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HomeMy WebLinkAbout040-1063-20-000 0 cn p n to p !, 1 V n d —1 M ` 1 i m L-: U o C 3 x�5 c °moo I�cn 0• L ?� N O O O. O y N Q 00 O' O ►h N c N CO m m �' �' H o o = °° v m CD a o c Q Q f0 w N O II ~` m O C7 o is CD cn - D m a a D' v D `� A (p' N co CL D fD (U - t- N N O flo I A N = A W W CD C (.n y 0 (OD 'D 0 _ N r N Z o c 000 a 000 u ' I3 � CD 3 �g a cs aj Ch CD m I @ O O ;I H 0 Er M A to 0 m y 6 3 O1 3 D�1 I O N N K CT O Z N A p r0+ Z co Z Z j_ Z N O C:) O D a O D ^� N rt M_ 1 1 Q Q Q m m m m Q m �• O N N 0 7 •� � . 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Permit Holder's Name: City Village X Township Parcel Tax No: Morrow, Harold D. I Troy, Town of 040 - 1063 -20 -000 CST BM Elev: I BM nsp. BM Elev: Description: Section/Town /Range /Map No: / 66 � 1 C-6 15.28.19.239E TANK INFORMATION ELEVATION DATA IQ TYPE MANUFACTURER ,r1.3 CAPACITY STATION BS HI FS ELEV. Septic - 4 5 Benchmark L�1 e 'S F; /ax3 3J 163 1 g 1 6 c d Dosing (�4 N•��� �� 5' k56 Alt. - l c 5'. / ' O O Aeration P6 L Bldg. Sewer , d 43 . 0, O Holding St/Ht Inlet 1a�9 cr, 2z3 � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P /L1 f WELL BLDG. Vent to Air Intake ROAD Dt Inlet OJ Septic Dt Bottom W 73 -34 7156 Dosing / / / _ Header /Man. Aeration Dist. Pipe Holding Bot. System ` t C15 , JA IS PUMP /SIPHON INFORMATION Final Grade J Tr I$ f Manufacturer Demand St Cover q GPM �;t� -... GO 5• `$'� Model Number PE 57 TDH j l_i Friction Loss System Hepo TD Ft �•bl a.�z •�3 Forcemain Length / I Dia. 7 Of Dist. to W SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 4 4 t Z �,� SETBACK SYSTEM TO V, P/L BL IWELL LAKE /STREAM LEACHING Manufacturer: UNIT INFORMATION Type Of System: CHAMBER B �� P ER OR Model Number: ( Cc.A0e_ .A-� 57 36 /// X,4_ QIj � 4- h_ 4 �1 DISTRI SYSTEM /JaCil— 7 /eo' o 6 ,k, l 1(p JZ 1 Header /Manifold .# LI / Distribution x Hoe Size x Hole Sp cing VeAto Air IntakL l S' � T Pipets) \ \ \ ri.�..� L.4 Length Dia Length Dia Spacing cl— S OIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mfched Bed/Trench Center 3 $'Z BedlTrench Edges ` Topsoil '*`.� I Yes 0 No I lsaY es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 314/314A Highway 35 River Fa // lls, WI 54022 (SE 1/4 SE 1/4 15 T28N R19W) metes && bounds Lot Parcel No: 15.28.19.239E 1.) Alt BM Description = �; ` �-"O`� �� � / ec� 2.) Bldg sewer length = 2 5 +,> •� O1 GO« - amount of cover = � Plan revision Required? Ej Yes ""No Use other side for additional information. SBD -6710 (R.3/97) _ — Date Insepcto Signatu Cert. No. l K o lae-tgwc?� commerce.wii.gov Safety and Buildings Division unty '5+ ^ 201 W. Washington Ave., P.O. Box 7162 "2_6 1� s /"moo n s n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) t D i epartment of Commerce 51612- Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ,,(��� p urposes in accordance with the Privacy TL Law, s. 15.04 I (m , Slats. ` I. Q� 1. Application Info rmation - Please Print All Information J Property Owner's Name Parcel # p V p Property a 's Mailing Address Property Location �j e 2 CROIX COUN Z 3 * G w .J PLA ST Govt Lot 1. " Ci , State Zip Code Phone Num er OFFICE 7C_ V.., V.., Section C 40 Z z (circle on J t T N; R _ E o W II. Type of Building (check all that apply Lot # --� Subdivision Name. ✓ I or 2 Family Dwelling - Number of Bedrow _ _ Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of KTown of III. Type of Permit: (Check my one box on line A. Complete line B if applicable) A. ❑ New System Replacement System g p y g Y (explain) ❑ Treatment/Holding Tank Replacement Onl Other Modification to Existing System ex lain ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that X Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf r ispersal ea Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of cturer / _ Gallons Gallons Units Y o New Tanks Existing Tanks 4. �`d ` w C7 a. I Septic or Holding Tank Dosing Chamber U t C L VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumber's Signature MP /M4WItNumber Business Phone Number 6 beC-Sa 0 1 A� I Zzb t�9 7 7�_ z73 Y'Y'� Plumber's Address (Street, City, State, Zip Code) VIII. County/ e artment Use Onl Approved El sapprove Permit Fee Date ssued Issuing ent Signa e El rven Reason r Denial $ 475+ 06 b 1 D 1) Conditi t Wasons for Disapproval > a ba 1L. 04 fAL4, 1. Septic tank, efftttlnt BRer and dispersal cell must all be servkies / maintained as per management plan provided by plumbw. 2. All setback- 'requirelflettts mu be maintained t � o o e e system and submit to the County only on paper not less than 8 1/2 x 1 I Inches In size SBD -6398 (R. 01/07) Valid thru 01/09 I • 3 by �o Qi �x � ICO PY !v 1 A LL • �0 o ti x �I i R 1/Yisooran Department of Commerce SOIL EVALUA� Page 1 of 3 i Division of Safety and Buildings in accordance wdh cREGEWSC) Code County ST. CROIX Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference Parcel I.D. 040 - 1063 - 20 - 000 rc peent slope, scale or dimensions, north arrow, and location i rest road. Please print all inf0nnafj0n.S'l CKUTA wuI'4 1 , Revi y Date Nt0NG 8 �ONING OFFICE g L Personal information you provide may be used for secondary pu rnracy s. 15.04 (1) (m)). Property Owner Property Location • HAROLD D. MORROW Govt. Lot - - -- SE 114 SE 114 S T 28 N R 19 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 314 Hwy. 35 -- - -- city State Zip Code Phone Number ity ❑ 11age •Town Nearest Road River Falls, WI 1 54022 ( ) - Hwy. 35 I 14:0Y New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement C] Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable N - A ft. General oorrxrlents Conventional In- ground trenches -- 0.7 loading rate and recommendations: D 1 going # ❑ Boring Q Pd Ground surface elev. 98.99 ft. Depth to limiting factor 102 in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 7.5YR2/2 - 1 3fabk &gr ds cs 2vf-m 0.6 1.0 2 12-17 10YR3 /2 - I 2fsbk mvfr aw lvf-m 0.6 1.0 3 17 -24 1 7.5YR3/2 I 1 fsbk mvfr cw lvf-m 0.4 0.6 4 24 -30 10YR3 /4 it 2fsbk mfr aw lvf-f 0.6 0.8 5 30 -36 7.5YR3/4 - # sl lmsbk mvfr cw -- 0.4 0.6 6 36 -102 7.5YR4/4 s Osg dl -- -- 0.7 1.6 Horizon 6 has 20-25% gr; cobs & stones I I I d F21 Boring # Borg 99.44 108 0 Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 1 0 -7 7.5YR2/2 - 1 3fabk ds as 2vf-m 0.6 1.0 2 7 -12 10YR3 /2 - I 2fa&sbk ds cam' lvf-m 0.6 1.0 3 12 -19 7.5YR3/2 - I sil 2fsbk mfr cw l 0.6 1.0 