Loading...
HomeMy WebLinkAbout034-1058-80-000 C N 00 r,. ° O o a M bq a) Q) 0 0 1 rnE° O 0 L B. S o N (D -0 rn w°3Ua arcC00o0 a> yC E - aZ c > `° (n 0 'o . O 3 @ m 0 E v, a� I _ . T o c U UC O L O o O N N C') L L Z' @ 'O ° U (0 N .. c0 O a) L N c c. 2: @ m E c 0 � t a° 0 U c N O_ @ Y O O a Z a cn ') o o a� 37 E 3 Z o f c ti U > Y @ C p ''O c C z L C w C E a - m c c m o).0 0 U o m E N vi 0 U. 3 0 c. `o_ o U o - In 0) o>Er� E ono m Q O co 'ia @J E Q 0 - Z @C c U 3 N d M ct : 3 1 . L Z y � cD W C £O N j U) " o . o ur U z v` E a 3 0 a , d a7 a) d a m a m m•N N F (n 0 N c U @ N m N o Z U c 0 = M �- N w �_ N = 0 O d Z d c U) c N H r E ' E r� o � E o L L) . `o � - o • 1y 0) s c @ c _ o o O U -p Q co O Q Q 0 C a) ® 2 Z Z 2 Z Z C O C d c N E N @ Y rn 1 rn _ 0 m co f�lr r- a • c c n p. rp c (� d N 3 O N a) N @ _ G o a a 0 _ G G a . E z w I - o CL 0 0 0 Z °- O O O m ►� a 0 g a o N h J U co rn rn Z m o Z o � o 0 _ O _ O O j O O O CL ° tYl. U v m Q (D Q C Q rn a a_' Q Z @ rn O c N N C N N C a) r N O 0 m l m c c 0 d o m M c_ \ CO ° c N E E ms ( � I c w 12 E 'n r w C :� 8 c 0) c ..a c0 H O N m Y N C O w :3 c > O. U ,.^ O O U U 5 N y O y' O N fn d O :a N Z Z U) d M 0 N Y Z o a�+ ✓� d +o � a d a C mt is L: a w L: d • ':a a d .2 ai y r d y C Mrri «� o `m 3 3 :a o 3 ;? o v a t 0 y 0 O N v Q) an m � � I CL LL -_ 0 0 C) C o z 3 4 z o a, H c o' �'m c o o I cfl C LL LL S 3 N Q O V. O d u { �: `I o � 4 > o L a v ` E 0 p . o f1 Z iT V) L) c i a a rn (!1 w c Co to U) Y 7 _ d 0 �i { C u O v 5. c 4� v O +J LL i C cl 1 > O C O j U . O G j O E O N 00 ! m 0 J Q1 U 01 o�� � c o j m "" O N (n O E i C O Q ' N aE v a c ° E. L C W « it C d O N v C E d N O Q 7 — 5) o N E a U O V O *k O U V) E o. m 7 U 00 00'0 00'0 lezol sa6ae4a luenbu!la(3 sa6ae4a lepodS s;uawssessd le!oadS ;unowd /Go6olea apoo leloads aasn :sleioedS LOZ # 43le9 :ale(] uol;eolitpoo ► :;unoa wlelo :Iipaao fuello 0 0 0000 puelpooM 00t 00t 000'Z£ 066'S Atiodoad leaauaa :9002 Jo; slelol 0 0 000'0 pUelpooM 099'90Z 096'Oti6 OOb'99 066'9 AUadoad leaauaE) 400Z Jo; sle;ol ON 099'90Z 096`016 OOt"99 066'9 60 WI1N341S32J uoseaS aje ;S le;ol ano.idwl pue saaod sselo uol;dinsea LOOZ 196/90 :pafue4a Isel :suoijenleA 0 :4 ;lM passassy :onlen;a3laeW a!e3 :# Me AbdwwnS LOOZ 90Z/9£9 L66 6/EZ/LO E£tl /L99 L66 6/EZ/LO 9£9/969 L66 6/EZ/LO Z3 6Z£ /b0L 6 Eb91799 6002 /£Z /80 ads _L abed /Ion # ooa a ;ea :fao;slH laoaed :s810N LObbZ9 £86 /L 6Sl M96 SOd Ol ,6V9 3 030 E S Hl ,96'9EE (b /6 096 t7/6 Ob 6u21- uMl -096) :(s);oeal 3 030 99 S Hl .96'L99 N Hl ,EZ'L9E M '1NOO :90d Ol ,V6£ M Hl 9Z 03S 2100 :6p18 opuoa/)13018 3S WOO 3S 3S O`d 66'9 M968 N6Z19Z 03S 3 - II AV ION /N :3e1d 066'9 .sej3)f :uolldinsea leBe 011M OOL 6 dS AiI0 o00MN3 8662 0S M 021 A10 Z66£ . uo!;duosaa #;s!a adA1 Meual}d = , :( sa)ssaappd Apedoad !elaadS = dS IoouaS = OS :s ;olalsla 6VLt IM dddNA M 021 A10 Z66£ N0120>101d NA 13A3'8 S3vivr NA"13AE] v S3nv 'NJ1213>101d - O jaumo -off juaaano = o `aaumo luaaano = p :( s)aauM0 :ssa.ippy xel 0 00 adA1 PwJad # i!waad # uol;eo!lddy eajy sales # deW a ;ea leolao;slH a ;ea u04eaa0 NISNOOSIM `AlNnoo X!0210 1S x tuaaan0 0 30 NMOl - tiE0 8L017'9 V6Z 9Z :# laoJed III 6 d0 6 39Vd aa.le M gL: 6 LOOZ /66/O 000 :# I d ON lia:) ainjeu6!S s,iouadsul aleo (L61C*H) OLL9 -09s I L F uollewjoiu leuo!1!ppe joi ap!s iaglo asn oN ❑ sa,k ❑ Zpa�!nba� uolsina� ueld — molu03 (.