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Home My WebLink About004-1053-80-000 s Parcel #: 004-1053-80-050 12/20/2007 10:01 AM ` PAGE 1 OF 1 Alt. Parcel #: 23.28.15360A 004 - TOWN OF CADY 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 0 - JENSEN, BERNICE TR BERNICE TR JENSEN 293 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description ' 293 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 35.000 Plat: N/A -NOT AVAILABLE SEC 23 T28N R15W PT NW NW EXP CSM Block/Condo Bldg: 17 -4471 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 28N -15W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 12/23/2003 749871 2479/329 QC 12/23/2003 749870 2479/328 QC 02/26/2003 711283 17/4471 CSM 02/07/2003 7087370 2134/319 POA more... 2007 SUMMARY Bill M Fair Market Value: Assessed with: 198073 Use Value Assessment Valuations: Last Changed: 04/09/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 78,300 106,300 NO AGRICULTURAL G4 28.000 4,300 0 4,300 NO UNDEVELOPED G5 5.000 2,100 0 2,100 NO Totals for 2007: General Property 35.000 34,400 78,300 112,700 Woodland 0.000 0 0 Totals for 2006: General Property 35.000 34,200 78,300 112,500 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: 04/17/2001 Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges n I Total 0.00 0.00 �. 00 L ' c ' WI FUND APPLICANTS - 2001 Invoice attachment 11/9/01 Date Applied Applicant Address Amount Due 12112/2000 Bethke, Steven R. 1923190th Street, New Richmond WI 54017 $4,087.00 06/28/2000 Bos, George O. 2299 200th Avenue, Deer Park WI 54007 $1,527.00 11/15/2000 Erkeneff, Nick 2310 200th Avenue, Deer Park, WI 54007 $4,550.00 11/29/2000 Haworth, Helene 316 170th Street, Hammond WI 54015 $5,314.00 06/12/2000 Jensen, Lester A. 293 310th Street, Wilson WI 54027 -2703 $5,250.00 11/03/2000 Lokker, Paul 857 220th Street, Baldwin, WI 54022 $4,325.00 07/05/2000 Radigan, Mary Ann 2264 205th Avenue, Deer Park, WI 54007 $2,164.00 10/03/2000 Simmon, Stephen 1156 County Road D, Glenwood WI 54013 $5,475.00 09/10/2000 Swanepoel, Joe /Lekme, Trisha 1977 County Road P, Glenwood WI 54013 $2,300.00 12/18/2000 Stoner, Gaylord 799 Highway 64, New Richmond WI 54017 $5,054.00 $40,046.00 State of Wisconsin . PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and Department of OR REHABILITATION GRANT PROGRAM Buildings Commerce Division GRANT WORKSHEET Owner's Name: l Governmental Unit: AN U.NDING TABLES` A. Site evaluation and soil testing. Grant amount $25 $ e"( B. Installation of a replacement or additional septic tank. Minimum Gallons Required Grant Amount 750 .......................................................... ............................... ...........................$500 975 .......................................................... ............................... ............................550 1 , 200 .......................................................... ............................... ............................650 1 , 425 .......................................................... ............................... ............................725 1, 650 .......................................................... ............................... ............................750 1 , 875 .......................................................... ............................... ............................875 r 2,100 or more ............................................. ............................... ............................950 $ 7 �5v C. Installation of a pump chamber and lift pump or siphon: Number of Bedrooms Grant Amount 1 or2 ....................................................... ............................... .........................$1,100 3 or 4 ........................................................ ............................... ..........................1,200 5 or more ................................. ........ .... ..... ... .... ......... ....................................... 1,250 $ D. Installation of a non - pressurized or in- ground pressure soil absorption area. 1. The following table shall be used for systems sized according to percolation tests. Grant amounts determined by number of bedrooms. Percolation Rate Design Loading When Properly Rate In Gallons Filed with County Per Square 1 2 3 4 5 Each Addl Before 7 -2 -94 Foot Per Day Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 800 $1,100 $1,225 $1,400 $1,725 $150 10 to less than 30 0.60 to 0.69 900 1,175 1,400 1,800 1,900 250 30 to less than 45 0.50 to 0.59 1,050 1,450 1,650 1,950 1,975 300 45 to less than 60 0.49 or less 1,150 1,900 2,200 2,250 2,275 300 E. Installation of an at -grade or mound soil absorption area. Grant amounts determined by number of bedrooms. Type of Design 1 2 4 5 Each Addl Bedroom: At -Grade $900 $1,300 $1,475 $1,825 $1,950 $250 High Groundwater Mound 2,250 2,325 2,550 3,400 3,775 250 High Bedrock Mound 2,350 2,950 3,000 w 3,400 3,525 275 Slowly Permeable Mound 2,900 3,100 3,250 3,400 3,650 300 Mound with less than 24" of suitable soil or greater than �o 12% slope. 3,050 3,400 3,475 3,550 4,500 375 $ 0 ro F. Installation of a holding tank. Addl Number of Bedrooms: 1, 2 or 3 4 5 6 7 8 Bedrooms Grant Amount $2,250 2,925 3,100 4,000 4,200 4,750 $225 $ G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250 -1,499 1,500 -1,749 1,750 -1,999 2,000 or more Grant Amount: $550 $650 $750 $800 $900 Personal Information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)). SBD -9167 (R. 1199) i PART'1. 