4 19 -24 IOYR3 /4 sil 2fsbk mfr cw lvf-m 0.6 1.0 5 24 -31 7.5YR4/4 sl If msbk mvfr cw I vf-f 0.4 0.6 6 31 -36 1 7.5YR3/4 - sl if - -msbk mvfr cw -- 0.4 0.6 7 36 -70 1 7.5YR4/4 - s Osg ml cw -- 0.7 1.6 ' Effluent #1 = BOD > 30:5 220 ng/L and TSS >30 < 150 ffKA ' Effluent #2 = BOD < 30 rrg/L and TSS < 30 nxyL CST Name (Please Print) Si re CST Number Mary Jo Hu rt ollister's Soil Testing & Desig LL 224832 Address Date Evaidaton Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 08-18-09 (715) 426 - 1775 I 1 f Property Owner MORROW, Harold D. Parcel ID # 040 - 1063 - 20 - 000 Page 2 of 3 Boring Boring # Boring 2 _ 0 Pit Ground surface elev. — ft. Depth to limiting factor n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 8 70 -108 10YR5 /4 s Osg dl - -- 0.7 1.6 H orizon 7 has 25 -30% gr, few cobs & stones Horizon8 has has few cobs & stones F 3 Boring ] Boring # • Pit Ground surface elev. 99.44 ft. Depth to limiting factor 110 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -8 7.5YR2/2 -- I 3fgr &abk ds cs 2vf-m 0.6 0.8 2 8 I 2fsbk ds cs lvf-m 0.6 0.8 3 18 -26 7.5YR3/2 -- 1 2fsbk mvfr cs Ivf-m 0.6 0.8 4 26 -32 10YR3 /2 �- l Ifsbk mvfr cw lvf-m 0.4 0.6 5 32 -36 10YR3 /4 - 'r 1 lmsbk mvfr cw lvf-f 0 0.6 6 36-40 10YR3/4 -- ' A Imsbk mvfr cw -- 0.4 0.6 7 40 -110 1 7.5YR3/4 - s Osg dl -- -- 0.7 1.6 ❑ Boring # Bourg — — ,a Pit Ground surface elev. ft. Depth to knifing factor in. Sod Appl ication hate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *01#1 'Eff#2 Horizon 7 has 30 -35% gr; cobs/ stones. ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L. " Effluent #2 = BOD < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. sBA833dren movoo) i l Plot Plan for Site and Soil .Evaluation Page 3 of 3 Property Owner p m cg.u� , J 1 " =40ft Legal Description �` /� � ��� ' /�� S 15, r, (except where noted) X1 'rowN OF TRoy sT. Cro rouN-r�, w�scnuS)n) e = BackhoePit Nodh h� M FeANm Li 4t Y� / cD g 5 a' `. ticBuR�c� Gws Q8� Site Location: \ 4- a 0%9R R ti 'c b, �5 I � 1 0 .I OZ y�NNbn /n N � b i 1Y. IV y`ING a ZONING OfF NN p1A ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer x-10 /7 t-A- fr Mailing Address j 1 y Property Address (Verification required from Planning & Zoning Department for new construction.) City /State `h' l� 7 \ EhL Parcel Identification Number — 1 o 6 . 3 ZO — O 0 LEGAL DESCRIPTION Property Location ' /o , 1 /4 , Sec., T Z b N R I W, Town of Tf zQ y - - Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Z 7 -3 Z , Volume (� / , Page # Z Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 9 0 M nw ick4 ! G a STANDARD CHAMBER 52" Qui k4 Standard Chamber 48 " (EFFECTIVE LENGTH) �J 6 12" - k (C!-W C I-4- 1 � z 8" 34" SIDE VIEW 5—1 Z SECTION VIEW Mult Port End Cap a 16" 12" 34" SIDE VIEW TOP VIEW FRONT VIEW ATOR SYSTEMS, INC. STANDARD LIMITED WARRANn , l (a) The s urai htepoly of each dnarnbw,, end plate, wedge and other accessory manufactured by Infiltrator ('lnatsl, when Installed and operated h a leachil ad of an onMe septic system in accordance with Infiltrator's instructions, Is warranted to the original purchaser ('Holden against defectfm materials workmanship for one year from the date that the septic permit is Issued