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HomeMy WebLinkAbout030-2058-30-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y = INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370298 Permit Holder's Name: []City ❑ Village ❑ Down of: eState Plan ID No.: Heins, Joe Village of Wilson 16 *.= 3Z32-0 { CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: cso . (50 - o' `T tl,�A4_c� 191- 1012 -50 -000 TANK INFORMATION ELEVATION DATA Z�jo o\x TYPE MANUFACTURER CAPACITY STATION BS HI FS EV. Septic 1'b G 0 Benchmark 06 _ r r � Dosing Alt. BM D, C) p( •� p Aeration _� ° Bldg. Sewer t crp ,$E r Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet — Air Septic (� ( 7 ) (-- )l " ' _ NA Dt Bottom ' 3 -�D� 2 3, p Dosing / " NA Header /Man. ID3 Aeration NA Dist. Pipe 2_,F3— 3.0 �p3•�0 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer ' lgem`{and St cover Model Number �I 1' GPM `0 TDH Lift Frictions 31 System stem TDH kS• t / Forcemain Length (.0 Dia. 2 " -Dist. To wen SOIL ABSORPTION SYSTEM ED EN TRENCH Width g r Lengt 6 3 r a) Q Tj�ert� PIT No. its Inside Dia. Liquid Depth layK��x DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING anu acturer: SETBACK CHAMBER INFORMATION Type O [OD � OR UNIT— e Num System: DISTRIBUTION SYSTEM b W rocjLC d w Header/Manifold r Distribution Pip x Hole Size x Hole Spacing Vent To Air Intake Length S.0 Dia. 3' � Length � Dia. a Spacing _6_,0 r N 3G or 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 10 1 ecti Location: , (SE 1/4 SE, �/4 27 T29N R15W) - 2 .229.15.99 , 1.) Alt BM Description = log / `f T 2.) Bldg sewer length= St ' of t of cover= 3.) contour= )02,0 -� S� 40) X Plan revision required? ❑ Yes U No Use other de for additi9 al information. 5 C -OL z Lo�t�.� C& lea- -_ IZ SB 6710 (R.3/9) eC sp urg„d gyp_ Q�O�t, f N ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �M I _ . ,...__ 1 j E 33 ; s t � I F _ 4- i m _ E I •� / / ✓/ V Safety and Buildings Division SANITARY ERMIT 201 W. Washin Avenue Viscons - P O Box 7162 Department of Commerce In accord with Comm 83,0, CItNs Aam,Code Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the systeM, o noMsss ty // t than 8 1/2 x 11 inches in size. =. \� �4� k \� "�; LPlan ry Permit Number • See reverse side for instructions for completing this applfcApon r� . ,t 4-0 zR Personal info rmation you provide may be used for secondary purposes � y" > j 4> tip vision to previous application [Privacy Law, s. 15.04 (1) ( m )] . view Transaction Num r � I. APPLI ATI N INFORMATION - PLEASE PRINT ALL A C3' D = 3,2 Property Owner Na a p� 4LL ' n /a, Zia, S T , N, R) r(o W Property O 7' 6 s Mailing Address Lot Number Block Number T I P- C t , State Zip 0 Phone Nu ber Subdivision Name or CSM Number s/) s--- II. TYPE OF BUI DING: (check one) ❑ State Owned 7 ❑ It Nearest Road Illage ' �- / ,' o Public or 2 Family Dwelling - No. of bedrooms n OF [.v! S ! 7�- ' 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) a 7• aZ C, �- C� GI 1 ❑ Apartment/ Condo / l Z 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 line B, if applicable) A) w 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an � -y -?'- -y S stem 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 found ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure ,p / 63 r 42 ❑ Pit Privy 13 ❑ Seepage Pit / �J 43 ❑ Vault Privy 14 ❑ System -In -Fill �. 250 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re fired (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 0 . 2 . Feet ► zSF eet VII. TANK in Capacity Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glaze Plastic App New Existin structed T nks Tanks Septic Tank or Holding Tank 12 1 ❑ Lift Pump Tank /Siphon Chamber. ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' S' ature: ( mps) MP/MPRSW NN o.: Business Phone Number: / Plumber's Address (S et, City S r�7 , Zit �� 1 l z t IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) Approved F1 Owner Given Initial Surcharge Fee) Adverse Determination - 325 - .OD 6-26 2aD 1 4,;, ­�eu, X. CONDITI NS OF APPROVAL / REASONS FOR DISAPPROVAL: ` w SBD -6398 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber t INSTRUCTIdiVS ` 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 plc{mber 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: I. Property owner's name and mailing addrps: Provide the legal description and parcel tax number(s) of where the system is to oe 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 new /or 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 num& 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 8 1/2 x 11 inches must be submitted to the county. The plans must inciude the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic, tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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 I.Qss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if ebquired "by the county; E) soil test data•on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1 Wisconsin Act 410 included the creation of surcharges (fees) for a number of mated practices which can 9 9 P effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us - Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 20, 2000 CUST ID No.226900 ATTN: POWTS INSPECTOR - ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD r NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/20/2002 Identification Numbers Transaction ID No. 323201 Site ID No. 194289 SITE: Please refer to both identification numbers, Site ID: 194289, JOE HEINS above, in all correspondence with the agency. ST CROIX County, Village of WILSON; 170TH AVE SETA, SETA, S27, T29N, R15W FOR: Description: MOUND SYSTEM FOR JOE HEINS Object Type: POWT System Regulated Object ID No.: 668691 - - The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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 potential for a lawsuit 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, A DATE RECEIVED 06/12/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 K 3 A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: JOE HEINS� PLOT PLAN PROJECT Joe Heins ADDRESS 965 W. Sherren St. Roseville Mn 55113 SE 1/4 SE 1/4S 27 /T 29 15 W Village Wilson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/9/00 BEDROOM 4 CONVENTIONAL IN-GROUW p CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 500 Bed Size 8'X 63' BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 0-3 jj� 7BM) Alt. B.M. 170th Ave 300' Scale 4* 1 /4" - 10' �~Rr�3 °� h {� "y ��r DFPART,,.VNT OF DIVISION OF SAFEIY AND bWLDiNGS r� SLE CORRL_SPOND[ -,NGE 3 2 ► �® B -2 Area 25' below system is to remain e --- M �� undisturbed 9% B -3 Slope ❑ a ;v- System is to be Ir c installed along the Well is to 102.8 Contour Line meet all Huffcutt setbacks ❑ Combo found in B -1 Tank Comm 83 Tank is to be properly Pro 4 bedded and provided with Bedroom approved warning labels, House dose tank is to have a lockdown cover � I . � � � � � \: � ��. �. �; � � � . � §� � q� � � `� \ 3 �a � � v� � . \� .