HomeMy WebLinkAbout012-1062-90-000
0 (n o 3 v 0 b r_
O d f c O CD `+1
T d m rn ^
to
O
co o N U) o rn Nom, o m° `c•
? m c Q = W N rti
In Q Z E CD ai -4 CD °
w C 3 p Co j V N C
C-D 2)
n
L7. = (A N p
C) Q 7 CT CD (D W O O
C) c fD CD
O D
;1 0
3 =r f o0
~ ' p L7
w
CD cn co
W W Q°
3 Q O O -
W '
° r N rn
co co CA
~ CO W O
n O C
N N ~ 3 O'
z o o o
Z
o W~ * *z'I
0 41
a
IC N N N F O
O O Zl
O m C^D N n (D
I =r
CD CD 3 N !V
y 7
C7 L
N m
N
z
z W z c
CD 0
v ° D a :3 o
p v 'I
o. (D m
m
c /yam
CD m
N
M.
V y
c CD CD
w CD a
i n 3 ~
Z CD -i (n
c p z CD
O p
C1
N
1
c ~
CL A Z =
(n I N
W CO
fD m C)
III
0 z
9 a
O Z
Y V
y z
CD A
41
D s D
p n
c.
a
C NCD CD 0'
.
N
-n
C
3
N ry 7
Z n
O p x o
7 N W CD
7 a j N
I (D ~ Cp
O = N ~7
I
N 7
= co 3
O Cn 0 D
v (D
a
3 CD a O
3 a
C 7L
s
CD
CD o s tv
O CD ~y k o
N_ vo
CD S- r
i p ~
w
CD
o m v a
o~
I
nco)o 3'on d
cn z 7y o linr II c n 3
W (D n c ° p !D 'D
A v A~ •
G $ 7~ rt .o •7 c C
(D rt CD
W W N rt 3 I ~ M I r~~ O
cC
ri n 13
O 2 z ° N v I 2 v, z ° g m cNC•
Z a y v Z a W a' G
W y D) y 7. * N r.(
'.7 v U) W
rt N. rt p 0) w 7 O Wl' (b
(D 1-1 1.3
O
N• rt N• rn cD 7 D 7 ° °
W N * C 1 bi W w j
0) CA (n
U) D eo a 1 m 0 a s coo
~ N
CD CO (n
W sp
o y
CD CL
00
I 3 O N l~
ON CD, W I c0
CD co OD O9 1 O QWj Ul O N C
N N N Zr 1 Cr
co (D z ~i
J c w N N% I Q) N to (A v
1 _ CD e~D 3 CD 3 t~
` °
3 d a l m 3 a
V N.
G a N
t z W Z Z CD 0 0 O
O D a OM o f p D a m
S (A J m cn c3 j N•
y c°D cn M
ri 2 ° ° 2 c
~ CD
co ~f
N• C 11)
C (D CL O.
W fD
7 6 J
Z ? (6
1 7 1 A Z A
O N O N C_
C] C!1 Z ~cti m a A C°
N tU rro cn -1 N
w oo W e
G (D
rt 0 0 a~ Z
N• H C A .Z7
o z ° 3
F- ON (3 y Z y
ON
W
o) H a
• In H
(D
s D ? oni a N
~
m a ~ 5i a ~
, c to
n m = v
w
c ° - o
m
d N C (DD N N 3 .'I
t-+ (D ~ CD Z a x o o a
rt pO~. O y
fzi ~ \O 7 N N.. N
CL 5*
00
Ln O N 70
C t0
0) 7 O (D v,
0. -U N trJ H V]~o I pNt
F+. O dOy S~ V
G Z m CD
ON :V4 0
K a
° s
a
W v 0) (D o t~j~~• N
d K E (D (a
CD S w
N
N. Fj rn co
x N c°n CD CD 0 0
v
G IG O ti
i w
CD CD
ti
v~ O
40
o ` b
CD CD
Parcel 012-1062-90-000 01/12/2007 09:58 AM
PAGE 1 OF 1
Alt. Parcel M 29.30.17.438 012 - TOWN OF ERIN PRAIRIE
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 - SCHOTTLER FAMILY LTD PARTNERSHIP
SCHOTTLER FAMILY LTD PARTNERSHIP
1374 CTY RD I
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1361 160TH ST !9
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 29 T30N R1 7W 40 AC SW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/24/2006 817042 QC
04/21/1998 577683 1317/017 WD
04/21/1998 577682 1317/016 WD
04/21/1998 577679 1317/011 TI
more...