'GRANT FUNDING TABLES continued H. Installation of an Experimental System. Amount Requested For Installation: The Department on a case -by -case basis reviews installations of experimental systems. If you are requesting funding for an experimental system not covered by the grant funding tables, $ — please submit a copy of the plan approval letter and experiment approval letter with corresponding identification numbers signifying that the experiment has been accepted by the Amount Requested Department of Commerce. For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the right Copies of paid invoices must be submitted with this request. $ 1. Installations not Covered by the Grant Funding Tables. The Department on a case -by -case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A -H, please explain your request here, attach a copy. of the paid invoice, and request 60% of the cost of the installation at the right. TOTAL PART 1. $ .., P WE = `?GRANT AMOUNT: ALCULATIONS A. Enter the total from Part 1. $ 5 acv B. Is the applicant a licensed plumber or contractor who installs private sewage systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. _ C. Enter the smaller amount listed in sections A or B. If this application is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, this is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this Is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is greater than $32,000, goes to section D. If this application is for an experimental system, carry this amount forward to section F. $ D. Enter 30% of the amount by which the applicant's annual family income exceeds $32,000. Annual Family Income Subtract - $32,000 Subtotal X .30 = $ E. Subtract line D from line C. This Is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in section E must be at least $100 to be eligible for any grant award. If the amount calculated is less than $100, enter $0.00 in section F. ) $ F. Total grant award requested for this applicant $ �' ••�iiviseerssin Department of Commerce PRIVATE SEWAGE SYSTEM coon Safety and Buildings Division gt. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitip627TitNo.: Personal information you provice may be used for secondary purposes [Privacy Law .15.04 (1)(m)). Permit Holder's a e: ❑ City ❑ II e a T w of: State Plan ID No.: ensen, Lester � �ernice M 14 s CST BM Elev.: Insp. BM Elev.: BM Description: ParcebT Np53- g0 -000 Z .S�v v VV 1V TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4W?-;V, Benchmark 3 9Z. Srr Dosing "we_ Alt. BM A Bldg. Sewer �4 (0 4 I'o q( Z S' ding Ht In Ca 10.80 9l•5 TANK SETBACK IN NA Dt Bottom FORMATION / Ht Outle M Oo ' q1. 36 TANKTO P/L WELL BLDG. > Aierintake ROA Dt Inlet S Z7 �� Septic �0 r .1z6' �•(ob g�.a Dosing aZ&D > 1CM > /oa r ( NA Header / Man. 3, 216 Z 'fc f A NA Dist. Pipe �- 3 •� 9:Z • µ2.. Ing Bot. System 3.15 3 •Cr 7- 9l•� S . PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand t cover 4 Model Number eim`f 3 RPM 6/t:* 3� � (o2.3s' I a TDH Lift • q Friction S ste I� ( a L m 2,. TDH Ft �#L 3 - / 45. 9a•�6' Forcemain Length o ' Dia. Z " Dist. To Well ? (� SOIL ABSORPTION SYSTEM BED/TRENCH width / Len t S I No f T e PIT its Inside Dia. liquid Depth DIMENSIONS I DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHIN n re- INFORMATION Type of r > cl p CHA R M a Number: System: >2 4 �Z� '� �D cum, O NIT DISTRIBUTION SYSTEM { Header/Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air intake 1 /� � Length P,Qi Dia. �_ Length 3.S•� _ Dia. a u Spacing y SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Y P No ❑ Yes [] No CO MMEN ( � co e cre o i 1 sec 1 Zocahon:' %4 3 ��t % Al c V1 T46V 4 23 T28N R15W) - 23.28.15.360 6 r y 1.) Alt BM Description= 2.) Bldg sewer length= rya - amount of 14-D cov r = Z 3.) contour = y q fi ��o, 7) fl /d;5�,,�•,� �,,�� , F �j�cl!- �Lle�, o� � P�•��+n:.�- ��•D°S^ M;�'`�`. fL) Plan revision required? ❑ Yes XNo Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ST. CROIX COUNTY WISCONSIN ZONING OFFICE r N N N r r■ ��,�� ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, W154016 -7710 (715) 386 -4680 Fax (715) 386 -4686 December 15, 2000 Mr. and Mrs. Lester Jensen 293 310"' Street Wilson, WI 54027 RE: WI FUND PROGAM Dear Mr. and Mrs. Jensen: Enclosed please find a copy of an "Affidavit for Low Income Residents." I noticed that your income was under $14,400.00 and it was not necessary for you to file a1999 Federal Tax Income Return; therefore, you must fill out the enclosed form, have it notarized, and return it to our office. ThAeState requires this form to be submitted along with your WI Fund application to be accepted. Please have this returned to our office no later than January 5"', 2001. If you have any questions, please feel free to contact me at (715) 386 -4680. Si erely, r I�� Shawna Moe Secretary Enclosure t AFFIDAVIT FOR LOW INCOME RESIDENTS COMM 87.06(3)(d), Wisconsin Administrative Code State of Wisconsin ) )ss County of ) (I, We) I. e s t e r & Bernice Jens a geing first duly sworn on oath, depose and say that (I was, we were) full year resident(s) of Wisconsin during the above - referenced tax year. (I was, We were) not required to file a Wisconsin income tax return for the tax year 19 9 9 (My, Our) income for that year was: Source of Income Am un Interest $4,039.00 Pensions 4,258.00 Social Security (Non - Taxable Income) 19,860.00 Note: Attach a copy of the Federal income tax return if available. ;( t ' Signature of Owner Signature of Owner's Spouse Subscribed and sworn to before me this t G.