7 `~1 --I z 0 m 0 2 0 o w 3 w o ~1• N o o w N w o h••i C}'~, O` C z a y N m v ° 3 CD W a m cn C 1 CID 0) N CL 0 y v w w °o r ro 7 n < N O1 -u a) 0 C4 CA a W O cn td v m 0 0O C7 d (7 CID a Q b = a W o a N n O o00 d W CID O j m 0 Fj- d m c~ (D 10 r (D n r vi O C y V' V' N co !T Q n (D N) M IV -0 z 000 (D Ij 00 H rt w nCA CA o ~y `may a ? 3 O c' rn hh rn :3 co vi !~i a v 03 00 CD - t~ N 7 ~ C, Ci t~v M rn oz 0. O L-n D D O O O ~ m a• u, o w Z tli Ul Z Z c Oro d O ~ ~ I w m' CD x t~ (D Q ((DD !rat 0 A Z F4 G) O N a z N ao•o mww w z CL A ° 0 Z rn H m ~ v C,) I CID (a 0 CL CID a~ a ao 3 0 v a o a cQ Cf) CD CL o m < m CD ~l 0 0 CID nc fD y 7 I 3 o m m A S S O 2 A ccn < 0) y O 0 0 N 00 cb 00) O d q b A CD °a O °o 0 Parcel 010-1053-10-100 01/05/2006 03:58 PM PAGE 7 OF 1 Alt. Parcel 23.30.16.332B 010 - TOWN OF EMERALD 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 - MORTEL, THOMAS L & R RENEE THOMAS L & R RENEE MORTEL 2595 CTY RD G EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2595 CTY RD G SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 5.990 Plat: N/A-NOT AVAILABLE SEC 23 T30N R17W NE NE LOT 1 OF C.S.M. Block/Condo Bldg: 6/1576 ALSO THE S 300' OF N 550' OF E 290' AS IN 730/482 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 906/128 07/23/1997 730/482 2005 SUMMARY Bill Fair Market Value: Assessed with: 80356 207,800 Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.990 30,000 161,000 191,000 NO Totals for 2005: General Property 5.990 30,000 161,000 191,000 Woodland 0.000 0 0 Totals for 2004: General Property 5.990 30,000 161,000 191,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 156 Specials; User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 30.00 Special Assessments Special Charges Delinquent har Cges Total 30.00 0.00 0.00 Parcel 010-1053-10-000 01/05/2006 03:58 PM PAGE 1 OF 1 Alt. Parcel 23.30.16.332A 010 - TOWN OF EMERALD 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 - MORTEL, THOMAS L & R RENEE THOMAS L & R RENEE MORTEL 2595 CTY RD G EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 34.010 Plat: N/A-NOT AVAILABLE SEC 23 T30N R1 6W 34A NE NE EXC CSM Block/Condo Bldg: 6/1576 ALSO EXC THE S 300' OF N 550' OF E 290' AS IN 730/482 (GERALD C SMITH, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) GORDON L SMITH, ROBERT DRAXLER & JOSEPH 23-30N-16W DRAXLER, AS EQUAL TENANTS IN COMMON) Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1242/156 WD 07/23/1997 830/96 07/23/1997 730/482 07/23/1997 661/614 2005 SUMMARY Bill Fair Market Value: Assessed with: 80355 Use Value Assessment Valuations: Last Changed: 07/29/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 30.250 4,900 0 4,900 NO UNDEVELOPED G5 0.750 100 0 100 NO AGRICULTURAL FOREST G5M 3.010 1,500 0 1,500 NO Totals for 2005: General Property 34.010 6,500 0 6,500 Woodland 0.000 0 0 Totals for 2004: General Property 34.010 8,000 0 8,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 010-1053-40-000 01/05/2006 03:58 PM PAGE 1 OF 1 Alt. Parcel 23.30.16.335 010 - TOWN OF EMERALD 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 - MORTEL, THOMAS L & R RENEE THOMAS L & R RENEE MORTEL 2595 CTY RD G EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 23 T30N R16W 40A SE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1242/156 WD 07/23/1997 830/96 07/23/1997 661/614 07/23/1997 420/572 2005 SUMMARY Bill Fair Market Value: Assessed with: 80360 Use Value Assessment Valuations: Last Changed: 07/29/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.000 5,400 0 5,400 NO AGRICULTURAL FOREST G5M 5.000 2,500 0 2,500 NO Totals for 2005: General Property 40.000 7,900 0 7,900 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 10,400 0 10,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DILHR Wisconsin Department of Industry, Leroy Jansky P.S.C. 7,- , 13 E. Spruce Street