� �\ . : \ � , \\ >� . � Designer 5a� -_ G 1 ,r Non -Woven Filter Fabric 4" Observation Pipe .Perforated Below Filter Fabric �Aistribution Pipe . AS= C -33 Sand / K G " Tops oil rrvasr_LSrs ._.J ♦ r % Slope Bed Of tai- 2 %= LFor Main \ Drain Rock From Pump Layer ; l Cross Section Of A Mound System Using A Bed For The Absorplion Area F '$ A Ft. FE' B Ft. I q Ft. Ft. K.._,3 Ft. L L W 3� Ft. mom �} eObservation Pipe e _- JK 1 W N � --- -rr -- --- - -r.-- 1 Force Main c - ..�....._._.� _.�._.._ _ From Pump o O Distribution Bed Of +•_ 2' Pipe Drain Rock Observation Pipe Permanent Marker Pipe or Rods Pton Yiew Of Mound USIng A Bed For The Absorp Area PA O E,,,_,,,_,OF_. .- I Perforated plot Oatou M View Perlprot�a �' Ena Cap �� PVC 1 e a��� NaNe tpCll OA 116119n. 4r0 94vOlty 6"404 PVC Force hah fIMT 1106L MSXT ra CaMOai PVC Morifol0 Pipe Otel rip ion Nee LAS 1 Nate lhowd B fMOflf TO EAO COp end coo Disiriputban pi i,orov P FL. R inches Signed: Y Inches Ho le Diameter License Numb '�" �j 9 Lateral " „--U� Inch (es) Da �-- Q Manifold " ;? inches Forst Mt f n pi Inches # of holes /pipe Invert Elevation of Laterals , -yot." t SEPTIC TANK pUMP CT3AMB£R CROSS SECTION AND SPECIFICATIONS a ABOVE GRADE WEATHER PROOF APPROVED cx VENT P=P k E 12 MIN. WITH CONDU MANHOLE COVER y 25' FROM DOUR WINDOW OR w/ PAp 6 FRESH AIR INTAKE WARNING LABE L FINISHED GRADE fit+ CI RISER Sit MIN• 4" MIN' A$ 0V E G AD E ., IN . 6" MAX. INLET t ', WATER TIGHT SEALS GAS- 1 s TIGHTS � A SEAL APPROVED BAFFLE ALM JOINTS W/ 4" APPS B ! i A?PlaViO FIFE 3' PIPS 3' — T — " t ON CNS'0 MAD SOIL SOLID SOIL t PUMP OFF ELEV . 12�i FT. - --•��► • C C OFF *" RISER EXIT D PERM�IITTED ONLi MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS / 7 fa1Go4A pf'r f n C4 SEPTIC / DOSE TANK MANUFACTURER : [�.#—� NUMBER DOSES PER AAY: TANK SIZES: SEPTIC 1 .;56 GAL. DOSE VOLUME INCLUDING DOSE �Sa_AL• FLOWBACK: � GAL,• zy. ALARM MANUFACTURER: CAPACITIES: A = 10�5 INCHES * � �+L• MODEL NUMBER: G B _ 2 INCHES x Ole 33 3 SWITCH TYPE: 2 GAL. z�• 3 MHP MANUFACTURER : ��,�. � C = �� CINCHES = GAL. MODEL NUMBER: / 0 0 SWITCH TYPE: SHEF �v D INCHES GL, REQUIRED DISCHARGE RATE �PM PUMP ALARM WIRING AS PER ILHR 16. 23 WAC vERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTR18UTION PIPE . /Z FEET * MINIMUM NETWORK SUPPLY PRESSURE . • - - - ' ' 1 0 & —.- FEET + 5d, FEET F ORCEMAIN X . 3��' FEET _,,,, PT /300 FT. FRICIOR . FEET TOTAL DYNAMIC HEAD INTERNAL DIMENSION' OF PUMP 'TANK: LENGTH 1...� ,�••� - ;/ WIDTH �: DIAMETER LIQUID DEPTH SIGr�Ep: LICENSE MlMBER : cott%209100 DATE -- f—_0;Q . En gineering Details - SHEF' 1 1 Performanc* Data 40 3fl Pump Choracl iistic i MOW moats SM@40M1 I SMEf402 Autamat MuJols SHIF40A1 I SW40A2 Norse or:w �� 4410 We load A s 17 1 6.5 0 L± Mow i Shaded Polo t4 h VA 1550 10 20 30 40 4 1 D 60 74 Aug 10 GPM LVaite9e 115 230 T otal ""W (feet) 1 10 j 14 17 ' 21 _ 2 5 1 18 r 30 35 !lens aim 120' i Ma�ftnid Temp. (m) 13.0 � 4 � 5.Z b•1 7. " � � NEMA to ' A GPM (US GPM) ' 70 60 50 1 40 30 30 10 0 ....�. � ( see) 14.4 — §:8 W � - 2 � _ 7 . 1.3 .63 T 6 — Insdal Tian Gm A S*1 N SlSize 1 1 4" NPT DIit onsional Data SaGd! andi A 4" w 1 s-s/V $41V 1 1 68.27, 1, AY nlenstons In 10 ft (metric for Power Cord I N36 111^ * std. ��''� — a't +� inktalational nsey. 2. Compomm dimensions may Mat of Construction (,99 i v im' * 1/6 inch. sleilelae it�el __ _. I 3. Not for conslruttW purpose Me � °a� c�+scH,�ae Oil Mk � :a NPT uniess certified. i if for s I SW IT CH 4, Di and weights are i P Calla approxiamte. meftolml Hai Foaa udten /Cavok — f-- -J' S. We reserve the 11 ht to make sholl Seal SW M r. A - IN- stud ' revisions to our pro and their I • s/owdaa :5tu4 specificofts without Wks. 01w ban ftm mm him 11 -3,re" p.y t6" (28B.A2) (2QO.T�; it 1 Loaf Tber" — 1998 Mydromutic'° Pumps, Askicuxl, io. AI Riglsts Roserond I n° HYDROMATIC" Your A,AhOrrzed local 0i0r;6Um( - � ,; 161mid,Ohio44 Te).4'9.789 -3442 Ftx -281 -4087 iVeb 5ite www.µMttahµump con, �rsrt,w ��:�lrf ....\., ,,1KES IN All MAJOR C'•TtES AND COUNTRIES c�;il•• puyv� :11 your pi,cna (lirnCory Vow loc;lf Jnir.Euio � � F , / J :ftr•'.: 4 r> r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 4 - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location J� J Govt. Lot 1/4 1/4, T. N,R �E (o r)(0 Is - Property Owner's Mailing Address Lot # Block# I Subd. Name or CSM# City State + Zip Code Phone Number ❑ City `Village ❑Town Nearest Road Aeo ;11,0_51 I I (K51 ) / 1 / ® ° ;;New Construction Use: &sidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flo gpd Recommended design loading rate bed, gpd/ft2 / 2 trench, gpd/ft Absorption area required bed, ft —��d trench, ft2? C� Maximum design loading rate bed, gpd/ft Z trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations ✓� Parent material Flood plain elevation, if applicable / ft Fu = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tan = Unsuitable for system ❑ S S ❑ U ❑ 3'� ❑ ❑ S Ell SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench la Depth to limiting act Remarks: / Boring .. 119v 3 �► 3' �w s ' z� e zze6Qn -e /!r u /V P: Ground elev. Depth to limiting 0 n. Remarks: CST Name (Please Print) nature Telephone No. Addr ss Date CST Number 6 �� �4,,4 � ���� 5 �v 7 C- o v 6 9 0 0 SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench / Ground Depth to limiting factor c7� Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) Soil Test Plot Plan Project Name Joe Heins Sha it Address 965 W. Sherren St. Roseville Mn 55113 TM #226900 Lot ----- Subdivision ---- --- Date 6/9/00 SE 1/4 SE 1/4S 2 T 29 N /R W Village of Wilson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Nail in Tree System Elevation 103.8 *HRP Same as Benchmark Alt. BM Top of Nail in Tree @ 101.2' * B.M. N Alt. B.M. 170th Ave 300' Scale = 1/4" = 10' l B -2 9% B -3 Slope ❑ B -1 Pro 4 Bedroom House ' N ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ARIA OWNERSHIP CERTIFICATION FORM i Owner/Buyer ��� �4 Mailing Address t c� 9,1 1j .SSI Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number L��` /0 / 2 - S 0 - 0 0 C LEGAL DESCRIPTION Property Location %., %., Sec. z �'�.2 N- R��,i / f �t/i �.5� --✓ Subdivision Lot # r --- Certified Survey Map # , Volume , Page # Warranty Deed # �z ���i' . Volume Page # Spec house ❑ 11,1n0 Lot lines identifia "des ❑ 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 wastewaterdisposal 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. I/we, 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 f the three 377 date. �4� / f ,0 0 SIGPATLJKE OF AP LI ANT DATE OWNER CERTIFICATION 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 operty described ove a of a warranty deed recorded in Register of Deeds Office. 