� 27th day0f December k2000 E No Public, S e o isconsin Lary My Commission Expires NOTARY PUBLI 1e e Se pt 28, CO 2003. sr COUNT- TGemmission �S `� WTY ZONINGORFI personal information you provide may be used for secondary purposes [Privacy law, s. 15.04(l)(m)]. CHRISTINE ZIGNEGO PO BOX 75 SPRING VALLEY, WI 54767 (715)772 -328 May 31, 1999 Mr. & Mrs. Lester Jensen 293 310th Street Wilson, WI 54027 Dear Mr. & Mrs. Jensen: It was not necessary for you to file a 1999 Federal Income Tax Return because your taxable income was under $14,400. The only taxable income you have for 1999 is $4,039.00 in I nterest, and $4,258 in pensions. You have non - taxable income of $19,860 which you received from Social Security. If I can be of any further assistance to you in this matter, please feel free to call me. Sincerely, Christine Baier r� CHRISTINE ZIGNEGO PO BOX 75 SPRING VALLEY, WI 54767 (715)772 -3286 May 31, 1999 Mr. & Mrs. Lester Jensen 293 310th Street Wilson, WI 54027 Dear Mr. & Mrs. Jensen: It was not necessary for you to file a 1999 Federal Income Tax Return because your taxable income was under $14,400. The only taxable income you have for 1999 is $4,039.00 in interest, and $4,258 in pensions. You have non - taxable income of $19,860 which you received from Social Security. If I can be of any further assistance to you in this matter, please feel free to call me. Sincerely, 4 a-e _ : � Christine Baier I Loo d� ST. CROIX COUNTY WISCONSIN ZONING OFFICE N N N N N N N N N rrrri ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road • ' _ __ _ - - Hudson, WI 54016 -7710 (715) 386 -4680 Fax (715) 386 -4686 NOTICE OF VIOLATION June 19, 2000 LESTER JENSEN 293 310 STREET WILSON, WI 54027 LOCATION: NW 1 /40F THE NW 1 /4, Sec.23, T28N -R15W, TOWN of Cady SAINT CROIX COUNTY, WI Computer #004 - 1053 -80, PIN # 23.28.15.360, RE: FAILING SEPTIC SYSTEM AT 293 310 Street. Dear Mr. Jensen: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(d) Wisconsin Statutes (Category II). This violation was first noted on June 19, 2000. The violation noted is discharging sewage to the surface of the ground. An on -site inspection on June 19, 2000 did reveal the septic effluent discharging to the surface. The soil and site evaluation report dated April 27, 2000, submitted by Jim Thompson (I.D. # 3602), reveals that the existing system is located in non -code compliant soils. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of May 14, 1999, in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: The septic system must be installed no later than June 19, 2001. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sincerely, &6 �; �' Rod Eslinger Zoning Specialist cc: file Wisconsin Department of Commerce Safety'and Buildings Division PRIVATE SEWAGE SYSTEM Count Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita rntNo -: Personal information you provice may be used for secondary purposes [Privacy Law .15.04 (1)(m)]. Permit Holder's n� a e: ❑ City ❑ ' II e T w of: State Plan ID No.: ensen, Lester c !Wernice a 1�w�isflip CST BM Elev.:- Insp. BM Elev.: BM Description: Parce 6[y4- jbs3 -80-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tr�cue Benchmark 31 9Z. SC DosingE�W -� A Bldg. Sewer / ( A 6. 1(o•Z� ding t Ht Inlet Ca ) O.80 9l•SS TANK SETBACK INFORMATION / Ht Outle ��, Oo 9 /• 3 S TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet '/ Air Intake 7,06 g$. �o T Septic >'FO ` .. �— NA Dt Bottom p,�� g�,o Dosing >Zdo ��' �� y (dp` NA Header /Man. 3.21: X Ae NA Dist. Pipe Ing Bot. System 3 9(•3S ` PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand t cover ,44 Model Number � 3 PPM e A4 :* J L'a� X 3S ` 1o2 •35 TDH Lift L oss riction Head TDH Ft M# 2 - 3 /'f 45.x 9a •S6 To rcemain Length p ' Dia. 2 " Dist. To Well SOIL ABSORPTION SYSTEM W BED/TRENCH width I Len th No. f T e PIT its Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE/ STREAM LEACHIN n rer: INFORMATION Type Of cl p CHA R Model Number: System: >2S6 `�Z� '9� S� , O NIT DISTRIBUTION SYSTEM t Header/Manifold Distribution Pipe(s) � x Hole Size x Hole Spacing Vent To Air Intake u ..--. f y 6 Length � Dia - � Length 35 •} 'S _ Dia. � Spacing c� It SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Cent ( I d� d Bed /Trench Edges Topsoil El YS No E] Yes ❑ No �o 4 3 st 82'? Wll� c 1')4 23 T28N R15W) - 23.28.15.360 6 r y 1.) Alt BM Description= 3 2.) Bldg sewer length= } � q � - amount of cover = z �. 3.) contour = y. q L ( 3) PL) QJA� Plan revision required? ❑ Yes XNo Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �aa� . w_ �_;. �. ......, ...,_. 3 F ® i e v F { I # b 1 a i - .. ..:- «. anw ..,«......< �........ ',. _ ---- ..m .. e 3 s i i b i # E &... E .e.. • � ae...}.e.. r ..se�e. dan.a o . ..e-n. ...... o-. ..... ..a . ... �... -. � .. ..... ,. .., 4 .... g • �. . .. . ... E . W ...... e .. �.... 9..m..o.P....a E 3 ; F Y S g [ { # { g ......... s a } b H � € °a ,� -..• ..e..... � . � wy ..m..� � .. � � -m.m � ..., -i- .. e # F x ... ..-, ( ..... ... -..., S. «.�..... e® ., ,... ..., .. F S y • t .„ w # � e a I w d i g d � { " _ �._.......� ..m _ t a._ { s• Safety and Buildings Division AlM icons iSANITARY PERMI TION 201 W. Washington Avenue n I n accord with ILH 5� W . A+d CA. P O Box 7302 Department of Commerce .� ,. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for 'stems. ' er nt�t1 county than 81/2 x 11 inches in size. ri f' [`,� ' ST. CROIX • See reverse side for instructions for completing thlppllcation �py� State Sanitary Permit Number i L 13i7V �2- -� Personal information you provide may be used for secondary purpo pi j C*01"• ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ANT r40E State Plan I.D. Number S ite ID 192938 I. APPLICATION INFORMATION - PLEASE PRIN f L.I AT O `. Trans. ID #318785 Property Owner Name / % - o 0t cation LESTER JENSEN 1ia S 23 28N 15 ��9) �' i tin T N, R W Property Owner's Mailin Address umber Block Number 293 310TH STREET N/A I N/A City, State 2i Code Phone Number Subdivision Name or CSM Number WILSON WI 5T027 (715 772 -4249 N/A II. TYPE OF ILDING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ o Town of CADY 310TH STREET 111 BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 9 YP P PP Y) 23.28.15.360 D 2 2� I # �x x 5x3f@ :� 1 ❑Apartment/ Condo 004-1053-80 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on Fine B, if applicable) A) 1 ❑ New 2. n Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an - - - - -- System -- - - - - -- System - -- Tank Only -- Existing System -- - - - - -- Existing System ---- - - - - -- ----- - - - - -- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill .et/. 79._;7 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 375 375 1 N/A 91.70 Feet 94.03 Feet VII. TANK Capacity in gallons Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- plastic Aper. New Existin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank k 1 1000 1 MIDWESTERN PRECAS ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank r 750 750 1 1 MIDWESTERN PRECASI ® I ❑ I ❑ ❑ 1 ❑ 1 ❑ NSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: a ps) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON L 220292 715 772 -3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE SPRING VALLEY WI 54767 IX. COUNTY/ DEPARTMENT USE ONLY []Disapproved' Sa tary Permit Fee (includes Groundwater Date I ssued Issuing Agent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial 3 2-j r0� 6 l4 OD Adverse Determination CON ITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: �L -� 40' � c&te . SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling_ III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every newJor existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 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 holdingtank(s), septic. tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; 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; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. l i a. f 1` ST. WISCON ZONING ZONING OFFICE " T L...� ST. CROIX COUNTY GOVERNMENT CENTER rrrrNrrs■ 1101 Carmichael Road Hudson, WI 54016 -7710 -- (715) 386 -4680 Fax (715) 386 -4686 NOTICE OF VIOLATION June 19, 2000 LESTER JENSEN 293 31O STREET WILSON, WI 54027 LOCATION: NW 1 /4 OF THE NW 1 /4, Sec.23, T28N -R15W, TOWN of Cady SAINT CROIX COUNTY, WI Computer #004 - 1053 -80, PIN # 23.28.15.360, RE: FAILING SEPTIC SYSTEM AT 293 310` Street. Dear Mr. Jensen: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83,01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(d) Wisconsin Statutes (Category II). This violation was first noted on June 19, 2000. The violation noted is discharging sewage to the surface of the ground. An on -site inspection on June 19, 2000 did reveal the septic effluent discharging to the surface. The soil and site evaluation report dated April 27, 2000, submitted by Jim Thompson (I.D. # 3602), reveals that the existing system is located in non -code compliant soils. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of May 14, 1999, in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: The septic system must be installed no later than June 19, 2001. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sincerely, iv Rod Eslinger Zoning Specialist cc: file r Safety and Buildings 4003 N KINNEY COULEE RD *\ LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 VA sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 27, 2000 CUST ID No.268093 ATTN: POWTS INSPECTOR BEN HELGESON ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 14UDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/27/2002 Identification Numbers Transaction ID No. 318785 Site ID No. 192938 SITE: Please refer to both identification numbers, Site ID: 192938, Lester Jensen Residence above, in all corres ondence ►with the agency. St. Croix County, Town of Cady NW1 /4, NW1 /4, S23, T28N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 665396 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. • BEN HELGESON Page 2 5/27/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/23/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ . 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 MOUND SYSTEM DESIGN S� �y ��►' Residential Application INDEX AND TITLE SHEET c ' � o0 Project Lester Jensen 3 bedroom residential mound A o Lester Jensen OV 4(f Address 293 310th Street Wilson, WI 54027 Legal Description NW1 /4N /4 Sec 23 T 28N , R 1 5W. S . lly Township Cad County St. Croix T p - 1i�+ F. Lot No. ■ MERC 4VAGS Subdivision Name pEppRT F Atw gp► � pIV N O Parcel ID Number 004 - 1053 -80 Plan Transaction Number Index and title sheet Page 1 p 2 Mound calculations Page 3 Mound drawings page 4 Pres. dist. calcs. and laterals TDH and pump tank drawing p 5 Page 5 Pump performance curve p age 7 Site plan P 8 Attached soil evaluatio report _ 9 Designer Bennie Hel eson License Number 220292 Phone No 715-772-32 Signatur Date 5/01 /00 Notice: Tampering with this file by unauthorized persons s under s i 1 prohibited. Deliberate modification will result in disciplinary �� [Privacy Law, s.15.04 (1)(m)). Personal information you provide may be used for secondary p u rp Page 1 of 8 SBD- 10462 -E (R.05I98) i MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? r (r or c) (y or n) C � Replacement system? Creviced bedrock site? n (y or n) Slope 1 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 26 n 66.0 cm In situ soil infiltration rate .6 gpd /ft` 24.4 Lpd /m Contour line elevation 90.7 ft 27.65 m Use standard fill depths? x OR Design depth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold c (c or e) Hole diameter 1 0.25 in 0.125,0.156.0-188.0.219,0.25, 0.281, or 0.313 inch only. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 5.00 ft Not a final calculation. Number of laterals 2 Pump tank elevation 84 ft Outside bottom of tank. Forcemain length _ 70.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only. 2.067 in Actual I. D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch - pounds Metric 5/32=0.156 9/32=0.281 Estimated daily flow F - 45 - 0 -- 1 gpd 1703 Lpd 3/16=0.188 5/16=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpd/fe 375.0 ft` 34.84 m` Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd /m Design width (A) 5.00 ft 1.52 m Cell length (B) 75.0 ft 22.86 m Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) zft in 30.5 cm Downslope fill depth (E) in 32.0 cm Basal area required (gpd /infiltration rate) 2 69.68 m Suppo rting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.08 ft 3.07 m Up slope toe length (J) 8.30 ft 2.53 m Down slope toe length (1) 8.90 ft 2.71 m Total mound length (L) 95.16 ft 29.00 m Total mound width (W) 22.20 ft 6.77 m Project: Lester Jensen 3 bedroom residential mound Transaction Number: Page 2 of 8 MOUND PLAN VIEW observation pipes (typical) E — 22.2 ft q A= 5.00 ft 1.52 m 6.77 m ...:. ': B = 75.0 ft 22.86 m B J = 8.30 ft 2.53 m W K 1= 8.90 ft 2.71 m K = 10.08 ft LIMM _ 95.16 ft L 29.00 m tYP• obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) I K = end slope dimension s (152 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm topsoil G H subsoil cap E = 12.6 in 32.0 cm lateral F = 10.0 in 25.4 cm invert 92.20 ft ______ _ 28.10 m - -_- - -- � �� JF G 12.0 in 30.5 cm elev. T "' ' H=1 18.0 in 45.7 cm ASTM C33 D Sand Fill y sys. 91.70 ft elev. 1 27.95 m 90.70 ft contour 27.65 m elev. 1 % —� slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell P P H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: i Project: Lester Jensen 3 bedroom residential mound Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch - pounds Metric Width (A) 5 ft 1.52 m Length (B) 1 75.0 ft 1 22.86 Im Lateral specifications Number laterals 2 Holes/lateral 7 holes Lateral length (P) 35.75 ft 10.90 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 8.16 gpm 0.51 Us Sys. dis. rate <3 6 . 3 gpm 1.03 Us Hole spacing (X) 66 in 1 167.6 Jcm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) x Place X in red "X" one choice 1 1/4 in (32 mm) x box of chosen from the options 1 1/2 in (40 mm) x diameter. provided. 2 in (50 mm) x x 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) X' one choice 1 1/4 in (32 mm) None required. from the options 1 1/2 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - CENTER CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. P end cap • n • I� X CIEx12 I x�24I Laterals & force main of PVC Sch 40 Last hole drilled next to end cap (per COMM Table 84.30 -5) Holes drilled on the bottom of the lateral, • = permanent end marker equally spaced Inch-pounds Metric Lateral length (P) 3' -- 575 ft 10.90 m Lateral spacing (S) 0. ft 0.00 m Hole spacing (X) in 167.6 cm Manifold length 0 ft 0.00 m Hole diameter in 6.4 mm Lateral diameter in 50 mm Forcemain diameter in 50 I mm Project: Lester Jensen 3 bedroom residential mound Transaction Number: Page 4 of 8 TDH and Pump Tank Drawing Total Dynamic Head Operational head 99.75 ft I 0.76 m Vertical lift ft y� I �t 2.10 m Are laterals the highest point in the Friction loss ft �`� 0.11 m system? Yes "X' here. L.= Total dynamic head ft 2.97 1 m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.5 gal 47.3 L back to tank? (" x' one) Minimum dose 125.0 gal 473.2 L x Yes Drain back 12.2 gal 46.2 L No Dose volume 137.2 11gal I C 519.4 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels junction box -� grade levels disconnect alternate 4" vent pipe electric as per NEC 300 and z outlet Comm 16.28 WAC location 18" (46 cm) min. V all of pump k�- approved chamber or outlet joint combination tank A Provide 114" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 85.3 ft C - pump tank manhole = 4" (10 cm) off elev. 26.0 m minimum above finished grade D - vent = 12" (30.5 cm) minimum IL above finished grade 84.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 25.6 m bottom of tank Tank manufacturer Midwestern Precast 750 gal. Pump tank capacity 19.5 gal /in Pump tank volume 750.75 gal Pump manufacturer JGoulds Inches Gallons Pump model number 13871 EPO4 c A 17.5 340.6 _ N B 2 39.0 c Alarm manufacturer S.J. Electro systems E C 7.0 137.2 Alarm model number 1101 HW I p D 12 234.0 Project: Lester Jensen 3 bedroom residential mound Transaction Number: Page 5 of 8 M OD EL 1 1 M Vertical • Pump • 04 • 0 Submersible Effluent Pump i GOULDS l 1. F Pump Specifications ' /3 HP I METERS FEE1 Up to 40 GPM I to i ! MODEL: 3871 Discharge size 1'/4" NPT 9 . 30 i Solids: 3 /6 " maximum 6 25 Motor = Single phase: 115V C3 6 20 Materials of Construction -- - Brass /thermoplastic 5 15 EPOS: Features and Benefits ?. 