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HomeMy WebLinkAbout030-2117-50-000 0 3 'o n d L/1 c 1 A. m CD I � w ; w 0 0� CD m 10 ID r G 0 N f0 m Q ID N N Q m N S CO Vi W 3 r�► 3 O p w cn v D CD ( ca ? N C. A 3 W ? 3 0 ° t°i� m I L Fp O m 0 0= C O C N O° C I 3 •• °po 000 !n fA � O 3 �SSi cfl (mil �• WCO) N -P S C) m� v v v w m m 1p o = m G d D N CD z N C) D D o O o a N. a � I I m c_ I w m a 3 Z m ' i ° Z ° o =r v, y Z CD O I a I 0 z a O I N o � I , I � I I I it fi 1 1 1 b N I O I � ti O C CD A ti d0 rsa O A o� y ° CL Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: 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)]. 370212 Permit Holder's Name: ❑ City ❑ Village ❑own of: State Plan ID No.: St. Joseph Townshi CST E ev.> Insp. BM Elev.: Bm DPcr ption: Parcel Tax No.: fJ C7 U TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z Q O!�z d Dosi ng c & Alt. BM e Bldg. Sewer 5> 1 3 `� Z� Hol g Ht Inlet Z TANK SETBACK INFORMATION e TANKTO P/L WELL BLDG. Air to I ntake ROAD Air Septic NA Dt Bottom Z - 3 2. Dosing SD ( I NA Header/ Man. NA Dist. Pipe Sr ding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer _A_ Demand St cover V Model Number a Si GPM TDH Lift Friction Sy s emZ- TDH 6 Forcemain Length q6 Dia. H Z r � Dist. To Well SOIL ABSORPTION SYSTEM RED/TRENCH Width Len / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN f N Z DIMEN SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE u acturer: INFORMATION Type O r CHA Mo tuber System: 7 j d 9 v/ s O NIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) /Q t x Hole ' Size x Hole Spacing Vent To Air Intake Length _T7 Dia. Length) f Dia. t Z 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #l: - q / 13bo Inspection #2:7 /13/ 0() Location: 313 144th Avenue, Houlton, WI 54082 (NNW 1/4 SW 1/4 19 T30N R19W) - 19.30.19.966 Whitetail Ridge -Lot 5 1.) Alt BM Description =7 { _ 1� s��c� � .) W X UV k j �.. 2.) Bldg sewer length= p W,­p �1 - amount of cover = 3.) contour= - 4 "g -. 1 �, 7 $) C Plan revision required? ❑ Yes No Use other side for additional information. d0 SBD -6710 (R.3/97) Dat Inspector's S194ture Cert. No. V isconsin �" Safety and Buildings Division SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. . ` i Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst aper not to s t ounty than 8 112 x 11 inches in size. . ST C M tK • See reverse side for instructions for completing this appy tl ,z Statesanitary Permit Number 1 `' '�), s 'Z C] Personal information you provide may be used for secondary purposes' Chock if re ion� t p evi ous application (Privacy Law, s. 15.04 (1) (m)]. " "'� State Plan I.D. Number C).F' I. APPLICATION INFORMATION - PLEASE PRINT ALL N Property Owner Name r cation f 1)4 R T -301 , N, R' 9.644 Ve Property O Mail'ng Address }e� j„ Block Number O ..._. Cit , 5t at Zi de Phone Numb r Subdivisi Name or CSM N r O ( 715) t l t 11. TYPE OF BUILDING: (check one) ❑ State Owned Ne rest Road t ��, Public 1 or 2 Family Dwelling - No. of bedroo Town OF <.+ P, PZ Gt' KCB III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) f q 1 ❑ Apartment /Condo O D-- 2 417` -5 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. New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5, ❑ Repair of an m -------- 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 rEl Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy 13 El Seepage Pit / X 43 ❑ Vault Privy 14 E] System CLA S� VI. ABSORPTION LSYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 41 Required sS.SI. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation T lJ 7J 3 7 / . 9e' S Feet /00 a Feet Capacit VII TANK in Ca gallo s Manufacturer s Name Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Concrete con Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank 1006 11 11 � ! 1S 1 / ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1 1 Cr Ob " ❑ ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Prlb s Si not re (N Stamps) rMfo4P}lSVdrto.: Business Phone Number: L C ►S e�netc'C aa54 1 715�ZS -S5� Plum er's Address (Street Cit , State, Zip C e): a . __R I &Y R.111-5 u�)_T 0 zz IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination g3ZS U "d� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 IRA 1/97) 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: 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. 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 number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber 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 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 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. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.statemi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 19, 2000 CUST ID No.691727 ATTN.• POWTS INSPECTOR ARTHUR L. WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2002 Identification Numbers Transaction ID No. 317021 Site ID No. 184143 SITE: Please refer to both identification numbers, Site ID: 184143, Evan Viereggie/Viereggie Construction L above, in all correspondence with theagency. St. Croix County, Town of Saint Joseph NW1 /4, SW1 /4, S19, T30N, R19W Subdivision: Whitetail Ridge; lot 5 FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 664000 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. • The well must be a minimum of 25 feet from any system tank, and a minimum of 50 feet from the absorption area. 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. ARTHUR L. WEGERER Page 2 5/19/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, 6 DATE RECEIVED 05/15/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 and 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 WSMART code: 7633 I I Page 1 of 6 MOUND SYSTEM A 3 BEDROOM LOCATED IN THE Nw l /4 OF THE SW 1/4 OF SECTION L ,T N, R W, TOWN OF ST C-VZcJ X COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW —CROSS SECTION : CA PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER r1't PA GE 6 of 6 PUMP PERFORMANCE CURVE Qo r 1"A PREPARED FOR r erg C y ° Q PREPARED BY WEGEFREFZ E3 C3 I L . TEST I 1%A C3 AND. DES I C3" SIEFZV 2 CE F.U. BOX 74 421 N. !MAIN ST. 6 �c QNS RIVED. FALLS. NI 54422 �.••""""••,.� 71"2 •' p Q A N . 1 5 - (y ' AASHUQ 4 t o tt u l v d WEOEFEA ,j t 1191SP c o u dI -t r�Lswopni. P �? OF COMMERCE moo, ••.......••''�4 Nos pEPARTM Y at S I G14 P" 151pN 4F E RESP oN CE JOB NO. O0' L2,7 - PLOT PLAN Page of Scale 1 u`PUC a -1 bo 1voT COmPftc -'r OR b k8T%- .t3 VMS PnIA!A --r- \ \ ti� SaeTt-e r WST!! 1 LOT _S �o LOT to S \ UT 9 ftuUm D �S Y NOTES l. shown are existing ground elevations unless otherwise noted.. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( - Y - required) 4. Septic tank to be \ too jbao gallon capacity manufactured by W I LMa� L C01-i tm�Ts X , VZ -oUu c7-S 5. Bench Marks Zm*j _ o-mo. , s "ti161 , -PVC P1PE wl - JY)'t� 6. Divert surface water around mound to ponding at the uphill side...;._ Page 3 Of Approved Synthetic Covering 1)3TM C 33 Distribution Pipe Medium Sand Topsoil - H G 0 F Elev - . �8• ^ 3 £ ID , 8 % Slope Force Main Plowed Trench of 2 " -2 2" Aggregate From Pump La Undisturbedt. Soil E Ft. Cross Section Of A Mound System Using F 0.'6 Ft. { Trench For The Absorption - Area G 1•a Ft. { Ft. H 1• S Ft. B I 1S Ft. Linear Loading Rate = b •0 GPD /LN FT J 7 Ft. Design Loading Rate= 0 -'I GPD /SQ FT - K 11 Ft. L Ft. =At=e- Position of Force Main W Z Ft. L jj -Fsr�e B K tvtuirtr A -- — ---_ - —_-- 11 Distribution Trench Of 2 - 2 '2 Pipe Aggregate 1 Observation Permanent-/ Pipes Markers (Anchor securely) Mound Using I Trench For Absorption Area Page Of b Perforated Pipe oetall 0 End View End Cop ) Perforated _",,� • PVC Pipe -4 oo Install permanent-marker at end of each lateral Hales Located On Bolcom, Are EQuoItY Spaced Q End Cop * PVC Force Main Distrioution Pipe Lost Hole Should Be Nexl 7o End Cop Distribution Pipe Layout P X Aiches Y 30 Inches Hole Diameter ` f linch Lateral ''=fi (es ) Force Main "' nches # of holes /pipe 1 Invert Elevation of Laterals -0 Ft. IS7� -l� l�? - l =3s_L GPI Place 1st hole l S from tee with succeeding holes at 3O intervals.. Last hole to be next to the end cap. - Combination Sept.i.c; Tank and PUMP CHAMBER CRO55 SECTION AND SPECI PAGE S OF -VCNT CAP WEATHER FKOO r JUUCTIOLI Box 4'C.I. VENT PIPC APPROVED LOCKING 110' FROM ODOR, MANHOLE COVER rv11H . OR FRESH µ-'aR'J11.JG LA6EL A(R INTAKI corsDV�T 6 mf-x. ' to– al 6.M�N c f WAI y� ►uSVC'.t17or7 PIP; il _ _ _ IAILET - J/FhrMf, -r- U-P PROVIDE - T AIRTIGHT $CAL • t� Al =F��S 1 I l f � V Approved - -A i Approved joint w/• Tank construction I joint w/ PVC pipe shall comply with f 11 ALARM - f I 1 ILHIR PVC pipe 1;3.15 and 83.20 8 I C f oN • f I ELCV. � FT. __� PUMP --� OFF D CONCRETE iiF� 1- C) O r BLOLK - RISER EXIT PERMITTED OMLy IF TANK MANUFACTURER HAS SUCH APPROVAL IT' AAPR�ES BEDDI SEPTIC F SPECIFICATIOtJS DOSE Y_ ANKS MAQUFACTURE:R: � Ca� ° 3 UUME3ER OF DOSES: S PER DAy TAMK SIZC: Vbou 1 GALLOUS DOSE VOLUME r ALARM AAUUFACTURER: S 4 S 5`T l 5 MCLUDING BACKIFLOW: MODCL WUMBER: IZt �AW CAPACITIES: A_ lS 30!_? IAICHCS OR CALLOUS SWITCH TAPE: 8 = Z IAICH£S'OR G�+LLOk15 PUMP MAMUFACTU I`� RER: C: I1JC)iE5 OR \ X) , I GALLO►JS MODEL NUMBER: - S�Z%I f D =�_- IAICHES OR �Sn'8 GALLONS SWITCH TUPE: —_� -s7' MOTE: PL1riP AMD ALARM ARE 7 F. � MINIM DISCKARGE RATE 3 S I (,pM INSTALLED pN 5EPARATC CIRCWTS VERTICAL DIFFERENCE DETWCEI,J PUMP OFF AI PIPE.. FEET f MIWIMUM NETWORK SUPPLY PRESSURE . _ , 2.5C1 FEET + Zp FEET OF FORCE MAIN Y. �^ � F 00 FLFRtCTiou FACTOR FEET TOTAL OyNAMIG HEAD FEET As per manufacturer IL gal /in. Liquid depth 36" ME40 DIMENSIONAL DRAWING MW50 DIMENSIONAL DRAWING "ON" - -- i 0 E ° N 14.76 r "OFF" `2 c rr Ci v E _ -E �°o T 2.06 '- F —_ 1 -1/2" NPT — E • ® 36.1 mm) ischarge _ _ I cn _ 9.04 1. 