0 / F / a6 SIG OF APPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with 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 voL 1465 504 STATE BAR OF WISCONSIN FORM 2 -1998 61264AL KATHLEEN H. WALSH WARRANTY MED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Robert O, McGrane and Lois H. RECEIM FOR RECORD McGrane, husband and wife, 10 -25 -1999 11:30 AM IfARRANTY DEED Grantor, conveys and warrants to EXEMPT Trish Heins and Joseph N. Heins, wife and husband. CERT COPY FEE: COPY FEE: TRANSFER FEE: 171.00 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Area Name and Rend Edina Realty Title 400 South 2nd Street Suite #115 Hudson, W154016 l91.1012.50000 Parcel Identification Number (IM This is not homestead propenty. The Southeast Quarter of the Southeast Quarter (SEl /4 of SEl /4) of Section 27, Township 29 North, Range 15 West, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this _1� day of Q"ck�e t 1 . `h..1 e . * �. McGrape a is H. McGrane AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) STATE OF WISCONSIN ) ) ss. authenticated this _ day of , L_ _ County ) n Personally came before me this L q day of i3t*ow flg9the above named Robert O. McGr� and Lois H McGrane husband Auld wife TITLE: MEMBER STATE BAR OF WISCONSIN t ome known to be the person(s) who Of not, authorized by 1 706.06, Wis. Stats.) executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attomey Kristine Ogland Hudson, WI 54016 Notary Public, State of Wpkonsin (Signatures; may be authenticated or acknowledged. Bah are not .�w��Aet%r`sAW GtiPWiSrAFW6i0F� (If not, state expiration date: necessary.) , RE NSF J/ /L 5 NOTA YPUBLIC 1016,51 o.3 STATE OF WISCONSIN 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY STATE BAR OF WISCONSIN FUM Na a -1993 INFORMATION PROFESSIONALS COMPANY FOND OU LAC, w, 500435.2021 Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 i sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 28, 1999 CUST ID No.283360 ATTN.• POWTS INSPECTOR ZONING OFFICE BOLDT'S PLUMBING & HEATING ST CROIX COUNTY SPIA 820 MAIN ST 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 RE: CONDITIONAL APPROVAL, Identification Numbers APPROVAL EXPIRES: 09/28/2601 Transaction ID No. 249056 Site ID No. 181313 SITE• Please refer to both identification numbers, Site ID: 181313 above, in all correspondence with.the agency. St. Croix County, Town of Springfield SETA, SE1 /4, S27, T29N, R15W Facility: Robert McGrane Proposed Residence FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 492703 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. 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. 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 09/20/1999 � � FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard 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 6 I Y MOUND SYSTEM DESIGN`, Residential Application S �' INDEX AND TITLE SHEET �� Fp � , 199 Project Robert McGrane Four Bedroom Residentail Mound Owner Robert McGrane Address 3068 70th Ave. Wilson, WI 54027 Legal Description SE1 /4SE1/4, Sec.27, T.29N., R.15W. Township Village of Wilson, Tn. Of Sprin County St. Croix caf2d ltionally Subdivision Name Lot No. O VE 1) DEPARTME FT n CO D M B MERD' NGS Parcel ID Number 191 - 1012 - 50-000 DiVISIO Plan Transaction Number NCE EE GORRESPO. Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump performance curve Page 6 Site plan Page 7 Attached soil evaluation report Page 8 Designer Dale Hudson License Number 220853 Signature � -r�-� Phone No. 715 -684 -3378 Date 8/26/99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). SBD- 10462 -E (8.05/98) Page 1 of 8 e 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 11 % Wastewater flow rate 600 I gpd 2271 Lpd Depth to limiting factor 16 in 40.6 cm In situ soil infiltration rate 0.6 gpd/fe 24.4 Lpd/m` Contour line elevation 100.7 ft 30.69 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. Hole diameter 0.25 in 0.125, 0.158, 0.185, 0.219, 0.25, end manifold c core , Center ore � ) �� 0.281, or 0.313 inch on . v Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 3.50 ft Not a final calculation. Number of laterals Pump tank elevation 86 ft Outside bottom of tank. Forcemain length 210.0 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 5132=0.156 9M =0.281 Estimated daily flow �gpd 2271 Lpd 3/16=0.188 _ 51 0.313 7 /32 Absorption cell Design load rate & area 1.2 gPdhf 500.0 ft` 46.45 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) 100.0 ft 30.48 m Depth of cell (F) 9.5 in 24.1 jcm Sand filter Upslope fill depth (D) 20.0 in 50.8 cm Downslope fill depth (E) 26.6 in 67.6 cm Basal area required (gpdrnfiltration rate) 1000.0 ft 92.90 m Supporting 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) 12.70 ft 3.87 m Up slope toe length (J) 7.80 ft 2.38 m Down slope toe length (1) 17.90 ft 5.46 m Total mound length (L) 125.40 ft 38.22 m Total mound width (111 ) 30.70 ft 9.36 m Project: Robert McGrane Four Bedroom Residentail Mound Transaction Number: Page 2 of 8 I - MOUND PLAN VIEW observation pipes (typical) J I F1 30.7 ft :::` A� A = 5.00 ft 1.52 m 9.36 m•..•.::::::::: B = 100.0 ft 30.48 m W g J= 7.80 ft 2.38 m K 1= 17.90 ft 5.461m K = 12.70 ft 7871m _ 1 125.40 ft 38.22 m typ. obs. pipe (anchored securely) I = down slope dimension"' = absorption cell (Ax J = up slope dimension O = plowed area (LxW) K = end slope dimension 6!' (152 mm) T MOUND CROSS SECTION D = 20.0 in 50.8 cm lateral topsoil G H subsoil cep E = 26.6 in 67.6 cm invert 102.87 ft - - -- -- - - - - -- ....... F 9.5 in cm 31.35 m JF G = 12.0 in 30.5 cm elev. ASTM C33 H =Min in 45.7 cm D Sand Fill y Sys. 102.37 ft elev. 31.20 m 1 100.70 ft contour 30.69 m elev. 11 % 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 H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Addition 1.6' of sand fill required at center of mound to compensate for "dip" in contou line. Project: Robert McGrane Four Bedroom Residentail Mound Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 1 5 ft 1 1.52 Im Length (B) 1 100.0 ift 30.48 m Lateral specifications Number laterals 2 Holes/lateral 14 holes Lateral length (P) 48.38 ft 14.75 m Hole diameter 0.250 ]in 6.35 mm Lat. dis. rate 16.31 Igpm 1.03 Us Sys. dis. rate 32.62 gpm 2.06 Us Hole spacing (X) 43 lin 109.2 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red 'X" one choice 1 1/4 in (32 mm) box of chosen from the options 1 1/2 in (40 mm) x x diameter. provided. 