HomeMy WebLinkAbout032-1064-10-100 Wiscihsin Department ofCommerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division Count ySt. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitngSr"tNo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s 5.04 ( 1)(m)].
Per it Hol er' Name: El City El a T State Plan ID No.:
Rehr 1ng, olierta �M ier;et
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel` 612+-1 -10 -100
& ILO S
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Sept Z�'D Benchmark�.'
Alt. 13M
Dosing (�� 5 `..
Avratfum -- Bldg. Sewer
Holdin / Ht Inlet 4
Sr �i -s�3
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. Air I ntake ROAD
Air
Septic S 3S' 3 Z / -� Z, / NA Dt Bottom
Dosing ��� > 3. '� NA Header / Man.
A NA Dist. Pipe tl b.d� /al Ls
J fo ding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand cov n
Model Number iPM ,1A 6c) C
TDH Lift r Friction � ( p ✓ Systemz TDH Ft ¢ — 5 -
Forcemain Length �(3 r Dia. .Z Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DI
SYSTEM TO P / L BLDG WELL LAKE/STREAM 79 anu a cturer:
SETBACK MBER
INFORMATION TypeO Num er:
System: J /CU �� OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
Length � Dia. 2 Dia. ,r Spacing t� -
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• � / A6 Inspection #2:
Location: 789 210th Avenue, Somerset, WI 54025 (NE 1/4 NE 1/4 24 T3 1N R1 9W) - 243119 19B -Lot 1
1.) Alt BM Description = tl�,{ CtVer-
2.) Bldg sewer length = �.�,�5 ��c� t f�
- amount of cover =
3.) contour= 3, � Z C 1 �, ��7
Plan revisi o re4uire6 ❑ Yes No
Use other side for additional informa ion. �,/ j
y SBD -6710 (8.3/97) Da Inspector's Sig re Cert. No-
Y
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITAR jPfRNEIi , ATION 201 W. Washington Avenue
Ai PERM - P O Box 7302
Department of Commerce In ac 8 ]gs, w(. .. 4'4 Madison, WI 53707 -7302
• Attach complete plans (to the county copy o lW ;'bn pap r��t less count -
than 8 112 x 11 inches in size. �fnn `T
O State Sanitary Permit Number
• . See reverse side for instructions for com p LUD leti I
RoM Personal information you provide may be used for secondaGOUTA ~' / check I revision o revious application
[Privacy Law, s. 15.04 (1) (m)). Nc +OFFICE /` 1 � State Plan I.D. Number
I. APPLI ATI N INF RMATION - PL A ION / ,b _ 3a
Prope wner N 1 ope tion
114 1/4,S T ,N,R /SE(or
Propert Owner's AdrAts Lot Number Block Number
10 C cc @,v(. -i— —�--
Cit State Zip Code Phone umber Subdivision Name or CSM Num (
' �� P s -% 1 IS Z5 0: 0 3 P b q2
II. TYPE F BUILDING: (check one) ❑ State Owned o Cit Nearest Road
Public 1 or 2 Family D welling - No. of bedrooms _ ° Town O 0A7 #
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) F 1 . IGI 1�
1 ❑ Apartment/ Condo (flg _ _ /� to y _ / Q Q
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 o on line A. Check box on line B, if applicable)
A) 1. ❑ New Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
------ Syfstem ___ ____System____ ________ Tank Only _______________ExistingSystem ________ Existing System
B) ❑ A Sanitary Per i s previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 2L&Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure �� J ` 'r1/ l X /o2 r . 42 ❑ Pit Privy
13 ❑ Seepage Pit t •S 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION STEM 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
(O 52 _500 'Z Feet Feet
VII. TANK in Capacit llo
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
tic Tan or Holding Tank 12yo �` ❑ ❑ ❑ ❑ ❑
Lift Pu Tank /Siphon Chamber 7,sG - Y) ❑ ❑ ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite ewAg stem shown on the attached plans.