5 7.Q . 4 • Top suction eliminates a I _ _ -.. i impeller clogging. 2 ' - EPO4 • Corrosion resistant construction. __..: ' - - 10 20 - _ - 30 - - -- 40 50 OiGRA • Float actuated switch. 0 2 4 6 6 10 12 Otter �i AP Y.-i mOI'S C METERS FEET 25 -, - -- - - - -- - -- - - - - - -- - Pump Specifications Features and Benefits MODEL uVP03 '/16 and '12 HP •EPO4 impeller- semi -open design C3 6 20 I ' Up to 60 GPM with pump out vanes to protect = 5 I U 4 ,5 I Maximum head to 32' mechanical seal. 1 ° • n EP05 impeller - enclosed design 0 3 ° Discharge size 1 /= NPT for improved performance. g I Solids: /< maximum 2 Motor • Rugged glass - filled thermoplastic 5 1 All motors feature ball casing and base design provides - -- bearing construction. superior strength and corrosion °' 0 0 S 10 15 20 25 30 35 40 U.S.GPM resistance. Single phase: 115V 0 2 4 6 e 1omlmr • Cast iron rnotor housing for CAPACITY Materials of Construction efficient heat transfer, strength, Cast iron Thermoplastic and durability. Stainless steel *Corrosion resistant threaded stainless steel shaft. *Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. IV (, Orb — - 3,ote < �. CA 8a , IA pcm. /v,W -4 m of'a 5 ,6a i 5 k c d don as, . 3 bed�oory, Scu1e / = 00 PropoSed /,oG0ga - res ,duce Sep&c banK. Setae ■ �cr' /� / w /. P; 6 $�i-rum 9pu., d -cY1, CLIr e ' I� ESf. ¢levy atfo f��' ♦ e le✓?z�•�n b�r�a; � ,s�v.,� a_f� .1 �•Jeu �.¢,X,S•dnq{�„ce /ne �F�.�a. -�'�r, = Y6.3o• ,�` �,•►, house v y -<.A. Vo p. d, e . p � � e- F�' /cccr�t /!nC btnea� i ■., d rive way. Qs l xr code-- _ /1 ,.A // 2 � of . 6,70ko 5y S ,� em OO �� o f� A'.�5(.��ecl Q I �.�1: = /OD•C0. Corn •l ��f� STr►13o 3 �J C>�F'� /u �., t Ji n e . stied e La wn 8� I -. 6.M.: (la:l ; n eu:^„v - - F' �nce ■ Po s-6 • E/e &A - - y.Z .Slo I I I � � I I � Pro�posc� 7so �• 4 ,7 1 8 A V;e-cj M 7002 `s V0 d ✓.C. I� I I I � I fo�ct main. 1-0 I I I I . - 7oFg (p p /1/7 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division Qf Safe and Byildin s Safety g in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County A.C.E. Soil &Site Evaluations include, but not limited to: vertical and horizontal reference pant (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - -- - - - - -- - Parcel I.D.# APPLICANT INFORMATION - Please print all information. 004-1053-80 1D #23.28.15 360 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location Lester Jensen Govt. Lot NW 1/4 NW 1/4 S 23 T 28 N,R 15 W Property Owners Mailing Address Lot # Block # J S . ubd. Name or CSM# 29 31 0th Street City State Zip Code PhoneNumber [ City Village r�Town Nearest Road Wilson W1 54027 715- 772 -4249 Cady 310Th Street [_] New Construction Use: L Residential / Number of bedrooms 3 1 to existing building Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpolftz .6 trench, gpolftz Basal area required 900 bed, ft 750 trench, ft' Maximum design loading rate .5 bed, gpolftz .6 trench, gpolft Recommended infiltration surface elevation(s) 91.7' at 12" above 90.7 contour. ft (as referred to site plan benchmark) Additional design 1 site considerations Existing system and soil conditions qualify for Wisconsin Fund program. Existing system elev. = 87.50' at 134. L rent material Glacial outwash Flood lain elevation, if applicable NA ft Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank Unsuitable for system [IS M U 17 S❑ U ❑ S O U F] S O U ❑ S [x U ❑ S N U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure GPD /ft Borin # Texture Consistenc Boundary Roots g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -8 10yr2/1 N one 1 2fsbk mvfr as 2f 0.5 0.6 2 8 -14 1 0yr4/3 No si l 2fsbk mfr cs 217 0.5 0.6 Ground 3 14 -20 10yr4 /4 None sil 2ms bk mfr aw if 0.5 0.6 elev _ 89.57' ft 4 20 -27 10yr4/4 None sicl 2msbk mfr aw if 0.4 0.5 Depth to 5 27 -34 7.5yr4/6 m2f 7.5yr5/8 sl 1 msbk mfr a - 0.4 0.5 limiting - -- - -- - - - -- - - - -- -- -- - -- -- factor 6 34 -60 7.5yr4/6 m2f 7.5yr5/8 is & gr Osg ml - - 0.7� 0.8 26" - - - - - - Remarks: - -_ 2 1 0 -7 10yr2 /1 None 1 2 fsbk mvfr as 2f 0.5 0. 2 7 -19 10yr4 /3 Non sil 2f sbk mf cs 217 0.5 0.6 Ground 3 19 -26 10yr4 /4 No ne sil 2m sbk mfr a - 0.5 0.6 elev _ _ 89.94' ft 4 26 -38 7.5yr4/6 m2f 7 .5yr5/8 sl l ms mfr ai - 0.4 0.5 Depth to 5 38 -66 7.5yr5/6 m2f 7.5yr5/8 Is & gr Os ml - - 0.7 0.8 limiting - - -- - - - -- - - -- factor , Remarks G round water see e o erved at 6 ". : - - - -- -paw - - - - - - -- CST Name (Please Print) Signa re: Telephone No. James K. Thompson S> 715 -248 - 7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 4/27/00 3602 1217 PROPERTYOWNER: Uster SOIL DESCRIPTION REPORT 12 Page 2 of 3 ,PARCEL I,D.# 004- 1053 -80 10#23.28.15.36 A.C.E. Soil &Site Evaluations Horizon 1�Pth Dominant Color Mottles Structure GPD/ftz in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz �o nsistence � Boundary Roots Bed Trench 3 1 0 -8 1Oyr2 /1 None I 2fsbk mvfr as 2f 0.5 0.6 2 8 -15 1Oyr4 /3 None sil 2fsbk mfr cs 217 0.5 0.6 Ground - - - -- - - - elev 3 15 -28 1Oyr4/4 None sicl 2msbk mfr aw - 0.4 0.5 91.04' ft 4 28 -37 7.5yr4/6 f2f 7.5yr5/8 gr sl l msbk mfr ai - 0.4 0.5 Depth to 5 37 -58 7.5 r5/6 m2f 7.5 r5/8 is & r Os ml 0.7 j 0.8 limiting Y Y g g - - - - -- - - - - -- -- -- - -- factor _ ,- 28" Remarks: 4 1 0 -8 1Oyr2 /1 No 1 2fsbk m vfr as 217 0.5 0. 6 2 8 -17 1Oyr4 /3 None sil 2fsbk mfr cs 21' 0.5 0.6 Ground - --- -- - -- --- elev 3 17 -24 1Oyr4/4 None sil 2msbk mfr aw - 0.5 0.6 90.40'ft- 4 24 -35 7.5y r4/6 m2f7 A lmsbk mfr ai - 0.4 0.5 Depth to - - limiting factor 24" Remarks! _ - -- - - Ground - - - -- --------- - - - - -- -- elev Depth to --- - - - - -_ -- - -- - - limiting factor - - - -- - - -- _ _._.. -- ---- - - - - -- ...