2006 SUMMARY Bill M Fair Market Value: Assessed with:
156177 Use Value Assessment
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 29.000 5,700 5,700 NO 05
100 NO
UNDEVELOPED G5 1.000 100 0
OTHER G7 10.000 58,000
456,900 14,900 NO
Totals for 2006:
General Property 40.000 63,800 456,900 520,700
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 63,600 456,900 520,500
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
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
/ TOWNSHIP .Er, Phi i'o SEC. T 30 N-R 17 W
OWNER ~rlliyi- slC//1
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE7'
top,
PLAN VIEW Sr
Distances and dimensions to meet requirements of I1HR 83
a r
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM'S
04
1
GCS rPQB \
Cx ,"sf: nq
/oc~a o / Z0 fkus~
os j
sep , c 7prnP 1/0,
i
a'QO 90/ ~ a
Ial
I- loe
venf
INDICATE NORTH ARROW
25l L /do-
11, ProP
BENCHMARK: Describe the vertical reference point used
t p.tee .4:e-e SGtJ. eF'2sys~
Elevation of vertical reference point: /GYJ~d Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: /000I?al
Number of rings used: . 'k Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side, Rear, O ZP-_.5' feet
From nearest property line Front 10 Side 10 Rear,0 /GID t feet
Number of feet from: well 1/20 building: /-1".1
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE A
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: 33 Pump/Siphon Manufacturer: Pump Size Y3 Z110
Elevation of inlet: Bottom of tank elevation:
2 0
Pump off switch elevation: Gallons per cycle: 1Z a
Alarm Manufacturer: o41,9,pm p!q-7t Alarm Switch Type: ,-C ar-7V
Number of feet from nearest property line: Front, Q Side, Rear, 0 Ft A;&")
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: /`e_,5' Trench:
Width: Len the 7 3 Number of Lines: Area Built: /s/Iq 4
Fill depth to top of pipe: 10eF
Number of feet from nearest property line: Front,` O Side, ® Rear,O Ft
Number of feet from well: 20
Number of feet from building: ~/S
(Include distances on plot plan).
SEEPAGE PIT
ter:
Size: Number of t Ate
Liquid depth: Bo om of ee agvatio
n:
Area Built:
Has either a drop box O or di ibuti box een u d on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: C aAbot Number of rings used: E eva 'on f of tank:
Elevation of inlet:
Number of feet from nearefffeet rop oline. Fro , O Side, ORear, OFt.
Number m well
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
X1Dated: .5 -30 d L, Plumber on job: ~jle . LIIY~~I~
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX ?9f9 BUREAU OF PLUMBING
MADISON, WI 5307
gkONVENTIONAL ❑ALTERNATIVE State Plan I.D. Numbers
~ (
El Holding Tank ❑ In-Ground Pressure ❑ Mound
i
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A E:
Arthur Doberstein R. R. 1, Box 183C, New Richmond, WI 54017 no _ .0
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV. CST REF. PT. ELEV..