Labor and Human Relations Chip?cwa Falls, WI 54729 Safety A Buildings Division (715) 723-£3736 Bureau 'of Plumbing u Name of Premises Date Plan I.D. No. 4/30/86 85 03987 OW eb/Location County Sanitary Permit # NE NE 23, 30, 16W EMERALD ST. CROIX 69632 Master Plumber & Firm Name Address DALE.. }IUDSON ROUTE 1 BOX 141 A EMERALD WI 54012 Journeyman Plumber/Soil Tester Address Owner Address DAVID CRAMER (formally) Psewage system audit inspection as per the requirements of s. 145.20 (3)(b), Wisconsin Statutes. The following code discrepancies were noted: 1. ILHR 83.15(2)(h), Wis. Adm. Code. Manhole covers. All above-grade manholes shall be provided with an effective locking device which shall be a padlock. No locking device was observed to be in place at the time of this inspection. A padlock shall be installed. The plumber is hereby directed to correct the above-referenced code violation within 20 business days of the date of this report and shall contact this inspector when corrections have been completed. If there are any questions regarding this report, please contact this inspector. Discussed with Signature ( )See Attached. A Ca" SBD-6192 (R. 01/85) Signature of Plumbing Consults Priv ate Ar- swag sultant Lt'. CoLAti-Z'~ L Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Dove Cnr:,,-j?E,^ TOWNSHIP SEC._ T ,SD N-R W ADDRESS f 2 X ~~ll ST. CROIX COUNTY, WISCONSIN SUBDIVISION AIX LOT X LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IL.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~f I !70' I U I Vent I I /✓ousC I I NO. 6 r X45 t~ o v~° INDICATE NORTH ARROW s-~e m BENCHMARK: Describe the vertical reference point used T w C ~ T Elevation of vertical reference point: Proposed slope at site: 7o SEPTIC TANK: Manufacturer: Liquid Capacity: I0z00 / Number of rings used: ve Tank manhole cover elevation: D / Tank Inlet Elevation: 90.0' Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Q Rear, O / /70 feet .From nearest property line Front,O Side,O Rear, 0 /C?0 7- feet Number of feet from: well 95 ~ , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 9. PUMP CHAMBER Manufacturer: Liquid Capacity: 4U/ i Pump Model: SP SO Pump/Siphon Manufacturer: /ro Pump Size y~ i Elevation of inlet: e?f, (o/ 7 Bottom of tank elevation: 041 'Z5 i Pump off switch elevation: Gallons per cycle: .20.9 Alarm Manufacturer: /p,n~7 Alarm Switch Type: Number of feet from nearest property line: Front, O Side, Rear, 0 Ft. Number of feet from well: /.ZO Number of feet from building: 50 (Include distances on plot plan). SOIL ABSORPTIO1N/ SYSTEM Bed: y~°$ Trench: ~ 17 Width: Length: -~t'71 Number of Lines:_ Area Built: ;7&/ Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, ® Rear,O A. Number of feet from well: /17~ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: D ameter: Liquid depth: Bottom of e` ge elevation: Area Built: Has either a drop box O or distribu ion ox be 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 properli o l ty , O Side, O Rear, OFt. Number of feet from el Number of feet from b di g: Number of.feet from neare t ro d Alarm Manufacturer: Inspector: Dated: /d Plumber on job: License Number: ,V10 6~-~ 7 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑ CONVENTIONAL ALTERNATIVE State Plan I.D. Number IIf assigned) E:1 Holding Tank ❑ In-Ground Pressure ~ Mound 8503987 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dave Cramer RR#3, Box 268, Beaver Dam, WI 53916 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV. CST REF. PT. ELEV. WE NE Section 23, T30N-R16W, Town of Emerald Name of Plumber: IMP/MPRSW No.. County Samtary Permit Number. Dale E. Hudson 6629 St. Croix 69632 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER Q _ © ® PROVIDED PROVIDED Q0.0s t7~rC) ®YES LINO ❑YES ONO BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY W : J BUIL DING. VENT