- - Remarks: Ground - - -- - - elev Depth to - - -- - -- - - - - -- - - - - -- limiting _ factor — — - - - -- - - - - - -- - - - = arks! j O�, 30/'3 1 Sti FY/3�i nq 3 b edroa,h ca he. � ,— res�de�ce clr I e "XLY �� weu �e,XiS-�inq{�rtCe /ne �np house t,--e,7 CA '...)/ c o ve r ICIO&J, 5Y5 {er» ASSC.�..+�ecl e �e�: = / Dd• cp, (� Cor n Shed e d La wn I Pos-£ E/ed` i � L I C/ I B? to 40 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code , A .C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal re#erence point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow ion and distance to nearest road. ' ° Parcel I.D.# APPLICANT INFORMATION - ;, @ i - 004- 1053 -80 ID#23.28.15.360 1� ass -p�ir iral/ e nnadon. Personal information you provide may ugedJot secondary purposes�(P y Law, s. 15.04 (1) (m)). Reviewed $V D Property Owner r' . ' � " Property Location Lester Jensen _3 Govt. Lot NW 1/4 NW 1/4 S 23 T 28 N,R 15 W Property Owners Mailing Lot # Block # Subd. Name or CSM# 293 310th Street City State Zip Cho; PmeNumber City Village XTown Nearest Road Wilson ,W1 , 54WG x}=47 Cady 310Th Street ❑ New Construction Use: r�>VP Vie, of bedrooms 3 []Addition to existing building Replacement eras! describe Code Derived daily Dow 450 gpd Recommended design loading rate .5 bed, gpd/ftz .6 trench, gpd/ t Basal area required 900 bed, ftz 750 trench, ftz Maximum design loading rate .5 bed, gpdff .6 trench, gpd& Recommended infiltration surface elevatiat(s) 91.7' at 12" above 90.7' contour. ft (as referred to site plan benchmark) Additional design / site consideration Existing system and soil conditions qualify for Wisconsin Fund program. Existing system elev. = 87.50' at B4. Parent material Glacial outwash Flood elevation, d mLaw NA ft S for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ®u S ❑ u ❑ S ® u El S ❑ u [IS ®u [Is M u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPDV Boring# Horizon Texture M. Munsell Qu. Sz. Cont. Color Gr. $z. Sh. Consis Boundary Roots Bed Trench 1 1 0 -8 10yr2 /1 None 1 2fsbk mvfr as 2f 0.5 0.6 2 8 -14 1Oyr4/3 None sit 2fsbk mfr cs 2f 0.5 0.6 Ground 3 14 -20 1Oyr4 /4 None sit 2msbk mfr aw if 0.5 0.6 elev 89.5T ft 4 20 -27 10yr4/4 None sic! 2ms mfr aw if 0 .4 0.5 Depth to 5 27 -34 7.5yr4/6 m2f 7.5yr5/8 A lmsbk mfr aw - 0.4 0.5 limiting fa 6 3 - 60 7.5y m2f 7.5yr5/8 is & gr Osg m - - 0.7 0.8 Remarks: 2 1 0 -7 1Oyr2 /1 None 1 2fsbk mvfr as 2f 0.5 0.6 2 7 -19 10yr4/3 None sil 2fsbk mfr ' cs 2f 0.5 0.6 Ground 3 19 -26 10yr4 /4 None sil 2msbk mfr' aw - 0.5 0.6 elev 89.94' ft 4 26 -38 7.5yr4/6 m2f 7.5yr5/8 sl l msbk mfr ai - 0.4 0.5 Depth to 5 38 -6 7.5yr5/6 m2f 7.5yr5/8 is & gr Osg ml - - 0.7 0.8 limiting factor 26' Remarks: Ground water see e o ed at 6 ". CST Name (Please Print) Signs re: Telephone No. James K Thompson 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 4/27/00 3602 1217 PROPERTY6WNER: Lester7ensei► SOIL DESCRIPTION REPORT , 2,7 Page 2 of 3 A. PARCEL LDJ 004- 1053 -80 1D#23.28.15.360 C.E. Sod &Site Evaluations GPDW Hortm Depth Dominant Cda Moflles Texture Biome Boundary Roots - -- — in. Munsef Ou. S7- Cont Cola Gr. SL Sh. Be 3 1 0 -8 10yr2 /1 - - — None - I_ -- _ - -- 2fsbk mvfr as 2f 0.5 j 0.6 2 8 -15 10yr4 /3 None sil 2fsbk mfr cs 2f 0.5 0.6 Ground elev 3 15 -28 10yr4 /4 None Sid 2msbk mfr aw - 0.4 0.5 9 1.04' ft 4 28 -37 7.5yr4/6 f2f 7.5yr5/8 gr sl lmsb mfr ai - 0.4 0 .5 Depth to limiting 5 37 -58 7.5yr5/6 m2f 7.5yr5 /8 Is & gr Osg ml - - 0.7 0.8 factor 28' Remarks: 4 1 0 -8 10yr2 /1 None 1 2fsbk mvfr as 2f 0.5 0.6 2 8 -17 10yr4 /3 None sil 2fsbk mfr cs 2f 0.5 0.6 Ground elev 3 17 -24 10yr4 /4 None sil '2msbk mfr aw - 0.5 0.6 - ............ ..... 90.Q ft 4 24 -3$ 7.5yr4/6 m2f7.5yr5/8 sl lmsbk mfr ai - 0.4 0.5 Depth to ,I X14 -`1 y 0 A l2, w limiting factor 24" - - -- — -- .._ - - -- tti .J � Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: 3 oP 5' z Bd' Sticd 3 bedroc.., 5cale: ` - �2X�S�ng{�nce /ne i mp house _/ Al Q�! /3C+/�q �G 2.A'1��Pr�� Orn O� S {�- » O °� , ��a�jc. Asx�.ned e le% _ �oo•co: (/ Cora Cr; b stied d La wn �'al�ow �1�, Feld Po s- E/e cf, - 3 S /oPe� ■ 83 It�. C'e �d I C/ I I a � I 1 0 �p consin Department of Commerce SOIL AND SITE EVALUATION Page t of 3 Division 8f Safety and Buildings in accord with Comm 83.05 Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow ovation and distance to nearest road. St. Croix Parcel I.D.# t �t I print all 004 -105 3-80 ID#23.28.15.360 APPLICANT INFORMATION - „P rmation. R D Personal information you provide may uWHof second purposesl Reviewed By cy Law, s. 15.04 (1) (m)). ® ate G / � Property Owner ' r " Property Location Lester Jensen N Govt. Lot NW 1/4 NW 1/4 S 23 T 28 N,R 15 W -------- - - - - -- - - - -- - - -- - - -- Property Owners Mailing Address Lot # Block # S Name or CSM# 293 310th Street City State Zip Gods, !?tjoneNumber , ❑City ❑ village ®Town Nearest Road Wilson WI 540216 (31- fr�72� -�� Cady 31OTh Street ❑ New Construction Use. Residen /� m' ' of bedrooms 3 ❑Addition to existing building ❑ Replacement 'ublinescribe Code Derived daily flow 450 gpd Recommended design loading rate -5 bed, gpd/fI2 .6 trench, gpd/ft Basal area required 900 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 91.7' at 12 above 90.7' contour. ft (as referred to site plan benchmark) Additional design / site Considerations Existing system and