5.66 5.44 ( 11.68 11.42 (296.5mm) ME40 PERFORMANCE MW50 PERFORMANCE CAPACITY LITERS PER MINUTE CAPACITY LITERS PER MINUTE 0 100 zoo aoo aoo 500 0 50 100 150 200 250 300 350 30 10 40 12 25 35 e 10 F 30 F- 20 W W W 8 f LL 6 LL 25 2 = Z ? Q 15 O W 20 6 Q S = = IU Q 4 J J = F F 0 15 4 F 10 O 1— O to z 2 5 5 0 0 10 20 30 40 50 60 70 80 90 100 0 0 0 CAPACITY GALLONS PER MINUTE o zo 40 fia as 100 1zo 140 CAPACITY GALLONS PER MINUTE 23833A275 11 MYERS LIMITED WARRANTY F.E. MYERS warrants that its products are free from defects in material and workmanship for a period of 12 months from the date of installation or 18 months from the date of manufacture, which- ever occurs first. During the warranty period, and subject to the conditions hereinafter set forth, F.E. MYERS will repair or replace to the original user or consumer parts which prove defective due to defective mate- rials or workmanship of MYERS. This remedy is exclusive and is the only remedy available to any person with respect to such MYERS product. Contact your nearest authorized MYERS distributor or MYERS for warranty service. At all times MYERS shall have and possess the sole right and option to determine whether to repair or replace defective equipment, parts or components. Start -up reports and electrical system schematics may be required to support warranty claims. This warranty is effective only if MYERS supplied or authorized control panels are used. LABOR, ETC. COSTS: MYERS shall IN NO EVENT be responsible or liable for the cost of field labor or other charges incurred by any customer in removing and/or reaffixing any MYERS product, part or component thereof. THIS WARRANTY WILL NOT APPLY: (a) to defects or malfunctions resulting from failure to properly install, operate or maintain the unit in accordance with printed instructions provided; (b) to failures resulting from abuse, accident, or negligence; (c) to normal maintenance services and the parts used in connection with such service; (d) to units which are not installed in accordance with appli- cable codes, ordinances and good trade practices; or (e) if the unit is moved from its original instal- lation locations, and (f) unit is used for purposes other than for what it was designed and manufac- tured. RETURN OR REPLACED COMPONENTS: Any item to be replaced under this Warranty must be returned to MYERS at Ashland, Ohio, or such place as MYERS may designate, freight prepaid. PRODUCT IMPROVEMENTS: MYERS reserves the right to change or improve its products or any portions thereof without being obligated to provide such a change or improvement for units sold and/ or shipped prior to such change or improvement. WARRANTY EXCLUSIONS: As to any specific MYERS product, after the expiration of the time period of the warranty applicable thereto as set forth above. THERE WILL BE NO WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PAR- TICULAR PURPOSE. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. No warranties or representations at any time made by any representative of MYERS shall vary or expand the provisions hereof. LIABILITY LIMITATION: IN NO EVENT SHALL MYERS BE LIABLE OR RESPONSIBLE FOR CON- SEQUENTIAL, INCIDENTAL OR SPECIAL DAMAGES RESULTING FROM OR RELATED IN ANY MANNER TO ANY MYERS PRODUCT OR PARTS THEREOF. Some states do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to you. This Warranty gives you specific legal rights and you may also have other rights which vary from state to state. Direct all notices, etc. to: Warranty Service Department, F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805. Myers® F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805 -1969 419/289 -1144, FAX: 