2 in (50 mm) 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. end cap � IE- X-- 4Ifx /2 I x12-31 Laterals & force main of PVC Soh 40 Last hole drilled next to end cap (per COMM Table 84.30 -5) Hales drilled on the bottom of the lateral, • = permanent end marker equally spaced Inch-pounds Metric Lateral length (P) 48.38 ft 14.75 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 43 in 109.2 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 1.50 in 40 Imm Forcemain diameter 2.00 l in 50 mm Project: Robert McGrane Four Bedroom Residentail Mound Transaction Number: Page 4 of 8 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 It 0.76 m Vertical lift 15.87 ft 4.84 m Are laterals the highest pant in the Friction loss 3.80 ft 1.16 m system? Yes "X" here. Total dynamic head 22.17 ft 6.76 m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 10.2 gal 38.6 L back to tank? ('x' one) Minimum dose 150.0 gal 567.8 L x Yes Drain back 36.6 gal 138.5 L No Dose volume 186.6 gal 706.4 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 g� m levels disconnect afteate 4" vent pipe electric as per NEC 300 and E --- outlet Comm 16.28 WAC location 16'(46 an) min. wall of pump k- approved chamber or outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 87.0 ft C - pump tank manhole = 4!' (10 cm) Off elev. 26.5 m minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 86.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 26.2 m bottom of tank Tank manufacturer Wieser 12501750 gallon concrete combination Pump tank capacity 16.12 gal /in Pump tank volume 757 gal Pump manufacturer JZoeller Inches Gallons Pump model number 140 o A 24.9 401.2 .N B 2 32.2 a Alarm manufacturer LevelA E C 11.6 186.6 Alarm model number JDLV p D 8.5 137.0 Project: Robert McGrane Four Bedroom Residentail Mound Transaction Number: Page 5 of 8 HEADICAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 185/4185 should not be subjected to less than 30 feet TDH. TOTAL DYNAMIC HEADICAPACITY PER MINUTE 1n Of sus 1�1yJJ SERIES 11 41 57.59 01 117.111 1/014140 WAIST 1614161 1659115 11LNIS IW4146 1W4118 1HN /11 III li FT. M. Gal. Lbw Gal. Lim. Gal. LOS Gal. LOa Gal. -lW Gal. LYS Gal LOS Gal. LIM Gal. LM. Gal. Lim Gal. LM Gal. LOS. Gal. Lim Gal :LOS 14 5 132 U.S 62 24 144 43 161 72 271 11 152 94 136 106 401 it 211 N 211 so 220 155 MY 155 M7 45 : 170 42 10 2A1 111 M 21 It 34 125 it 2N 71 All M 341 100 111 61 211 61 211 so no ul M/ 111 072 45 :111:. 135­ is 4'11 81 M 13 it It 72 45 110 H 242 17 j it M ny M 2 r so 27e 142 7 145 So 45 11 20 6.10 2.5 1 1 11 2S 11 36 111 71 276 12 Ito 59 221 60 221 SI 220 136 sty too SM 43 176 40 2S 1A2 4 10 61 <231 74 210 37 21t S1 211 $l 126 121 444 113 Ms 4S 111 1 3 10 1.14 sl - 211. is 244 55 .Tee St IN M '340 sl 2; 121 41 121 461 4s ;1111. 40 1611 20 110 46 111 - . 46 172 SS .M 7S x.18) so 220 105 - 311 114 471 4s III 38 1 25-- so IS2,1 21 10 31 125 51 111 M -011 54 224 M $11 100 370 45 - 110 to 6611 is it 43 141 36 116 51 211' 11 2M Is :32 4s :111 12 70 21.14 30 114 10 M 32 111. 51 111 70 21S 43 III 36 191 10 K'34 14 53 45 fro 21 106 54 -204 45 1170 1 1 10 21,11 - 32 111 1 1 IT 140 45 - .Ito 100 30.46 11 k 21 : : N 34 110 3260 r 26 6 M 3o yip 110 120 1661 N ' 105 110 ».L2 to i3e 32 Loch Val— 21.4• 21' 1115 2T N' 46' M' K' iT 7T 115 /1' 112' t1T 100 30 95 28 90 186. 26 4186 85 � 165. 24 80 4165 75 0 22 1� 70 x U 20 2 65 0 18- 60 163, 4163 189. J 4189 0 55 r 16 50 14 45 12 40 140, 188, 35 4140 4188 10 30 137, 185, a2.Z. 25 139 4185 6 20 Ilk *­aa 15 4 10 2 5— 43 '48 3, 5 98 161, 7,59 4161 0 _LJ U.S. GALLONS 10 201 30 401 50 601 0 80 1 90 100 1110 120 0 140 1150 160 LITERS 80 160 240 320 400 480 560 640 0 FLOW PER MINUTE 009922 31.4,2 ;.P -F4• t nimum reyu;reo�S4c,,0 /y� Note: For Head Capacity on Model 112, industrial column- explosion pr000f pump, see FMO219. p9.1Po1�� IJ26 /t ■ �a ( Q�¢rv� Tr•ce IiKe. N 33` cv;CSOr�, cv /• n / e i •r 310- / I V Sr s�SC � SQe. ,27 T. 291. o� cj; / �o Yl0.i l i v� Gr rt¢✓+ i4s� l__!'6 )X CA) o r-<I EI v a 99.57 \. �z P de. 41c IK / / /35 � prop,Zed i zs17-s-ccf -0 k0 D. ✓,C, Proposed /4P:15'af9�gd ?, lot " 1Dm �rade . res;devree 0 k—P,a po s td. emu. /3.ZO 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 • AC.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 honzorrtal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# 191- 1012 -50 -000 APPLICANT INFORMATION - Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Robert McGranc Govt Lot SE 1/4 SE 1/4 S 27 T 29 N,R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3068 70th Ave. City State Zip Code PhoneNumber ❑ City ® Village ❑Town Nearest Road Wilson WI 54027 715- 772 -4778 Wilson 10Th Ave. & 310Th St. ❑ New Construction Use: Z Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate — 0 bed, gpd/ft .3 trench, gpd/ft Basal area required bed, ft 1500 trench, ft Maximum design loading rate 0 bed, gpd/ft .3 trench, gpd/ft Recommended infiltration surface elevation(s) 102.34' at 20" above 100.67 contour ft (as referred to site plan benchmark) Additional design / site considerations Site suitable for A +4 " mound to replace proposed privy. Mound would require 20" of ASTM -03 beneath system. Parent material Glacial till. Flood plain elevation, if applicable NA ft S for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ®U N S ❑ U ❑ S ® U ❑ S ®U ❑ S ®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 Consistence Boundary Roots Bed Trench 1 1 0 -6 10yr4 /3 None sill 2fcr mvfr as 2f 0.5 0.6 2 6 -11 10yr4/3 None sil 2fsbk mvfr as 2f 0.5 0.6 Ground 3 11 -14 10yr5/4 None sil 2fsbk mvfr cs if 0.5 0.6 elev 99.11 ft 4 14 -18 10yr5/4 None sit 2msbk mfr cs if 0.5 0.6 Depth to 5 18 -24 10yr5/4 None sl 2msbk mfi cw - 0.5 0.6 limiting 6 24 -38 7.5 4/6 m2d5 r5/6 scl Icsbk mfi - - 0.2 0.3 factor � y 24" Remarks: 2 1 0 - 10yr4/3 _ None sit 2fcr mvfr as 2f 0.5 0.6 2 9 -24 10yr5/4 None sil 2msbk mfr as 2f 0.5 0.6 Ground 3 24 -32 10yr4 /6 None s1 2msbk mfr cs if 0.5 0.6 elev 99.04'ft 4 32 -50 7.5yr4/6 None s Osg ml cs if 0.7 0.8 Depth to 5 50 - 58 7.5yr4/6 m2d5yr5 /6 sc Om i mfi cw - NP NP limiting - -— factor 50" -7-7 Remarks: CST Name (Please Print) Signa e: 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 8/2/99 3602 1087 - Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page I of 3 Dkisim of Sd* and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil tic site Evaluat;ow Attach complete ate plan on paper not less than 8'h x 11 inches in sine. Plan must minty klckK* tart not limited to vertical and hortz=M reference print (BfA), dir+ec don and St. Croix percent slope, scale or dimemslons, north arrow, and location and distance to nearest road. parcel I.D.