TO FRESH ~J ALARM FEET FROM I LINE AIR INLET ❑YES Vt]NO 1 ❑YES XNO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY JPUMP MODEL PUMP; SIPHON MANUF ACTUHEH WARNING LABEL LOCKING COVER + PROVIDED: PROVIDED: ❑YES NNO a'ra(na j L EYES LINO IIRYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTV WELL JBUILDING JVENTTOFRESH (DIFFERENCE BETWEEN O 2 FEET FROM LINE S 1. / 2 S O AI 4,NNLET.: PUMP ON AND OFF) $6YES LINO INEAREST--i J~C SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I , 1H jiAMI rEH MATE RInL AND MARKING; or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN 4 the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH IND. JI TH P SPACING, COVER INSIDE DIA -PITS LIQUID BED/TRENCH rR NC;ES MATERIAL PIT DEPTH DIMENSIONS i` ' A'v'EL DCPT14 FILL DEPTH UI SrH PIP" D I S T H / PA PE 1 R. PF MATERIAL NO DISTR NUMBER OF PROPERTY WELL. eUILDING: VENT TO FRESH Jt ~4 BELOW PIPES ABOVE COVER EI EV. INLF I ELEV U PIPES FEET FROM LINE AIR INLET. .NEAREST► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE ADIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PFHMnNtNrnanHKFRS oBSEHVnnoNWE LLs YES LINO YES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BE 1) DEPTH OF TOPSOIL JSODDF 1) SEEDED ULCHED CENTER EDGES , ❑YES. NO YES LINO 1M,9YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO. OF LATERAL SPACING IGHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS (j a s MANIF LD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NJD PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV DIA ELEVPIPES DA. ELEVATION AND 85"2s /o37s / t~ d DISTRIBUTION D to INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS J( YES LINO _ DYES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING: FEET FROM LINE. ~yS JS YES NO YES LINO NEAREST- sketch system on Alfl-in county file for audit. Reverse Side. SIGNAT TITLE DILHR SBD 6710 (R. 01/82) now:r..11111111 wisconsin APPLICATION FOR SANITARY PERMIT L✓IeV'~'SL(PLB 67) COUNTY ILHR wee oEVCararmenr of tnousrav,taeoc~sr~umanres~rigns UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MA IN ADDRE h PROPER LOCATION a b e r iowk 1/4 1/4, S , T,3f? N, (Dr~ TOinr~ of LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER S 0 3 cl?/7 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FORA: ❑ New System ❑ Tank Replacement ❑ Repair 5d Replacement ❑ Revision ❑ Privy 9 Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank EJ System-In-Fill ❑ in-.Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Fir As So' Cond' ons. Total #of Pr ab. , Site Gallo Steel Fiberglass Plastic Gallons Tanks C Crete nstructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer. IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: X Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 00 .0 X Lift Pump/Siphon Chamber 970 Manufacturer`. ,--n PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 75' Private . ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: rPh;one Number: I~. l7f 1:'JF•I ?tea... ? 17 4t" s., .o ~lo ` /5 Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signa ur of Issuing Agent: Fee: Date: ❑ Disapproved Approved ❑ Owner Given Initial Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber - ' i ( y p vin/. ~ S r P-7 V I t a f, 83 21 ale f~ r~ yy O. . d O O. N j E_ ,o U r i:~r:w<'"V L D rno C o o 4) L v O y, C L O U m d O H V N E L L (AL r 3 C~ L Ul C7>~ 0 0-0 co C co O R! C (D 3 °a = v E U L L (o N m _C ~ ' L rr Q _OS- U Sul O c a C co 0)'o G V N ti L N O _w c m W ~cctsm vai o E o~ d V) 3 03 U _ "c`o c M a W 0 csi0 3 aL icy F-• c CD w o C Q y r O O E U O 39 0 0- 0 0) U) c W- C 4) w 3 O 30~~;-o U (M .0 co L c -0 0 CL _ U U o = L U M.