£ .zanoo JO lunouxe- = igl2ual ianmas 2 pig ('Z = uoildilosaQ WEI IIV (' I E1LOb'Si'6Z'9Z - (MMI N6ZL 9Z Wl ANS Wl MS) 6LSt'S IAA, `ddeux `rn peog �ilun0 Z6i£ :uO. 0Z / / :Z# uoiloa suI / I :T# uoiloa suI ( suosiad 'salauedaj:)s!p apo:) apnl:)ul) :SIN3 W WOE oN ❑ sa k ❑ oN ❑ sa k El posdol sa6P3 q:)uaJl/ pas ia;ua:) 43uajl/ pas paq:)lnW xx pappos papeas xx 10 41dad xx Janp q ;dap Janp q ;dap Alu0 swelsAS opeag -IV ao punoW xx Alu0 swelsAS ainssaad x H3A0:) 110S 6wDedS el(] g;6ual el(] 416ual amelul J!y ol;uaA I 6uoedS alOH x az!S aloH x (s)adid uo!;nqu;s!Q plopueW / japeaH W31SAS NOIIf1812I1SIO llNn !10 : walshS :ja wnN 1 0PO VY 7338WVH:) oadAl N011VWa03Nl )I9V813S :jampe nueW 9NIH9V31 WV3KS /DIVl 113M 9018 l/d 01W31SAS N I N3WIU N I N3W1t7 gjdad p!nb!l e!Q ap!sul s4!d 30 ON lid sagDuaJl }p gl6ual gip!M H9N3Ul / (138 W31SAS N011d»OSOV 110S ilaM xs!a 'ela gl6ual ulewa�aoj Ij Hal walsAs HH uoll�l.l1 li!l Hal Wd9 jagwnN RPM zanoo IS puewaa aajnl:)einueW apejE) leu!j N0l1VW2l03N1 NOHdlS /dyynd walsAS - log 6ulploH adld 'IS!Q VN uolleieV 'UeW / japeaH VN 6ulsoa wolloB IC] VN : laul Id QVOB a�le;ulnv 'D(318 113M l/d Ol)INVl l olluaA l alln0 IH /I N011HW210ANI )9V813S )INVI lalul IH /IS 6ulploH jannaS '6p18 uo!lejaV WE 'ltV 6u lsoa jaewg3uag DijdaS A313 Si IH S8 NOIlV1S .IlI:)VdVD 1Min19VjnNVW 3d1k1 VIVO NOIIVA313 NOI1VW2103N1)INVI 000 S0 i - t , £0 _ : xel la»ed :uogduisad W8 Aa13 W8 "dsul : W81SD du4suemo,L plaig2uizdS sauzep VU011oid : dl Ueld alelS : ;o umoa [] a6ell!A ❑ Al!:) E] :aweN s,�aplOH 3!wJad 88ZOL£ l(w)(0 bo'gl' AOe^ud] sesodind tispumes jo} pesn eq Am eolnoid nog( uollewJo;ul leuosaed :'O Ni!wJadAjel!ueS (1IW213d Ol HJV -LiV) NOLLYWHOANI lVa3N3J xioz 1S l»Od3H NOW)USNl uolslnla s6ulpllns rte • : luno:) W31SAS 39VM3S 31VAI2ld 93jewwooto3uewlledeaulsu03slM , F z 3 � f 3 f } ®.P.s..,.�.A.a �� .......- .e..... ...e«��.�.®m. lm��l»e,.®,. e.t»v......z.�.,... ....$..,_e>.. e.. ` - -.._�.. A_,..,...„..,a ..� ,.,.. .1......... . .W. m. ,.. k _.....- .,�..ma. ®.�.,'4�.�.�.. (,.. .. w.., ,.n e.e ..v .,. �,..e.....m. ' . 7,,.,.. 3 rov«.�.....�.,.»...w...,- ..�.... m....m. :H3E]NnN lIINH3d JlHVIINVS y T H313)IS aNV S1N3WWO3 IVNOI11aaV r Safety and Buildings Division SANITARY PERNIITAPPILICATION 201 W. Washington Avenue Aisc6nsin I P O Box 7302 Department of Commerce In accord with Comryieb5; Wis, Adrraode Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) fort system, on'paP4 Kot less °; Cnunty than 81/2 x 11 inches in size. CR • See reverse side for instructions for completing this application 7 " "' State Sanitary Permit Number Personal information you provide may be used for secondary Check if revision to previous application purposes ¢� [Privacy Law, s. 15.04 (1) (m)]. p � € �. u1G�tt�•'. �, # State Plan I.D. Number I. APPLICATION IN -PLEASE PRINT ALL TNFb K TTON :r °" axo r 343 _3 Pro rty Owner Name "` - � °Prjilocation 6 rC —Rr // k/ i/4_g ( 1/4, S Zfe T z9 , N, R /� (or�/ Property Owner's Mailing Address lot Number Block Number 2 C/lz Ad. V Al• A. I N, A City tate Of Zip Code Phone Number Subdivision Name or CSM Number &W aAA9 W / V ( 7/s ) 7 -1z 41 7yf N. A �/.1( e. e� W]l 5 0 1 II. TY F B ILDING: (check one) ❑ State Owned ° C it y Nearg Road Public 1 or 2 Family Dwelling - No. of bedrooms — ° Tow of cQQ C CJ III BUILDING USE (If building type is public, check all that apply) Parcel Tax Num er(s) '2L, -2R. 15.4o7 8 1 ❑ Apartment/ Condo (: 3 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Q Campground 7 Q Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 Q 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. j. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System - _______System ___ ________ __ Tank Only____ ___ ^ ____ Existing System --------- - 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 Q Seepage Bed 21 a Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 Q In- Ground Pressure 5 , x ' 42 ❑ Pit Privy 13 []Seepage Pit , 43 ❑ Vault Privy 14 ❑System -In -Fill R 5, 3 VI. ABSORPTIONS STE INF RMATION: 1. Gallons Per Day 2. sorp. rea 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 `�` .> /QZ .5 3 7 1V. 4 . �C, 3 Feet 3 Feet Capacit VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g allons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank old; igTarrk ,000 600 / ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank LSiptaer 444armber 0 6 ® ❑ 1 ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s ge system shown on the attached plans. Plu er's Name: Print) Plumber's Sygnatur S tamps) MP/ .. Busin Ac ess hone Number: k �wm�� � / tiz - — .582 7�s .�36 - V63� Plumber's Address (Street, City, State, Zip Cod 9 -n &ap j S 7 IX. COUNTY / DEPARTME19T USE ONLY Q Disapproved S itary Permit Fee (Includes Groundwater ate ssue Issui g Agent Signature (No Stamps) Surcharge Fee) Approved ❑Owner Given Initial Adverse Determination X. CONDITIONS OF P ROVAL /PEA ONS FOR DISAPPROVAL: I s 9 . 1< � . `D -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber z 1 INSTRUCTIONS ' 1. A sanitary permit is 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 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 dimLmsions, 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)_ section of the soil absorption system if'required by county; €) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N*isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary March 29, 2000 CUST ID No.260751 ATTN: POWTS INSPECTOR JACK BOWMAN ZONING OFFICE BOWMAN PLUMBING INC ST CROIX COUNTY SPIA 2819 KNAPP ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/29/2002 Identification Numbers Transaction ID No. 303935 Site ID No. 188801 SITE: Please refer to both identification numbers, Site ID: 188801 above, in all correspondence with the agency. St. Croix County, Town of Springfield SW1 /4, SW1 /4, S26, T29N, R15W Facility: James Pickerign Existing Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 654345 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. 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 03/22/2000 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 Residential Application INDEX AND TITLE SHEET Project Pick ign Owner James Picked n Address 3192 Ctv. W Co i Kna WI 54749 kv a y Legal Description SW,SW,26,29,15w t Township Springfield Cou C r&z Subdivision Name N.A. Lot No. N.A. Parcel 1D Number Plan Transaction Number Index and title sheet Page Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump Inform Page 6 Site plan Page 7 Attachments, (soil te!Lt) . Page 8 Designer lorettal Jack A. Bowman License Number MP 5875 Signature Phone No. (715) 235-4634 Date March 16, 2000 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 146.10, Wis. Stats. Personal information you provide may be used for secondary pu [privacy Law, s.15.04 (1)(m)]. SBD-10462-E (R.05/98) Pagel of 7 Effluent