# 191- 1012 -50-000 APPLICANT INFORMATION - Please print all Information. Reviewed By Date Personal Information you prime may be used for secondary purposes (�vacy Law, s. 15.04 (1) (m)). 1— Property Owner Property Location - -- - -- -- Robert McGrane Govt L ot SE 1/4 SE 1/4 S 27 T 29 N,R 1 W Properly Owner's Mailing Address Lot # Block # Subd. Name or GSM# 3068 70th Ave. CRY State Zip Code PhoneNumber [ City ® Village ❑Town Nearest Road Wilson WI 54027 715- 772 -4778 1 Wilson I 10Th Ave. & 310Th St ® New Construction Use: Z Residential / Number of bedrooms 3 ❑Addition to existing budding Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 0 bed, gpd/ft •3 trench, gpd/ff Basal area required bed, ft 1500 trench, ft Maximum design loading rate 0 bed, gpolft .3 trench, gpd/ft Recommended infiltration surface elevation(s) 102.34 at 20" above 100.67 contour ft (as referred to site plan benchmark) Additional design / site considerations Site suitable for A +4" mound to replace proposed privy. Mound would require 20" of ASTM - 03 beneath system. Parent material Glacial till. Flood pain elevation, K applicable NA it S for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S® U ❑ S❑ U ❑ S MU ❑ S® U ❑ S M U n S Z U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDM Bodng# won in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench 1 1 0 -6 10yr4 /3 None sit 2fcr mvfr as 2f 0.5 0.6 2 6 -11 10yr4 /3 None sit 2fsbk mvfr as 2f 0.5 0.6 Ground 3 11 - 1Oyr5/4 None sil 2fsbk mvfr cs if 0.5 0.6 elev 99.11' ft 4 14 -18 10yr5 /4 None sil 2msbk mfr cs • 1 f 0.5 0.6 Depth to 5 18 -24 l Oyr5 /4 None A 2msbk Emfi cw - 0.5 0.6 NMI" 6 24 -38 7.5yr4/6 m2d5yr5 /6 scl 1csbk - - 0.2 0.3 factor 24' Remarks: 2 1 0 -9 1Oyr4/3 None sit 2fcr mvfr as 2f 0.5 0.6 2 9 -24 10yr5 /4 None sil 2msbk mfr as 2f 0.5 0.6 Ground 3 24 -32 10yr4 /6 None A 2msbk mfr cs 1 f 0.5 0.6 elev -- 99.04' ft 4 32 -50 7.5yr4/6 None s Osg ml cs 1 f 0.7 0.8 Depth to 5 50 -58 7.5yr4/6 m2d5yr5 /6 j sc I Om mfi cw - NP NP t — limiting - - - - -- -- - -- -- - - - - -- - _-t - -- ---- - - - --fi - -- - -- - factor 50' - Remarks: - - — - - - - -- - - -- - - -- CST Name (Please Print) Signs . Telephone No. James K. Thompson �p 715- 248 -7767 Adder A.C.E. Soil & Site Evaluations Data CST Number Ref # 340 Paulson Lake Lane, Osoeola, 54020 8/2619 3602 1087 i OL r, �,st6 w / �D ysy va'� u �ro 'u�s�'� Jo �6�//� "CYIS/ .7Y / �fl awl- ro L of c?A / : a7� N ii vZF/ �l ✓ v �_� p 40C ' 4 /J2 ■ �; ( fit ¢�v�£ Tree �►Ke. P'� I� 33' 3a to 70 n (3► / / 1 v �• O "S E/ce, Asyx cd Sf. l ei �• mil. II ■ / g3 A __6of_: 7°,00P / r�loar: EI e � — 98.57 4 Bz / A WI -Ico -& E'J Gu - �L ✓i �lq i3zo - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353109 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: Village of Wilson "TB lev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 191- 1012 -50 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Mode[ Number GPM TDH I Lift I Friction System TDH Ft oss Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manuf acturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 El Yes El No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 3068 70th Avenue, Wilson, WI (SE1 /4, SE1 /4, Section 27 T29N -R15W) - 27. 29.15.99 Plan revision required ❑Yes C] No (� Use other side for addi tional information. L SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € 3 _a E e E w 'E , f e Y,. i J i ,...,. v N B i a ., ....... ....... ... ....._.. _ _.. �..,. _..... _ fie. ,. .,,...� 5, 2 f f 6 u s e d " t , F � i 4 z t g E 3 s ( i � .. ,,,....... - ,.,... ....,.. ..,. .,.. gym. .. .. « __ .. m.. e e � £ E' i d � r am a f .... d .....,. .._....... 3 �..... , ✓ m,...., 2 � _ ., ¢ ., .._ .. f .. _.....,,..�..g e.,..,�....... _�.� f c E i £ i S§ B F , m. ...ems a � 3° ,,..w i s f i , , E i s F , w, n e t � £ i d m m N m _a f g —J— Safety and Buildings Division V iscons i n SANITARY PERmtr..APPL ON 201 W. Washington Avenue ,� - - - - � P O Box 7302 Department of Commerce In accord with Co j lr�t`83:05; Wis. /,dm. Co': Madison, WI 53707 -7302 • At r h I ttac c ompl et e plans to the count co only) fort ste r not " Count than 8 1/2 x 11 inches in size. 1 `— >X • See reverse side for instructions for completing thi �Iic &WA 1 7 1999 ,__ State Sanitary Permit Number 3T GF OIX q cXx 1 ``�� Personal information you provide may be used for secondary purpos �� ukTY ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. ' ' n ZOlYIN6(�l�tCE �� \`'� `' State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT RM TI ' Property Owner 1 N 1 ame P opE ocation ©D c G c, r'' ri 1/4, S 2 '; T 79 , N, R 15 (or) (@ Property Owner's Mailing Address Lot Number Block Number Cit �� y, )� tat Zip Code Phone Number Subdivision Name or CSM Number l,�/l f C> 7 (7/5 ) 77Z -y778 II. TYPE OF B I ING: (check one) ❑State Owned 0 Cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms a n OF !,t/i /SOYA IOAv 311 111 BUILDING USE (If building type is public, check all thatapply) $1% Parcel Tax Number(s) 1 Apartment/ Condo �9/ ,7 0 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 line B, if applicable) A) 1. gNew 2. ❑ 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 F1 P' 13 ❑ Seepage Pit ault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �Q Feet Feet Capacit V11. TANK in Ca gallo Total # Of r Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass App. New Existin structed Tanks Tanks tspptir n /C70O ' �( [D 11 E] ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name :: (Print) I Plumber's Signature: (No Sta_mpps) MP /MPRSW No.: Business Phone Number: �7 Z a �/>V'� � l�(,d , E. /-i-ttYti L' 0 F: 1j Plumber's Address (Street, City, State, Zip Code): � IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Iss ng g nt Signature (No tamps) [ Appro ved []Owner Given Initial Surcharge fee) Adverse Determination 1� /ov 1 f i X. CONDITIONS OF APGROVAL / FOR ISAPPROVALr `l' Pi^ o wi, ( yG IK , ' aid, tS � � ( � W " S " V Ala kw'aii w i41 �aGsu�{ iicl ' / rdv j �,�, ✓ 1�,� •v s f I I {�t l�(s 6c.