- - O 0 U) p p~ Q O O N (a L. (7 Q L 7 Oet~ N~ C 0-aLco N 'o cc c C O d L O C G? O co R1 .0 c 0.0 0 E ~ o CMZ E m c= M ter- E 1 O- C C C O C C O co o m O o L- (a 0) cm GOO N m OL V O O U.. ¢Y ~t Dw ( L rn _Jo a) 0QAw co co co oY o O m 3 y C C V OO U O 0 cm a\D F 3v, y. 3o 00 CL a to oa ~ccoa) a)~a a~r cm c o~ (a ~C cLo c`o o E Z g foss La E O co el 0 0 0) a) cm c o > > y c a~ a~ 3 ° OEaNN~c coq F0 3 m° 7 y a = H _J O ~r wiscons-■~ APPLICATION FOR SANITARY PERMIT . ~ ILHR (PLB 67) COUNTY ww~ oEwaartn6nTOC UNIFORM SANITARY PERMIT # InOUSTR4'.LRBOR 6 HUMRn RELRTIOnS -Attach complete plans in accord with s. 'H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/ax 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER - MAILING ADDRESS PROPERTY LOCATION ^CTTP`. 1/4 1/4, S , T30, N, R it (DOG TOWN OF: - a LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK r E PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair 56 Replacement Soil Absorption System ❑ Revision ❑ Privy 9 Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-ln-Fill ❑ In-Ground Pressure ❑ Vault Privy ELI Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Fir As S ' Cond' ons. 1)4 1 Total $!`of Pr lab . Site Steel Fiberglass Plastic Gallons Tanks C Crete 0or C nstructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK:J Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber' J Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch)`. REQUIRED (Square Feet): PROPOSED (Square Feet): _/r0 375 '37(_11' ® Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number. ? 1(7 Y3 7 Plumber's Address: Name of Designer. COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber tv - idc t x 9, o 1 Ga;l~'nR f f r f Septic, f Pu rep ?a ViK 1 ' 1 't.7 R f t 1 i Hot; 5 if, 1 1 ~ qo lie 245 Bv 83 ~Q e a -ale BI t { Sec COUP/ s Not 1 > yy> L s 1 .00 ~ d ` ~C3 i 1 1 1 NQ?t i S f /014 .1 tYI` f 3 r /0 far 'I loq- /4'~ sr1,'c, r r 9-G Y f l4q ,►ent 3-7'f.'~3 ~e 4 ? 'e. / stole; _ Department of Indulatry, GROUNDWATER Safety & Buildings Division Labor and--Human Relations RING P.O. Box 7969 Bureau of Plumbing MONITORING Madison, Wisconsin 53707 EPQR Noto: Show ` the In inches. Location: Lot No. B1oA No, DEPTH F OM SURF CE TO WATER/NONE A/1`k F 14623 /T 30 N/R/ N(or W AIA NA OBSERVATION WELL WELL WELL WELL Township/bWa , • DATE # 2 # 3 01 County: Ownox s Name-.' ,3- _,?S ^24 n ,0 I? : hc' 2 ?4v L q ` Di7L' orlC' I~~DYO~ Mailing Address: y 3-,2h8`-gs e "flo'ge o rre WELLUMBER: / Z a# cf " " F5 (5'' N'01ge _5'9..' A~ 'n ' 7 WELL !(/On DEPTH: Co ~O 3"'o U~ D I• PROPOSED I D -TT IT- SUBDIVISION LOT 41`11-95 an,e AAr2e Rainfall Data Obtained From: ~ Y5 71'1 ,t''~,,~~ °7 ~ 1 M a oC Iota ct e, s, 6,94c ;-v, t.J~s `C " /UDI irk. , MONTHLY DATA -_Z4 Y5 Sept Oct Nov' Dec Jan Feb Totai(8.51') 11-2 S"8J! 70 2 70 75 . 93 2.5'9 ./Pz ' Aj~ T!O 2. A~e Not) March' April May Total (Need 7,6n) s 5 r? E? e d4/~rt' ,2,W , yG 3.0/ 8.35 S 16 e) 17 Provide daily rainfall data on a separate sheet for March, April And May. .11 ' W-11 Write total rainfall for Marcb, April and May In the above boxe- r.7 ARTIFICIAL DRAINAGE - -lC7r0 r7~ Alc> Check the site for artificial drainage. If the site is affected by such - drainage, submit complete details for the drainage system. Indiciate wh 5-Z3-r5 p will be responsible for maintenance of the drainage system. CHICK ONE; No artificial drainage Iafotmation regarding artifici al drainage 3 O S Na f ,Y) affecting this site. affleeting this site is attached. ?Y'('. ;!D Attach a SaD-6395(115) or S81?