for the septic system containing the Urals; provided, however. that if a se tic permit IS not required by applicable law, the warranty period wal begin upon the date that Installation of the septic system commences. To exSrcIS1 Its warranty rights, Holder must notify Infiltrator In writing at its Corporate Headquarters In Old Saybrook, Connecticut wltian fifteen (15) days d Waged defect. Infiltrator wil supply replacement Units for Units determined by Infiltrator a be covered by this Limited Womanty. � • � Infilrators ability spedAcatly excludes the cost of removal and/or installation of the Units. O THE U TS, iN WARRANTY ARID REMEDI M S (a) ARE EXCLUSI THERE ARE OTHER WAR WrT11 RESPECT T SYSTEMS INC TO THE U n5, CLl10iNG NO IMPLIED WARRANTIES TIES O O MERCHANTABILITY MERCHM1iABIl1TY OR FITNESS FOR A PARTICULAR PURPOSE. (c) This ed Warranty attar" be void ff any part of the chamber system Is mentlfactured by anyone other than Infiltrator. The United Warranty does not Wend ° Incidental consequsneaL special or ",pact damages. Infiltrator 00 not be Roble for per aftim or kfuldated damages, hdudkag I°se of Environmental Onslte Wastewater Solutions' production prosts, labor and materiels, ovemead costs, Or other basso Or expenses hcufTed by the Holder or any 9" party. Spoo k* excluded IF m Limited Warranty coverage are damage to the Units due to ordinary weer and tear. afteratlon, aocklent. misuse, abi or neglect of the Urals; I * Units being subjected to vehicle traffic or other conditions which are not Permitted by the Installation hatnktk»e, faWse to maintain the 6 Business Park Road " P.O. Box 768 mwnhxsn g Dund covers set forth in the Installation instructions; are placement of hproper materials Into the system containing the Units; faaxs of the Urals ion tie septic system due to proper Sit ing or tnproper sing, excessive water usage, kryxoper grease disPCSa, or improper operation; or Old Saybrook, CT 06475 W o not caused by Infiltrator. This Unnited Warranty " be void If the Folder fails to compy with all of tiara tertrre set Lath h this L4Nted 860 - 577 -7000 - FAX 860 - 577 -7001 Further, In f 0 avant Shoal Infilrator be responsible or any loss or damage to the Holder. the Urals. or any th rd party musing from knstalatkn or ship. 800- 221 -4436 meat, or any product R"Ity clams of Holler or any third parry. For this Limited Warranty to apply, the Units must be Installed h accordance with aY site lions required by state and local oodee; all other applicable laws: and Infiltrators installation heh alone. n e d l �. lative of Infiltrator has the authority to charge or extend this Limited Warranty. No warranty apples to any party other then the odgi- The abrne is are Stand rd Limited Warranty offered by in".. A firtated member of state8 end counties have different warranty require - meets. plydneser of units Should contact Inaltrator's Corporate Headquaners in Old Saybrook Connecticut, prior to Mich purchase. to obtain a copy of the applicable wemMrty. and S carehily read that warranty prior to the purchase of Ukats. I A //"� — U.S. Patents 4,759,661; 5,017,041; 5,156,466; 5,336,017; 5,401,116; 6,401,459; 5 5,716,163; 5,588,778; 5,839 