� I .q, c, it wf i S � mss Otte. SBD -6398 (R. 4199) DISTRIBUTION: Original to county. One copy To: Safety &Building 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) most'bCi pumped by a licensed puinpef- W - enever 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 applicationmust include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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 new /or 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 8 1/2 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 holding tank(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 pumpmanufacturer;_D) cross section of the soil absorption system if required by the"Courity;"E)'soil test data on a 115 form; and F) sizing informattbn. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for 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. - 1 — rte- li ke- P; 33 dwn.e(•� 30 70 w; CSUY�, cv /• QI / ■ / v 10 caz�» : / 310 5cyyr5�'`y SQe. Z7, T. 29x1., 6e4ee. Assu•rc_d _ e 1�� M / g3 y • / � P ,�e/-e�e Y ,4,opnoxl,�(a�e r TOOP- 51-01'E5 1 > I'POTH 51DE: - . Of BUILDING) - GRAB BARS C4 ) b" TYF WALL 12" r — WOMEN - ri MEN ID , 36 "DOOR _ _ _ 0 36' Doo17 —9 "VENT PIPE I PER SIDE i e" DGOR _ 36' DOOR i 62 ' DOOR 20 OR B" DIA. MANHO OPENING - AND c0 /ER These buildings are handicap accessable and can meet DNR specifications. With no wood floors or walls to rot, this building is a maintainence mans dreams. If cleaning is required, the building can be hosed down with water or disinfectant. The buildings are very resistant to vandalism. The stools are made of durable plastic and will not dent. The door and frame are constructed of steel. After completion the building is painted inside and outside. The roof is set and then the • The inside of the building is • This unit can be done as a bug screens are installed. finished off which includes in- - two- 4eaaf one seat unit. A Ventilators draw air from both stallation of grab bars, stools, concrete roof can be added pits. and stalls. also. When looking at the long -term maintainence cost of this building, you can see what a value it would be. We can also manufacture a secure utility /storage structure. This building would be ideal for storage of flamable or hazardous liquids and materials. For more information contact: AL PR �P 9N� HUFFCUTT CONCRETE 0 0 737 Herbert Street Zc9 �P Chippewa Falls, Wisconsin 54729 ASS (715) 723 -7446 Huffcutt Concrete is a member of the National Precast Concrete Association and Wisconsin Precast Concrete Association. Steve Olson, President 1.n-54Pacc 429 - , 609579 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number DocumentTStle ST. CROIX CO., WI T / / RECEIVED FOR RECORD 09 -03 -1999 4:00 PM AGREEMENT EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 12.00. PAGES: E Recording Area Name and Return Address �(,L.M GS � / �c m�OSa►�7 3yo &,ason Co"►Q osceo(q L ot. 5-{02 Parcel Identi6rstion Number (PM "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This information mutt be completed by subtniatr- docamew title. ranee & return address, and PIN (rf rrquired). odier such as the grmuing clauses, legal d cripoon, etc. may be placed on d s jirst page of the docsmwa or may be placed on additional pages of die doct -ent Now Use of this co-r page addr one page to your docuntatt and $2.170 to the reeonAng fee. Wisconsin Sanars, SAS] 7. WMA 2196 STC - 106 �,..1454 430 PRIVY INSTALLATION AGREEMENT St. Croix County, Wisconsin PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION. Prperty Owner(s): Reserved for Record -ng Data 2 0ber• 0 -Ca Le ,e Mai mg Address: Location: t. S Z 7 T -ZP N R/ S marr W city, village, Township Or: 11 116(4t v w; Parcel Ta um r: Sr7 — Legal Oescnptlon: SEyysFJs, Sec.27 7- .Z9?., ,kO /5-0. 1. No plumbing will be installed in the privy. 2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault hall maintain minimum setbacks as specified in Table 1. Table 1 Well Building Lake /Stream Additional County Setbacks 11 Open Pit 50 Ft 25 Ft Min. 75 Ft Sealed Vault 25 Ft 25 Ft Min. 75 Ft 4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code. S. Privies used for one- and two - family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self - closing and vault ventilators should terminate at least one foot above the roof. 6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code. 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the register of deeds in a manner which allows its existence to be determined by reference to the property where the privy is installed. Prm n!r s Name s SU d and sworn to before me on this date: pSON moo• .. •••. s ne ignat re h :'�• • A � U ' O ota,y P My commission expires on k. . �3 m `= NOTE: This document was drafted by the State Department of Industry. Labor and Human I en,. Bureau of Building Water Systems. Wwonsin Department of Commerce SOIL AND SITE Page 1 of 3 ' ivision of Safety and Buildings in accord with Comm 8 is. A C de r ti 'r A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan RFC`- Co 1' reference point BM directi _ include, tart not lrrllted to: vertical and horizontal pa ( ), St. Croix percent slope, scale or dimensions, north arrow, and location and distance to t road. 7 Parcil R c,, 91 -1012 -50-000 APPLICANT INFORMATION - Please print all information. gY X Re Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 1) (m)). ' Property Owner Pr taca ``t, Robert McGrane Govt . 1/4 S 27 T 29 N,R 15 W Property Owner's Mailing Address Lot # l ;k t' Name or CSM # 3068 70th Ave. City State Zip Code PhoneNumber E City Z Village ❑Town Nearest Road Wilson WI 54027 715- 772 -4778 Wilson 10Th Ave. & 310Th St. Z New Construction Use: Z Residential / Number of bedrooms 3 []Addition to existing building Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate - bed, gpd/ff? .3 trench, gpd/ft Basal area required bed, ftz 1500 trench, ftz Maximum design loading rate 0 bed, gpdff .3 trench, gpoff Recommended infiltration surface elevation(s) 102.34' at 20"above 100.67' contour ft (as referred to site plan benchmark) Additional design /site Considerations Site suitable for A +4" mound to replace proposed privy. Mound would require 20" of ASTM -03 beneath system. Parent material Glacial till. d e Flood plain elevation, ff applicable NA ft S- for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S® U M S❑ u El S ®U ❑ S® U ❑ S® U ❑ S N U SOIL DESCRIPTION REPORT Depth Consistence Dominant Color Mottles Structure GPIXF Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Boundary