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HomeMy WebLinkAbout030-2114-10-000 i o is -0 O 0 69 m o !r T O (a 'r 7 �zd c d u O N C i EO 2 E N L)CL O � 7 M O C \1 M CL E o N E �r 6z O Q.0 O (�H TC C V \Y\ Z �� a y J l9 m � O N m V \ Y Q > C Z o< 0 0 > LL C CD U)Y O d 3wa E m O O W 2 nZ y a I v I' aa) rn l z E Z r Q v o z c) W !' (L m MP U) o z v fA F- y N E I' Q 1� N O o 0 • il, 'O t m f6 N 0 U V O w N O O Q Q 2 Z z 0 Z o I C a' m LU CL ° oca` FE 5 m O O O •N I'i � aaa a. O 7 Q f/� �p 0 O W 00 00 Z O co j 0 0 0 Cl) LO m C a to 'C y O m N .6 G1 Q z U) N O ca H N w O 3 y C Q E O O O C O M Q) �_ V O CO Z V f06 N U n. O O O O r \ fr 4 O a C y N m R N N N N v Qj y O C C Q1 N CI • ~ y C O N O y Cl)cl cc co SO - M Z co Y Y 2 co V fn o n n v � v� € . :. dt a d • a a °' 3 E t� t A tiaM oaici I I " ' 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)]. 353330 Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Swanson, Kim & Nancy St. Joseph Township 3&0 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: (� �� �� B �,� g1 030- 2114 -10 -000 TANK INFORMATION ELEVATION DA A 'N • w l0 I R TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P �zm Benchmark 71•5 0//�.'f�` Dosin wt�� � P� VQ Alt. BM , t o l '( Aeration Bldg. Sewer 5 � 13, C�pg dc�r [ Holding St/ Ht Inlet / �.3o l o g-, ZO TANK SETBACK INFORMATION St/ Ht Outlet ,$Z qa., 68 TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet ` .3 O(a • 6(o Septic S 1 NA Dt Bottom _1 0 "( 3 2 0 3, 0 Dosing 2 r NA Header 1 Man. Aeration NA Dist. Pipe yq 720. �a Holding Bot. System C Q S °� 42-o- a.} PUMP/ SIPHON IMf ORMAT ON Final Grade Manufacturer Demand St cover q Model Number rj'!��`f� 3D GPM gad! ��T �7� f5 1��' 2 a TDH Lift �'�•13 Lriction Z�� Syste Z•5m T H 23(�Ft �rVt#'Z C �� , °!`f 7 13 - -a Forcemain ength g(�' Dia. F 2 " Di t.To ell SOIL ABSO ION SYSTEM IZ. - 2 f— -� t S. `E' 3 BED/TRENCH Width Lengt , / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V `f DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM CH Manufacturer: INFORMATION Type Of i r ) CH ER Model Number: System: I ` c� UYI� b� �. IkIOT/ LINI DISTRIB SYSTEM -� r 3`� 6 Header / anifold 2 Distribution Pi e(s) Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. • S�� Spacing ii SOIL COVER x Pressure Systems Only xx Mound Or t -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No E] Yes [] No COMMENTS: (Include code discrepancies persons res Inspection #l: t /yu his ection v Location: 330 129th Avenue, uds 401 (SE 1 4 1/4 31 T30N R19W - 31. 9.938 White Eagle -Lo i 1. Description = P Alt BM Descrt j�5t `1 2. Bldg sewer length ' " U / C 0 L g 1� S u - amount of cover= �Z - a - 3.) contour= �711 � 9.w�[2�l-k+�- � _ _ f• L ,�.� / ���Q,�' Plan revision required. ❑ Yes ❑ No Use other side for additional information. SBD 6710 (R.3/97) Date n ctor's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E i a TT M .. �. em e ^ [1-1 ' P � e a E 3 f 4 a ... k k � €, .e....,...�. .... ,, ... ...... .e.. ,.... .. ...,.. ;. I 3 ? ° 3 s ......_,_ .� ._,. P.,.,.W,...,.. __a ^.W� _. ,. .._., ... _. ... __ _. ,.e..... .d. ,., .. .,. _. ... :—f-- _• ,� _. .__. ., ..J _ .�_ .... _ _ ...... s } 'Al ,�� e. • a m r � 4 � � a e € i ; k x '. t t771 : a ... ... ...... .. __ _ -. — 1: t E 3 r � # 1 s A a E p > e i ce _ + 'a r w. LA, — d--.�s a.fl B `S a • � x- € -4 I a . a yy c mm� i f , f 3 e ^ ,.�,, S _. 1 1 A _ .&.,...,... . _ a... _�... _ ......