and Dewatering Pumps M ODEL `1 115V -1PH -6 U a 8„ • 115V -1 PH - 6 amps ®• Pumps down to within 1B' of base JZWV' AST IRON SERIES p tied 8', 3 -wire power cord and f/ /[ Corrosion resistant • Automatic UTIU UMP • Oil - filled motor • 115 VoIVSingle Phase/60 Cycle P • Rotary shaft seal • 011 - Filled Hermetically seal otor • Thermal overload protected • Passes 3B' solids (sp e) • 1 V' NPT vertical discharge with a , 1 W NPT Dischar garden hose adapter • Rugged cast motor housing. • Compact design will tit In a 6' • Effident sink for Heat dissipation opening • Engl red thermoplastic motor cover& b e CAPACITY on -Clog Vortex Impeller Engineered CAPACITn H umrrsi IN Glass OOed Hip UNIT IN Feet Me Gal. Lirs. • Automatic Reset thermal overload Feet Meters Gal. Ltrs. protected 5 1.52 15 57 314 1.06 29.5 112 Carbon & Ceramic Rotary Seal 10 3.05 1 51.3 • UL Listed 9', 3 -wire cord and plug 5 1.52 29 110 • 5 3.05 25: 95 15 4.57 8.5 2.3 • Watertightneoprenesealbetween motor 15 4.57 18 68 20 6.10 2 7. and Cover 20 6.10 7 26.5 Lock Valve: 21' • Stainless Steel Screws (No sheet metal Lodz Valve: 22 per) "5 'CAST IRON SERI * / "57" CAST IRON SERIES - BRONZE SERIES * / " BRONZE SERIES • Automatic or Non- Automatic. • .3 H.P.,1 Ph.,115V or 230V. • Non - dogging vortex Impeller design. CAPACITY • Passes % inch solids (sphere). HEAD UNITS/MIN • 114' NPT discharge. FeeN Mehra Gal. LCs. • float operated, submersible (NEMA 6) 2 pole mechanical 5 2 43 163 switch. 10., 3. 34 129 • Automatic reset thermal overload protection. 15 . 4.57 19 72 • Stainless steel screws and switch arm. • Cast iron switch case, motor and pump housing. Ledo Valve: 9.25' • Engineered, glass tilled hnpeller with metal lnserL' • *Bronze noosed pmrp houft awrfch • Glass tilted polypropylene base.* 53 series SC 44251 • Models 55 and 59 have stainless steel handle & guard. "' "z• moforand pwgp Iroeark� ar�Erh ban ler . 55 Series se -4415 57 Series SC -2225 8 � yyl yNtywp ��yy 1ana tll SWWsrds v�v° Se Series SBA 115 S � A me MOrowl dnMAM ' "98" CAST IRON SERIES • Automatic o on- Automatic. m CRIPACITY I 14 H.P.,1 Ph., fTgv or 230V. HEAD uNtisIMIN • Non - clogging vortex impeller o feet Meters Gal. L • Passes 14 Inch solids (sphere). ea s M. 5 i.52 72 273 • 114' NPT discharge. 231 3.05 61- • Float operated, submersible (NEMA 6) 2 pole mechanical l0 to 4.57 1 170 switch. • Automatic reset thermal overload protection. 20 s.t o 25 95 • Stainless steel screws, guard, handle and arm and switch Lock Valve: 23' assm. • Watertight neoprene '13' ring between motor and pump housing. CID �disn Standards _ - Aaocopproval BN98, non- automa ic, available pac with a availebN f / J �0•d P�YbackmsrcuryrbatawRch. l9 � o� 1 TOTAL DYNAMIC HEADXAPACITY PER MINUTE EFFLUENT AND DEWATERING can 13M� ■ ■ \■ \��► \ ■ ■ ■ ■ ■ ■ ■1 ■►\►\■110 ►\■■■■■ ■1 iNNORRE TOTAL DYNAMIC HEADICAPACITY PER MINUTE SEWAGE AND DEWATMING TVIIIIIII ® ® ® ® ® ®® ®lei Com Km" �lmwl ,. ■■DO WI■■ ■1 ■■►�1 ®� SITE PLAN Bowman Plumbing, Inc. ✓' Master Plumber No. 5875 Pro Pickeri J gn 2819 Knapp Street Menomonie, W154751 1 - (715) -4634 FAX ( 715) 235 -3650 1 " � l � / l LEGEND - 6- borings f/ Scale 1 - 40' except where indicated i L • System Elev. 96.3' oil contour 95.3' No ILHR 83.10 proble s{ f � I Wisco Department of Industry , SOIL AND SITE EVALUATION Labor and Human Relations Page �^ of - 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. / Cyr