419/289 -6658, TLX: 948 -7443 Printed in U.S.A. 6/95 23833A275 A uCI 7- GuWE 6 of � TOTAL HEAD I N FEET V6ll 91-ti£) o Ul o Ul o Lnn o � O o o � 0 0 N O m O A D w n o - H ° - 0 -P H ° r r O LTI m z O N c pill 44 � 3 G � ° C Z o -�{ m m ° C 0 W N O co O W Dl _ O O O O - N W P Ul m v m m TOTAL HEAD IN METERS Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT e N of 3 Labor and Human Relations U. Pa g lion o(Safety 8 Buildings • in accord with ILHR 83.05, Wis. Adm. Code - . • Attach complete site plan on paper not less than 8112 x 1 'size. Plan must include, but , NTY not limited to vertical and horizontal reference point n N f slope, scale or PARCEL I.D. dimensioned, north arrow, and location and dista esst rodd: a B 0 - to`4,0- LO APPLICANT INFORMATION- PLEASE P , LL W t ION R IEWEDBY DATE - 2-' PROPERTY OWNER: fsAQ� ATY LOCATION EN � N v 1ETZ i; GG ` jf' / t`a' -1 114 S w t /4,S 1O� T 3 p ,N,R 14 E PROPERTY OWNER':S MAILING ADDRESS • ST Cgp l� BLOCK # SU80. NAME OR CSM # �Z o8 ivRMElz t� a>v P COUNry CITY, STATE ZIP CODE P) FDFFtC QVILLAGE MOWN ' NEAREST ROAD 1fivaSt� w i 5 01 k5 $6 - $6 4` ar, Sp vi' \' S'EO zUfl'2 New Construction Use Residential / Number o - (J Addition to existing building ] Replacement ]) Public or commercial describe 2 Code derived daily flow gpd Recommended design loading rate? bed, gpd/ft -3 trench, gpd /ft Absorption area required - bed, ft - trench, ft Maximum design loading rate , S bed, gpd/ft • b trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations X ©�LGl,J 1 Parent material Lw,45 � - oUNj� TELL Flood plain elevation, if applicable It S = Suitable for system CONVENTI I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U= Unsuitable for s stem 0 S RU 9S O U OS QU 0 O U O S ®U 0 S [2 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrtc y Roots GPD /ft in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. - gW Trends L 7 ) 111 4- l0 ll� CL 3 l 2 Z )b L f' IL 3 I Z — L Z S bir w Ground 3 iy 3$ 1 p `t f2- V/ - s i 1 2m Sbk Yn C �j — 'S k � elev. M-G6 1w-f rz- L � s L Vz-�1/ Depth to limiting factor Remarks: Boring # a -!O 1 b`L R- 3I Z -- � Z'Fs vn V'�>r �w .. . S , l Z z '<o z6 - �• s �rtz3 y -� �h t_ z� s1�k � v ��- �w — � 5 `� � Ground elev. 33 _6V .S `i R V/ t - q�.s ft Y Depth to limiting factor Remarks: T Name.— Please Print Phone: Arthur L. We erer 715 - 425 -0165 dr ass' - egerer Soil, Testing & Design Service - P.O. Box 74 River_Fa11s,WI 54022 Signature: I , Date: CST Number.. '�vr' �4 -�7 -5 �s -g� 220254 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCELI.D.I TAT• bF aid_ 1 4`ID -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure in Mu GPD /ft . nsell Qu. Sz. Cont. Color Consistence Boundary Roots Gr. Sz. Sh. Bed Tmrrh ................ Z t o - 3 � t p `� �Z � l 6 -- S 1 � Z•� sb k �► �Ft c tv - , s -� Ground !Z 31� elev. ag_ S It. S `1 R V1v S 1 R y` S �. C_lw, Yn �h ►.gyp . 2 Depth to limiting fact q 8 ! Remarks: Boring # Ground # elev. i ft. Depth to i limiting factor Remarks: Boring # _ t;:� iiic•rSii:: . i Ground elev. f t. Depth to j limiting t factor j Remarks: I Boring # Von] 7 Ground l elev. it. Depth to limiting factor Remarks: r r.ri no•n,n .,r ...,, r - ' PLOT PLAN Page 3 of 3 SCALE 1 "= yp a.l s� t��L 'PC�zssA 8.2 LOT S Ln T '7 �oCf�1pN Sh"'TcH ' t4ST?F loT g DoT `� i ,o ft'%% TL tyz - b�. �s zzoZSy ( 715 ) 4 2 5 - n 'I 6 S `r CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM o wner /B uyer r G Mailing Address a agell 4 zaZ f� 2 Property Address 3 13 L (Verification required from Planning Department for new construction) City /State �{�� �„ !