Roots Bed Trench 1 1 0 -6 10yr4 /3 None sil 2fcr mvfr as 2f 0.5 0.6 2 6 -11 10yr4/3 None sil 2fsbk mvfr as 2f 0.5 0.6 Ground 3 11 -14 10yr5/4 None sil 2fsbk mvfr cs If 0.5 0.6 elev 99.11'R 4 14 -18 10yr5/4 None sil 2msbk mfr cs if 0.5 0.6 Depth to 5 18 -24 10yr5 /4 None sl 2msbk mfi cw - 0.5 0.6 limiting 6 24 -38 7.5 4/6 m2d5 5/6 scl Icsbk mfi - - 0.2 0.3 factor 7.5yr4/6 y r 24' Remarks: -__91421- Z 1 0 -9 10yr4 /3 None sil 2fcr mvfr as 2f 0.5 0.6 2 9 -24 10yr5 /4 None sil 2msbk mfr as 2f 0.5 0.6 Ground 3 24 -32 1Oyr4/6 None sl 2msbk mfr cs if 0.5 0.6 elev 99.04'ft 4 32 -50 7.5yr4/6 None s Osg ml cs if 0.7 0.8 Depth to 5 50 -58 7.5yr4/6 m2d5yr5 /6 sc Om mfi cw - NP NP limiting factor 50' Remarks: CST Name (Please Print) Sign e: 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 8/2/99 3602 1087 'PROPERTYOwrt Robert McGrane SOIL DESCRIPTION REPORT +oar Page 2 of 3 PAIMEL LDJ 191- 1012 - 504000 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure ft P �o n siste nce nd Roots GPD/ Horizon De Texture Boundary in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed : Trench 3 1 0 -8 1Qyr4 /3 None Sil 2fcr mvfr as 2f 0.5 0.6 2 8 -16 IOyr5 /4 None Sil 2msbk mfr as 2f 0.5 0.6 Ground elev 3 16 -18 10yr5 /4 U7.5yr5/8 Sil 2msbk mfr CS if 0.5 0.6 101.08 It 4 18 -36 1Oyr4/6 m2d7.5yr5/8 sl Icsbk mfi CS if 0.4 0.5 Depth to 5 36 - 55 7.5yr4/6 m2d5yr5 /6 Sc Om mfi cw - NP NP limiting factor 16" Remarks: I i Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Tee- I t X e- P; I� 3 � Ownz�� 30 f 70 .4(,Ae. c� c�,'Lson, ck)/. Qi / ,L.o ca m» • / � �. K ' SC S e. T. 2 �Q-ne� �� .z � 9�t, / /scJ �'� /a9e o� c�,/ -r, / nat ih C•�rce l hsl S�. �6 i �C �' ; � �. l 1 � / / free . ,gssu.•� e:cf 5 /ate 79 / M / $3 sz ■ // / A ���axf��ca�e 9 � S �t /3.20 33 ?o r4✓�e. . i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address Sr'r"�2 e, (Verification required from Planning Department for new construction) City/State zz ,0 k Parcel Identification Number 11"'�I 1 491 Z - LEGAL DESCRIPTION N ' Property Location S %,, Sf 4, Sec. 22 7 , T N -R l W, Town of _S��lti �',e /6f . Subdivision Lot # Cerffled, Survey Map # Volume , Page # Warranty Deed # j129 Volume G L page It Spec house 0 yes [ono Lot lines identifiable U yes ® no SYSTEM:MAIMNANCE Impmpermc andmaintcaanceofyourseptic systemcouldresultm itsprematuriofarlureato handle wastes. Propermaintenance consists Of pampiug out the septic tank every throe years or sooner; if needed by s. licensed pumper. What you put into the system can affect the function of the septic tank as. a tratment stage in the viaste disposatsyttem, Tba proPetty owner agrees to submit to St. Quix Zoning Department i .certification fomr, signed by the owner and by a mastmphwbcrjoumeYmanP restric edphu bexorali ensodpumpe xvedfyingthat (1)theon-sitewastcwaterdisixs system is in Propu operating condition and/or (2) after inspection and pumping.Clf'aooenary), the septiatank is less than 1/3 Full of sludge.. the ttadesxigrud have read the above noquinemeatt and :green to maintain the private sewage disposal system with the standards set fork b mein, as set by the Dcparlmcnt of Commerce and the Dgwft ent of Natural Resources, State of Wisconsin.. Certification sutiug that Yom septic system has beem make acd mast be completed and rctUmcd to the St. Croix County Zoning Office within 30 days of the throe year expiration date. �iukh OF APPLICANT 15 ATE OWNER. CERTIFICATION I (we) eettify that all siatcments on this form are true to the best of my (our) knowledge. I (we) am (are) the owner of the property dumbed above, by virtue of a warranty deed recorded in Register of Deeds Office. IGNA OF APPLICANT �—" R DATE « « « « «« Any information that is mis- reepr=atod 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 refereeennoe is made in the warranty deed ST CROIX COUNTY SEPTIC TANK MAINTENATICE AGREEMENT AND - // OWNERSHIP CERTIFICATION FORM Owner/Buyer oL e_ a^� Mailing Address 7d �i/e > lire �oYt- 2 5 ��2� Property Address C, (Verification required from Planning Department for new construction) City/State 4�J Parcel Identification Number /l"/ 5 e 2 - n00 LEGAL DESCRIPTION N 1 k..ry,i V0 X.� Property Location -S /,, Sf_� y., Sec. 7. TZN -R �,� W, Town of S rl'k f;C, /(/. Subdivision Lot # Certified Survey Map It Volume . Page # Warranty Deed # _ _/D V7 3 Volume G L Page # -� Spec house O Yes al Lot lines idcatifiable M' yes m no SYSTEM MNANCE InProp rmeandmasadenanceofyoarsepticgstemcouldresvltia% tspnmat=. faffuretohandlewastes .Propermaudenanoe consists of pumping oat the septic tank evM7 dir ee yc= or soon. if needed by a U=sed pamper: What you put into the system can affect dw . fmcaon of the septic tamlcas. a treatment stage is the: wade di mds ysmm. TbC FwPedY owner Fees to submit to St. Q nfx Zoning Department a .certification form, signed by the owner and by a P - -)° plimAer, rest Actedphrmberor a lieensed pumper verifying that (1) the on -site wadmaterdisposal systerk is in proper opentmg condition and/or (2) after inspection and pumpiag.(if necessary), the septic-tank less .than 1/3 m of sludge. Ywe, the und=ign od have read the above roquircmeaft and agree to maintain the private sewage disposal system with the standards s fodk hamin,'as set by the Department of Comm=e and the Department of Natural Resources. State of Wisconsin. Certification that y*w septic system has boea manddwed mast be completed and returned to the St. Croix .County Zoning Office within 30 days of the throe year expiration date. IGNATURE OF A?rLiCANT ATE OWNER. CERTIH'ICA7`ION I (we) certify that all statements on this form are true to the best of my (our) kmowlcdgc. I (we) am (are) the owner(s) of the property described above, by virtue of a wammty deed recorded in Register of Deeds Office. IGNAWRIrw APPLICANT DATE ** * * ** Any information that is mis-rcpresented may result in the sanitary petmit being revoked by the Zoning Department. «�• «�. ** Include with this application: a cumpod warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT No. WARRANTY DEEO it I',ATI: OF 11 -I ORM I i THIS SPACE RESERVED FOR RECORDING DATA THIS [:11)f-;. \ "1•URF,, \lady ihi, 25[1• - ,1, Id April _ _ K�C�I_�Tc_: 7 U� , \. 11., 10 72_, hel een_ A. A. Willink and Dorothy- Willink.,_ ST. CR, ) . \A 11, his wife ! Recd for F N 3�) day of a 4 i;.: ! Z2 ieS ..I th( lira pr -rt ;Intl j 2t_ ��'�� - h� Robert 0, McCrane and Lois ff. McGrane, husband and wife / RNafs; t I t..ies of I I.- _( (u:(l -- V, i t n t,, 1 ies RETURN TO ( It, lip 11 1 h � -1 u. 1,11! 