Z Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County �� c 0 include, but not limited to: vertical and horizontal reference point (BM), direction and / X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # p - C) OC�� APPLICANT INFORMATION - Please print all information Reviewed by Date Personal infonnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner -.. Property Location r -n 1' n Govt. Lot S'� 1/4 S C,,, `1 /4,S � T 49 N,R 15 X (orC Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number Nearest Road _ ❑city Village, © Town 7/5 )`IZV -g7ll.3 �,`nc tic/ ❑ New Construction Use: © Residential / Number of bedrooms ` 6 Addition to existing building zu ln f '- / /�Z 1111-e- [0 Replacement ❑ Public or commercial - Describe: A ,A - Code derived daily flow s - / gpd Recommended design loading rate . - bed, gpd /fL_ trench, gpd/ft Absorption area requiredl °'6 ^`` bed, ft P�?'`' trench, ft Maximum design loading rate _ bed, gpd/ft gpd/ft i Recommended infiltration surface elevations) ,�I'i,j Gcr, 'Cr,. 9�. •� -�� C '�tt�� ' 3 ft (as referred to site plan benchmark) Additional design /site considerations -`z� Parent material Flood plain elevation, if applicable ill. q ft GJ n I4.. n S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank u= Unsuitable for system ❑ S 0 u 9s El El ® U El ® U [is ©u p s� U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 3 tv. F ' A, P Ground elev. Depth to limiting factor ' Remarks: �� r9c� r 7Z IJ / cC • ;A c� Boring # 13 -j- Y- s i Ground r .3 C yt< S' / elev. ' Depth to limiting factor 'ice in. Remarks: CST Name (Please Print) ! Sig ature Telephone No. ess (715)235 MS. loretta A. larrabe e /cc Address BusineSS: ,% Date CST Number Bowman Plumbing nc. 51 7 CS'ITI 3719 2 5 47 J 8 Menomonie o 'e 19 mo SOIL DESCRIPTION REPORT PROPERTY OWNERS rc° iL � Page '�P of - I O 9 PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots § in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench a a s ✓ �. J � ~ elev. µ , Depth to limiting >� , fac 0,,,��' i / • Remarks: Boring # V /. ckJ 01 k S 4 5 �� I Ground �3. y/ 1 ! l s 6 k (� . 14 3 elev. 9�n e 6 / /4 3 — Depth to limiting factor, ", 0 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground Y J - I ff "/j elev. ft. , Depth to limiting factor ,L -, Remarks: Boring # Ground elev. ft. ' Depth to limiting factor ' Remarks: SBDW -8330 (R. 08/95) `SOIL AND SITE EVALUATION REPORT Paae 3 of3 James Pickerign SW,SW,26,29,15W `U� Springfie d oWnship St. Croix cA ty -AIL Al. v , - -- t=etta"1arrabee CSTM 371 LEGEND 0-borings borings dug with back hoe k4 VJ4 �10111-1- Scale 1 except where indicated No ILHR 83.10 problems at this time ILI A ST CROIX COUNTY SEPTIC TANK MAD�NANCE AGREEMENT AND _ - OWNERSHIP CERTIFICATION FORM i Owner/Buyer M'. James Pickerign Mailing Address 3192 Cty Rd. w, Knapp, WI 54749 roperty Address same as above (Verification required from Planning Department for new construction) no City /State Knapp, WI Parcel Identification Number d LEGAL DESCRIPTION Property Location S* Y4. S* %, Sec. 2r - T „29-_ N- R Town of =dngfield Subdivision N.A. Lot # N.A. Certified Survey Map # - - . Volume . Page # —74— Warranty Deed # �J" q'�o �� . Volume Page # , 3 & Spec house 0 yes )0 no Lot lines identifiable U yes O no SYSTEM AN(M Impcnpexttse and miof yore septic system could nnit in its premature fam'luce to Candle wastes. Proper maintenance coasisls of P8 'odt the septmc.taalc evamy three years or sooner, if needed by a licensed pumper. 'What you put into the system can affect the function of do septic tank as a treatment stage in die waste disposal system. The Fwatty owner agrees to oftnit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumbe4 joulneymanplumber, reatrictedphmmber or a licensed pumper verifying that (1) the on-she wastewaterdisposal system is in proper operating condition and/or (3) aft inspection and pumping (if necessary), the septic tuk.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 systemUs been maintained must be completed and returned to the St. Croix Counter Zoning Office within 30 ys of the three year iration date.. ATURB OF LICaANT DATE OWNER t�RfFi�►Tt[)ly I (we) cer* that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of Property described sbgve, by virtue of a warranty deed recorded in Register of Deeds Office. G ATURE OF APPLICANT DATE * * * * * *. Any information that is mis- repcesentedmay result in the sanitary permit being revoked by the Zoning Department. *�� •� `* ludgde with this Md a den: a 4tamped warranty deed from the Register of Deeds office s copy of the certified survey map if reference is made in the wamnty deed PIP DOCUMENT No. STATE BAR OF WISCONSIN—FORM I WARK VE A14TY DM Z96 :109 PAGE THIS SPACE RESERD FOR RECORDING DATA THIS DEED, made between !1enry S. Se R/ ST. C"X CO., Wis Fenry S. Sery'vik Roc'& kw T 6th Grantor day of Sep A. 0. 1984 and kerj:"rn n nd El --n P1 ek il" as - r)Int tc—nnrr, at 11:45A sm, ofl . 0 Grantee, aotn -A We Witnes�jth, That the said Grantor, for a valuable consideration dollar 1 ,21, 'YV La�j Qt 17S.1 ILI'ahle con-A-d-rat Inn- RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsi Part of the Southeast Quarter (3E !/4) of the Southenst Qt (SE 1,A) of Section Twenty-six (26) , To ?'went;. -nine ( 2-0) Tax Key R' sz on the South line of sa 1 North, Runge Fifteen (15. West, described as follows: Corvrencin Section Twenty-six 31 feet 'v,e3t Of the Southeast corner thereof; thence North 1 3� w 4 -r-" I 5; .15 feet; thence South 98 19 East 3 '- feet; thence South 3 25' East - eet to the Place of Eeginni-g. 11-is Dee! Is 1 in satisfaction o th?t certain Land Contract bet the Vendor anr! the Purchasers listed abol, dated June 14, 1 I This Deed r2leazeG the Lis Pf��-'�Cr.3 dated Auzrnst ' 197B, and filel in the of the Ret7ister of Deeds of St. Croix County, '.-Asconsin. This A s not homestead property. TMNSFM (is) (is not) S udo. Together with all and .:angular the hereditaments and appurtenances thereunto belonging; FED (" And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this y rk+ — day of 19 70 j (SEAL) (SEAL) (SEAL) —(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this_-------day of STATE OF WISESM51 19 ss. County. Personally came before me, this day of Wqvem6er the v :red TITLE: MEMBER s BAR OF WISCONSIN (if not, authorized by § 706-06, Wis. Stats.) This instrument was drafted by to me known to be the person whu ?.ku'tMh tV.. g oing instrument and acknowledged the same. ft (Signature, m-iy be authenticated or acknowledged. Both r Ic - LX� W nfe not necessa; MY L 7ermanent. Al not cc i,sion is p date 'Vanes of per•­ signirK in any capacity must be typed or printed b-•o• WARRANTY DEFO-STATE BAR C!' WISCONSIN, FORM -40 1-1977