SW NW, Section 29, T30N-R17W, Town of Erin Prairie
Name of Plumber 7-17nN,.CountySanitary Permit NumberDale E. Hudson 629 St. Croix 69665
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER
ED ` : PROVIDED
• Gj q 7 c~ PROV
w ZI ~Q,( 00 Gf ES ❑NO ❑YES O
BEDDING: EVENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPER WELL BUILDING. VENT TO RESH
ALARM . FEET FROM uNE~O 1 3 ® l AIR IMy,~
0
❑YES jNO C ❑YES ❑NO NEAREST U II
-
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
W IDED: PROVIDED:
CISf1JL YES ❑NO I b0 C) 33 1-~ ~orxC' P YES ❑NO YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUI DING: I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE(/~/V //o ~y AI OT
PUMP ON AND OFF) ` alp L...U YES ❑NO NEAREST ~/Cy /
SOIL ABSORPTION SYSTEM. Check the soil moisture at he depth of plowing [%(,Til JDIAMETER MATERIAL AND MARKING
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:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID
BED/TRENCH 1 TRENCHES M Riau PIT DEPTH
DIMENSIONS
GRAVEL V_I1 .1 FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DIS R. NUMBER OF PROPERTY WELL. BUILDING: VENTTO FRESH
BELOW PIPES: t! ABOVE COVER. ELEV. INLET EL V. END: PIPES. LIN AIR INLET:
1 ZZ Z? FEET FROM C
NEAREST I/
l _ wJ Q
Y~ (y
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM CFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA
meets the criteriJ a for medium sand. TIONS MEASURED.
❑YES ❑NO ~
SOIL COVER TEXTURE I PERMANENT MARKERS JOBSERVATION WELLS
1cr ❑YES ❑NO ❑YES E
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED .DEPTH OF TOP OIL. ` SO D: SEEDED. JMULCI~13
CENTER. EDGES: 11
❑YES ❑NO ❑YES ❑NO [:]YES-. ❑NO
f Of
PRESSURIZED DISTRIBUTION SYSTEM:
'.VDTH. LENGTH: NO.OF LATERA S IN : GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COV
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND 3EV.: ELEV.: CIA.. ELEV.. PIPES. DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTIC RRESPO STO APPROVED
PLANS. ~ U
❑YES ❑NO E: Y ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
ET FROM LINE:
❑YES ❑NO ❑YES ❑NO AREST
1s so
It` y7~--
Sketch System on{1 0 Ret county file for audit~P
Reverse Side. p
SIGNATURE: TITLE: _
°Gl Q
DILHR SBD 6710 (R.01/82)
wr-ca„sin APPLICATION FOR SANITARY PERMIT
® ILHR COUNTY
(PLB 67)
oeaaRTrrMnroF UNIFORM SANITARY PERMIT
wKWSyavLFWPR6"UmRnROLATton5 / 9
-Attach complete plans in accord with s. H 53.05, Wis. Adm. Code for the system, on paper not less than 81/2x11 inches in size.
See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
f ca - b 1x7 X64, / err
PROPERTY LOCAT10N
LC~1 4 /4. S T30 N, R 7 11 (or TOWN OF: r^i n
LO N,UMIBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE 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
Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
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 Far As Soil Conditions.
Total #of Prefab:" " Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity fSr
Lift Pump Tank/Siphon Chamber ~Q
Holding Tank capacity
Manufacturer: S
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of of ; Site Steel Fiberglass Plastic
Gallons Tanks An ate strutted
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
'TllJ 112,5 11-3-4 ❑ Private X 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:
Plumber's Address`. Name of Designer:
v r' S~4
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
S yn'~~ j?~QS' ❑ Owner Given Initial
/,'d A I'lill (
?Z,22j , / o i7 Approved Adverse Determination
L
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
PAGE OF
PWMP CHAMBER CROSS SECTIOM AND SrEQFlCATjQN§
VEMT CAP
4%.i. VEAIT 'PIPE APPROVED LOCKIAIG
WEATHER PKOOF
MANHOLE COVER
2.5' FRGM DOOR, .fLIAILTIOAI BOX
i' WIUDOW OR F'RVSN I~"MI~I• I
AIR IuTAKE
(.BRA DE
4y MIM.