1.1 11�( I r -I I�;rt. 1�•1 ..rl. 1�1 hlrr,ulnn f ti,, ruin oI .:Forty - F ive Thousand DO1laws them n II11 I !".i,l h( tl,v r.Jd I,:rl 1Ps of flu r I I I, il, the re'n't ttiher< I- hcrd,% v; ,T,l( 1 i_ -I,' rt nii 11 1 n;Ixl II (ce,l ( :nn cl I 11 runt llotd, .1 1 „ Ili( -c pit 1•r.t> r ; ,I, It, n, iiu, rt , rtIIII r l,,1 , II,I 1 -a '.nu lint'' Ill I ., I�;lrt 7 e9 �•I I �r( - r(1 I). lrt)LhClhcir, ulrl per. 1 1 n i - I,c ( I Iral ( - 111, - :tIt,I .ot. St.. CroiX .. of �ll, The East One flail' of the Southwt quarter (E' -, of SWl) and the West one Half of the Southeast k (W of SE',) and the Southeast Quarter of the Southeast Quarter (SE;; of SE all in Section Twenty Seven (27), Township Twenty ;line (29) North, `range Fifteen (11)) Wt.�st l . (It' NI (.l - �' , :AR] CON EINI I; I)t :S( IM "PION ON REVI - RSI' SIDE) I'o> cilu ( t,i111 .11 nl,l -il ,IL r Ili( I n !il u, Ii .,u :! l,urtu: I ,(? tl„ u•uct hclr nv 't. r ul u,� n gain l ,i' li t, , -I -A( _ h!, f it l iIII(Ir 1, (Loris of iu n(I to th( .ILn,I L.�n,lin(! l nn�i .,u�1 ILI It,—Ill aunt =,n:,1 appurtenI!IC, Vo 1I•ICC 1 'o Hold tl, ,Ins !� n � 1- hu�,� (i Iril 'k,11, the hcte 'il. !-.(W- old : ppilrl, : "ll -, Ihl - ,iii !'til ieS,:! the , f —:id :id pol- ,,i to their h,n, an(1 ; ,n= f71R1.A I -L. \nd ilre s ;lid A. A.. Willink azla .)orut.hy. Willink:, iris vit(: lot - themselves tlltk i`'. _._ -. hl�n (��(r(I I. anU 1 In lni >fl t 1 :' -. - c. c L.111 �:r.nll I ti.iin 1 .:Fill with flit l:.:rlles , the,elund 1 .tliel-r - _- It r =:nnl I ,I th(- (n c,.lint•:n 1 tl„ p. - r <,•nt� i they WeXt: of (bc prrnlirr< alnitt (lr rnc�(l, a� of a i,00d, ulrt per,(r,, drl >xvlu!e an <1 inUr,'clo-il�!,• , u.i< ,:( ,nl cril.tnn• n the LIw, iu fce - ins ;tit, anll il:.lt iLc s,lme ;Irr ft c( :ul(I rlr.Il from all in('utnhruu',s �rh:uorrr .unl th,lf flu ahl_nr h ;u,,;ained pu•mi• -td in the (Inict and p,t(e.1hlc possession of the -id Irlrt Les ,f the >,-md !lartthe -it, ir- ,,,I .II! :Md cccrt per,:on or 1)(I oll- i'mkilh chirnint: flit xchole or anp part thetpot,. -_.. will forger \1 a1: IL: \\ I : \ \I) Ill H.\1). In 11'itness Miercol, the "lid pal t .i"- (If the fir -I ;) ha__ve - licrcuuto art_- Lhe l.r.- h.uldg_ ___.or! sr:ilS - tlo- 25 (I IN 111 April SUINI;I) , \1l') SL; \LEIS IN PRI:SI,NCE 01' / „ _A• A. Willink kiirley A. Rademak�er Dorothy Willink Dale W, Fern '!" , H: O \\lSCONSIN, .... ...... ...... -_ ... -... St. Croix I I!I, - ow h, iorc me, thl- 25th (I..v of - April A.. A._ Wi llink_ a.n.d Dorothy_Willink—.— .. and ac.n„cledt,c,! Ifw ,Inlcl - i D- ale._ -W. - .Fern r `i rq� al utaryPuhli(' - Court \\r O - oz A , .1,.: C.omnlis ion (1`zpirc;) /Is)_. 213174 - li I 1 ~to ntnre, g witnesses anti notary). rso 51 (1) of the Wisconsin Statutes provides that all of U.c t?raInstruments to be recorlied shall have Plainly printed or typewrltten thereon the names ; %AARRANT1- DEED - STATE OF WISCONSIN; FORM NO. 1 I H. C. . -Et co- YILW, Uttr DOCUMENT NO. WARRANTY DEED � S'1'.A'I'1: OF WISCONSIN-1 OR \I I THIS SPACE RESERVED FOR RECORDING DATA 1 c� I HIS INDENTURE, ,1Lule th ' � u, ..25th.. <lat ,! _. April KEGI:iT ,.S 72 between- A. A. Willink and Dorothy - Willink ST. CROL'< CO ,this. his wife ' - - Recd for Fec rd 'h 1 30 1, _ p art _ ._.3 !I I __ h;irt.ies i d2 Of t ,s If. Mcn_e, husband and „t III( lir_t part and at___ - Robert o. McGrare and Lois t� M. wife Gra - _ -- i t � '' Rrght -r of .•n �� p:u L,leS of II.r �e( and Is,r !i' i t n c s s c t il, - I i,.it ILc !'.iitl I,.,r - t ieS „ l ih, I:r -„ I�.irt. f,a ,uul in c( n:.i,irr.,tinn RETURN TO -- -- -- — „i Ih,• >n,n o f :Forty Five Thousand i)oIlass: .... , .. . t„ - them in h uuI trod bt Ow .,,id I.,rt les _of Il „ u,nd } th(. rcrcilrt tshercuf t hcrcbt ,'unfirm d, .o,d 11% Ihuc pe c scnL 'or r(r Ili,• I�,Ilntrinc (Ir- ,rilu,l n;,l , - L,t, •:�u.,l,a ni I!ir (� n„I•, (,I. St._.Croix - - ' � -._ ... . -. ,uul The East One Half of the Southwest quarter (E; of SW ?) and the West one Half of the Southeast t�uarter (W1 of SE',) and the Southeast Quarter of the Southeast Quarter (SE, of SP,), all in Section Twenty Seven (27), Township Twenty ;line (29) North, range Fifteen (15) West. \a '"PION ON REVI?RSI'. SIllE) I'u>elbcrt,i ( u,.l -iu h, r( uni ,.c in , :u,t tti� .,;,1 rt,i:,in,: „l;,l!the (­(.!tc � i,t, tit le, in(c,r�l, cl.nm ur d(ur.0 nl $•f the lirst Imit, rich, t in !.,n ,,, 0(I111Iy, ( ithc, u, 1_ ___j, , , etl,( rI'll., t in :nul 1„ ti „ ,hnt - ,� L., r;.,inr,! I „ cn , lil.�,nrnt.:nr.l ap gnlrtcu- rnr(� -. T o 11im :111' To hold III, � �� ,- ,,, ;,hots (i(- ,liked trill, III,- herc.iit. naCni aml ::l,ln rl"I,mc,��. uGtu thr -.,id l).,rt lesof the srnnvl l,,ri, .n,d to their hci,, : ,,d a- -i_,n, I ONE% I_1<. And 111e said A. A.. Willink , And JOrtzthy. Willink, f>is wife . (nr .. tl]eDISCIYt_s. Cf1f.1C - _.hri,5, tt(,nt ,. lid ul lit ni<tIII(Is. ..._..uIN n.,uI cr ;n,l, I,,rp.,in, uul :rI•,r,( h, uul with the ��,id 1 ;rti(iS F t11 ..eco11 (1 1) 111 -the bras an,l ,� >i ns, I I I , it III lino• of tale cn ,saline ;u,d dcliy I ( the” pn-ent, they W£ze_ .tr, Il �( nrd of the Inunise> alu,cr (h - criLed, ar of a good, nurr. I,crtect, abrolute and incirfruri d'. of inheritance �j n, the L,tr, ill tee >iu,;>le, an,l tl,.,t the s,,nu ,uc frcr :nul (Ir ;,r frnul :ell incuml trhat( ccr _ -..__ . uuI th;,t Ihr nL(t( Ir igaincd Ilicini - in tile iuid pr ;,ceable I ion of the s.,id part.ies the "c'mid plirtthP- i.b(ir�.uul g,nn � t in l �ll�it t ness t ��'6 r r on `1 tl`1 one lattlull\' claunult-, thr tchole or any part thereof, - -__ __. A. I> 'I ( rot... the,[- ilh en(r1�ei - �l:U.LI "f :1N 1)I�:AU. , tr(I >arG.lES_n1 the lir >t pa rt ha_- uB- _hercuntn hx of April - ., j .__. jl` SIf ;NEh AND SG,ALGD IN PRF.tiI?NCI: OF Sl :al.! !' 7 �, .� A A._ Willink l (SEAL) '$hirley A. Rademak r Dorothy Wlln -. -. _. k _. - . - ,� Da le W. Fern .- �I: V , ti r .11 1: OF «ISCONSIN, . . i St. Croix - C' untc- !'(, ml;, cons In-1 -urr I"t" thr -- 25th _ - _ ._ d..t� of _ . A I) v) 72 .- A. A. .W -i IO.x _a.nd Dorothy..W.illink -- _ - - - -- n_ the hctr -,n 3 r:crcutr,l the t nt ,(nn� iq trununt and ac!.m IFt: • j os�r. D.alo._W...Fxn. _ .n z _- - - _ . � 1I,i: in dr,rftrJ bt r � I' � Counts, Al is. Notary Public . H uc •. b I ) (I�,) 2/3/74 i I i iS ti , S•) 51 ll) (,t ti �ti 1. on 1 Stutut w -- - _ _ -___ -. ___- -__._- provide. U,ut an iuetnmtcnu to bo r�cor:l e.l shall have Ltlnl I oI the t!ra a r gt❑ tt with sry :htd uutary). p y prinh•d or [ypewrl tten thereon the namer tI AIL ItASt'1 DI:Ir:IJ SI.YI'Ir: Or " I OKbf N(-), h r. c. ru,rx co.. ruweu.[[