soil conditions qualify for Wisconsin Fund program. Existing system elev. = 87.50' at B4. Parent material Glacial outwash F lood Main elevation, if appli NA ft S for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S M U ® S❑ U ❑ S M U ❑ S® U EIS ®U ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consist Boundary Roots Bed Trench 1 1 0_8_ 10yr2/ None 1 2fsbk mvfr as 2f 0.5 i 0.6 2 8 -14 1Oyr4/3 None sil 2fsbk mfr cs 2f 0.5 0.6 Ground elev 3 14 -20 1Oyr4/4 None sil 2msbk mfr aw if 0.5 J 0.6 89.5T ft 4 20 -27 10yr4/4 None sicl 2msbk mfr aw if 0.4 0.5 Depth to 5 27 -34 7.5yr4/6 m2f 7.5yr5/8 sl lmsbk mfr aw - 0.4 0.5 limiting 6 34 -60 7.5yr4 m2f 7.5yr5/8 is & gr Osg ml - - 0.7 0.8 - - -- - - - -- - - -- - - - - - - - - - - - -- -------- - - - - -- - -- - - - - -- - -- -- -- -- - - -- - - -- Remarks: - 2 1 0 -7 1Oyr2/1 None 1 2fsbk mvfr as 2f 0.5 0.6 2 7 -19 10yr4/3 None sil 2fsbk mfr cs 217 0.5 0.6 Ground elev 3 19 -26 1Oyr4/4 None sil 2msbk mfr aw - 0.5 0.6 89.94' ft 4 26 -38 7.5yr4/6 m2f 7.5yr5/8 sl lmsbk mfr ai - 0.4 0.5 Depth to 5 38-66 7.5yr5/6 m2f 7.5yr5/8 is & gr Osg ml. - - 0.7 0.8 limiting factor 26' Remarks: Ground water seepage obi6rved at 6 '. CST Name (Please Print) Signa re: Telephone No. James K. Thompson _ _ - - �� 715 -248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 4/27/00 3602 1217 i AM. OMER: LesterJamn SOIL DESCRIPTION REPORT 12n Page 2 of 3 - .RCEL LDA 004- 1053 -80 ID#23.28.15.360 A.C.E. Soil & Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure sistence Boundary Roots ---- GPDIfr? - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -8 10yr2 /1 None l 2fsbk mvfr as 2f 0.5 0.6 2 8 -15 IOyr4 /3 None sil 2fsbk mfr cs 2f 0.5 0.6 Ground elev 3 15 -28 10yr4/4 None sicl 2msbk mfr aw - 0.4 0.5 91.04' ft 4 28 -37 7.5yr f2 f 7.5yr5/8 gr sl lmsbk mfr ai - 0.4 0.5 Depth to 5 37 -58 7.5yr5/6 m2f 7.5yr5/8 Is & gr Osg ml - - 0.7 0.8 limiting factor 28' Remarks: 4 1 0 -8 10yr2 /1 None 1 2fsbk mvfr as 2f 0.5 0.6 2 8 -17 10yr4 /3 None sil '2fsbk mfr cs 2f 0.5 0.6 Ground elev 3 17 -24 10yr4 /4 None sil '2msbk m fr aw - 0.5 0.6 - -- - - - - - -- - - - - -- - - .... - -- - - - - -- - - - -- - -- -- - -- - 90AV ft 4 24 -3$ 7.5yr4/6 m2f 7.5yr5/8 sl lmsbk mfr ai - 0.4 0.5 Depth to limiting �1- - - -- - - -- -- - - - - - -- factor - -- - -- 24' - -- - - -- — - -- - - - -- Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: 3 Elm z 80' -f Stied EYiS�inq 3 bedracm Scale: dc�ve�a �4Rna ne G7fiSt�in� w�,,% QbSar� mp house t/•Lr/ Ch ode/'F/o&j, of �� f Corn saed ed Ca tin I ��r�ow A�, .�•� �d I I As- E/e d,- y 9,Z o I 3 I 3 "� � S /oPC � ■ 83 Aj. I I I 10 82 j to T ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Le sex J e_v� s ►-� Mailing Address 3 ,z. qo L 7 Property Address (Verification required from Planning Department for new construction) City/State L), L -z, o-, Parcel Identification Number 0 0 5/ -/o S 3 -b'd LEGAL DESCRIPTION Property Location k)w ' /a, 4.A& ' /a, Sec. a�3' , T �Y N -R /-;�_ Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # = 29 34 , Volume s�! , Page # t� Spec house ❑ yes 5 no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year xpiration date. ., J / I G o I TURE OF P CANT DATE ER CE I ICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property describe bove, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE OF AP I NT DAJE 03 * * * * ** Any info ti that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I DOCUMENT NO. p STATE BAR OF WI +� y 329391 V OL ?9 r THIS SPACE RESER FOR RE • S ela Jensen aLk�a Sella Jensen REGISTERS OFFICE TIIIS DEED, made between _ ST. CROIX CO., WAS• Rec'd for Record this_?5th_ _Grantor dayof__ Sep_t�____A.D.19_Z5 and — Lester A. Jensen and Bernice Jensen M. husband and wife as joint tenants Grantee, W i toe s s e t h , That the said Grantor for a valuable consideration Ten 891st-- Of Deeds Thousand and no/100 ($10,000.00) Dollars _ conveys to Grantee the following described real estate in St. Croix County, RETURN TO State of Wisconsin: North Half (N of the Northwest Quarter (NW-1) of Section Twenty - three x {23) Township Twenty -eight (28) North Range Tax Keyil Fifteen (15) West, St. Croix County, Wisconsin. This is homestead property. Grantor retains in the above described premises a life estate. The consideration for these premises and the receipt thereof is hereby acknowledged by Grantor having been received by Grantor from Grantee by reason of improvements, upkeep, repairs, furnished to said premises by Grantee over a period of years from 1955 to and including 1975. FEE 4 E'M _ PT Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Executed at Spring Valley, W isconsin this_ 23rd of September 1975 . SIGNED AND SEALED IN PRESENCE OF �- Z ��'L'� (SEAL) Bela Jensen a /a Sella Jensen (SEAL) I (SEAL) '? (SEAL) Signatures of authenticated this day of 19 fi i Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. STATE OF WISCONSIN { Pierc 5s. _ County. d Se 1975_ Personally came before me, this 2 3r tember day of p , the above named Bela Jensen i to me known to be the person_ who executed the foregoing instrument and the .0 ,, This instrument was drafted by Rob fib. s5n% GAVIC, RICHARDSON & SKOW Notary Public ID ' Count Wis. The n., -.! witnesses is optional. My Commission ( �� , r• fj j� ~ .�PO�lanent. (?� 5� ..._.�.� . �. ....._�._.._.__"_°.___.,.... �r • . ! LI r Names of persons signing in any capacity should be typed or printed below their signatures. ' H.GMi1lerCongerly� WARRANTY DEED —STATE BAR OF WISCONSIN, FORM NO. 1 — 1971