I
18"MfAt. ~
PROVIDE I _
IAIt f T AIR'T'IGH'T' SEAL, I I
APPK0'jE D JOIMT A APPROVED JOIN
W/C.I. PIPE CO .1tO I I,) I W/CI. PIPE
EXTEUD11JG 3''
EIITENDlW& 3' ~tc,Ivro ALARM
QAJTG SULI❑ ,GAL , dl/ I OMTO SOLID SQI
one
PUMP OFF
Q
COUCRETE BLOC,K
RISER EXIT PERMI-FED OWLy IF TAUX MAKIUFACTURr.V, HAS SJUCH APPROVAL
_APE CI F I CTI
Sj..IAVIC AMP
TAM KS MANUFACTUR F-K' Gl/G/S~ S OUMBER OF POSES: / PER DA4
TANK ;,IZE : GALLOIJS DOSE VOLUME:_,,~4 GALLOMS
A-LgK!N MAkIUFAC-TUR.JI r y2 &ALL.OMS
aK CAPACITIES: A~ IIJCHES OR ±
MOVi;L ►IUN1R'sER: _ 2000-~ Z IkICHESOR GALLOUS
5WITCH TyPC: ~,/r/~~° Gl/✓_ y_,__-.~.s C= -INCHES QR CALLOUS
PUMP MAMLIFACTURLK Q= IMCHES OR a GALLOUS
M(UUEL AIUM5fL: -570,33' WQTE PUMP AWE) ALARM ARE TO BE
~e~ r P INSTALLED ON SEPARATE CIRCUITS
RUMP DISC HAR.(xE, RATE J~ GPM
VERTICAL. DIFFERF-MCE BETWELAj PUMP OFF AMD 013TRIbUTIOM PIPE'. FEET
+ MIMIMUM METWORK SUPPI.9 PRESSURE FLET
FEET OF FORCE MAIN X X,, tFRICTIQiJ FACTQt~.,FEET
TOTAL 09UAMIC. HEAP FEET
IA1TETtI+JAt_ DIMEWSIOWb, Of TAI.1K; LEWC7TH iWIDTI^I _.,...'d ...jL.IQIIID DEPTH ` /
7pe ?eol
51GUEDc L ICEAISE AJUMBER P~61,:129 FATE: 99~ t1~~~
~71/
/1Gf~ 1~c~b~y' sfe~'✓~
HYDRw0w RTIC H•82
PUMPS
y 28
24
11' (J
819
86 r 20
®~~lcs z 16
~s
=12 S
J
H 8
4
SUBMERSIBLE 0 5 10 15
20 25 30 36 40 46
U.S. GALLONS PER MINUTE
SUMP Head-Capacity: SV25 and SV33 Submersible Sump Pumps
Max. Solids V4" Sphere; 4 Pole, 60 Hz
PUMPS
28
24
1'~ G v~'SC 0 } 20
QQ// a 18
~O ~OCP ~ 12
J
w 8
O
4
0 10 20 30 40 50 60
U.S. GALLONS PER MINUTE
Head-Capacity: SP33 and SP25 Submersible Sump Pumps
Max. Solids SP33, 9/4" & SP25, Y4" Spheres; 115 Volts, 80 Hs.,1750 RPM
140
i
120
100y~
HIGH HEAD
EFFLUENT ; 4 60 O 40
PUMPS ~ 20
9 20 40 00_ 80 100._ 120 140
U.S. GALLONS PER MINUTE
Head-Capacity: SP50H, SP100H and SKH150 High Head Effluent Pumps
Max. Solids SP50H, SP100H & SKH150,1/4"Spheres;
115 Volts, 60 Hz., 3450 RPM
NOT
5 W-1- Nay
1,30 At 17a)
K'Pe40,144d P*pe
tP r 4f
~ 6 fit. n C7 4 d P Q i+' ~
8 9 33r . oo ~p
ram -%;n
~t:Ya'G ~ ~ CI ~ S ! OHO C?7'
or n e, r
I3/►? c
M
s
a
m
10
32
-
6rR
D.^ ~a r1 Ley : ~9 fOro
Da,& .