-�?� Parcel Identification Number ; - 7 11 7 SfJaS� ti'�� LEGAL DESC TI ( 5 N Property Location `/4, �' /., Sec. T_f6 N -R f W, Town of -,�77 O o� Subdivision W&7f 1�g a2 Lot #. Certified Survey Map # Volume , Page # Warranty Deed # Volume Page # OU Spec house ❑ yes X 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 masterplumber, journeymanplumber, 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 113 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 exp* n date. GNATURE OF APPLICANT 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. NATURE OF PLICANT DATE * * * * ** Any information 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 w �fJt3$�l�3 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST CROIX CO- WI DOCUMENT NO, �' RECEIVED FOR RECORD 04-07 -1999 4 :80 PH This Deed made between MARVIN O. RADKE, a iRRRANTY DEED single man, Grantor and VIEREGGE CONSTRUCTION EXEMPT D COMPANY, INC., a Wisconsin corporation, Grantee, cERY F�EEY FEE: W That the said Grantor conveys to TRAWER FEE 480.00 Grantee the following described real estate in St. Croix DING Fes° 1 County, State of Wisconsin: A parcel of land located in the SW 114 of the NW 1/4 and the NW 114 of the SW 1/4 of Section 19, T30N, R19W, town of St. Joseph, St. Croix County, Wisconsin described as follows: Beginning at the West quarter comer of said Section 19, thence N0008'36 "E 55.42 feet along he West line of the NW 1/4 of g Tax Parcel No 030-1040-10 Section 19; (bearings referenced to the West line of the RETURN To Northwest quarter of Section 19, assumed to bear North 1© /YaA .(, f P� OOo18'36 "E); thence S89oO4'41 "E 1229.07 feet; thence South , OOQO2'08 "W 55.42 feet; thence SOOoO5'02 "W 481.68 feet; thence Southwesterrd 9654 feet along the arc of a 833.00 feet radius curve concave to the Northwest whose chord bears South 33°09'09 "W 909.04 feet; thence S66o 13' 16 "W 169.50 feet; thence N89o05'06 "W 388.36 feet; thence Northwesterly 187.90 feet along the arc of a 233.00 foot radius curve concave to the South whose chord bears N67o39' 11 "W 182.85 feet; thence S89o14'38 "W 27.63 feet to the West line of the Southwest quarter of Section 19; thence NOOo24'09 "E 1255.54 feet along said West line to the Point of Beginning, containing 1,539,526 square feet (35.343 acres) more or less, and being subject to all easements, restrictions and covenants of record. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and dear of encumbrances, and will warrant and defend same. 7t Dated this day of April, 1999. (SEAL) Marvin O. Radke STATE OF WISCONSIN )SS ST. CROIX COUNTY r Personally came before me this day of April, 1999, the above named Marvin O. RasIke, to me known to be the person who executed the foregoing instrument and ac.)&4*led - fhg' e. Y Notary Public, State of Wisconsin My Commission is permanent. THIS LNSTRUM ENT DRAFTED BY: Robert W. Mudge, Attorney MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 to t �v 4r e �( Ph 1S S .� 1 LLVN sy s ti o m uj tL LU Y J O O 5 4 2 1 a N ° i i Qo p i �N2 I Z ° a zI «S € k� tY 99f Oct C ooz8 8 I I L U C', ' I L] Q X ? 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