_„ �. . _..,�..,._ i 1 t .. s S � z { ^ m�a tie i k i g s a 7 i s.1 Te : 33 0 - / �9 , fa- 2 Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 B Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County, �. C/QD ! X- than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 35 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 300 `j O / Property Owner Name Property Location K 7M r iU�'.tl eY SW�iV s� �VIV11 S 3/ T 3 , N, R lq E (or W Property Owner's Mailing Address 2 D�O��� Lot Number 2 / Block Number od /� � . N. w City, State Zip Code Phone Number Subdivision Name or CSM Number /4N Y! o �Z (4 3 sy Iell II. TYPE BUILDING: (check one) ❑ State Owned o it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o vo wan OF S T T � /Z III. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) ?�� � 1 ❑ Apartment/ Condo 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. rVf New 2 ❑ Replacement 3 ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ____ System ___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 Oj Mound ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pr sure f I 42 ❑ Pit Privy 13 ❑ Seepage Pit / 60 43 ❑ Vault Privy 14 ❑ System -In -Fill C�gp— I q 3 O IM VI. ABSORPTION S M 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) C . 3 p Elevation ( dro , 2 l 2- ! Feet 49 1A 2 - ' Feet Capacit VII. TANK in Ca gallo Total # of Site Fiber- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel g lass Plastic Appr New Existin strutted Tanks Tanks i WAS Septic Tank or Holding Tank �20� /,14 C ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) H PW /MPRSW No.: Business Pho a Number: Plumber's Address (Street, City, State, Zip Code): 4 s,,5 d Z Attil 12Y IX. COUNTY / DEPARTMENT USE OLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determinatio . S - 1 3 -- I ()- 2& D X. OA CONDIT� OF APPR VAL REASONS , �OR QISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permitis -valid for two (2) years. 2. Your sanitary permit maybe 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 ownersh p.or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation = 5. Ohsite 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 hav!e-que'st ohs I -concerning your onsite sewage system; contact your local code administratof or the $tate pf Wisconsin, Safety and Buildings Division, 608-266-3151.'\ - To be corimplete anciaccurate this sanitary permit application must include: I. Property ow name and mailing address.`' 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 must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. LorrVplete plans and specifications not smaller than 8,1/2 x 11 inches must be submi tted'tothe 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 refer04e'p6irits; q;tomplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump perfoemance curve; pump model, and pump manufacturer; D) cross section of the soil absorption system if required by the'cQunty; E) soil test data Qn a 115 form; an6F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER $URCHARGE, 1983 Wisconsin Act 410 included creation of surcharges (fees) for a number of regulated practices which can effect groundwbter. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 Viscons►n www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary March 06, 2000 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/06/2002 Identifica ers Transaction ID o. 300901 Site ID No. 187910 SITE: Please refer to both identification numbers, ST CROIX County, Town of SAINT JOSEPH above, in all correspondence with the agency. SE 1/4, NWIA, S31, T30N, RI 9W Lot: 21, Subdivision: WHITE EAGLE KIM & NANCY SWANSON WHITE EAGLE TRAIL FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 651408 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. 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 03/06/2000 FEE REQUIRED $ 180.00 '/ ����_ FEE RECEIVED $ 180.00 PTE AGEL', PO TS PLAN REVIEWER II BALANCE DUE $ 0.00 Integrated Services (608)266-2889, M - F, - 1630 HRS PEPAGEL @COMMERCE.STATE.WLUS wqS ode:."'. cc: KIM & NANCY SWANSON oRIGINAL VLBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, Wl 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # ` -' Date Feb. 16,2 Owner K & Nancy Swanson Phone 65 4 30 - 3544 Address 2480 No. Ridge Ave No., Stillwater, Minn.55082 Legal Description Sit a address: 330 129th Ave. Hudson, Wis. 54016 PIN 030 - 2114 -10 -000. Lot 21, White Eagle Subd. SE 1/4, NW 1/4, Sec.31, T30N, R19W. Town of County . St... Joseph _ __ S- t•- - -Cx __. C.S.T. Arthur Wegerer M00576 Installer Local Authority/ Supervision S Croi County Zoning Dept._ PROJECT DESCRIPTION New construction. For a proposed 4 bedroom house. Estimated daily w asteflow: 600 gals. Soils are permiable (.5/.6 GPD /Ft2) and per CST suitable for a mound system using 12" sand fill. Proposed: for maximimum final clarity and pretreatment of effluent, a Zabel filter system shall be installed in the 1200 gal. precast septic tank (Midwestern Precast Inc. Memonenie, Wis.). A st ate approved above ground locking cover shall be provided for servicing access. C p Q.w RECENE "'Wej - - OR - 3 2000 1/ A r y pFE7Y & BLDGS. DIV. D/VjSt S SA y Co fR ..,r „nu,ngdii y SEE coRR�s W. U0,11C1{T - HUDSON, Pg.l PLOT PLAN VIEWS �. Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS ;�;unrmnmr� Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS 111i.s design for installation is based entirely on measurements, elevations }afidscape conditions (slopes etc.) and soil suitability provided by CSTM Tie accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the vorkmianship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. Do sill N tt, below the IN1101e file 0 I soil biolOu On most roman Iddi . z� N CIS\ IV Vft * N .. o " kA o C � o � 1 ZL W ~ O P5. Z °f 5 CRO5S SECT Io,v O F M oUo D cv rte (3ED L3 E o F I =v � A55ec ATE 'Di 5T T Riauto� 2- 5 G, rHick►sFSS PIP O F T °P sort. 5 /s l' EM E I evA 'rio,3 uui F O RM T'oE- 0j, It 9z0. 3 0 F ` I Plowe►7 T o P i o g °J 5loPE roRcE' uu F RM REP 9i.�F 3 0 .V� /0 FT — F-L6vhrio#J s --- ,, E INVERT' of y IATiFRA(S ` /20. 9( F .2 Z FT. 9z�• /z " _— To o f R ock � j , H / FT. ' �r' °P °F ! ,)-, IATERA IS _ PLAN Vl Ew o f Mou.�JD w rte 1 3E D FvRcE MAW A 8 F r• F, - -- K /2- Fr 13 -- .� t 9 ------ - - - - -- _�_ -_� — - - Fr w t -- -- - - - - -- -- -- _ _� . , 1 _ -- F K - >I a I I F r o w 3� y I ---- Fr 7 a O F ?VC cAPPED To l i 06seRVATIO,X3 A 99tQF5hTE P(pES RE(.2uMec) f3 SAL. �Ai� tUAs low A hRt� - F .. S SOIL 10-fOrRATIOE' - C APAci T % Sdt. Fr. PRoPoSev BAS AI AReA = B '� ( A fi / 9 Q. FT" - � 5 o -f 5 DISTRIr3u'rI plpE N Rk L,gy0( �DlA L- �v�E ��. P R To �n\ E a� t -� p (0 Fr 4,0 F r x � Z / FnRcE MAC &, 7,0 - IMcNE_ 80 Fr y ye o P V G — I c < VAR, ABL TOTAL. V (9 1 D U b I U 1.1 e 3 ' (,A15 I' T^ Pi C ft INc ICES MAIJIFOLD IN�I{ES oI- HoiES /R ( ZOVERT C LEVAT100 �F LATEIN 1720-90 Ap r CD • Re"ovE- � l h �� R;�1 (3 5 y R Ne�ES �ocATEr, 0,3 130T - r E'gL) All Y SPACED . Di STRi BL)T'lo" DISchAR &E RATE- r ta7Rch LArERA L 0-r1 GAL 0 T TAB O 'D FATE r-O NET wo K 32. GqL /MI'A). a 5 MI'NI'MUM ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 UW) W 30 F- tL 8 E Z 25 Z 0 W 20 6 J a 15 a 4 0 F- 10 2 5 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. l ME40 Series 4/10 HP Effluent and Drain Water Pumps - r I W NFr ® ® (38.1mm) Discharge P � I OP v I I ® ® ® I ® 5.66 �---- (144mm) -- -� 11.68 (296.5mm) �. „ frn "OFF' 8 (V � vj ^� v n O v v v a p N F. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -8658 Telex 98 -7443 K3329 7/91 Printed in U.S.A. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations 9 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S� " C w �k not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' o i o - Z 1 l q APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R I DB DATE PROPERTY OWNER: PROPERTY LOCATION N E w PtM� ftKt) IQ 1 skjt " S w j eeVT-.� Slv 1/4 M ►u 1/4,S 31 T 1Z ,N,R 19 E ( W PROPERTY OWNER':S MAILING ADDRESS • LOT # BLOCK # SUBD. NAME OR CSM # Z\4 $D N - - rtFZL b G E h t:, . N . Z 1 - 1 ^--N 1'}- t71 �PcGI CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN ' NEAREST ROAD ! 1- uu--1 2 t -iN SSOB Z- ( I ST . N wtt 171Z &TCL I: J�Z� L [� New Construction Use [)(J Residential / Number of bedrooms [ J Ad&Qn to existing building j J Replacement [ J Public or commercial describe Code derived daily flow bOIJ gpd Recommended design loading rate `1 bed, gpd/0 trench, gpd/ft Absorption area required bed, ft S 00 trench, 0: Maximum design loading rate S bed, gpd /ft ' 6 trench, gpd1ft Recommended infiltration surface elevation(s) 'Olt Z 0.3 It (as referred to site plan benchmark) Additional design/ site considerations Y W / $ ' �' L 3 ' 8 � • M l w 11KU lij IZ` OF- StA" R L_(_ , Parent material r-, - l PrL o Qr W vr H Flood plain elevation, if applicable 01j ✓� ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ®U IRS ❑ U ❑ S ®U Q S ® U [IS O U [1-9 ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxbry Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrench µ� ) o -V3 t o-t cz. 31Z z'Fs a"S - • S J0 t Zwl S .b Ground 3 41 -�y R 3 t V') elev. ° 1 n - It Depth to limiting factor Remarks: Boring # o_�� lo�t2 viz s I zP.3b C63 - S Jb E l C,� 1 L- 9 b tz wtv Ground � 3 � - bL, � • S � tZ.3 l � >, v m '�► - ' � � • y elev. It Depth to limiting factor R emarks: TName:— Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: ,Z' CST Number: . 1g WO 220254 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page ? of 3 PARCELLD.# �3O- z1.t -l/_�0 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots : k Gr. Sz. Sh. Bed ranch s Ground ulV- 9 /Y L eS�1? 1v14 Ct,� •�l .S elev. ° 1 19 - o ft. y BLS '1.S V tz Depth to limiting factborb h Remarks: Boring # - Ground V tag ! L t �U �?�] U 6 c ' LL M f3 5 U 1 elev. ft. O O)— S S . Depth to limiting 0►v factor v ti '► eO1Zp . 7 - fj i3 . �t 4g -� 3 - Z ZT w S w M Z Z 8 v Remarks: Boring # Ground elev. ft. j Depth to 1 Iimiling factor Remarks: 3oring # � .........:... around ! ;lev. ft. )epth to imiting actor Remarks: _ _ PLOT PLAN Page 3 of 3 SCALE 1 "= 30' mo o o� ! \ W oIz vi 1 � I - q..F}- We ate• 3 - t o - 2a�0.. . ` �tn.►.cgMO�I � 7 2 o ( LL I p Q 2 3 ' cs s o+— o. r =a " Z .. CN JI 2 — Iwo ( 715 ) 425 —n 6 s CST Signature ` Date Signed Telephone No. CST # Wisconsin Departrnent of Industry SOIL AND SITE EVALUATION REPORT Page l of 3 Labor and Human Relations 9 — Division of Safety & Buildings in accord with ILHR 83.05, Ws. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but- S�' C �_'Q 1.X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' o 30 - Z l l y - 10 - �O APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION N E - lvw PVIA t Kjt1 IV r�ry e Swtv)\j S 6N eevF:teT- SE 1/4 M w 1 /4,S 31 T 3p ,NR I E ( w PROPERTY OWNER':S MAILING ADDRESS - LOT # BLOCK # SUBD. NAME OR CSM # Z\4 $0 t�R`f��C�ID G+� frUtr . N . Z t - >ti LTA GLL CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE E FOWN ' NEAREST ROAD SCIL►.1 Z "M SS08 Z- D4 New Construction . Use [X] Residential / Number of bedrooms [ ] AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 601J gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft Absorption area required 50 t3 bed, ft S trench, ft Maximum design loading rate S bed, gpd$ • 6 trench, gpd/ft Recommended infiltration surface elevation(s) _ °t Z 0.3 ft (as referred to site plan benchmark) Additional design / site considerations _ YA OUwe1 W /9 63' 8 EQ • ILI I A J t MU M kZ." Or - S" F - 1 LL- Parent material oQ r W d!-S N Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem CIS ®U ®S ❑U EIS OU I ❑S R) U ❑S OU ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Cu. Sz, Cont. Color Gr. Sz, Sh. Bed rerxft O - Lrj 1p`LR 31Z V.1.'f1- ou - •S •�, 2. to �l Z- s�R 31y - 6>^L Zti►tsbk ►n `Ft- ct,�, S .6 Ground 3 141 _6V 5 tIZ 3 [y - S t& O S C) •l •`L'� elev. 0 1 1 ft Depth to limiting factor Remarks: _ Boring # o -�l �0�2 �1z s I z►n sbh ►n v �F►. �v — S' JQ C,�• -• � � 1. � 9 b �z rKv Ground 3�-6u - I'S `ttZ3l elev. c i It. Depth to limiting factor � 6D" Remarks: CST Name: - Please Print Phone: V Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Talls,WI 54022 ' Signature: F CST Number. " 2202 4 j qy J PROPERTY OWNER SOIL DESCRIPTION REPORT Page _Z of 3 PARCEL W.# 030 - �O - 0k) Depth Dominant Color Mottles Texture Boring # Horizon Structure Consistence Baxxiary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 3! Z Bed rer n.,... Z l p ZU t D `1 tZ Y Ground 2D - L 1R 3!Y elev. C 9 - O ft. y qS -bb -S Utz 31 S �6H sg p Depth to limiting factor i Remarks: Boring # - �;����:. t_6 i N IS � ;µv Ground t_' t I L I tv 0\3 i u G D LO M SU1 elev. i Depth to O I limiting 0� factor v ti ' L° O1Zp . 7 7 - 2$ wq p . :It4g A 3 - 2i s tnl w I 2 Z 8 IV Remarks: Boring # i Ground elev. ft. } Depth to limiting factor tt ti Remarks: 3oring # 'round s ,lev. ft. )epth to imiting actor Remarks: •rl rr •, •rN f • - r •.... PLOT PLAN Page 3 of 3 SCALE 1 "= 30 i� j� � �o r� o i c-o ►-�, P Pr-e -T 1 3 lea l9 °- I e ' ' H \ JI CN QYo g.l S3w1# I__ �JL,918•Z O hv Ip "t{IGEf� 3 r ``D!!j_ PUC l?1_PL_TN - ILL. °1 L$,1.J O► "3" K - $M1 tv _.BE M-- _L�_ Zs - 1 1=1ZCl WJUUA/A g$- 123 -ZI R zzoZSy x. ( 715 ) 4 .5 — F, S w CST Signature Date Signed Telephone No. CST # sco 'n tDepartritertt of Industry, ... LaEArand Huinon Retahons SOIL AND SITE EVALUA'CIONREPORT _ gage = of Divigion of Safety'& Buildngs - . in accord with )LHR 83:65,'ws: Adm: Code COUNTY SZ' • CCZ V, Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARS L .�# dimensioned, north arrow, and location and distance to nearest road. �- APPLICANT INFORMATION- PLEASE PRINT AL INFORMATION REVIEWED BY DATE 7w t r PROPERTY OWNER: PROPERTY LOCATION NZ - W W ?? M%Y-4 -GO t. SE 114 MV3 1 /4,S 31 T 30 ,N,R 19 E ( W PROPERTY OWNER' :S MAILING ADDRESS I LOT BLOCK # SUBD. NAME OR CSM # DF-40P o S� 6 9 e. V G G �LUD . Z \"3m rT� T G I F CITY, STATE ZIP.CODE PHONE NUMBER []CITY []VILLAGE NrOWN NEAREST ROAD ST, WNL, MN SS 1%\ (6SUQl0- GoIF sT, (� New Construction Use N Residential / Number of bedrooms - -" (] Addition to existing building (J Replacement [ j Public or commercial describe Code derived daily flow ' gpd Recommended design loading rate _ b ed , gpd1ft - 5 trench, gpd/ft Absorption area required - bed, ft trench, ft Mandmum design loading rate • S bed, gpd/ft � trench, gpd/ft Recommended infiltration surface elevation(s) — ft (as referred to site plan benchmark) Additional design/ site considerations S Ela "tsTC ol-3 PKG e Z Parent material cl GvN_jy\ s 1•I Flood plain elevation, if applicable N A It S = Suitable for system CONVENTIONAL OUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem EIS O U S❑ U [IS ®U ❑ S ® U [IS ®U [I S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boardary Roots Bed Tw& z `�►- a, - . S — s I I Z sb S m -'s P_ - C", L "vn3b1� Yvl CW S Ground L41-6Y -1 - S`iR3LY - S0.61 0 S elev. 9 Va ft. Depth to fimiting factor � Remarks: Boring # S) ot w S < <o Is 1 C-S okW Z -� sL � � (3r� mv q Ground - , elev. It i Depth to firniting 'M°Ir r U Remarks: OWN T Name: - Please Print Phone: Arthur L. We erer 715- 4'�Ui.b_5 egerer Soil Testing & Design Service -P.O. Box 74 River F alls, X54 � Signature: Date: CST Number: �L'V '� 48 -IL3- Z M00576 ; OWNER lP iZ5 5;M U"hJ T2b. Co 2 PSOIL DESCRIPTION REPORT P age Z f 3 P RCELI.D. r. Color Gr. Sz. Sh. Depth Dominant Color Mottles ` Structure GPD /ft Boring # Horizon Qu. Sz. Cont xture Consistence Boundary Roots Bed Tmr& In. Munseli t: �o`1VL 31z sit Z -sb� ti�t'�1- eS - 2 1�) zo l o \ 1z y l s Z,��s �� w► �'r cs - • 5 Ground 3 7 -0 -4S 1 • S `t�L 31 ", �Sb1 -t Y>7 W — ' . S elev. _ Cti L/ us -6o 31 y G o 0 "5 :_;Depth to limiting f ct % Remarks: Boring # 13 Ground i elev. f #. Depth to IhMng' factor Remarks: Boring NU S i.J iv ' 'Z U l A ! S rak P CS QtoundSZ S`t5 Sv 1 L1 OxJL C� Q :stay': ft, - ,, " 1. t1 r� S U— o Oi= .,Depth to 4 s LETS L t 1 limiting - Jactor { Remarks: Boring # UaU 0 Ca►J 6 1 El U Ground_ C�-- S s LG stay:' ft. Depth to limiting feotor Remarks: SBD- 8330(R.05%92) J." , PLOT P LAN Pa 3 of SCALE 1"= Z� / 1 1 1 y C � O"L _ I Y.3 °,`o1 S Fo�,z 'rat uvr�p • I.UT r' 91�_Z'oN �• l SASE 1U BE rrT U"73T z S ' Ptzo M lit (3vfvD . — A. t Slz�, K 4 a. b O N oT ct1 M h R - r.T o Z b �S1v2F4 Y1 uy1-D Niel) OR -, ;�t� pjv- A Zs D13 MQ SUupz or- - r , r im H u UP�. ( 715 ) 4L -0 - 169 14 00576 CST Signature Date Signed Telephone No. CST # L • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND � ,�'� OWNERSHIP CERTIFICATION FORM �•' ��� v , qL Owner /Buyer Mailing Address ? y0� /P�dG -E �yiQ % /l�lT/� %iZ /�it/ • . �s��Z Property Address 330 Aa ' (Verification required from Planning Department for new construction) City /State aVP 54 �i(J� Parcel Identification Number 03e2 - - /0 - 0-0 LEGAL DESCRIPTION Property Location 5 � ' /,, N W Y, Sec. y3 � , T 3 D N -R W, Town of S 7• Subdivision 1 04/ , 7' 2ff;F6 -14F— , Lot # 2 ' Certified Survey Map # , Volume Page # Warranty Deed # 60 1L1/ f2, , Volume �/ 1Z , Page # 3� Spec house 0 yes 8 Lot lines identifiable Ik` e ysOno SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master, plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days � e pir • n date. A'� SIGNATURE OF 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 prop describ d abo , by virtue of a warranty deed recorded in Register of Deeds Office. IGNATURE O LICANT 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 F vr 1472 364 Es 1 *41.82 STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DF.FD 5T. CROIX CO., WI This Deed, made between Preservation Development, LLC, RECEIVED FOR RECORD 11 -19 -1999 2:30 ph NARRANTY DEED Grantor, conveys and warrants C COPY FEE: to Kim W. Swanson and Nancy A. Swanson, husband and wife, COPY FEE: TRANSFER FEE: 600.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address Lfdo S, k1 r Pt of 030- 1091 -20-000 Parcel Identification Number (PIN) This Is na homestead property. Lot 21, White Eagle, St. Croix County, Wisconsin. pRt Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of October, 1999. Preservation Development, LLC B By AUTHENTICATION Signature(s) Preservatio Q ©c) i It O a authenticated this 1 ' Kristin Ogland TITLE: MEMBER STATE 1 (If trot, authorized by § 70t THIS 1NSTRUMEi Attorney I Hudson (Signatures may be mithenticai necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures ,YAFJLAryTy D= STATE DAR OF WISCONSIN FORM No.I - IM INFORMATION PROFESSIONAL$ COMPANY FOND OU LAC. 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