Iz - r+ 7T
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 /4 r771- 1 _ / o
Location of Property SGtJ It N4) 14, Section T 30 N - R 1 7 W
Township ; f'~
Mailing Address,
/1/~~ rnor s yo f 7
Subdivision Name IV14
Lot Number 11114 `
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 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. arranty 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) ceAti.6y that att eta.tement A on this 6on.m aAe tAu.e to the beA t o6 my (oun)
knowledge; that I (we) am (alte) the owneA (b) o6 the pnopen t y deb cu bed in .th iA
in6oAmati.on 6oAm, by v.iAtu.e o6 a wamanty deed %econded in the 06jice o6 the
,,-County RegiA teA o j Veedb a6 Document No. Z 5 and that 1 (we)
p4e6entty own the pnopoaed -6 to 6on the dewagr e~ZCC'apoat eyatem (o& I (we) have
obtained an easement, to nun with the above de6cAibed pnopenty, 6on the
cona.tn.uct on o6 ba.id dyb.tem, and the name hab been duty tecotded in the 066.tce
o6 the County Re9iA teA o6 Deeds, ab Document No. )
7L
SIGN TU OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE IGNED DATE SIGNED
• H
C/)
a
STC - 105 r"
• r
_ a
SEPTIC TANK MAINTENANCE AGREEMENT ry-~
0
St. Croix County z
d
OWNER/BUYER Le,. a
S .~ii7
ROUTE/BOX NUMBER ge,)e Fire Number
CITY/STATE zv Ifl C /nD~1 DC/ir. ZIP -5'y'O/7
PROPERTY LOCATION:,j(~ k, IVA)-14, Section T30 N, R /7 W,
Town of St. Croix County,
Subdivision Lot number.
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. ,A
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- 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.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 96-.
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
;:rye
a~ w rn s:V . •w
E o c
0. 0 0 ohs .o '
s
C O N 0 i (n 0 C O 0 m
(D c
N M 0
w..
C M N '0 '0 0 -
LU ocOVr-0 3ov
3 0 o a 0 v E c n~
Ix N ayi C 0)
i N 'b
0 v, O O w
4) 0)"o 0
U =m~°'~c t4)
1
W ~CDVaiN ooE D
a~ ; 0
IL w N
N 3rnvty ~
cv
~ co ` (D
3 0r ) " 3 4) o E " (Dr
Z C , F- cC N C cv
f-y o
U) - c~DOatc ~ vio ;
O 3ooa,o~.
cc o ~ C) cc= " 0 0
O ~Q 0 m
OZ 0) a jS o>
Q aaoa`o cc (D c
w rn - 0 ~ c
c O~ o" 0 0 o
C c° 0 0 co co
c
03ca>.0 rnZc
Nr-=:3 0..-E
D cc C L o ~O ~0
O C L
O c~ O " N r- c
o
cvj ~Ofi..
co 0 N 0 0 o ( E V L- ob)
nj , - - = co
v cco 4Co a) ) 0 3 ~ e
_ 0) C« OD M i U 0 O
T- 3 U) r 0
a H
0... 010 a dt0a I
fn L- L- z
a. a i O ao
O EN (A v)~ F-:: 3 m
CO~'-y-Oc Do~3 o A :3 :3 co N
« N
W c
O J
H G
LAp3UR AND
HUMAN RELATIONS PERCOLATION TESTS (115
707
LO A SON: SECTION: ('H63.0'9(1) & Chapter 145.045) MADISON, PO•ISON, WI BOX 53707
"N 7
J~~~,Ul% 2n 1T /1~ TOWNSHfRf114~{{ }S}p,a~{I~y:
7p7Q (or , P LOT NpBill Np: SUBDIVISION NAME:
COUNTY: OWNER'S BUYER'S NAME:
MAILING ADDRESS:
USE / ~O~e~s Biy'
NO. BEDRMS, : COMMER AL DESCRIPTIO DATES OBSERVATIONS MADE
Residence PROFIL DESCRIP IONS: PER
❑New Replace O ATION TESTS:
RATING: S- Site suitable forsystem
CONVENTIONAL: MOUND: U- Site unsuitable for system
!0S ❑u El S ®U IN-GR~OUIS U V[1p®SSURE: SY~STEM_IN~i_FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
StJ 0SOU 7
If Percolation Tests are NOT required
under s.H63.09(5)(b), indicate: DESIGN RATE:
/v If any portion of the tested area is in the
1171 Floodplain, indicate Floodplain elevation:
BORING TOTAL PROFILE DESCRIPTIONS
NUMBER DEPTH 4taV, ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
OBSERVED EST. IGHEST TO BEpROCK IF OBSERVED (SEE ABBRV. O
B` j , IOO•o~ / 11
B, 5 9 9,33
'
B-3 ?P,39
o
B_ c ' 3 l
C ~
B'
B'
PERCOLATION TESTS
TESL DEPTH WATER IN HOLE
NUMBER AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES
P_ PE IOD 1 PlEll PER RATE MINUTES
PER INCH
Aell -5,
P-
P-
LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the Ill
)ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings s and land slope.