Plumber's Name: (Print) er Signature: o Stamps) MP PRS Business Phone Number:
Plumber's Add ress(Street,9ty,S Z, ): a S� U yOd
IX. COUNTY/ DEPARTMENT USE JO NLY
❑ Disapproved San' ary Permit Fee (Includes Groundwater ate ssue Issu ng Agent Signature (No Stamps)
Approved E] Owner Given Initi all Surcharge Fee)
l � 621 �
Adverse Determinations V-
X. CONDITION OF APP OVAL / REAS NSF R DISAPPROVAL:
A c Adddd
9BD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
I N �T�tiET-ION 5
• 1, ,
1. A sanitary p is valid for two 2 years.
Yp
?�qr
2. Your sanitary permit maybe renewed befoi* t. a e�tph�OnFd *jlpnd at-a4ime of renewal any new criteria in the
Wisconsin Admin4str_ative Code will be applj0le. *.4.c ; f
3. All revisions to this permit must be approved py j e'�6As ,jpg authority.
4. Changes in ownership or plurrrbq"r requires a Sarntary P.ernii Traftiafer7 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) rr'ust be pumped by a licensed pumper WYsenever .
necessary, usually every 2 to 3 years.
6. If you have questions conc -orning.your onsite.sewage system, contact your local code administrator or the State of
Wisconsin etyand Buildings Division, 608- 266 = 3151.
To be complete and accurate this sanitary permit application must include:
• R .
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.
V1. 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.,.Plumbec_mustaign application form.
IX. County/ Department Use Qf ly.
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.
WISCONSIN
Department of Commerce
Safety and Buildings Division
4003 N. Kinney Coulee
La Crosse, WI 54601
Phone: 608 - 785 - 9334/9352
Fax: - Pages Including this sheet
Date , 2000
TO: Koh ESL tN 6 LER FAX*
FROM: JSWI @ Safety & Buildings FAX* 608 - 785 -9330
RE: to wl1cS & m_r a
MESSAGE:
-t�j-.4 r S CA LL.. ate � cArD
c� _se �cJs�• 1416 7►
v
Yd C TKY wC'Pts -APPA45VIleb oN 017—/CD-
Oy f �'ti �` ��Ftt.t+cs (a 7, SScTS o d� 57rb
g S
Inc, GOB -Z"
THANK -YOU & HAVE A GREAT DAY!!
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
MD #: (608) 264 -8777
isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Govemor
Brenda J. Blanchard, Secretary
June 27, 2000
CUST ID No.221471 ATTN: POWTS INSPECTOR
ZONING OFFICE
DENNIS J GILLE ST CROIX COUNTY SPIA
372 140TH ST 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
Identific . 6 71 Nu mbers
PLAN APPROVAL EXPIRES: 06/27/2002
Transaction ID No. 324671
Site ID No. 194712
SITE• Please refer to both identification numbers,
Site ID: 194712, Frances Breault I above, in all correspondence with the agency.
St. Croix County, Town of Somerset
S24, T3 IN, RI 9W
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 669803
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.
• The changes made to this plan on 6/27/00 by this reviewer were acknowledge and approved by the system
designer. .
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force
on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not
change.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
DENNIS J G E Page 2 6/27/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, %r DATE RECEIVED 06/16/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WiSMART code: 7633
MOUND SYSTEM DESIGN
Apoicadon
INDEX AND TITLE SHEET
Project FRANCES BREAULT
Owner FRANCES BREAULT
y
�o
Address 789 210 AVE n • t� 1
SOMERSET WI 54025 KPP� - ._ --";V h
pEPARTMEN E
A tNGS
10
Legal Description S24 T31 NR 19 W CE
SEV 6
Township SOMERSET County ST ROIX
Subdivision Name Lot No. 0_
Parcel ID Number 032 - 1064.10 -100
. 51ransaction Number CA
Q
•
�'• ally a
Ctin dittOn -in
Index and title sheet Page 1 m
Q F COMMERpE ' Mound calculations Page 2 C
tME NT 411,1D Mou rawings Page 3 Z R1
Of
ptip A s. dist. talcs. and laterals Page 4 IO L-3 10 5 �-� M
ptvts TDH and pump tank drawing Page 5 W w..
C2 9C
E Go REP �pEt.10E cm M
E
S Cn o a
CI
ie
Designer D IS GILLE License Number 221471
Signature Phone No. 268 -6637
Date 6 -13-00
Notice: Tampering with this Me by unauthorized persons is prohibited.
