HomeMy WebLinkAbout034-1057-50-000 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)]. 363936
Permit Holder's Name: ❑ City ❑ Village ❑ TiSwn of: State Plan ID No.:
Flick, Wayne or Jenny Springfield Township 3 (( (5- 3 'iU 5 low
CST BM Elev.:- Insp. BM Elev.: BM Description: P cel Tax No.: S
TANK INFORMATION ELEVATION DATA a57, a9� c�� qoo p
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic D Ben �— C Zp oS,� I
Dosing ,� 8M VSr KD • b S r
Aeration Bldg. Sewer 7 -. 7-p q7
Holding St / Ht Inlet O nb - _:�b `
TANK SE CK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic > Sp ` NA Dt Bottom Z, $o QZ . a
Dosing t` a ' NA Header /Man.
Aeration NA Dist. Pipe 3g /C30 .
Holding Bot. System 20'
8 (9'0
PUMP/ SIPHON INFORMATION Fin l ]g (W L90
Manufacturer Demand cam/ o p (, 2o
odel Number * \� GPM D o f
TDH Lift Lriction System2 ,5o TDH lolS Ft mead
Forcemain Length _c fC> Dia. Z Dist. To Well
SOIL ABSORPTION SYSTEM
BM TRENCH Width f Length r No. Of renches PIT f Pits Inside Dia. Liquid
DIMEN S S D IMENSION
SYSTEM TO I P/L I BLDG LAKE /STREAM LEACHING fa r:
SETBACK CHAMBE
INFORMATION Type O Model Number:
System: MD 0 + )o OR LW
DISTRIBUTION SYSTEM see -4•�< < �- �- w•�s �°- "p`i�`° was
Header/Ma if Distributio ipe(s) 4 x Hole Size x Hole Spacing Vent To Air Intake 14 ' r / / It u
Length Dia. — i Length � Dia. 2 Spacing &t7 ----�
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.) nsnectlon # - D IS /on Inspection #2- -
Location: 3285 70th Ave, Wilson, WI 54027 (SE 1/4 SE 1/4 25 T29N R15W) - - t 3� 6
1.) Alt BM Description = CT • (p i< 3 lc.__.2
1) Bldg sewer length =
- amount of cover =
3.) contour = q • 2, o ) v"`�' ` °� 6 . f) r l 0 5-2 O
Plan revision required? ❑ Yes JK No
Use other side for additional information. D`a Z( I 'D O l n6
SBD -6710 (R.3/97) @te /I L � Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH •
SANITARY PERMIT NUMBER:
4:
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49 N
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* 6consi n Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with Comm 83.05, Wis. Ad 1 Madison, WI 53707 -7302
�2
0 Attach complete plans (to the county copy only) for the syste er note my
than 8 112 x 11 inches in size. �� R �► C&I X
• See reverse side for instructions for completing this applica ' Rfc EjVEO S nitary Permit Number
-�U� 3�3�3�
Personal information you provide may be used for secondary purposes ; o _� Q ?QQ ❑ if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
ST CROtk St n I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL R U 60184 w'�
Property Owner Name r CLrtio
1lkL h !Gr'� 1/4 T �Lg , N. R (orCV)
Property
1P n) s Ming Address N Block Number
Cit,Stte C/ Zip Code P�neumb� Subdivision Name orCSMNumber
�j $) 3 D
. TYPE F BUILDING: (check one) E] State Owned it y Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms d Tow OF ��) �)
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
f&4—
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. M New 2, Q Replacement 3_ Q Replacement of 4 Q Reconnection of 5. Q Repair of an
______System ________ System_____________ Tank Only______________ Existing System ________ ExistingSystem
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 W Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 Q Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill b e2 7�0 r. ,
VI. ABSORPTIO SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation_
145— �e& 9�d 1 40, 2 Feet 03 Z / Feet
Capacity
VII. TANK in Ca gallo s Total # of Prefab. Site Fiber Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Exist strutted
Tanks Tks
Septi Tank ockle4dm9 -+ mk OQfl D00 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /6444oa.Chamber 1 & 04) -- D ❑ ❑ I ❑ I ❑ ❑
II. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility fo nstallation f the onsite sewage system shown on the attached plans.