g and the direction and percent
cent
►YSTEM ELEVATION 9c_
_ I
1 .
t
i
I ~ 1 I
i
i
f f
1 i
i ~ 1 I
i <
I_
i
i
E i i ~ i I f
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 Code, and that the data
recorded and the location of the tests are correct to the best of my knowledge and belief
sconsin
AME (print): -
/Lo TESTS WERE COMPLETED ON:
-
CERTIFICATION NUMBER: PHONE NUMBER (optional)
12 -3e7l
CST SI ATURE:
116UT10N: Original and one
copy to Local Authority, Property Owner and Soil Tester.
S B D-6395 I R. 02/82) OVER
-
1
- Alo
Z f
s; fie
aali
S 10-4' N6J,
3 'l Per 'a r-a~`~ c P, P e
41
o e o> o~ a ti c a o to n tO /`xz/f l0 q
9 00
pomp
00
c or nd r..
Ad -.CJe .
npts I3c>7ck Mark
tares /4°~+~
3 ~ f
Ta .1 Raol Area
~xx
moo,:*"•~ ~T3! n
I6 Fx
~ --4 BAl
e9l
p ,
Al N
a.
cf-
PAGE OF
PUMP t HAMBIR-.ROSS SECTiM AND SPE FICATIQU
J w
-VELDT CAP
4%,l. VENT PIPE WEATHER PROOF APPROVED k-OCKING
2t z5 FROM DUOR JUNCTIOM BOX h11AtMHOLE COVER
,
WINDOW OR FRUSH 12"I"11U.
AIR INTAKE
GRADE 1
COWDUIT-
IB"MIN. -
INLET PROVIDE 1
AIRTIGHT SEAL.
APPRO`JED JOINT A I I APPROVED JOWTS
W/C.I. PIPE _ I! W/C.I. PIPE
E:XTENpIF1G 3' ~ ~
OUTO SOLID :GlI- ALARM EXTEN0ILJG 3'
8 ONTO SOLID SOIL•
~ I
! OIJ
- 1
PUMP--.-,
OFF
D
COMCRETE BLOCK
RISER EXIT PERMITTED Gld+ _4 IF TAMK MANUFACTURER HAS SUCH APPROVAL,.
SPEGIFICATIUIjS ,
SEPTIC AND f/
DOSE TAAIKS MA"UFACTURER' ~ 'y° n -S KRIMBFR OF DOSES: / PER DAy
TA"K `vIZE. ; SVO GALLONS DOSE YOLUME: GALLOMS
AL ARIA MAWLIFAGTUR6Ri _ 441a
CAPACITIES: A=-'325IMCNES OR & '_Z5GALL01JS
MODEL kJUtAbER: , •C OOH - 6•= q2~ ..rIMCHES OR GALLOWS
SWITCH TYPE: /YC c_ C-le _ C« INCHES OR ~ 75GALLOMS
PUMP MANLIFACTURE R: 0, (4 D- ZZ j JCHES OR 2041 GALLOIJS
MODFL NUMBER'. > .388-7~w '
C1T PUMP AND ALARM ARE TO BE
N' 1,
SWITCH TYPE:: _ INSTALLED OLI SEPARATE CIRCUITS
PUMP DISCHARGE RATE. GPM
VERTICAL DIFFERENCE BFTWEE;IJ PUMP OFF AND DISTRIQUTIOM PIPE...,~.v FEET
+ MIAJIMUM NETWORK SUPPL.y P,R~t„S,$URE . . . • . . ; FLET
+ L-!~ FEET OF FORCE; MAIN X `.~.F%cFTFKICTIOkI F,AC-FOR..`'ICY F9ET
TOTAL_ 0tJMAMIC, HEAD FEET
an ewe 7• p ' , „
IMTERNAL. DIMEMSIOAIS OF TAWK: LENGTH ;WIDTH ~..;,.;LIQUID DEPTH ~ /
SIC~A1Eb. ~k_ICE:AISE IJUMBER DATE:
Submersible
-Sew~ e Pumps MODEL 387
g SIZE WS03-WS10
RPM 1750/3500
METERS FEET IMP VARIOUS
60
16 50
l yA
14 ' Wsr
O 12 40
Hp a
10 w~
30 Hp _ eF
- - - -
O 8 HpsQT'B 8, ~8
6 20 W ~F S N
eri
i Np 1 "s
W
4 tea, BF s
1
2-
0 0
0 20 40 60 80 100 120 140 160 180 GPM
~ ~ 1 I (
0 10 20 30 40 W/h
CAPACITY
[QGOULDS PUMPS, INC.
59NECA FALLS WW YM (3148
1
AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP
.~r ®'f2 r-orZ' SEC•.,<-VT 3~1N-R//2W
ADDRESS X`''~ soST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT ~A LOT SIZE ,W
PLAN VIEW
Distances and dimensions to meet requirements of H63
yF.RYTHING WITHIN 100 FEET OF SYSTEM
1-4L) I0
6 C- .
O
9
L--1
-00
IV I
zo
q
s'
L
I di a e o th A ro
SC L, :
BENCHMARK: (Permanent reference Point) Describe: h7 free /i/I6
Elevation of vertical reference point:,/d , 0' Slope at site: 3"77
SEPTIC TANK: Manufacturer: Zc~ e es- Liquid Capacity: / ao (1 -a/
Number of rings on cover : &onif Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
yc e gallons; tots capacity o
Number of gal. pump set or a cycle-
distribution lines gallon: size of pump head;
gallon per minute horsepower ran name of pump
and model number
Type of warning ev ce
HOLDING TANK: Manufacturer_ Number of gallons
Elevation of manhole cover
Type of warning device-
SEEPAGE PIT SIZE: Number o pits feet diameter
feet liquid depth seepage pit in et pipe-elevation
bottom of seepage per: evat on feet.
lines- /-width iS" length fL,tile depth,2
SEEPAGE BED SIZE: number of
SEEPAGE TRENCH: width length
PERCOLATION RATE . /:E REqUTTffD-/.-V,,,,e,;0,d- AREA AS ;O BUILT /26 p
INSPECTOR
_
DATED PLUMBER ON JOB
LICENSE NUMBER ~S8 3
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR `SAF gy. -u L9,
LABOR & H17M'AN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
E] Holding Tank El In-Ground Pressure ❑ Mound Ilt assigned)
i
NAME PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: .6 -
BENCH MARK (Permanent reference point) DESCRIBE IF IFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.:
Na
m
f
lumben MP/MPRSW No.. County: Sanitary Permit Numben~
SEPTIC TANK/HOLDING TANK: (t
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
/ ~ & DYES ONO DYES ONO
BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY JWELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
DYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER jB INEGIQUID C ACIPUMP DELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDED: PROVIDEDYS ❑ DYES ONO OYES ONO
ROPERTV WELL BUILDING) VENT TO FRESH
GALLONS PER CYCLE: Pu P AND CONTROLS OPERATIONAL: NUMBER OF
, 1 J
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST.]
SOIL ABSORPTION SYSTEMrol. heck We sod m istu at the depth of plowing FORCE ",TH 1-METER MATERIAL AND MARKING
or excavation. (If soil can be led 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 NSIDE DIA.-.# TVEN UID
BED/TRENCH TREK ES MATIL$j6L: PIT TH:
DIMENSIONS
H-11 U1Yi M FILL DEPTH D STH. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. NUMBER OF PROPERTY WELL BUILDINTO FRESH
BELOWPIPES ABOVE COVERELEVINLET ELEV. ENDPIPE : FEET FROM LINENLET
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-
meets the criteria for medium sand. TIONS MEASURED.
DYES NO
SOIL COVER. TEXTURE. PERMANENT MARKEHS. JOBSERVATION WELLS.
DYES ONO DYES ONO
DEPTH OVER TRENCH'BED ID EPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED.
CENTER EDGES.
DYES ONO DYES ONO DYES ONO
PRESSURIZED_ DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH k. LENGTH. TRENF ES: LATERALSPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER:
DIMENSIONS I S. S ~0 sj
MANIFOLD PUMP MANI LD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV. DIA. ELEV. PIPES: DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
_ DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: UN" BER OF PROPERTY WELL: BUILDING:
FEET FROM (LINE:
DYES ONO OYES ONO NEAREST--~
w~c 3
3
S3
5 5
Sketch System on Retain in county file for audit.
Reverse Side.
GNATURE. TITLE
DILHR SBD 6710 (R. 01/82)
1'
DEPARTMENT OF APPLICATION >
SAFETY & BUIL
INDUSTRY; FOR SANITARY DIVlslo
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 $7) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An.index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner,,: Mailing Address:
II ~tv/e o e~eS~ei~J ew /4mowC/
Property Location: City, Village r T sh" County:
.;5w'/4 /VCAfi/aS Ig7 /T30 NiR 17 Ev (or ER;,) PR 4diele, oS-A• dR.6ix
Lot Number: Blk No.: Subdivision Name: KI/ Nearest Road, Lake or Landmark: State Plan I.D. Number:
EIIRI P~ /Et.J e~. (If assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. e/
TOTAL NUMBER PREFAB POURED-IN STEEL NEW NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY 00 O -1 e X X
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: eA) Ks C,
R
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental ® Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ❑ Seepage Trench
r er Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
t, Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for inst tion of the private sewage system shown on the attached plans.
Name of Plumber: SW nature: MP/MPRSW No.: Phone Number:
V~° e f~ ~oL q/~ 505~~9 (7i5>loS~ 33
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signat a of Issui Agent: Fee: D/ate:APpROVED Sanit~jary Permit Number:
LJ DISAPPROVED O(,
R ason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81)
T OF REPORT ON SOIL BORINGS AND DINGS
INDUSTRY, ,
LABOR AND PERCOLATION TESTS (115) 5969
HUMAN RELATIONS J(a~/ 07
co 1 J
LOCATION: SEnCTION: Q
W Q00
TOWNSHIP/ ITY: LOT NO.:BLK. NO.: S IVISI -CU R ti; OFFS "'b
COUNTY- OWNER'S BUYER'S ME: MAILING ADDRESS:
USE r G /'17 0 N ~ ~
DATES OBSERVATIONS ' u
NO. BEDRMS.: COMMERCIAL DESCRIPTION: NS: E LA TI N TESTS:
X~R
F_ 0 V_ esidence New ❑Replace AS _
RATING: S= Site suitable for system U= Site unsuitable for system `P 6
INS[JU ONVENTIONAL: MOUND: N-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional)
as 7 os®u os u asZu
F rcolation Tests are NOT required DESIGN RATE: SYSTEM If any portion of the lot is in the
r s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
~Z It
qQ /
B- ry
B-3 7,2 97, B- /s 7;2~ . > C. L , !r J G ~G SG C '50
rr
B- '7A- ?627 a14" 5c, C - J_Z
9- ~W- , ' tr " tj[h4C4TION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH
P n 2 Z
P- /V0 f 51*
P- O 41
P- c
P_
PLAN VIEW: 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 elevd Pn at all borings and the direction and percent
of land slop.
SYSTE ELEVATION a sloe&
.
d !St
UP,
r
e..
x
~Q
IL e A0
e. 4
P1
170 A * .
C "'61"t
O FAR l~ a / s a30 > 9 9• _ Ca:R
8 9?1 '83
,a
164
57
o ~,5 a
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
,
ADDRESS:/ / CERTIFICATION NUMBER: PHONE NUMBER optional):
/cJ ~~.q~W t.v r W r S Eu
t7 K CST S RE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
40 • , ,
Q ~ l
c, r4
?;'nom
Qp-
l® c
II
t R1 & N i A i
Lm 'o, 11
-"3 -Z -0
-G -Z
O h Q N, C
O ~ " rA 1
oRf