Deliberate moditication wm 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 (R.05/90) Page 1 of
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MOUND DESIGN
RESIDENTIAL MOUND REPLACEMENT SYSTEM
Slope 2%
Wastewater flow 600 gp
Depth to limiting factor 31
Soil infiltration rate .3
sYtY>rM
- Eo� elevation 97.1
Syste;.elevation 96.1
End manifold
Trench spacing 20'
# of trenchs 2
Forcemain length 75
Trench width 4'
Trench length 62.5'
Design depth 12"
Lateral length 60'
Hole spacing 48"
pump tank EIC 87.0
Force main diameter 2"
Lateral diameter 2"
b9 3�Cc� IVAVDX3 2 AIjl 3 - rTO LE99- B9Z -SIL ZV =L0 000Z /VZ /90
Page Of
Cross Section Of A Mound System Using
2 Trenches For The Absorption Area
Trench Of }" - 21" Aggregate S" Straw Or Marsh
6" Aggregate Below Pipe Hay. Or Synthetic Cover
Material
- :Manifold Pipe
tkdiine' Sand' Distribution Pipe
To soil
6 H
p - -- - —� 97.1
J1 D
.. E
Plowed Layer
% Slope Undisturbed Soil
D �.0 Ft.
E Ft.
F A 3 Ft.
G 1. Ft.
Signed: H 1.5 Ft.
License Number:
Date: �—
A Ft. L .1 Ft.
B 2.S Ft. J Ft.
C � 16 Ft. I Ft.
K 14.3 Ft. T Pt.
Alternate Position Of Force Main --��
e
Observation I Permanent Marker �
W / !,
G�
J Cl' t
Pipe � � ��
A - - — -- -- -- — — — — - — —
Dis tributi on Plp `
C r Force
W i -- - -- = -- — -t- —_— —_— —_ Main
B K
I 'Trench Of 21"
Aggregate
Plan View Of Mound Using 2 Trenches For Absorption Area
Trench spacing - x (2�
if of trenchs 2
l±orcenmin length
Trench width 4'
Trench length 62.5'
Design depth 12"
Lateral length 0'
Hole spacing 448"
Pump tank EIC 87.0
Force main diamete 2"
Lateral diamete " Lateral dis. rate 18.64 gpm
Hole size mch System dis. rate 3728 gpm ./
r
LAT. IMI = 97• e
x
' PVC sch 40 2 ~
O Z LATERA O T i P, I (( ktcx -C-S
Last hole next to end cap. Holes drilled on
the bottom of the lateral equally spaced.
n :a9r� IVAVOX3 2 AMI '3179 LE99- e9Z -SIL Zb:L0 9992/VZ/90
TDH and Pump Tank Drawing
Total Dynamic Hared
Operational head 2.50 ft ( 0 0.76 m
Vertical lift (, , ft t a 5.76 m tiro lalerals the highad pant In trio
Friction loss 1 4ct ft� � 2.12 m cyatem? Yet - V here. x
Total dynamic head t0.54 8.65 m if no. whae is Itm Noma elevador,
D060 Volume downstre of pump?
Doss is > 10 limes lateral volume Forctrlrarl wain
Lateral void volume gct gal (�,� 95.E L back to tank? (V am)
Minimum dose gal i96.g 953.9 L k Yes
Grain back /Z.3 gal 65.9 L No
Dose volume sl 1019.8 L
2,o9,20 (PAL.
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
appruvred maMwle paver vrffh
7�C — weather proof watr inp label and leek % device
grade levels tundlon boxy'
dleconnect . G►ade levels
ahemate
4" vent plop electric as per NEC 300 and t
Comm 18.28 WAC �' wo>rtbn f 8'' (tea cm) nit
to of pump L - ` approved
&+amber or " Q outset joint ���ILLL
combinatfan tank
A Provide I W* neap hole or anti-
alarm an . - , plhk n-davice es neceasarr
pump on t3
C
D nha ark" tents
pump 81.1 f t pomp tank mae - t• (10 cm)
off GISW 27.6 m minimum above fniahed Wade
• D vanl• -• 12'(30.5 em) minflnurn
abuye Mishod grade
ft Pump tank AW40n - '
3 " (7S mm) of bade under rank 2 7.6 m bosom of tank
'Tank manufacturer v
Pump tank capacity 16 gal /in
Pump tank volume Igal
Pump marruNcturer incne • Gallons
Pump model number c A - . O
0
g 2 X0.0 h
Alarm manufacturer C Z, t4 Z (O
Alarm model number A D 1 Z O
Project:
Transaction Number'. Page 5 of
99 19vd 1tilldDXd a ALJ1 2 LE99- B9Z -SIL Zb :LB OOOZib
' .FEB -29-00 TUE 03:47 PM JH LARSON F %fry N % c 3746 P. 03
.. ,.;.. � •. is ••�
HEAD CAPACITY CURVE
MODEL " 9111 "
e � �
10
i %. "1 1 'i 4/;; NOT
2 6
0 70 Ell? ? �
a. 1 0 20 30 40 !s0 a 0
lllERf 1 ta0 240 !" ,. %%
so ..
0 FLOW PER MINUTE
_ I
l
YO7AL Cl 1 0" McAOMLOWnA MIN"r61 t f
E►rtullrrA1,00f / l
�l
CAPACR1r
nuLO YNIt~
rely MltiRi GAU LYRA ,
79 273
t0 305 61 93, 1 t
tb 497 45 179 1 ,t /tf>
20 Gig
anon.
CONSULT FACTORY FOR SPECIAL APPLICA
• ENctrlcai slternaws. for duplex systems, are available end a�ah t hree 0�ale SYS� � ,,~s are �tvaiteble for confrc>1i4n9 single
supplied with an alarm. back v .; :,Its !twat noel svAtc;hass are a vail.3bia
• Mechanical altarneWs. for duplex sYs /ants• are aveitabi6 with f Dou ble v pi l
or wkh" alar switches. for valri84sc teve !4ri;. ✓:'t8 COnfrDsa
ON GTE
I sntegtal Foot novoted ? t- F:.i.en�cfit lw no ORlernat control ro(ftlred
Ong ed ad It mod els - W i ht 39 lbs • '/r H, i a 3utyb p199Yb&"I verietrle a! soilcn of JOL"" 0199Yimck vat ablo tdvei.
lion float 6witcr Row to !'M 04
_ Meatta�ica rtta yet , t%. , , .p:,; c
9" FMp7 to cae „ t:;ec r •r' Aim , o2itw. C. Pak.
/ S Cont , of 6w+1r.n ec;tvot•tr, apor du
oy piax (�) Cr ( }
4 r � _.. 3 _ot 4 _.�. Host eyaMm
_ 1 _ Auto 4,7 1 of t a 7 A Fodr (4) r oln t'eF,. i • " 'o watMriiQf t co t�ecl,on tK wlroft In
Non 1.7 ? or I A or t a 5� 7 1 We (2) ha * --POK to, r r,eL of 6pllce
i;A'�SfON
I r Alehfte6ai6 bfi00Otf' Vtltra110nafan4r .PM�'t�•P�}1MCtt All Infblbuo +s :,t t,.a•oh. c • eevites sn0 wh undOf OIOIYBdtnCIWN, W
oa eeiMOntl ZoNP6 OAS
!ft 6atod Nnetr , a Alt r,u s. el reEet s a9
FaNlfor'lNUOn a .. nt6MA!IeR+6to�•f'M01 6urr,?r r r
sFMQ/, t. ENt1AI :etAll6rttRfor,FIwID ,� ,.� rr�, •J' a�dttirQcc• And kcatlltAt;l(OlFiAi•
vrew
tew!8wltdfe , tlortyt F ... c � f 7
>?Mrnpell0106,FMoml; and$ into fteeSit�{ llx9un10ConirolrlNVmby +M^s7At1i ?2 rocrnlNJ
RESERVE
POWERED DESIGN
For unusual corld iti sates factor is engineered mlu th de-- ,'. of every Zoeller PUMP.
es erve Y
o ns a r
_..__ A # MAri 7O: V 0 BOX
iBy.Jv N� AIM v {'•t�.:t�t'•lrNt.ar .
` ���� !MI TO: cent Avn Rua
I.G4iJ.9rn >, xr J�, rt, t t Qwi,,r /r+Sw,�s
PL/MP !d: fad ?i fNI?IJ t t rbK! 6?t r u
fAxflr.) �l, JS.`t
r ,
Wiscor)sin Department of Commerce S OIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
c- c 3 Z - /0 6 - /v /n o
APPLICANT INFORMATION - Plea jT1h11►iff roia Reviewed by Date
Personal information you provide may be used for pu ses (PQ 15.04 (1) (m)). ll
Prop Owner R Property Location
9 t P. 1 4 ��_Y "�C,�, Yt-, Govt. Lot X 1 /4 �3 1/4,S, i/ T31 ,N,R 9 E (or�V
Property Owner's Mailing Address Z Lot # Block# I Subd. Name or CSM#
C S Zip Phon G E:1 City El Village J? T own Nearest Road
cJ�L - C C P S` W� y L � �d fYr -2
❑ New Construction Use: Residential / u r of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow 4 gpd Recommended design loading rate L L bed, gpd/f1 j. Z trench, gpd/ft
Absorption area required 0 bed, ft O trench ft Maximum esign loading rate . Z- bed, gpd/ft gpd/ft
Recommended infiltration surface elevation(s) �7• ft (as referred to site plan benchmark)
Additional design /site eqnside rati ns
c
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventi onal Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S •®-U F - S ❑ U ❑ S Q U [- � U ❑ S U ❑ S 'E] U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
o• *41 3 CL 4 ,c acs , Z
Ground u 33 -ys Of y/ — ptL auk ,7
Depth to
limiting
in. '
l
Remarks:
Boring #
w I 0- ,2. aw
7- a sY,P.s/ ? aw Z
�Ground 4 h 3 44 3/ jKS/n 5_1D l �
7 1�e ( ft.
Depth to
limiting
S f r
in. Remarks:
CST Name (Please Print) ignature Telephone No.
Address Date CST Number
/5�0 S7 meal 4 INS I V OO 2 2 A
r
� SOIL DESCRIPTION REPORT
PROPERTY OWNER Page-
PARCEL • Z • of .
LD.#
Boring # Horizon Depth Dominant Color Mottles Texture Structu Consistence Boundary Roots 2
13 in r M""ll Qu. I I Color Gr. Sz. Sh. Bed , Trench
Ground JI S L a W
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Boring #
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Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
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Depth to
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Boring #
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
,rte
Owner/Buyer �"rt.'� /
Mailing Address 1 ':2 /G 71
Property Address `s ' �2le)
(Verification required from Planning Department for new construction)
City/State /M -t �' �' l /_ ✓� 5" Parcel Identification Number 0 3 L
LEGAL DESCRIPTION
Property Location M ! ' /r, Sec � Y , T jN - Town of , ' �t - h -e S e
Subdivision , Lot #
Certified Survey Map # � �� , Volume Page # G4
( 2- Q; 6 ?sZ l Z3
arranty Deed ## Volume fS� , Page #
pec ouse ❑ yes ?M5 no Lot lines identifiable A yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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
days of the three year ex . ti on date.
11 A—A4-1CA-4
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.
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
a copy of the certified survey map if reference is made in the warranty deed
1
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VOL 1 521PAGt 239 6asaC=3-r=.
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
5T. CROIX CO., WI
This Deed, made between Melvin J. Breault and Frances A. RECEIVED FOR RECORD
Breault, husband and wife, 06 -23 -2000 10.30 AN
WARRANTY DEED
EXEAPT I
Grantor, and Roberta . Rehling, a single person, CERT COPT FEE:
COPY FEE:
TRANSFER FEE: 429.00
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 (if more space is needed, please attach addendum):
Recording Area
Part of NE 114 of NEll4 of Section 24, Township 31 North, Range 19 West, Name and Return Address
St. Croix County, Wisconsin, described as follows: Lot I of Certified
Survey Map filed August 14, 1986, in Vol. 6, Page 1692, Doc, No. 415803. iL
�
032 -1064- 10-100
Pual Identification Number (PIN)
This Js homestead property.
(is) OW
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2 2 -e(- day of June 2000
• + Melvin J. Breault ty Frames A. Breigi t alk a
FhMQB5 fteallt, Iris AtborW in Fact
+ s rancea A. BreaaN a , Ce _ ) 4d
AUTHENTICATION ACKNOWLEDGMENT
Signaturc(s, Frances A. Bresult, STATE OF WISCONSIN )
�� // � County )
authenticated / this2 -�GWay of June 2000 Personally came before me this day of
v ; 0A the above named
+ Kristine OSland
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY +
Attorney Kristine land Notary Public, State of Wisconsin
udson, WI 54016 My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
+ Names orpersons signing in any capacity must be typed or printed below their signature. Wammow Praftubmem Canpry. Fond W tea w!
STATE BAR OF WISCONSIN aooaa MI
WARRANTY DEED FORM No. 2 -1999
DOCUMENT No. STATE BAR OF WISCONSIN FORM 3 -1989 TN ..Acs siusrcD ►OR 109COIw1►. DATA
QUIT CtAIN DEED
4512 4� RE OFFICE
lot: c>UVwE CROIX CO., WI
Reed for Record
• Melyin__J._ Bre.ault Frances . - Breauit:s::...... SEP 061989
husband and wife 8 :30 A. M
...............................•.. ........------ •- ••-- ...........
quit- claims to ................ ............... ............................................ A C?
"'^ C
Melvin J. Breault and Frances A. Breault,
- - - -- ... ................ . .• .............-- .......... .
husband __and _wi as survivorship__marital_..._ 0 f
..... pzaperty. .................. ---- ------- - --- --- -- - - - - -- - - - - - -• ........................
............ ..• ..... ..... ............. ...................................................................
the following described real estate in ....... $ Croix County,
State of Wisconsin: "TURN To
Tax Parcel No: ..............................
Southeast Quarter of Southeast Quarter of Section 13, Township
31 North, Range 19 West.
Northeast Quarter of Northeast Quarter and the East. Half
of East Half of Northwest Quarter of the Northeast Quarter
all in Section 24, Township 31 North, Range 19 West.
This deed is given for the purpose of creating survivorship
marital property and is a marital property agreement within
the meaning of WIS. STATS. Sec. 776.58.
This ---- iS ... ...............• homestead property.
(Is) (is not)
Dated this ... ( -. - --- --- day of .......... - -- September - -- • - • 19. 89
... ............... - -•-
...... . (SEAL) _16 <- ? .(SEAL)
•
....... •---- • - - - - -- ---------_- ................ ' - -- Melvin, . Breault _.-
y _
---- - - - -- - -- ---- ---- -- -- -- -- .. _.(SEAL) (4A L)
• Frances A. Breault
•--•--- •- •- -------- -- --- -------- -• - - -- •. --------- . ..... - -..
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) - Melvin_ J. - -- reault_ ___ _______ _ _____ STATE OF WISCONSIN
and Frances A. Breault, husband and
wife- -- - - -- - - - -- -- ---- -- - - -• .............................. y 1
- --- - - - - -- -- _- - - - - -- ..Count
authenticated this ./�_.-_dsy .September..., 19..8.4 Personally came before me this .......... ......day of
.. 19 - the a'wve named
........... ...............
udith A. R gton
TITLE: MEMBER STATE BAR OF WISCONSIN
-------------- ----------------- --- -----
.- - -
(If not, -- .........-- ---- ---- --------- --- --- --- -- -- - ----- - - - -- -
authorized by $ 706.06, Wis. Stats.) ..
to me known to be the person -.- - - -.. -. ;vho executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMF_N7 ..AS CRAFTED BY
Judith A. Remington -- - - -- .. . ........ ..... ....__.
REMINGTON LAW OFFICES •- .. __ -- __... -_...- --...___ ____ - - - -- ---- .. -.__-
New - Ri. chmond ,...Wl ........ 540T ...... - _ -... Notary Puhlic -- -- - -- ___- ._- (ounty. Wis.
(Signatures may be authenticated or acknowledcnd. Both tic Comnli is perm::nent. I If not, state expiration
are not necessary.) dale: . _ -. 19....._..)
QUI CLAIM D@F.D STA 14: 11 It OV 14 Is$ ON-ON I!"'. ro. 1•.-.
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Vol. 6 Page 1692