-6309 (;i a proposed subdivision), for soil information and estimated depth to high groundwater using mottling. Subm# 2 copies of the Groundwater Monitoring Report to the Bureau of Plumbing, P.O. Box 7969, Madison, W1 53707 and submit 1 copy to the local authority. INpj jj.j LOS-Provide a diagram showing accurate locations and surface. elevations of all monitoring wells. SU DIVISI(N-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 Iocation of tests reported on this form are correct to the best of my knowledge and belief. Date: CST o: na u DILHR SBD-6412 (N. OS/81) ,-,Zj-fS" 13 g 'I 11 6 O n m D On SL WO N N r A ao P Z _ 1Nn P W N O ,a 0 V P P N m N C 'o ° ...DA U e p. O M _ N ~ TE 't b e y -C o Y e+s M x rnn A m d 3 a a m Di o 'a G 11 n W to m M o o A 34.ft.. Z O ° 4- Li zF7m a T N- rt e ti ' o° °a o + _ swi,. (ha r, w Roin, melted N >r i~,e{ D~ 0 D% and hand-dlhs) 2 mm P~ , 30 D y, - - - - - - - - - - - - Snow, Ice pellets 0 AO i -'r hail (Ina. end Z OZ ; (r Om l FL D 7-1 "evielesel-11-i-teselp Snow, iu pellets hall, ' eon o T m _ _ _ _ _ _ _ raundc (b ? A _ P f m m r r - - - - - - - - - - - - - n n ! - + - - - - - - - - - - ~ - - - - - Roo r*t m A - - - - - - - - - - - - - - - 3 30 _o C) -I o _ - - - - - - _ - - - - - - - - - _ l z z 8 A Y' - - - - - - - - _ - - - - _ - - - o > o z Z r 10 - - o ° 'U g i r- _ - - _ _ - - - - - - - - _ - _ - S N 1 I F 3 B Ll 1 W m m a T , U Fog g ~ n < I e - s•n- N 0 m P I. y -4 er . - - Ice Pellets Q S z v Gln:.~ . cr E z Th-d v -m - :Thunder MaJ Roil R e W"ds I ~ Damaging ~ ~ m Winds 9 Time of observation if ` Q - different from above _ CONDITION ? 1 > mC m D y a ; 0 ;U TENDENCY m z 1 Z z I I ..r. -ee z i 3 z '^V m Y > t o o ~ o Is C) r v s M r1Di 1` D o' Q ~y, ~ ~ o A Qi n , m N m 171 > P < > N' > > Y zz Z r- ~ ~h my > a i m 1 ~r O n C+ D f1 s(, N W. N Y ~ N N N p 1, o m a y N N O Z r V U u N ~ d V m V P U A N G P U A e a'o c o t m y DATE ur m D D 3 a m m 1 , D m = -1 e c Z < JFy. 01~. ry ~!+rl, M!'* i~1 r 3 -I A m O 9 { m '3b "qs. 'i u r id Z Z 41 -i o r r e n -D O C D m ' O m G) m M O m A " Cu < x ci T m ~J o o a0 T ^ * Z S n m ~ +t R^on, melted N G1m a7 " w, etc. lms. 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BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township A"'Kk%KM9A NE ?4 NF !4 S 23 T 30 N/R 16 V W Emenaid St. ftoix Street Address: Subdivision: County: Landowners Name: Mailing Address: David Cname)L R. R. 1, Emeha.ed, W1 54012 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's 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 use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable 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. I understand that this application does not permit me (the applicant) or my 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 permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations aec t in this arNlication. r Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: WISCONSIN DEPARTMENT OF INDUSTRY, LA13OR AND HUMAN RELATIONS DIVISION OF SAFETY 6 BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. C&Oix Location NE 1/4, NE 1/4, Sec. 23 T 30 N, R16 XW(Xxx W Town d~~(lkd(r KKiCIX~C EmeAo-ed Street Address Lot No. Block Subdivision Landowner's Name: David Crca.meh The application for this site is for: ❑ new construction use. 0 replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Hto have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota nurn ers ssuec-to you.) ]one of the applications needing a quota number. The quota number assigned to this application is - - L__ifor one additional homesite on it farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [..-Ifor an individual lot for which it sanitary permit was issued but was later ruled unsuitable due'to new or changed soil criteria established by the department. I for an application on file prior to February 1,.1980. I__Ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Ma failing conventional soil ahsorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private 'sewage system, check here. L_1 I certify that the above information is true and accurate to the best of III knowledce. Name Thoma6 C. Netzon Signature County Official Title A6si6tant Zoning Administ a-ton Date Apnit 2, 1984 DILHR-SBD-6158 ;R 12182) H H Y 'y ST C- 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d a OWNER/BUYER -a✓,A/~p~ ROUTE/BOX NUMBER/c. 3~(30Xa~~ Fire Number CITY/STATE 15f-a ve~ 41) 6) Lr 39/6 ZIP PROPERTY LOCATION:_~'k, IVZ k, Section 23 T30 N, R _W, Town ofa St. Croix County, Subdivision &X Lot number-A Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this.program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 'w H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- u 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. SIGNED DATE - nc ~y St. Croix County Zoning Office P.O. Box 98• Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT 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/contractQr.,("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 Location of Property -NZ-- ~4 Av~34, Section , T30 N - R Z_ W Township ~L'n y.Q Mailing Address & -3,13t, alt 13-e0(1-1rr s0a),4.tu-T -5,3940 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel 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 _ Syr 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. PROPERTY OWNER CERTIFICATION I (We) ce4ti6y that a t btatements on this 4o4m ate tAue to the best o6 my (out) know. edge; that I (we) am (ate) the owner (,s) o6 the p4o petty des et ibed in -ih iz injo4mati,on {ohm, by vi tue ob a wa4Aanty deed hecoAded in the 06~ice o6 the County Registeh o6 Deeds as Document No. and that I (we) plies entt y own the pho po.s ed site doh the sewage poz a. sy6 tem (on 1 (we) have obtained an easement, to tun with the above descA.ibed phope&ty, 6oh the con.6t .uction o6 .said aystem, and the same has been duty neco)Lded in the 066,ice of the County Regi6teA o6 Deeds, as Document No. SIGNATURE OF OWNER SIGN441 E OF CO-OWNER IF PLICABLE) DATE SIGNED DATE SIGNED ^ Safety and Buildings Division DILHR PLAN APPROVAL Bureau of Plumbing P.O Box 7%9 a .A a ❑ General Plumbing Plans Madison, WI 53707 91 Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY 4g Plan Identification No. k, Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review Petition for Modifi(ation Project Name Project Location - Street No. or Legal Description ii C:< - Ir !1 t-ti' k`.1E < d~f ,rr C E .•'~/'t_: ~Yt= C. .J -~i !i County ❑ City ❑ Village KI Town of: ! a r r ka ! / c The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. X1 FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: i James Sargent 7 Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: ~E] OWS ❑ DPS ❑ H&R & Rec. San. Section -10 County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other State-of ' Wisconsin ` Department of Industry, Labor and Human Relations August 6, 1985 SAFETY & BUILDINGS DIVISION Bureau of Plumbing 201 East Washington Avenue P10. Box 7969 Madison, Wisconsin 53707 III. Dale Hudson 820 plain Baldwin, W1 54002 Plan Identification No. 85-03987-t Dear Kr. Hudson: Re: David Cramer Groundwater Monitoring KE*NE,23,30,15W Torn of Eserald, St. Croix County, WI Groundwater monitoring data submitted in accord with section ILHR 83.09 (7) {a}, Wisconsin Administrative Code. has bow reviewed. Approval is hereby granted to allow the installation of a mound system. This approval is for the depth to gmwtdwaterr only and does not include review of the design and size of system. All other criteria in chapter ILHR 83, his. Ads. Code, crust be not prig to Issuance of the sanitary permit by the local authority. No Installation can begin before issuance of that permit. This latter in no way relinquish" the use of soil mottling to determine the depth to high groundwater on any other parcel or any other portion of the parcel than that described herein. In granting this arpprmval, the Division of Safety and Buildings does not hold itself liable for any a ination oversight, construction or my damW that may result in or art astallation and reserves the right to order changes or additions should conditions arise making this necessary. This ap"al