Plumber' me: (Print) Plumbe ' ig t e tamps) MP /MPRSW No.: Business Phone Number:
/eD L - 51 14 7 /- Z Z 35 - - Z4016e
Plumber's Address (Street, City, State, Zip Code):
D 9 7e g' � 1* W, 7* S y ?.S`7
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue uing A t Signature (No Stamps)
bdApproved Q Owner Given Initial s OO Surc rgeFee)
Adverse Determination / 0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
Al. Zkc.- 1,6hf, „
W ljv wt. mu 66 13 3 ` atop. (L too' W k«,t eve/ i5 5r64 �
<< w
SBD -6398 (R.4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber ,
INSTRUCTIONS y
sanitar permit is valid for two ears
2_ Your sanitary permit maybe re�2wed 0@ expiratrgil date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code..%Will be applicable�.
• ; _� iitl
3. All revisions to this permit m 'y * St'l�e acveti by�the pernisYUing authority.
4. ``Chahiges.in ownership -or plume 'Tequires,i-SA �r P rrai2 Transfer / Renewal Form (SBD -6399) to be submitted to the
county pr pr to installa'tion ,4'; ",•tia ""
5. Onsite sewage systems must be pr6p�rlty I .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'sname 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 ibnly,'
X. County/ Department Use Only.
4
Complete plans and specifications not smaller than 8 1,/2 x 11 inchesmust 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; frictionloss; 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 1'15 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
9 9 P
effect groundwater.
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
+ isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 17, 2000
CUST ID No.139462 ATTN: POWTS INSPECTOR
ZONING OFFICE
TODD L SINZ ST CROIX COUNTY SPIA
E5609 708TH AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 -5520 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
iden D N. 3665 tubers
PLAN APPROVAL EXPIRES: 05/17/2002
Transaction ID No. 316653
SITE: Site ID No. 192164
Site ID: 192164, WAYNE & JENNY FLICK Please refer to both identification numbers,
ST CROIX County, Town of SPRINGFIELD; 72ND AVE above, in all correspondence with the agency.
SE1 /4, SEl /4, S25, T29N, R15W
FOR:
Object Type: POWT System Regulated Object ID No.: 663697
MOUND DWELLING 450 GPD
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.
The following conditions shall be met during construction or installation and prior to occupancy
or use:
• 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 b the state or the local municipality shall be obtained prior to commencement of
q Y P tY P
construction /installation/operation.
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 lawsuit that may delay the effective date of the code so this status
may or may not change.
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 05/12/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
OAMES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(608)266 -3937,
JQUINLAN @COMMERCE.STATE.WI.US W SMART „code; X33
cc: WAYNE & JENNY FLICK
Safety and Buildings
PO BOX 7162
MADISON WI 53707 -7162
r - TDD #: (608) 264 -8777
hsconsin www.commercestate.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 17, 2000
CUST ID No.139462 ATTN: POWTS INSPECTOR
ZONING OFFICE
TODD L SINZ ST CROIX COUNTY SPIA
E5609 708TH AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 -5520 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 05/17/2002
Transaction ID No. 316653
SITE: Site ID No. 192164
Site ID: 192164, WAYNE & JENNY FLICK Please refer to both identification numbers,
ST CROIX County, Town of SPRINGFIELD; 72ND AVE above, in all correspondence with the agency.
SE1 /4, SEI /4, S25, T29N, R15W
FOR:
Object Type: POWT System Regulated Object ID No.: 663697
MOUND DWELLING 450 GPD
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• 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
constructions installation/operation.
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on
regulations in force on the date of approval.
The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be
eligible for sanitary permit approval if submitted to the issuing agency on or after July 1,
2000.
Note: There is a potential for a'.�r slat that may delay the effective date of the code so this status
may or may not change.
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 05/12/2000
1�0 FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
L AMES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(608)266 -3937,
JQUINLAN @COMMERCE.STATE.WI.US WiSMA1tT code A¢33
cc: WAYNE & JENNY FLICK
Wayne & Jenny Flick - Mound RECEIVED
Transaction # MAY - 8 2000
SAFETY & BLDGS. DIV.
Location: SE 1/4, SE 1/4, Sec. 25, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: May 5, 2000
Owner: Wayne & Jenny Flick
Address: PO Box 171
Kna , Wl 54749
Plumber: To Sinz
Signature:
License # MP 139462
Attachments: 6748 -Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan
COMIAERUt
4: system cross section DIVISION OF SAFETY AND BUILDINGS
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve �rf SEE CORRESPOND C E
page 1 of 7
I
System Calculations
one family residence 3 bedrooms
Loading rate �'� Z - gallons /sq ft per day
Depth to ground water 71 ,Z 12 in
Depth to bedrock } O in
i
Cross slope C( %
Force main length �rro ft of in
Manifold /header length VA 0 `" ft of _ in
Drainback 1b '� gallons
Lateral length @ � ft of l`�L in
Lateral elevation ��Oi� ft (bottom of pipe)
Lateral hole size )q— in @ (° °'`� in ( S • 1 = 1 ft ) spacing
1'5 holes /lateral, \� holes total
Lateral volume �`�¢ gallons
Total lateral discharge rate '�� gpm @ S ft head
Elevation difference �'� S� ft
Friction loss �' �' �' ft @ ` gpm
Total dynamic head �� ft
Pump /sipon 2 gpm @ 2 - ft of head
Manufacturer AA °L� Model #
Dose volume 1 � gallons
Lift /siphon tank �•�`-'� �o ' �"'� gallons
Septic tank � , gallons
Measurement pump on & off �' in
Height alarm from tank bottom in
Reserve capacity l fig+ gallons
talcs page Z of
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WEATHERPROOF
LOCKIwG COVER JUNCTION
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/p6y GWCK D��C.DUVLL7 ---�
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' aLLOW M4►it10 i
VENT
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SEPTIC E SPECIFI
DOSE w �� �K' C�.
TAAIr.$ MAIJUFACTURER: QLMBER OF DOSES: PER DAy
TANK SIZE: � - ('C GALLOWS • .DOSE VOLUME II
ALARM MAUUFACTUKLR: de IIJCLL1011JG SACKFLOW: \ Z � GALLONS
/'IODEL WU"'EK: , ° I `" CAPACITIES: A= Z; f¢ WCHES OK GALLOWS
SWITCH TYPE: ' g= Z WLHESOR 2 � g GALL0IJS
PUMP MAWLIFACTURCR: ° ~"'� `� C,a T' 1ULHE5 OR lZ� GALL0U5
MODEL WUMDEK: SW' 'LO Dw 6 IN CHES OR %R GALLOQJ
SWITCH TYPE: w CA.I l Ilk �.
1 MOTE: PUMP AWD ALARM ARC TO B6
MIMIMum DISCHARGE RATE. IQ GPM, INSTALLED OW 5EPARATE CIKCLlTS
VERTICAL DIFFEKE DETWEEIJ PUMP OFF AUO OISTRIbUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PKECSUK . . . . . . . �'� FEET
+ FEET OF FORCE MAIN X � F �ooFtFRICTIOU FACTOR. FEET
TOTAL DyWAMIC. HEAD = FEET W
p 2
IAITERWAL DIMEM61OWS OF TANK: LEWC+TN -` _;W DTH � LIQUID DEPTH
• t�a� -C 6 �R �
s Engineerin D e tails
Pump Characterristics Performance Data
/Irtltor lteN Sobeah,"
' T' „
AtrttoWk 114" SNEi30A1 i
NOrie"Y/er 0 6 �
�ONd Allt'7 _
AUI*r 7M Shaded Peb 14 }
R.M. 1SSC I
Phan e
r itS
Next: 60
12n Amb*t re�� ° ° 10 :o m ro H
NURA o. sis a A '
halladoa
can A
Dis<har SI :. i -I j2' N/7 (�laaa) iofd Moor f9 *t 4 i 12 16 20 24
Solids Heao�hog 3/4" [14aaa1 GPM (U.S.) 1 44 1 26 29 23t 12 0
UAN weight 30 6s.
fewer Cord 16/3, SRW, 2W std. Dimensional Data
Materials of Construction _ ' >Ri
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pals Ststhiisss Sto11 ,•.,
ro y .. .• + '• v z 3. Na (a arekutwn Wrote
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tiv 4. DYnnkms and Mdp1b are
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Pow C01111110111 Cyst va a, we teem 16 * a rata
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U-10% HYDRQMATIC" - YwrAuihorzedLo:dDisrrbvror -
1840 Ovey Rood AsNond, Oho 44105 Td: 419.280.3041 Pox 419.111.411
Web Site: www.pentWrpunp.com
SALES OFFICES IN ALL NLI JOR CRIES AND COMIES
item u: W- W.8340 1208 ISM �' 1
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Wisconsin Department ofCommerce SOIL AND SITE EVALUATION Page 1 of 3
'Division of Safety and Buildin Comm 83.05, Wis. Adm. Code
Attach complete site plan on paper not less t Ri . Plan must Coun
include but not limited to: vertical and horizontal reference in B direction and
p° ( St. Croix
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.#
APPLICANT INFORMATION - Please print all information I d 034 - 1057 -20
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). VI we By Date
a./ 3 U 6 1
Property Owner Property Location
Flick Wayn & Jenny Govt. Lot SE 14 SE 1/4 S 25 T 29 N,R 15 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
PO Box 171
City State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road
Knapp WI 54749 715- 665 -2430 Springfield 72Nd Ave.
® New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building
Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd/fF .5 trench, gpdfff?
Absorption area required 1125 bed, ft 900 trench, ff Maximum design loading rate .4 bed, gpd/ff .5 trench, gpdfff?
Recommended infiltration surface elevation(s) 100.2 ft (as referred to site plan benchmark)
Additional design / site considerationsi 5' x 75' rock bed mound on 99.2 as upslope edge of rock w/ 1' sand fill
Parent material till over sandstone Flood plaiii n elevation, if applicable NA ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system E] S® U ® S❑ U El S® U E] S® U ❑ SO U ❑ S® U
SOIL DESCRIPTION REPORT
Boring# Horizon
Depth Dominant Color Mottles Structure GPD/ tz
in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
.....1...`?' 1 0 -3 10YR 3/3 - sl 2 m cr mvfr cs lVm .5 .6
2 3 -34 IOYR 4/4 - A 1 m sbk mvfr es lm .4 .5
Ground 3 34 -44 l OYR 4/4 fld 7.5YR 4/6 sl 1 m sbk mvfr cs if .4 .5
elev
99.2 ft 4 44 -74 10YR 6/6 c2d 7.5YR 5/8 fs 0 sg dl cs - .5 .6
Depth to 5 74 -86 10YR 6/6 c2p 7.5YR 5/8 fs 0 sg ml - - .5 .6
limiting
factor
34"
Remarks: 74 -86" is at field capacity w/ side seep observed (a, 82"
..................
.................
.....2 >' 1 0 -6 l OYR 2/2 - sil 2 m cr mvfr es l f/m .5 .6
2 6 - 14 10YR 4/4 - sil 2 f sbk mvfr cs l m .5 .6
Ground 3 14 -20 10YR 4/4 7 10YR sil 2 m sbk mvfr cs lm .5 .6
elev
c3p 10YR 6/2
99.2 ft
4 20 -35 l OYR 4/4 7.5YR 4/6 sl 2 m sbk mfr as 5 .6
Depth to 5 35 - 42 SSBR
limiting
factor
14"
3 � J
Remarks: SSBR by resistance to penetration; shallow soils above estimated high ground water —avoid this areas
CST Name (Please Print) Signature: + Tele o. Z p{t1NG
Henry F. Grote . 715-6 -2 %
Address P.O. Box 57, Knapp, WI 54749 Date CST Numb £
7/30/97 222774
i
PROPERTY OWNER: Flick, Wayne & Jenny SOIL DESCRIPTION REPORT t47 Page 2 of '
PARCEL I.D.# 034- 1057 -20
Depth Dominant Color Mottles Structure GPDlftz
Horizon Texture onsistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 0 -6 10YR 2/2 - sl 2 m cr mvfr cs lf/m 5 6
c2d l OYR 6/2
- - 2 6 -20 10YR 4/4 7.5YR 4/6 sl 2 f sbk mvfr cs lm 5 6
Ground
elev
96.1 ft
Depth to
limiting
factor
6"
Remarks: lacks A +4" -- avoid this area
4 ? 1 0 -4 10YR 2/2 - si] 2 m cr mvfr cs 1 f/m ; 5 .6
2 4 -10 10YR 4/4 - sil 2 f -m sbk mfr gs lm 5 6
Ground
elev 3 10 -32 10YR 4/4 - sl 2 m sbk MVfi7 cs if .5 .6
99.2 ft 12d ] OYR 6/2 A 1 m sbk mvfr as 1 m .4 .5
4 32 -36 10YR 4/4 7.SYR 4/6
Depth to 5 36 -40 IOYR 5/8 clp 10YR 6/2 scl 0 m mvfi _ - NP •2
limiting
factor
32"
Remarks: 10-32" has occasional Gv si coats on peds & occasional gr
....5`.. 1 0 -10 lOYR 3/3 - sl 2 m cr mvfr gs 1 V .5 .6
2 10 -28 10YR 4/4 - sl I m sbk mvfr cs lm .4 .5
Ground
elev 3 28 -41 10YR 7/4,7/6 fad 7.5YR 4/6 scl 0 m mfi cs if NP .2
97.3 ft 4 41 -60 10YR 6/4 c3p 7.5YR 4/6,5/8, s 0 sg ml - - . 7 .8
Depth to
limiting
factor
28"
Remarks: occasional SS frag in horizon 3, 50-60" is at field capacity, seep observed (d 56"
Ground
elev
Depth to
limiting
factor
Remarks:
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nVO2 /nn FRI I0:31 FAX 715 386 4686 ST CRX CO ZONING: znni
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer A/
Mailing Address /'' D 7
Property Address �� v�
rn la D artment for new constriction)K.(.��/
(Vcnficatron required fro Planning ep
b3� -1057 2a
City /State Parcel Identification Number
LE GAL DES TON
Property Location � . %4, '5 C ` /<, Sec - ,� S , N -RL_W, Town of • ���L .�
Subdivision Lot #
Certffned Survey Map # 2 574,/ 7 , Volume page #
Warranty n eed # L 3 �L , 'Volume 1 23 Page # 3
Spec house ❑ yes 9n0 Lot lines identifiable OryW ❑ no
SYSTE_N MAIN'T'ENANCE
Improper use and maintenance of your septic system could result in its pre t= failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wbat 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
rnastt:rplumber, journeyman plumber, restrictedpluutber or a licensedputnper verifying that (1) the on-site wastewaterdisposai 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.
Vwc, the undersigned have mad the above requirements and agree to maintain the private sewage disposal systern with the standards
set forth, herein, as set by the Department of Commerce and the Uep&dmcnt 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
da of the year expiration date.
TE
SIGNATURE 0 ,LICANT DA
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) Lmowledge. I (we) am (arc) the owncr(s) of
the operty described ab vi of a warranty decd recorded in Register of Deeds Office.
S ATURE OF PLICANT DATE
IG
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 trap if reference is pnade in the warranty deed
h
+ ' STATE BAR OF WISCONSIN FORM 3 - 1998 1625Ea3-A '
QUIT CLAIM DEED KATHLEEN H. WALSH
1523P 43 kEGISTEk OF DEEDS
VOL
Document Number ST. CROIX CO. WI
f J RECEIVED FOR RECORD
This Deed, made between c�( 1 /��C� / 06 -29 -2000 4:00 PM
QUIT CLAIM DEED
Grantor, EXEMPT N
CERT COPY FEE:
and COPY FEE:
TRANSFER FEE: 3.00
RECORDING FEE: 10.00
P
Grantee. AGES: 1
ran r quit, claims to Grantee the following described real estate In
r0 l �C .County, State of Wisconsin:
�y'VP ' V � Recording Area
L o 3 .Sf� r �e > Pa 3 v Name and R turn Address , Qno ' ('_
L oCLC'jgW -f- /l 11
5 E )q 0 1 E � �G77 b� °� S ° , � � 7 V9
�c�n S `7 - Ds�
� � a 9 g 03� I - W O
Parcel Identification Number (PIN)
Y e This �— homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Dated this a � day of Sc,- '--1 'e� , a °gam
E 1'U y L- (SEAL) U S a (SEAL)
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of Wisconsin,
•� S5.
L1Gc 11-1 +^ County.
authenticated this day of Personally came before me this 5' -- day of
VA e.. ao o the above named
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who, e (�� feq�oing
authorized by §706.06, Wis. Stats.) instrument and acknowledge the same.. 4P.
THIS INSTRUMENT WAS DRAFTED a = _'�Y.a� 1 �.,.! ►d ^,= Y
Notary Public, State of Wisconsin
My commis��siyyon�� p �is "" permanent. (If not, stateixpvathfr� %dato•
(Signatures ma b or ack ed. Bot
nowledgh are not (tit.C�,� 3 1
necessary.) — —
" Names of persons signing In any capacity must be typed or printed below their signature.
QUITO -LAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blai
FORM No. 3 - 19913 Milwt
I
paweu anoge ayl ' o on '-a u,) s
!° hP siyl aw alojaq awes AIieuos'ad jo Aup siyl paleolluaylne
(lunoo
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(s) am1eu%
INgwoGg IMONNOV NOI VOI.LNgHIfIV
(1v3s) ("Iv3s)
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(IOU (Si)
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(NId) jegwn uol1e094tuGPI leered
I Cell _ _ _
r
8
'FILED 1
L JUN 2 9 200 0 0
M ReQiste of Deeds
g $Lc(ouxco.'vA 2 625617
ch
CERTIFIED SURVEY MAP
BEING LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, PAGE 1067 LOCATED IN THE
SE 1. OF THE SE I i4 OF SECTION 25, T. 29N. , R. 15W., TOWN OF
SPRINGFIELD, ST. CRO I X COUNTY, WISCONSIN
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umuuuurn
1
OD Z z° n z APPROVED
..�ca��gCOly
w ST. cRoix COUNTY JAMES M.
%nnlnn 7nninn 1nr1 °arks Committee
V
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