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030-2103-10-000
r " Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: 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)). 353292 Permit Holder's Name: ❑ City ❑ Village ❑ Tawn of: State Plan ID No.: Wiechmann, Charles St. Joseph T _ CST BM Elev.: / Insp. BM Elev.: BM Description Parcel Tax No.: •0 tm . o / c I (L Pvc C, RM 1 030 - 2103 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r,- �- ODD �bUD Benchmark 4 `�t y.`Z( Dosing ( Alt. BM 3 3 - - W 10-20 Aeration Bldg. Sewer qs, Zq Holding St /Ht Inlet 0 Sf� 0.y4 C 1 9 / Ito TANK SE ACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air M Septic D NA Dt Bottom 13 ' 01 z 13 7 90.9 3 Dosing NA Header / Man. r--r Aeration NA Dist. Pip s s -3 jt N � t y v Holding Bot. System '+ ��� PUMP/ SIPHON INFORMATION Fin G rade 310 3.53 6o• "Forcemain emand St cover . o 7. 0 q�,1p2 . Y o � (I 30 GPM e D �s4 , I�X .� 4/ q i Lriction �,k SysteTDH(SS8 Ft gth ` I Dia. 2 Dist. To Well SOIL ABSORPTION SYSTEM (cj) GQ�s 4" RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI N 3 .2S D IMENSION S SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manua urer: , SETBACK CHAMBER X - S INFORMATION Type Of c�, Z r Moe Nu r: System: Colo m e OR UNIT u DISTRIBUTION SYSTEM ct Header / M . fofEi Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length '�+` 77 Dia. L aung 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/Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: tl /2 y /tm Inspection #2: Location: 1280 89th Street, New Ric hmond, W1 54017 (NE 1/4 NE1 /4 36 T30N R19W) - 36.30.19.833 Durning & Lewis - Lot 1 vr �. w� �.1 5r a'l 1.) Alt BM Description = 2.) Bldg sewer length = - �o ' . w � u 3 to - amount of cover = I{2 t- -�X4 Plan revision required? ❑ Yes No Use other side for additional information. OS 29 0 0 /SZrp 1 14 SBD- 6710(R.3/97) 1_ ate C- � Inspector's Signature Cert No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: F � a.. _e n "y i 6 f � r e � � E _ -1 — _ I 41 E § ............... ,,, .,,. . . i ,... ........... ,._...,....... n... .,.............,.. .�,..........._�.......�.,,..,. i .�... g ......,..,..... �.. I { e g g A s ., .. ._ .�.....,� t - a. « ...............« �............ »........,...,....� .m., .�.��... &.e�.m....b�. ..... t.... ... -..... _..e. ...... F.. .......w....a,�,<.... w.Z.- ......�...e....... ..� �........�..s.- ,- ..F... .�.�.......�„�,. �.�.- «.w»L.>.,,m« ...�� � w:«... -3�«.� SANITARY PERMIT APPLICATION Safet and Was hi n g ton 201 W. Washin isconsin I n accord with ILHR 83.05, Wis. A P O Box 7302 Department of Commerce P lete P lans to the count Madison, WI 53707 -7302 �2+ • Attach complete co )forth s s rt► , a er f e County ( ) Y PY onl P Y Y 3 than 8 112 x 1 f inches in size. �► s) C PC (( teSanitar (( U s L • See reverse side for instructions for completing this ap ation . _1,�� � v Permit Number .� 3 _3 aq 2- Personal information you provide may be used for secondary purposes heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. -�' a Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT Ai INFOR Property Owner Name Z l R Or % ,, t 1/4 36 T 30 , N, /f �( ) Property � d Mailin Address Lot N:u'ri - BlockNumbee City, State Zip Code Phone Number Subdivision Name or CSM Number tW671 L 6-Yo ( ) /t/jf 44 r it e"A's II. TYPE OF B ILDING: (check one) ❑ State Owned 0 !t Nearest Road a e Public 1 or 2 Family Dwelling p V - No. of bedrooms Tow II n OF h AAl .5 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number( - 1 ❑ Apartment/ Condo O U - " 3 /O 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 S. ❑ Repair of an - _____System ________ System_____________ Tank Only______________ Existing System ________ Existing System B) a A Sanitary Permit was previously issued. Permit Number 3'j 3 Z fz- Date Issued / — /B— 2oo0 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 �❑ E] E] Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault 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 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 7p S7Z 7 Q8 b Feet /06,3 Feet Ca acit VII. TANK in gallo s Total # of Prefab: Site Fiber- Exper. INFORMATION Gallons Tanks manufacturer's Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ��� l ,y C ,�/ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Name: (Print) Plum is Signature: Stamps} MP /MPRSW No.: Business Phone Number: 'T' z Z. 5 Z 7! — »z — 3 Z 1 1 4 Plumbe s Address Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) A roved Surcharge Fee) < Owner Given Initial PP ❑ l S 2�b� ' Adverse Determination X. CONDITION OF APPROVAL / REASONS FOR DISAPPROVAL: P t c.� � c ao o u.r.oe,Q P e,,, ti (SS LtgO l l SBD- 6398 (11.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new Criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD -6399) to be submitted to the county prior to installation S. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every 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. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of 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. F IZeUl � cm " JOB r� r 1,� "J , ecA ,ua ti TIMM EXCAVATING SHEET NO. L OF Route 1 Box 192 �� �� WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #6% MN CHECKED BY DATE SCALE / !/ 76 ..... ..............:........... ......................i........ ..... ..................... .... ..... _ ..... ..... ..... ..... .... .... ..-- .... ..... ..... ..... ..... .... .... .... .... ..... ..... ..... .... ...... ..... ............................ .. .................... .... .... .... .... ..... ..... .... ..... ..... ..... .... .... ..... ..... .... .....C' ........ ..:........... .......... ............. .. ..... .... .... .... ..... ..... .... ... _ .. ��� . ..... .... .... .... .... ............................. .... ... ...... ..... ...... .... >... �'° ✓ .... .... .... ......... <........... ...; .......... �......... ......... :..... ...... .... .. ..... ..... ... .... ... .. .. .... .. ....................... .... ......... ... . >> ... a ...: ...... ........... ..... ... .... .. ..... ..... .... 8f . .......... ...... :.. .. . ..... ..... � ... .Y' .... .. ..... ... .... L ......... , . 3........ j ... . .... k -,.. ,..�' '�.' ,. ......... ... .... t . ..... :...... . . .. ......... .. '�.'goo., PRODUCT 205 -1 Inc.. Groton, Man. 01471. To Order PHONE TOLL FREE 1- 80(-225.6380 1 ��f�'I � �,vn� ►"'� WEATNERPR �NCTIaN by LDc1(1 G GOvfiR �c 4�.Ii1'iu � QUICK ClacowKr►R --1 4" C.T. 1►+�►atnci+0otw�� C.T. PJVC 3, JTO NDISTuft6ED SOIL. 24" %.D. VENT ' e>:�aw MtWyOLE M 4 � Z* MIN. /glLi T NO:t p�a0vrj.D A C . s . P►+' .SXET WFLES 1 AL 3' owro G RpV1iO ELF.,. ow Pump Co""crF : G Lw• 6coC9 5EPT1C E SPEC.IFI'CATIOUS v DOSE 1 TAWKS MALIUFACTURE // R: w IJLI SER OF DOSES: g PER DAy TAWK SIZE GALL01JS DOSE VOLUME ALARM MAlJUiACTUKGR: S INCLUDING BACK /LOW: /Z6 GALLOWS MODEL 1JUMOE1t: `' CAPACITIES: A= ) 5 - 2 'WCNE5 0R GA LLOWS SWITCH TyP[: � B c 2 1 IWCHES OR 0 1 7 -GALLOWS PUMP MAMUFACTURCK: CJ1- O "` C iWCHES OR lZcTy GALLOWS MODEL WUMBER: }1 P� `l D Iu4HES OR : + ALLOWS SWITCH TYPE: �`O WOTE: PUMP AWD ALARM ARE TO DC MILIIMU M OISCMAR K AT E 30. INSTALLED OW SEPARATE CIRCUITS G� TC G ►M VERTICAL DIFFEKEAJCQ BETWEELI PUMP OFF AAIO 013TRIbUTIOW PIPE.. ��� FEET I + MIAI IMUM AIETWORK SUPPLY PKESS;UK C . . . . . .. . . . . FLET + L FEET OF FORCE MAIN )( S ' k f %oortFKICTIOIJ FACT C` 0 31 F E E T �� �)(+"► TOTAL DyWAMIC HEAD = �,$� FEET UU (/ !7/ // �� / Y IIJTERAIAL DIMEM6106JS OF TAWK: LEW&TH � �!�;WIDTH _!P-; LIQUID DEPTH ✓Les tA-J1edt 0a i' Goulds Submersible Effluent Pump x EPO4 38 71 EP05 ON8 fasteners 300 series • Fudy submerged in high ■Motor Housing: Cast iron r ` stainless steel.' grade turbine oil for for efficient heat transfer, esigned for the �- �fdllONil � s:: • Capabls3 of running lubrication and efficient strength, and durability. dry without damage to heat transfer. ■Motor Cover. Thermoplas- { i H ems components. tic cover with integral handle Moto • Ho Available for automatic and g Motor and float switch attachment • _ manual operation. Automatic • EPO4 Single phase: 0.4 HP, points. sump 115 or 230 V, 60 Hz, 1550 modals include Mechanical Water transfer Float. Switch assembled and ■Power Cable: Severe duty - -RPM, built in overload with led oil and water resistant. ` • I)ewalerin0 presut at the factory. ra " N automatic reset. P ■ Bearings: Upper and lower EP05 Single phase: 0.5 HP, $PECIN ATIONS • 115 V, 60 Hz, 1550 RPM, FEA1fURES heavy duty ball bearing s construction. POP EIS` = built in overload with ■ EPO4 Impeller: Thermo - so ` Solids handling capability: automatic reset. plash Semi -open design 3 /: rttaximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING "` ` •. up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP Canadian Standards Atxocisuon 6.: up to 24 feet. with three prong grounding ■ EP05 Impeller: Thermo- +:DI "- size: 1 /i NPT. plug. Optional 20 foot p mo (CSA listed model numbers "' seal: carbon- length, 1613 &M with improved pla performance. stic enclosed design for end in "F' or "AC ".) f• rotar�i' rdmic- stationary, three prong grounding plug ,.BONA elastomels. (standard on EP05 . ■Casing and Base: Rugged ) thermoplastic design provides Tempe ure: P 9 P 1041 C) continuous superior strength and 140° 5040 intermittent. corrosion resistance. �(;7> '•.Faste 300 series METERS FEET stainless steel: 10 T - — T - - - - T ieof running - -- — - •dry out damage to s 30 _ Capab: -- -► : 5 GPM components. Pump: EP05 8 • Solids handling capability: c 7 2s - Y4" maximum. • Capacities..up to 60 GPM. s 20 • Totaliloaft up to 31 feet. N Discharge size:1 NPT. s - - - -- x • Mechanical seal: carbon- c. 15 'rotary(cdtamic- stationary, 4 44 . BUNA 1A elastomers. - — -- -- __ -_ -_ _- -- -___ _ . _ -- •ATemperature: 3 1 1 104 °� 1 WC) continuous 7 p • — EPO4' - -- - -- - 140°F 60°C) intermittent. 2 T 1 0- OC 10 20 40 50 GPM y, C 2 1 6 8 10 12 m 1 \- CAPACITY ©1896 Pumpe, Irx Effective May, 1995 83871 r, Saf $uiidingiDivision NITARY PERMIT A. ': T APPLI ON ashii�bvn Avenue `�S "OTo I� �� � ''� In accord with ILHR 83.05 W" . �o I P 7302 - Departmercel l�� 1 -9 dis6n, WI 53707 -7302 • Attach cbpVIet %1*nA( thit;un q py only) for the Sys n p es6ot less;, 4 nty 1 T than 8 14 x� 1 i i P l ECEIVE 4 t' n a et anitar Permit b r ,. • See re Personal i atio rovlde may pe re for in£?rl6f c pleting this appliatlon y nform osf es d secondary purposes k it revision to previous pphcation [Privacy Law, s. 15.04 (�m�). C Plan I.D. Number COUNTY I. APPLICATION INF ATI N -PLEA E PRINT ALL �C�E Property O Name Pr rty T , N, R (or)Q c'w I�S Property wri r4Maili Addr ss Lo BlockNumbgj� City, Sta �' Zip Code Phone Num p er Subdivision Name or CSM Number �� tC,k t- r 01"7 ( V14 e IL TYPEOF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road [] Village �k l Public Q§ 1 or 2 Family Dwelling - No. of bedrooms sa Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numb S) 2 1 ❑ Apartment/ Condo 3 -3 ` / 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. P1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - _____syrstem ________System _______ _ Tank Only______________ Existing System ________ Existing System B) [ 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 CaSeepage Trench 22 ❑ In Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit f ) 43 ❑ Vault Privy 14 ❑ System -In -Fill 4 h Q e 3/ � � ✓ a �-t� 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 46 o -� Z, 7 O Feet 1 Feet VII. TANK Capacit in gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank d� ❑ 1:1 0 ❑ ❑ Lift Pump Tank /Siphon Chamber (�O ❑ ❑ 1 1:11 ❑ 1 ❑ _1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name: (Prince Plumber's Signature: ( Stamps) MP /MPRSW No .: Business Phone Number: ✓ )) - Plumbers Address (Street, City, State, Zip Code): Q 7 - - 7 IX. COU Y /LTEPARTMENT USE ONLY ❑ Disapproved Sa tery Permit Fee (includes Groundwater D ate Issued Issuing Age pt Signature (No Stamps) RApproved E] Owner Given Initial Surcharge Fee) Adverse Determination ' I:;Z- I - //(� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership "or plumber'requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 266 - 3151. . To be complete and accurate this sanitary permit application must include: 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 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 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. i F � I I 1 G 0 to I T 4 I f - 1 l II� - _ 7 i 1 � If l -T-1 . Wiscgnsin Department of Industry SOIL AND SITE E V A L U AT 1 O N REPORT Page 1 of i abor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but cSt. Croix 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. 030- 2013 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RE IEWEDBY DATE _ (g_ PROPERTY OWNER: PROPERTY LOCATION Jamea Durning GOVT. LOT NE 1/4 NE 1/4 T 30 XR 19 ) &or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 7217 Courtly Rd. na ' CITY, STATE ZIP CODE PHONE NUMBER ❑ ITY []VILLAGE [x]TOWN NEAREST ROAD Woodbury, MN 55125 (612)739 -5208 St. Jose h Ct . Rd "A" ] New Construction Use [x] Residential / Number of bedrooms - [ ] Addition to existing building [ j Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 643 ' bed, ft 563' trench, ft Maximum design loading rate _ bed, gpd /ft : trench, gpd /ft Recommended infiltration surface elevation(s) 99.23 -/ ft (as referred to site plan benchmark) Additional design/ site considerations alt site system el.= 98. 03 1 /-' Parent material 0Ut waGh -Gt rP aterrace Flood plain elevation, if applicable .,a ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ®S ❑ U ®S ❑ U ®S ❑ U 51 S ❑ U ®S ❑ U ❑ S C111 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence ftxxiary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& .....1._.... 1 0 -9 10 r4 2 none sl 2msbk mfr crw 2f .5 .6 2 9 -18 7.5 r4 4 none sl 2msbk mvfr qw if .5 .6 Ground 3 18 -80 7.5 r5 4 none Cos oSQ ml na na .7 .8 elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -10 10 r3 3 none sl 2msbk mfr C1W 2m .5 .6 ??I> 2 2 10 -28 10 r4 4 none sl 2msbk mvf .6 Ground 3 2 102 ft. , Depth to limiting factor +80 tA(�� 2 X Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -620 1 + Address: 1554 200 Ave. New RicUhiud, W1.54017 Signature: G P I _ , Date: 5 -13 -97 CST Number: m02298 PROPERTY OWNER James Durnina SOIL DESCRIPTION REPORT Page 9 bf PARCEL I.D. # 030 - 2013 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10 r3 3 none sl 2msbk mfr Cfw 2f .5 .6 3 2 12 -20 10 r4/4 none sl 2msbk mvfr qw if .5 .6 Ground 3 20 -84 7.5 r4 6 none cos osa ml na na .7 1.8 elev. -- - 101 ft. Depth to limiting factor `( jv +84 Remarks: Boring # 1 - 4 2 10 -20 10 r4/4 none sil lcsbk mfr 9w if .4 '.5 Ground 3 20 -80 7.5 r4/6 none cos OS9 ml na na .7 1.8 elev. 101 ft. Depth to limiting 5 / factor +80 Remarks: Boring # 1 — k mfr 2f .5 .6 5 2 mvfr cry if .7 .8 Ground 3 70 -74 5 r4 4 none is os mvfr na .7 .8 elev. r 74 -84 7.5 4 6 one cos os ml na na .7 .8 1 00.3 ft. Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel James Darning 1554 200th Ave. CSTM2298 NE4NE4 S36- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #1- Darning & Lewis Addn. N / 2 " -40' BM.= top of 2" pvc pipe C el. 100' �Ylt. BM.= nail in pine tree @ el. 98.80' t g f �j r Gary L. Steel 5 -13 -97 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Nyxe l- S �J j o r m a a Mailing Address Property Address cZ O '� (Verification required from Planning Department for new construction) City /State /UZ1,c.J „1 j JC Parcel Identification Number Z 14 3 — /0 — C vv LEGAL DESCRIPTION Property Location Al,�— ' / <, /VL' ' / <, Sec. (o . T N -R_,(!Ct_W, Town of mil• c Subdivision t7c,.rn „ /.�.;� f ,, S �� Lot # I Certified Survey Map # , Volume . Page # Warranty Deed # / , Volume IL/S-1 . Page # Spec house ❑ yes N no Lot lines identifiable CR 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, journeyman plumber, restrictedplumber or a licensedpumper 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. 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 days of the three year expiration date. G 1 11 31 0 , 6 SIGNATURE 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. A " 1 0 A , 131 4D SIGNATURE OF APPLICANT 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 i a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM I - 1998 1616442 WARRANTY DEED KATHLEEN H. WALSH 1481 DGL 595 ST. CROIX CO., WI REGISTER OF DEEDS Document Number RECEIVED FOR RECORD This Deed, made between JAMES J. DURNING and _ ._ 01 -01 -2000 10:10 AN SANDRA J. DURNING husband an w — WARRANTY DEED EXEMPT I d Grantor, CERT COPY FEE: and CHARLES W. WIECHMANN and CATHERINE M. WI _ COPY FEE: husband and wife as joint tenants TRANSFER FEE' RECORDING FEE: 10.00 -- -- PAGES: 1 _ Grantee. Grantor, for a valuable consideration. conveys to Grantee the following described real estate in St Croix County, State of Wisconsin Rcr_„ghi ^.1 AIO21 (the 'Property"): Name and Return Address � Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN Lot 1, Durning & Lewis Addition to the Town of Post Office Box 469 St. Joseph, St. Croix County, Wisconsin. Hudson, Wisconsin 54016 030 - 2103 -10 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible In fee simple and free and clear of encumbrances except Dated this 29th day of D ece m ber 1999 (SEAL) f.` (SEAL) J. DURNING (SEAL) ° (SEAL) v SANDRA J. DURNING AUTHENTICATION ACKNOWLEDGMENT Signature($) James J Durning and State of Wisconsin, Sandra J D urning ss ' — St. Croix County. authenticated this 29tH day of cember 199 9 . - Personally came before me this day of �99 - the above named James J Durning and Sandra J. Durnin Barry G. Lundeen TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person >i— who executed the foregoing authorized by 5706.06, Wis. Stam) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -- Attorney Barry C. Lundeen _ — M D GE, s + S . C . Notary Public, State of Wisconsin 110 Second Street, Hud son, Wisconsin 54016 My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary) ' Names of persons signing In any capaclty must be typed or primed below thelr signature STATE BAR OF WISCONSIN Wisconso Legal Blank Co., Inc. WARRANTY DEED FORM No. 1 - 1999 Miwaukeo. 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