shall remain valid unless the site is altered in such a way that the depth to groundwater would chaff, or unless water is ever present within the critical depth for system operation for at least seven consecutive days. DILHR-SBD-6423 (N. 04/81) j State of Wisconsin ` Department of Industry, Labor an, Human Relations Mr. Dale Hudson SAFETY & BUILDINGS DIVISION Page August 5, 1985 In the event that this approval creates liquid waste problems at ground level or if any other operational or maintenance problem occur, the provisions necessary to resolve these problem stall be commenced upon receipt of approval by this department. Sincerely, Edmund M. D rozd, CP!Sr Soil Scientist Section of Private Sewage END=1378v cc: Lamy Jansky, Private Sewage Consultant - District 6. Chippewa Falls Harold C. Barber, Zoning Administrator - St. Croix County David Cramer, Owner DILHR-SBD-6423 (N. 04/81) SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) 16 STATE OF WISCONSIN DILHR betach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence 6 P.O. BOX 7969 MADISON, WI 53707 q 608-288-3815 DATE: tJ~ 214 Ju.a 1~1 PROJECT: 0 2 ® ~9.5a Lr, !at`ta'r, UdV 1 fi - jlr" i »e'rt I}'ri Z - Tn Euiera 1 d 6dl pit Lfl; it, Croix ~ i L:20 Mdln c;a1i ir., sN 54, PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. ` `It; Preliminary review indicates the required fee is $ i 12, Fee Received is $ 0 Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment-Refund forthcoming. Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information Verification to Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). { data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. SBD 667.8 (R. W83) (Plb 100a) (Wis Stats. S. 145.02) `STATE OF WISCONSIN DILHR Detach-And " etur"pper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 7 P 201 E. WASHINGTON AVE. RM 141 Any Return Correspond P.O. BOX 7969 dG e, 0 MADISON, W153707 608-286-3875 DATE: O r~I19Ca PROJECT: 07/08/€S5 r. 8s Cramer, David - Pro./CORK. 7/17/85 NE,kE,23,30,16id Tn Emerald Dane Hudson St. Croix W1 820 Main Baldwin, W1 54002 PLAN ID. # 85-03987 m DETACH HERE PROJECT NAME Cramr, David - Pro./CORN. 7/17/85 PLAN ID. # 85-03987 m This is to acknoudedge receipt of your plans and specations for the above-indicated project. Preliminary review indicates the required fee is $ 32-00 Fee Received is $ 32.00 Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans;will be held in abeyance. ❑ Plans being returned. ❑ Overpayment,-Refund forthcoming: ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan: Submission ❑ Soil boring and percolation test data on 115 completed Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county; owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. ; Holding Tanks private sewage system to buildings, lot lines; well, water- ❑ Holding.tankprofile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete. vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local ll. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). Application forUse of an Alternative System signed by owner ❑ Reason for insta8ing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on county onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). , Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. Ground slope with T contours in entire area of soil absorption ❑ Detail and model of, pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system.- provide soil ❑ Gross section of dosing tank showing pump(s) or siphon (s). data. ❑ Construction details of septic, holding or dose tank if site VI. S tems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. Total area filled (fill to extend 20' beyond edge ❑ Construction details -and cross section of soil absorption ` of.trench before side slopes begin.) system: ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff.