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034-1078-30-100
� / )\ \q \ j & f 2 # o m § k ) � I ) I m 1C) 2 } ( \\ a I � ` � &§ � / t E I 2 I 2 CL G d E } f\ 0 ° E R ) w )° I § %M§ 20 \ � / ) /7 « z\ \ zk\ 4 ) /k\ ) C �\ I 0- 2 e =@ 0. o 5 EC: \ \ / ƒ ( 7 / @ \ E < 2 = f /� L 7 \ k / k § f e . e § _ § 7\\ a. m a 2 ( ( 2 (D $ \ 3 $ ] c r U) R \ § . D e § $ I o - \ ® e \� } / a kk . I / \ \ ) .2 / \ \ / \ k ) \ 4 � � .. = k o � { ; ® \ k £ k ..k ƒ \\�£ 3 k)£ s & ° R k 2 �\ k o� ±/ \ w co m _§ 0 �o m(D m _§ / k n \ \ k IL � \ \ k •� $ a a a m a a a 7 I t _ § e 2 q \ CO ° �/ / \ ƒ \ \ \ �+ \ \ } £ 2 = _ _ ° / \ § » 6 / § / - �/ / f_ @ ° ± 2 # z e �I 5 2 < A m m © » § ) § ° I §/ \ m 2 t n 2 ` G § n \ / ( D �) 4) \ \ \ a © » ®/ 1 3 ® e® o 4 a w a 2 co c 2 g 2 \» e\ 2 D ° / m /\ §$ a r I 00 4 5 § m o 2 k§ I� G o m± t k 0 Cl) 7/ z z > o _ e E n\ z_ z■ m _ $ / \ [ I k CL — , a •• (L » a » Q E CL e\ () k k c 0 2 0 ■ 0 ,o G u Parcel #: 034 - 1078 -30 -100 11/07/2007 11:39 AM PAGE 1 OF 1 Alt. Parcel #: 34.29.15.522B 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/01/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KRUEGER, JAMES L JAMES L KRUEGER 613 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 613 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 5012 -CSM 20 -5012 034 -05 SEC 34 T29N R1 5W PT SW SW CSM 20 -5012 Block/Condo Bldg: LOT 01 LOT 1 (5 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 10/24/2005 810094 2914/92 WD 07/01/2005 799093 20/5012 CSM 04/12/2005 792049 2782/335 WD 11/20/2003 747050 2459/457 TI more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 63,600 102,950 166,550 NO Totals for 2007: General Property 5.000 63,600 102,950 166,550 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 12,050 69,400 81,450 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 799rb93 VOL 20 PAGg 5012 KATALT$ H. w REGISTER OF DEEDS CERTIFIED S V RVEY MAP ST. C OR , CO wi RECEIVED FOR RECORD LOCATED IN PART OF THE SW7 /4 OF THE SW7 /4 07/01J2005 08:30A?l CERTIFIED SURVEY HAP OF SECTION 34, T29N, R7 5W, TOWN OF REC FEE: 13. SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN COPY FEE: 3.00 PAGES: 2 W1/4 CORNER SECTION 34 PREPARED FOR SURVEYOR COZY HOMES. LLC EDWIN C FLANUM m 3026 60TH AVENUE NORTHLAND SURVEYING, INC. Z rn WILSON, W154027 P.O. BOX 14 1 g ROBERTS, WI 54023 r Z o m O O m - - - — a` — 4LsD L�,QMD - l 1 b NORTH LINE OF THE SW1 /4 OF THE SW1/4 --7 z I .54 389.31' o z I I � m lmI 4 ' m IZ i �Z o I__ I - C2 g �I (� 8 SHED /� LOT 7 (� nY 5.00 ACRES INC. R/W 0) k9 217,892 SO, FT. N I EXI STING DRIV (Q m 4.65 ACRES EXC. R/W m j 202,589 SO. FT. ( n m HOUSE OLL N ( S �o SEPTIVENTS 0 O 33' � 33' 8.97 389.88' RECEIVED 889 °26'7 5"W 416.86' LEGEND Q• 1' STEEL SURVEY MARKER FOUND CI 314"X 18' IRON REBAR SET WEIGHING , " 1.50 LBS. PER LINEAR FOOT "" A+PQ c y --X X EXISTING FENCEUNE `4 • . • - • • • 100' BUILDING SETBACK LINE SW CORNER SECTION 34 SCALE IN FEET 1"= 100' THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 05 -41 DATE 5-r-05 SHEET 7 OF 2 SHEETS 10 0 O 100 Vol 20 Page 5012 , r + Safety and Buildings \ ' 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary December 22, 1999 CUST ID No.267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1 101 CARMICHAEL RD RIVER FALLS WI 54022` HUDSON WI 54016 RE: CONDITIONAL APPROVAL' Identifica ' n um ers APPROVAL EXPIRES: 12/22/2001 Transaction ID No. 86847 Site ID No. 185503 SITE: Please refer to both identification numbers, Site ID: 185503 L above, in all correspondence with the agency. St. Croix County, Town of Springfield SWl /4, SWl /4, S34, T29N, R15W Facility: James & Debora Phillippi Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 642193 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. Stars. • 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. i 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 12/22/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 rard 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 I a (9 ` l 00" � 35333 u.til 3cow� w 5n� �,U 4. s ae . ( 4 �,� � car� � ��� F-,` V�A A 1'4 -TITL S �vy E , - r ' Page of 6 MOUND SYSTEM FOR A .3 BEDROOM RESIDENCE LOCATED IN THEs 1/4 OF THE S W 1/4 OF SECTION 3Y , T Zq N, R S W, TOWN OF Sp Z ;uG Ftetp , 3T. c LX COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT PA GE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR p,.Q .�• �� �ML?S. HBO 7D �OCLA PLtit�EPP 1 Co n y �i�� ° b 13 ST'C� ZL1 H D �2Q, ED pp TMENT OF ►Epw1G �� ,Z 0 7999 DANCE atl s Q C PREPARED BY ' " WEGEF;tER S C3 I L- TEST I NC �g ®v94N0@ � DES I cSr4 E3EFRV I CE '0SC0N / ®fig P.O. BOX 74 421 K. KAIK ST. �•, 4 aa?riva L • RIVQ. FALLS. YI 54022 woGEHER 715 -42 ELLSwURrn, W . , •'ds ��S j G � E -49 JOB NO. Wisconsin Depaitmentof Commerce PRIVATE SEWAGE SYSTEM Count y .Safety add Buildings Division 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)). 353336 Permit Holder's Name: ❑ City ❑ Village ❑ U6wn of: 4 � t ate Plan ID No.: Philli i, James Sp ringfield Township 1D4k ; CST BM Elev.: Insp. BM Elev.: BM Description: _ Parcel Tax No.: o ' ( p ' I I L OU412- 034 - 1078 -30 -000 TANK INFORMATION 0 ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION // BS HI FS ELEV. Septic /'re� aa� bS-O Benchmark (. �e0 p�.IgO �� •� Dosing U Alt. BM ' V/A Aeration Bldg. Sewer cf. 13 4I•� Holding St / Ht Inlet 10.5-0 If-10 ` TANK SETBACK INFORMATION St/ Ht Outlet —, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet ---�^ Air Intake Septic , f c{a '7 1, — NA Dt Bottom 13. . ` Dosing �• `� �� - 3 ` NA Header/ Man. a, Aeration NA Dist. Pipe 3, 0 . (a0 Holding Bot. System .$- 0 ' PUMP / SIP #6N INFORMATION Final Grade S Manufacturer �o�J,QQ. f `� gj . Dertland St cover b y Model Number S GPM DH Li ft.$ Friction L System TDH \ gSFt i L Forcemain Length Dia. FFii Dist. To Well S L ABSORPTION SYSTEM g Width r Length L , } r f FFenrhe> PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' DIMENSION SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manu urer: INFORMATION Type O r CHAMBER - 17o del Number: � System: sm � 5- OR Ll IT DISTRIBUTION SYSTEM ✓` /°Df Header/Manifold Distribution Pipe(s) / r r x Hole Size x Hole Spacing Vent To Air Intake Length p / Dia. 2- Length _a'�Dia. ` Spacing y .� 3 b u �— 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 No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) ns ection /z� /�o Inspection #2: Location: 613 Highway 128, Wilson, WI 54027 (SW 1/4 SW 1/4 34 T29N R15W) - 34.29.15.522A 1.) Alt BM Description= 2.) Bldg sewer length= 3 f - amount of cover 3.) contour = a;F �4. �.(0 g � (b(6p) r, Plan revision required? ❑ Yes IM No Use other side for additional information. 01 �o SBD -6710 (R.3197) Date Inspector's Signature Cert. No. , ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _A i r i 4 � t f I 14 1 g a 9 t m a._ z . N m� g 7 t s t t 3 a f i 2 ! � t s { _ P � t qty p t g � e e i I ? s f s { a :U38Wf1N 11Wa3d AHVIINVS H013)IS aNV S1N3WWO3 IVNOIllaav Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County , than 8 1/2 x 11 inches in size. St C 2� • See reverse side for instructions for completing this application State Sanitary Permit Number 353331 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N g<°8f 7 Pro eny Owner Na Property Location 0.m 5 N`1 I 5W 1/4 5W1i4,S 34 T a , N , R IS E(or)9 Property Owner's Mailing Add res s I a Lot Number Block Num er 13 pct I�iUUCa City State Zip Code one Number Subdivision Name or CSM Number \�lis(n,, 5y0a1 cI 1 ) Iia -3 11. TYPE L ING: (check one) ❑ State Owned E] (7 !t� Nearest Road VII age f� Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ri r\ d 14 I ag III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) (� 1 ❑ Apartment/ Condo 3 0 ? 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. ❑ New 2. j, Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System _ -_ _ Tank Only Existing System Existing System B) nitary Permit was previously issued. Permit Number r� _- �� �� Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 M Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , i 42 ❑ Pit Privy 13 ❑ Seepage Pit f x�7� 43 ❑ Vault Privy 14 ❑ System -In -Fill C (o . Q VI. ABSORPT SYSTEM INFORMATION: 1. Gallons Per Day 12. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L45 //�� Required (sq. ft.) Pro osed (sq. ft.) (Gals/daY /sq. ft.) (Min. /inch) Elevation V 3 7 (0 . f J � g. Feet 101 Feet Cap VII. TANK in Ca allons g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed T nks Tanks Septic Tank or Holding Tank ( 1 600 r\) I d`V C5+tr n ® El 1:1 11 11 11 Lift Pump Tank /Siphon Chamber t✓ /D5 M; d W e5 + - ern ® ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibililW for insta tion of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signat re o Stamps) MP /MPRSW No.: Business Phone Number: 5A an �1) 3LI Plumber's Address (St et, City, State, Zip Code): 1 lut.w 1Dri l w0 ca q 11t, vv1 54o )? IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater I D ate Issue IssuingLAgent ignature (No Stamps) 'Approved ❑ Owner Given Initial Surcharge Fee) Advers e Determination � �`S 3�1�2 X. ONDITIONS OF APPROV L / REASONS F DISAPPROVAL: L SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS r 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,ow- ner-'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 i'nformation. 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. } PLOT PLAN Page Z of (� • Scale 1 "= 4fj _ oci�u�Tw v ✓ wQu J � - � �toPA L Zb' o f �LPv e MX4% E (� ` � � D � � a �,o ��. zKPvc F.nc- Te �F 'nD�rNDIUu� ' �'�""N �.Qb °. �•S Pte. Cofl�� I � ad o @.l. ab•0 i - 'L`� ` of BED J EL. qg .0 �'LRS S o2 NOTES •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (/ required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. tank to bem 16So gallon capacity manufactured by YA Lbw Lsy ��T t N c 5. Bench Marks S BEd U� 6. Divert surface water around system to prevent pond-ing at the uphill side. Page ' Approved Synthetic Covering i c�sTwi C. 33 Distribution Pipe Medium Sand H _ G Topsoil __ ^_ F Elev. o► 3 E D b y % Slope Bed Of V-2'" Force Main Plowed Aggregate From Pump Layer D Ft. Cross Section Of A Mound System Using E Z.3Z Ft. A Bed For The Absorption Area F o -43 Ft. G I•o Ft. A $ Ft. H t•s Ft. Linear Loading Rate = 01 s -1 GPD /LN FT B Ft. Design Loading Rate= o /SQ FT I 1 S Ft. J Ft. K Ft. �l tcrnatP Prtc' +;n e�— L - 15 Ft. 44 =e Mai n W 33 Ft. L Observation Pipe--,,, 8 K ♦-------------- - - - - -- ------------------- A - -t W o - - -- I• - - - -- ----- - - - - -- ------------------ - - --�I Force Main � �, Distribution \ \ , - - B e d Of 2— 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchbr securely) Plan View Of Mound r T Absorption Area Usin A Bed For he P g Page 4 Of to Perforated Pipe Detail / 0 End View Perforoted End Cap \`�" PVC Pipe cn Install permanent marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cap End Cap P u. s Ft. Distribution Pipe Layout S V Ft. X a t Inches Y 3 Inches u Hole Diameter y Inch Lateral ) Inches) Manifold Z Inches Force Main 2 Inches # of holes /pipe $ Invert Elevation of Laterals Ft. %X-I -In = 4 - 36x _ 3 G"P'M Place lst hole � " from center of manifold with succeeding holes at 3 6 `intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE S OF �o -VEIJT CAP WEATHER PROOF JUUCTIOU BOX VENT PIPE , r APPROVED LOCKING ' —.10' FROM DOOR, MANHOLE COVER wt'M ./ OR FRESH +�'ARtl1WG La.OEI. AL IIJTAKI S 6' I I B A) IAILET vv /�9�RZ6t[fi �-P�Q PROVIDE I i - - - -- • AIRTIGHT SEAL 1 I v 3gfip��S I I � I APPROVED ,101A1T: APPROVED JOItJT - A W /C.I. PIPEaR Tank construction I I I w�C I' ��PE�P�c I I I ALARM shall comply with ILHR 133.15 and 33.20 I I oW C I a -I:-1S CLEV. FT. PUMP OFF CONCRE �1.LSU. $1.00 � BLOCK 1 3" APPRcnet� RISER EXIT PERMITTED OWLy IF TA MANUFACTURER HAS SUCH APPROVAL BEDOIaVS SEPTIC f SPECIFICATIOUS 005E µ'1�flW p T' NUMBER OF DOSES: 3�3 PER DAy TANK MAIJUFACTU0.CR: TAWK SIZE: \Zbb 65 GALLOUS DOSE VOLUME P ALARM MAIJUFACTURCR: S. mil.- 1ZD S�LS`T�SF'L IWCLUDING 5ACKFLOW: S3 GAILON.c, MODEL ►DUMBER: CAPACITIES: A= INCHES OR 306 GALL011S SWITCH TtJPC: r �� � 8= INCHES OR GrLLOLJ5 PUMP JKAWU FACTURE: R: C- INCHES OR 1 s 3 GALLONS MODEL UUMBEM 4� D= INCHES OR ` GALLONS N MOTE: PUMP AND ALA AA SWITCH T TO 5E� YPE: _ `�7 MIMIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AIJO..DISTRIBUTION PIPE.. ' FEET + KII.IIMUM KJETWORK SUPPLY PRESSURE ; 2.5 0 FEET H FEET OF FORCE MAIN X Z_'>y F Yo fr.FKICTIOLI FACTOR.. Z ` 60 FEET TOTAL DYNAMIC. HEAP — � 5 FEET Pump chamber DIAMETER - y WTERAIAL DIMEWSIOIJ� OF TA1JK: LENGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA - 231= GAL /INCH AS PER MANUFACTURER = \n GAL /INCH HEAD CAPACITY CURVE 3o MODEL "98" 4 5J8 - ►� s 25 ® I t 3 5/8 � s o ® O l q7 } tg -ZS O I I 0 4 4 3/16 A to 3�. 2 5 1 112 -11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE' TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENTAND DEWATERING CAPACITY 1 HEAD UNITS /MIN r FEET METERS GALS LTRS ■ 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 4 3/16 20 6.10 25 95 Lock Valve 23' ^ � SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are.available with Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1 / 2 H. P. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 &7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) 098 230 1 Auto 4.7 1 or 1 & 7 — float system. 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hate J -Pak, for watertight connection or splice. CAUTION Forinformation on additional Zoellerproducts referto catalog on Combination Starter, FM0514; Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable Level Switches, FM0477; ElectricalAlternator, FM0486; Mechanical Alternator, FM0495; Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FM0487; and Single Phase Simplex Pump ControVAlann Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40156 -0347 Manufacturers of . SHIP TO: 3649 Cane Run Road Louisville, KY 40211 -1961 Quw TY/ – UMPS SHOE �9�9 ! P U MP !O. ( 502) 778. 2731.1(800) 928 -PUMP FAX (502) 774 -3624 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of .3 Labor and Human Relations g — Divisianof Safety 8 Buildings in accord with ILHR 83. ir;. ode COUNTY Attach complete site plan on paper not less than 81/2 x 11 inche in sties Plan m, include but not limited to vertical and horizontal reference point (BM), direct' crapd % of ape sgelfq or PARCEL I.D. # dimensioned, north arrow, and location and distance to neares road. ' 3 y- 1�'1� 30 - OOD APPLICANT INFORMATION - PLEASE PRINT ALL INF ,ftMATIrL'1Jr1<.: D DAT PROPERTY OWNER: ' LOCATION 5 f�1i) �1` 11J b�$ p Ill -1 PP l ` % K 1/4 W 1 /4,S 3y T Z°l ,N,R l S E (or 111 PROPERTY OWNER':S MAILING ADDRESS. LOT # 9 40m.# TSUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER GE EFOWN ' NEAREST ROAD 1-,.) v t Wl S vZ1 hLS)��Z- 3158 SC'�2LNC,r [ ] New n Use [Jcj Residential / Number of bedrooms 3 [ ] AdditiQn_ to existing building Replacement [ ] Public or commercial describe C accred dai flow L150 ✓gpd Recommended design loading rate - I-LL be gpd/ft trench, gpd/ft Absorption area required �jZS t'ed, ft 3'"1 S french, ft Maximum design loading rate ^ S v tfed, gpd /ft • b � tt 1 h, gpd/ft Recommended infiltration surface elevation(s) C ) 8 0 It (as referred to site plan benchmark) Additional design / site considerations 1"UUhAj w /8 'X47' 13 9 , `F1l kjkM\3wl Z4" D Sf0% -b F1 t-t- , Parent material Lo t ou tM GLArG t'1 t_ 'T1 L.L Flood plain elevation, if applicable tJ A . ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN R HOLDING TANK U = Unsuitable fors stem 1:1 S 1U ®S ❑ U ❑ S ® U El RU [IS ®U [Is EgU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 8 e Trench � .v >> I o -�Z •lo�t� � l 3 � si 1 2.�-sb�c vh�w �w - s -� : Z 12..18. to �t 1Z �ll4 - siI 3'F mfr es - 5 .Q Ground 3 1$ YA e ' l t•S� -i�SIB L �� y"L . .y elev. ct tt Depth to limiting factor 1�N Remarks: Pf 6 y Boring # Sb�t Ground 3 1�! Z - �•S`iR..3LV c, S `1R �!g l� �C -Sb1= yrt�l- cs — 'y • elev. y �. -33 S '-Z R - 31 " L l�w� wu •� ; _ . 3 4 ° -o ft Depth to limiting factor Remarks: y CST Name:— Please Print Phone: Arthur L. We erer 715- 425 -0165 Add ress: egerer Soil lesting & Design Service - P.O. Box 74 River.Falls,WI. 54022 Signature: -� 19 Date: ` Z _ 13 ` 11 Numbe 220254 PROPERTY OWNER pNtIU -I'VP SOIL DESCRIPTION REPORT Page ` Z-of �3 PARCEL W. # 'Z) 1111>j 3t, -OW Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench >. Z 1 ! -! I U ` rL �!! y — s 3`F �► blz s cs .s •6 Ground 311 e- �i.S �f CL S AA, elev. g Depth to ; limiting ' tac tQr „_✓ b i Remarks: Boring # {it•: ..? i • i Ground s elev. + ft. Depth to limiting factor + _ Remarks: Boring # Ground _ elev. ft. + Depth to limiting j factor _ Remarks: 3oring # _ 'round ;lev. it. )epth to imiting actor Remarks: LOT PLAN Page 3 of 3 SCALE 1 "= yp ocz.i, w ry �o - O 'D 3 ectz �tor1 L B►'1tit1 � ! \ tea 0 %$nit I 0! Cu� X15' \ t\..a►�{5 L ' S p - ZL-t0" Ck1 Z0 -SUH OF slbw6,- - - -- Irqa X19 -319 L .I. - 4 hz zzZIS C57 Signature o il � Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page )i of .3 Labor and Human Relations g — Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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. - c a - 30- OOD APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -7fq-1 es P/v't> bZla 1] I u-1 PP t GGW- 6 %w 114 S W 1/4,S 3y T 1PL ,N,R l S E (or t PROPERTY OWNER':S MAILING ADDRESS• LOT # BLOCK# SUB 1. NAME OR CSM # 6 t3 S �t� I ZE!, — _ — CITY, STATE ZIP CODE PHONE NUMBER — []CITY []VILLAGE [SOWN ' NEAREST ROAD W Z — I h LS) - ) - )Z ' ISF, I Ve —i 6Fi�L \7 S` tZ� (] New Construction . Use [JCJ Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ J Public or commercial describe Code derived daily flow 'ASO gpd Recommended design loading rate • 4 Z bed, gpd /ft trench, gpd/ft Absorption area required 'b bed, ft YI S trench, ft Maximum design loading rate ^ S bed, gpd/ft • b trench, gpd/ft Recommended infiltration surface elevations) C) 8 • C� It (as referred to site plan benchmark) Additional design / site considerations MIJufvn w18'x47' 13th . `f' i &,jk Um 2,y" ov 1=1 Li- Parent material Lo t-_.s - n t.% Flood plain elevation, if applicable ►J A , It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem El ®.0 ®S ❑ U [IS ®U [I s Ez U ❑ S O U [Is oU SOIL DESCRIPTION REPORT Boring # Horizon Depth I Dominant Color I Mottles Texture Structure Consistence Bouxbry Roots GPD /ft in. Munsell Qu. Sz. Cont Color I Gr. Sz. Sh. I I B� rerxh ry 1 o - �o�tz l 3 si 2.�s w\4ti- Ca-w - • 5 -� m'F�- eS . S •� Ground 3 l$ 3 �•S' > R y/6 e ; . y Q S l8 L O \ti, V�L E - • 3 • V elev. °t ft Depth to limiting factor Remarks: �tb " Boring # J o -to I�`-12 3t - s �: Z �.. Z tp_l�. lt,-t R 4�1y - S t 1 Z,�' yn�t- �S . 5 •6 • S Ground 3 1�1 z �•$ ` R- 3 L C -� S ` 5 1.L ��b1Z yv��E �S _ -\1 elev. y Z_ S `Z 9l3 ° 1.b -D It Depth to limiting factor Remarks: T Name:- Please Print Phone: Arthur L. We erer 715- 425 -0165 ress: egerer Soil lesting & Design Service -P.O. Box 74 River.Falls,WI. 54022 Signature: g9 319 Date: 1Z -13` CSTNumber F L PROPERTY OWNER pHlk - "pPI SOIL DESCRIPTION REPORT Page --of PARCEL I.D.# 03y I %Y)b 50 - Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bgxtdary Roots 11 , Z Bed Trench y " O— I t rN-1 312 S L Z 'FS bk w�'FH — • 5 Z 11 -lb i�ti cL VIy 3�Ck, as Ground 3 16 3S S `1 R 3 ! e� 3 �.S`iR S ig, L o�, �� .� •S/ elev. g Depth to ` limiting ' factor, i i Remarks: S �� Boring # ._:... Ground s elev. ft. Depth to limiting I factor = i i Remarks: Boring # Ground elev. ` ft. Depth to limiting ! factor !, Remarks: 3oring # t around �lev. ft. )epth to imiting actor Remarks: _ PLOT PLAN Pa 3 of 3 SCALE _ �R-iu N w ry 1 p 0 {i 0 - O Vto M1. \ G B►'1y �' 1 _Z 8 � J Lt, t3u15s B3 I =_ OF Stp1N6 ---- --- - - - - - -- g -319 �. lZ l� -1� _ zzoZSy CST Signature (_ 71 ) 4 S —n 7 s Date Signed Telephone No. C_ ST CROIX COUNTY SEPTIC TANK 'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �0. ►n, { 5 t' h i 11 1 � Mailing Address Property Address (Verification required from Planning Department for new construction) City/State ��Y1�.t,� Parcel Identification Number _LEGAL DESCMPTION Property Location �.� /�, 5W %, Sec. 3� . T `� N -R :2. W, Town of fi r_ = . Subdivision Lot # Certified Survey Map # , Volume . Page # Warranty Deed # 5 g L 18- - Volume 2 3 . Page # G U Spec house O yes ID no Lot lines identifiable P yes 0 na SXREM MA IIVTENANCE 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 tmastorplumber, journeymanplumber , restrictedplumber 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. JIM, 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 Wiscoasin. 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 exp' tion date. - Lao DATE SIGNA OF APPLIC OWNER CERDFICATiON 1(we) certify that all statements on this form are t to Lre best of my (our) knowledge. I (we) am (are) the owners) of the property described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. r SIGNATURE OF APPLIC 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 flit certified survey map if reference is made in the warranty deed Parcel #: 034 - 1078 -30 -000 08/09/2005 08:42 AM PAGE 1 OF 1 Alt. Parcel M 34.29.15.522A 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - COZY HOMES LLC COZY HOMES LLC 3026 60TH AVE WILSON WI 54027 Districts: SC = School SP = Special Pro s(es): ' = Primary Type Dist # Description 613 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH egal Description: - s: 40.000 Plat: N/A -NOT AVAILABLE SEC 34 T29N R15W 40A SW SW -1 Block/Condo Bldg: S 2.0 Z Tract(s): (Sec- Twn -Rng 40114 1601/4) 34- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 04/12/2005 792049 2782/335 WD 11/20/2003 747050 2459/457 TI 05/30/1995 529518 1123/630 WD 1123/627 AF mom... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05126/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 38.000 32,700 0 32,700 NO OTHER G7 2.000 9,550 69,400 78,950 NO Totals for 2005: General Property 40.000 42,250 69,400 111,650 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 42,250 69,400 111,650 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I .. � !.. '•'�, �..r.. .. saJel -t,. �fn:+wc.w r:: r. _.��.�...� -. �. r.+�•�.....+. —+-- + 52518 state Ba g of Wisconsin Form 3 — 1983 lSTr�irS GF�'+ WARRANTY DEED ' DOCUMENT NO. _ MAY 3 0 1995 Ronald E. Doll a married man. It k0:00 A.',j ��WCJ pogja D conveys and warrant to .1ffil1PA r Phillipni Debora N..Phillippi, tatsbsnd and wife• as survivorship marital DroperLy - ! SPACE RESERVED foil RECORDING DATA 1 - -- NAME AND RETURN ADDRESS 'r St. Croix Mil CO�M�IIN�N STATE BANK the l uilowing described real estate in 4106 :rW 93 CO'AMY, State of Wisaom.in. EN �er 6 706 1 I 034- 1078 -30 (Parcel Idetitiration Number) t The Southwest QNorth of the southwest $ Wisconsin. Sec tion 34, Township 29 , Rang This is not bowestead property. Exception to warranties: Easements, restrictions and rights- of-way of record, if any. 19th Dated this day f May Dated y (SEAL) (SEAL) (SEAL) (SEAL) fi • AUTHENTICATION ACKNOWLEDGMENT I STATE OF WISCONSIN Signatures) p st-_ County. 19th Personamy came before me this day of Al authenticated this day of _ - , l9 19_9 the above named Rovg1d E. Dolle TITLE: MEMBER STATE BAR OF WISCONSIN (if noe, — wbo executed tb. ' authorized by 1906.06, Win. Stets.) to me mown to be the person Tin installment and aaowledge 'NARY PUBLIC THIS INSTRUMENT WAS DRAFTEO BY Kristina Og lrxA Singe.2 8tte of wiwons Atto at Law Notary Public __ Pierce County, Wis. ti (':ignat;ires may be authenticated or acknowledged. Both are not My commission is per m 'eober 7 sate expir1 9 necessary.) — Y OF aced below thrir res. •N• -a a( pervwes s in an) np•CNp ,aouN be Wed D^ fftsconsitv legal Blank CO.. like- WARRRNTY GEED STATE RAR OF W13CONSiN Milwaukee. Wm. { FORM NO. t — tin t .. _. =, �w.--,... ssr�n^ v. e.++, pi .'.�Nl'•7t°3�miF;`= ^I6e+'�'`- --.3. -. - g` �... ��e'_ 4 ...,,.'. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations .Qixision of Safety 8 Buildings in accord w+th,1LHR 83:05 , Wis. Adm. Code ^ COUNTY n Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Ptah t include, but not limited to vertical and horizontal reference point (BM), direction and Yo of stopd cafe or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road: = 6 — /h 7 tr - �U APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION y� ° REVIEWED BY DATE PROPERTY OWNER: PR LOCATION T T 1/4 S 1 1 /4,S <-3 VT c N,R 1S- E() W PROPERTY OWNER':S MAILING ADORESS y , . '� BLOCK# SUBD. NAME OR CCSM # CITY, STATE ZIP CODE PHONE NU id.:. f ' ' ❑CITY QVILLAGE,BMWN NEAREST ROAD oRWA 7 067 77�• - -7 W o' [ ] New Construction Use [ esidential / Number of bedrooms > [ J Addition to existing building 14 [ ] Public or commercial describe Code derived daily flow 95 gpd Recommended design loading rate bed, gpd /ft — trench, gpd/ft Absorption area required — bed, ft trench, ft Maximum design loading rate — bed, gpd /ft — trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations C' Parent material 77 Flood p1 din elevation, if applicable ft S = Suitable for system CONVENTIONAL- MOUND IN-GROUN PRE AT -GRADE SYSTEM IN FILL HOLD G TANK U = Unsuitable fors stem ❑ S B0 ❑ S ❑ Cam' 1 ❑ S 0 1� ❑ S Q-6— ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoLrtdaly Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s � �w•sbk c�J c�� Ground 5�_y 7. s ) L 5 c2 10 F elev. Vlri 3 w _ ft. - . 3� `�. s yk ..s Yk "'_ c 4 I Depth to limiting fact f Remarks: ��rfE "A = C Bonn kJ4- ,...# C - -- 7 Y 3 p75 - Y4 c SSMC t�� Ground e ft. Depth to limiting factor, Y Remarks: CST Name: — Please Print Phone: Pia r't i-� � 7 Address: U ! o ) -f . L -E .L Signature: - ♦�� Date � _ CST Number: PROPERTY OWNER y�w� ���+ tl.V SOIL DESCRIPTION REPORT Page of 3 PARCELI.D.# 034 /07� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh vti. a c y L 0A Ground S c elev. — ft. -. S s r ( c 66k rA 0�t , Depth to limiting factor Remarks: Boring # i C^ ro 9 -�i ; sb k. a S I � -tom 3L i Ground elev. ft. Depth to limiting factor i Remarks: Boring # (UF- Ground elev. ft. Depth to limiting factor (b" Remarks: Boring # 73 w Ground S -3D C Y elev. IDmbng factor .6, Remarks: SBD- 8330(8.05/92) 1 T i n, n, k i L -a • — s �y � I 1 the °� B` s �• 3 I z a 81 v o; V' 04 I A CJr - a C a. 5 LA: er-C- S vwat"les irG�.ca }e c( Sa�u�afec� i a (� CL CI -C I = 8L i kk�e� �S C--` C S JUN714 -00 10:31 AM P.01 fax Transmission No. of pages incl, this one: 4 To: Rod Eslinger Fax number: 715/3864686 Voice: cc: From: CHRIS BAIER Date: Wednesday, June 14, 2000 If you do not receive all pages, please contact: HELGESON EXCAVATION INC W1229 770TH AVE SPRING VALLEY WI 54767 715/772- 3278/715/772 -3278 Subject: SOIL EVALUATION JIM PH/LLIPPI Special Instructions: YIIUV .M JUN -14 -00 10:32 AM P.02 Wfsconsln uman tram ti Industry, $OIL AND SITE EVA REPORT Page / of 3 L.'.�or and H uman Relntioru .i Div e4m 01 SAfety & Buildings In accord with ILHR 83.05, Wis, Adm• Code COUNTY Attach complete site plan on paper not lose than 81/2 x 11 inches in size. Plan must include, but �5 C" n ( f not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I-D, 0 dimensioned, north arrow, and location and distance to nearest road. 0 � 4 — /0 7 S , U APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER; PROPERTY LOCATION •^ '� t �� ; GOVT. LOT , fro 1 , SU. SCI. 1/4,S 3 ,N,R E ( W PROPERTY OWNERS MAILING AD E o L ` LOT BLOCK a SUBD. NAME O C M ar CITY, STATE ZIP CODE PHONE NUMBER OCITY ILLAGE , WN NEAREST ROAD (J Ne Construction Use esidenNal / Number of bedrooms :__ � J J Addition to existing building ( eplacement ( J Public or commercial describe Code derNed daily Now 5! p gpd Recommended design loading rate _ ^,� bed, gpd/ft — trench, gpdM Absorption area required — bed, R2 trench, 42 Maximum design loading rate bed, gpd/ll - -t ench, gpdM Recommended infiltration surface elevation(s) __ N (as referred to site plan benchmark) Additional design / site considerations % t A , k Parent material 5 Cc <�- T, % _ Flood pi din elevation, if applicable itJ� n S ■Suitable for system CONVENTI MOUND KGROUNO PRFSSURE AT -GRADE SYSTEM IN FILL HOLD TANK U ¢ Unsuilable for s stem C7 s t7i� ❑ S E ❑ S E] U " ❑ S f3� ❑ S C� p U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Con5istenco 1 BoLn:Wy Roots GP /ft in. Muns ell Ou. Sz. Cont. Color Gr. Sz. Sh. xs ? Bed ivich Ground % •- , Depth to I limiting factor,, , Remarks-, 2- rn e R ^ Boring It c L s ka kle S"' i 7 S' Yr . C v' t J , Ground I $ e v, H, Depth to ILL limitin JUN 714 -00 10:32 RM P.03 PROPERTY OWNER y_ +..�:4� �4, 11_,x 7�� SOIL DESCRIPTION 17EPORT Page •J of 3 Depth Dominant Color Mottles Texture Structure Consistence Botrwkq Roots GPD1f Boring # Horizon in Munsell Ou. Sz. Cont, Color Gr, Sz. Sh. — 9 ` e — d Tmr& l--i _ yro. R e Ct Ground - ^,• S y� u, r, ,�. sl,�c S lay. 3 Depth to limiting laclor ' Remarks: Boring At oA I Z C �'� 1 I 1 Ground I elev. I Depth to limiting factor �I 1 Remarks. �uF Borin g tM tj 1 0 e7 t r I 1 Ground elev. ft. i Depth to limiting factor F5� 1 Remarks: —_ Boring # If ' Y- 2 s ), 1 1 fop e ar 77 vQ ' Ground ` Slay. � It. Depth t0 � � .� .. I � s 11L eclw__.. ..._. ._.__ ...__.....L.S.�._. ._..........� ---_ I`i9nlydrlt5; _— ..._..._. .._._..._._ —.. _.___._ ...— 68D•6330(RASItiF) - - `. r L• r l r•— � 1 - �qrC ♦ r ►Afi•rh 41•1 1 r Ii y Y F o. 5 Sod iii �I I �I 1I e c 1, k' It �.o I • \ , S IR (I V IL I st"'I v�elilc. i��t��re4�re� Sd��tda�teC x116 clivct.��� f�t10��' i�c icy `icll• 1 1 8C i A.5 �,104�•r� 4 � T m T n C • I R cn < � c � ° w =r ? o � o o � 3 c • CD CD iD w o (D y 00 0) N C = N 01 N N " -4 ` CD cn N O. j r co p�j O N O 7 a Ul W co N O C W C � n CD W O y O •� O D G n H N O N N Ro 0 S', w m w (n v D ,� a 2 (n z D eo a cc� v W a 3 0 W a � f 3 a o c w a c _ o - 2 .+ O N N f0 CD Z C o A ? o = y 0 0 O OD 00 CD y w Q lam• C O 3 o Z 0 0 g g N w _ cn CA CA o w 3 N N CA o D �W IO' G -I O (g 0 0 L C CD y 7 fib (D !D N O .. O fD R m 0 CD (5 fG d CD d N CD � m -4 CT CL z lV Z Z Z N O 0 O D D r O D Q o n a zT j N CD m m ;o H '9 CO) O S O N W 7 n a 3 Z (D CD N 0 0 Cr CL ?' 0 y W T W T CL c 3 A Z O O CD w w v a I m - a m D a CD o - ID c - .o o a o a 0 a ' N Z N O CD sCD o CD I a 30 =r Dv o m (D ' N I O i O I m I a o o b I CD m CD O En O ° o g o g ° o CL ° o �, Parcel #: 034 - 1078 -30 -100 06/09/2006 05:00 PM PAGE 1 OF 1 Alt. Parcel #: 34.29.15.5226 034 - TOWN OF SPRINGFIELD Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/01/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JAMES L KRUEGER O - KRUEGER, JAMES L 612 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 613 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: 5012 -CSM 20 -5012 034 -05 SEC 34 T29N R15W PT SW SW CSM 20 -5012 Block/Condo Bldg: LOT 01 LOT 1 (5 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 10/24/2005 810094 2914/92 WD 07/01/2005 799093 20/5012 CSM 04/12/2005 792049 2782/335 WD 11/2012003 747050 2459/457 TI more 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/14/2006 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 3.000 9,550 0 9,550 NO OTHER G7 2.000 2,500 69,400 71,900 NO Totals for 2006: General Property 5.000 12,050 69,400 81,450 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 034 - 1078 -30 -000 06/09/2006 05:00 PM PAGE 1 OF 1 Alt. Parcel #: 34.29.15.522A 034 - TOWN OF SPRINGFIELD Current �k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/01/2005 00 5 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RETIRED COZY HOMES LLC O - COZY HOMES LLC, RETIRED Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 34 T29N R1 5W 40A SW SW CSM 20 -5012 Block/Condo Bldg: WAS CREATED Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 04/12/2005 792049 2782/335 WD 11/20/2003 747050 2459/457 TI 05/30/1995 529518 1123/630 WD 1123/627 AF more... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 01/31/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch # Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS B O & HUiGIAN RELATIONS P.O. PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON, WI 53707 BUREAU OF PLUMBING ' Sp/!,SW!,- ,S34,T29N -R15W CONVENTIONAL ❑ALTERNATIVE fate Ian I.O. Number: assign Ml Town a6 Spkingiietd ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound Highway 128 NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bettv McKahan Route 1, Ulct6on, W1 54027 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber J MPIMPRSW No County: Sanitary Permit Number: Date B. Hud6on 6629 St. Cnoix 119380 SEPTIC TANK /HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED ❑YES FIND ❑YES ❑NO BEDDING. VENT DIA.: VENT MAT L. JHIGH WATER NUMBER OF 2 ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM )% LINE: AIR INLET: ❑YES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO 1 I DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVE INSIDE CIA J* PITS LIQUID TRENCHES MATERIAL: PIT DEPTH DIMENSIONS ,: GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER OF PROPE TV WELL. BUILDING. V NT TO FRESH eELOW PIPES ABOVE COVER ELEV. INLE T ELEV. END PIPES. FEET FROM LINE: AIR INLET: _ NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES 1:1 NO DYES ❑NO DEPTH OVER TRENCH.'BED DEPTH L OVER TRENCH;BED DEPTH OF TOPSOI. SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ONO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING: JGRAVe L DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: J NO,DISTR. DISTR. PIP DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AN ELEV.. ELEV.. CIA.. ELEV.: PIPS. DI A.: DISTRIBUTION= HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED i PLANS YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER 01' PROPERTY WELL: BUILDING: F EE LINE: ❑YES El NO DYES 1 INC I NEAM -00 , S ketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) Zoning Admini[st.ato& =0_1!L�: SANITARY PERMIT APPLICATION COUf� f CRa /n In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT# —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for insti for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES �K NO PROPER RP WNER v `/ PROPERTY LOCATION �� �)G1�A/69/V 5ijla 5w %,S T`4 To99,N,R (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER 111LOCKNUMBER SUBDIVISION NAME --[ CITY, STATE ! ZIP CODE PHONE NUMBER CITY NEARS T ROAD, LAKE OR LANDMARK '�L74.Z VILLAGE : /-a✓9 � oZ II. TYPE OF BUILDING OR USE SERVED: / Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in ##1. Check ¢# 2,3 or 4, if applicable) 1. a. ❑ New b. ❑ Replacement c. ® Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. ❑ Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepa Be d b. ❑ S eepage Trench c. ® Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet El Private ❑Joint ❑Public VI. TANK CAPACITY Site in ga ons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank W Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Co Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate I suing Agent Signature (No S ps) Approved ❑Owner Given Initial S har a Fee r Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT - APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground !'se included the creation of surcharges (fees) for a number of regulated practices which WisCO inS. can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried >r @sur e is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03 /86) Violation Number Form - S T C - 101 .r PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township /Municipality Lot No. B1,k. No. Subdivision IT,,-Z N R f� W NX Nom/, /VX Procedure prior to sanitary permit issuance where a septic tank must be replaced during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY PERMIT: I ,ge 7�V �1 the undersigned do hereby acknowledge that I am receiving a sanitary permit to Ceplac e- �1� / iC �� without a soil and system evaluation due to inclement weather or health emergency. Furthermore, I acknowledge that a soil and system evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin Administrative Code, it will be replaced i with one that complies with Chapter I L H R 83 of the Wisconsin Administrative Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. SIGNED DATE lUdV ��, 1900 i A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. Is 1 ,9 Signat re of Applicant Date Subscribed and sworn to'before me I STATE OF WISCONSIN This �4 day of 19 . 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CROIX COUNTY, WISCONSIN COPY FEE: 3.00 PAGES% 2 W1/4 CORNER SECTION 34 PREPARED FOR SURVEYOR COZY HOMES. LLC EDWIN C FLANUM 3026 60TH AVENUE NORTHLAND SURVEYING, INC. Z WILSON, WI 54027 P.O. BOX 14 I - ' ROBERTS, WI 54023 z m A NORTH LINE OF THE SW1 /4 OF THE SWIM - -7 z I 9.54 389.31' �> z ' mI •- 'C ZI 1 A + � o , , 1 .0 c o j r "; "I 1 s HE O LOT 1 N o t I 5.00 ACRES INC. R/W +� 217.802 SO. FT. i +� c Q 1 _ EXI STING DRIV 4.65 ACRES EXC. RfW m °� .a 202,589 SO. FT. m Hf OUSEE WELL 92 m 1� m O ( of 100 $ �. _I O +� � I o m + SEPTIVENTS m 33' i 33' 1 s J 8.9 RECEIVED I I 7 389.88' 889 0 26'1 S"W 418.85' LEGEND Z O• 1' STEEL SURVEY MARKER FOUND I I O 3/4" X 18' IRON REBAR SET WEIGHING 1.50 LBS. PER LINEAR FOOT -X X EXISTING FENCEUNE ` 100' BUILDING SETBACK LINE SW CORNER ' SECTION 34 • SCALE IN FEET 1"= 100' THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 05 -41 DATE 5 - 6 - 05 SHEET 7 OF 2 SHEETS "DO 0 100 Vol 20 Page 5012 It in 1 7 99+IJ93 VOL 20 PAGE 5012 KATHLIM R. WjE9 '---- REGISTER OF DEEDS ST. CROIX CO. , WI CERTI FI E� S V RVEY MAP RECEIVED FOR RECORD LOCATED IN PART OF THE SW1 /4 OF THE SW7 /4 07/01/2005 08:30A!! CERTIFIED SURVEY AM OF SECTION 34, T29N, R15W, TOWN OF REC F FE 3 3 0 COPY 0 SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN PAGES: 2 W1/4 CORNER SECTION 34 PREPARED FOR SURVEYOR COZY HOMES, LLC EDWIN C FLANUM 3026 60TH AVENUE NORTHLAND SURVEYING, INC. Q z WILSON, WI 54027 RO. BOX 14 ROBERTS, WI 54023 o m � OT A NORTH LINE OF THE SW7 /4 OF THE SW1 /4 --7 z I 54 389.31' 1 I > 1 Z 'Imf � I I I� Z ( _X $ I� N I 0)I (+A 4 z SHED LOT I I I 5.00 ACRES INC. R/W 217,802 SO. FT. �+ I �,v1 C i NC�1 ro ( I EXI DRI _ lil I 1 I : _ - 4.65 ACRES EXC. RfW ° n 202,589 SO. FT. I HOUSE m o O I Co �' WELL I S m O I� O' SHE C i o N C O SEPTIC VENTS 33' I 33' OV � I S�g•CEM I � I 8.97 389.88' 889 °26'15 ° W 418.85' �' MMG°�fsQ44CD fSpMD�3 LEGEND z (9 ) 1" STEEL SURVEY MARKER FOUND I p 3/4" X 18" IRON REBAR SET WEIGHING I 1.50 LBS. PER LINEAR FOOT -X X EXISTING FENCELINE • • • . • • . 100' BUILDING SETBACK LINE SW CORNER SECTION 34 • SCALE IN FEET 1" = 100' THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 05 -41 DATE 5-6-05 SHEET 1 OF.2 SHEETS 1 00 0 100 Vol 20 Page 5012 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations g Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY n Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but `� 7-- (f /l (f 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. 0 34 — /V 7 $ - _�)U APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 ,S ) 1/4,S < VT N,R /,S E ( ) W PROPERTY OWNER':S MAILING ADIJIIESS LOT BLOCK # SUBD. NAME OR M # Lk- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY QVILLAGE.BMWN NEAREST ROAD �I5o•� ��, X 4 f G-!�7 0IS-) 77,;: ,_ /S. `> .rim _( ? \-e.(A W �$ [ J New Construction Use ( esidential / Number of bedrooms '_ 5 [ ] Addition to existing building j placement [ ] Public or commercial describe Code derived daily flow 9:5L gpd Recommended design loading rate bed, gpd /ft — trench, gpd/ft Absorption area required — bed, ft trench, ft Maximum design loading rate — bed, gpd /ft — trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material -5 />L ��,��, "7; % Flood p1 din elevation, if applicable A!4 ft S = Suitable for system CONVENTIONAL- ❑ N9CONVENTIONAL- MO S D IN-G P URE AT -GRADE SYSTEM IN FILL H TANK B U = Unsuitable fors stem ❑ S 'O ❑ El � El Q-6— �S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 4:LvvSSk :nii f 3� Ground ISM - I c= `I �4 s r s ) X i •,, s L%_3 10 elev. ; 3.? _ ft. �� . �� '�, s yR s - t - Depth to limiting factor,, Remarks: Boring # s Lao Ground e ft. Depth to limiting factor !q - f I Remarks: CST Name: — Please Print rr Phone: Address: ! 7 0 -/ l J S 7�7 r Signature: Date CST Number: PROPERTY OWNER yl 1 2 SOIL DESCRIPTION REPORT Page of 3 PARCELI.DA 634 /07b"'?30 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trernd� 1 r. y- lj {,d Ground -� S `/ �- c s6�c r `.J elev. ( �s � - r C C l Depth to limiting factor Remarks: Boring # t� yr- l C .j 1 J F Ground elev. ft. Depth to limiting factor Ey Remarks: � c>/ Boring # r vF Ground elev. ft. Depth to limiting factor (b" Remarks: Boring # ez Ground elev. ' ft. D mngo I `7 /oy2 Y Xi factor Remarks: SBD- 8330(8.05/92) r r I r6 l v n I h c hick, 4 L. jk J SR Ovc`. 1 ) ! 'Svc ( Vv\O�IQS IIIC` �C0.�t� S Q�LL �0.T�� I Sci�s c�'I�rec�ly be�ou! t�� `fop ,So i 1 l � I I i i J g �i < R� fi A �h C /CeS