844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator. Eqi Wizer and SldeWlnder are registered trademarks of Infiltrator Systems Inc, Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registers I trademark in Mexico. Contour, Contour Swivel Connection, MicroL SnapLock, ChamberSpacer, PoslLock, QuickOut, OuickPlay and Quick4 trademarks of Infiltrator Inc. Prig, d In U.S.A. f, RECYCLED 3HP Systems Inc. ®201X3 Infiltrator Systems Inc. Printed in U. Q011203HP-0 APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 [IGOULDS PUMPS Submersible # WhL ANW6 ( IJ Effluent Pump PE WX ; NtWW PUMP SPECIFICATIONS MOTOR FEATURES Pum — General: General ■ Corrosion resistant • Disc harge :1'A" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload pro- cover, • Solids handling: lh" tection with automatic reset. ■ Upper sleeve and lower maximum sphere, • Class 8 insulation, heavy duty ball bearing APPLICATIONS • Automatic models include a • Oil - filled design, construction, float switch. • High strength carbon steel ■Motor is permanently Spedally designed for the • Manual models available. shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design heavy duty 16/3 S)TW with 115 or 230 volt grounding PE51 Pump: PE51 Motor. plug • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy u • Maximum head: 37' TDH • 115 and 230 volts portable and compact, �� METER5 FEET • PSC design ■ Mechanical seal is carbon, 40 — _ ceramic, BUNA and stainless PE51 I MOD PE31, PE41, Pest steel, 35 I I I I I I I HP:.33, .4o, .so ■ Stainless steel fasteners. 30 •P�4 I' I Y 2 GPM AGENCY LISTINGS a i• r• i ! S�• • T • ' � C US •' 20 i , .. F "�' i •I i I I a - _ j I Tested to UL 778 and ion ! I C5A 222108 Standards i- 15 I r I I wi I I . i • I_j_ I _ By tana�n Standards Assodown o I ,' I r File #LMaS4s 10 -^•- i r I ' ..� , I �...I I ; i. ! I Goulds P-npS is ISO90o1 rteyispere& i 0 00 10 20 30 40 50 V60 70 GPM so 0 5 10 15 m Goulds Pumps ® ZOOa ITT Water Technology, inc. CAPACITY 3Ti4t X004 ITT Industries Combination Sep.t;ic Tank and P CHAMBER CRO55 SECTION AIJD SPECIFICATIONS VEU7 CAP WEATHFR PROOF JuUCTIOU 90X ti`C.I. VENT PIPC APPROVEO LOC.KII.1G In F ROM OOOR. re,�Oj�-) MAIJHOLE COVER wt� t,uAR►JI>14 L.A16EL.. -, IN0OW OR FRESH S u�sP�T1o>J P IPF ALK_IUTAKE iu. It - 6 � M �� • �1.. � OO T I �.�(�,,,�,. u 1 - _'"' - - - - -- � 1 1� �., PROVIDE I/JLE T AIRT16HT SEAL APPROYED JOUJTS APPKOVED JOIMT ZPC$�L Ft� I II r W /C. T. P1PE��'" W /C.I -PIPE DR Tank construction �I� ALARM shall comply with TLHR (13.15 and 83.20 1 I ou C I PU1-4P -� --� ` OFF O COAICRETE �L BLOCK 3" APPR -C' RISER EXIT PEFj T17ED OuLy IF TAIJK MAMUFACTURER HAS SUCH APPROVAL SEWING SEPTIC F SPEC.IFICATIO�JS DOSE WmbER OF DOSC5: PER DXA TAi.IK MA►JUFACTURCR.: TAWK :,IZC', —Z v GA DOSE VOLUME Z GALLONS AL PkAMUFACTURCR: S•5.��- � SL( � ItiCI- up 6ACKFlOW MODCL WUM5ER: LQL Nw CAPACITIES: A= Z�'� I U CHE5OR �"Z GALLOU5 SWITCH T7PC: Z IUCHES'OR L G � LLOU5 PUMP h4AMU FACT URCR: �S ©CCC� C s IUCHES OR 1L. =_ JiALLOU5 MODEL }JUMdER: - D=__.�L_IA[CHE5 0R & ? CALLOUS . 5WITCH TYPE: w1 -� 1JOTC: PUMP ARID ALARM ARE TO OL MIUIMUt'1 DISCHARGE 'RATE� INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWMJ PUMP OFF A1JO..D15TRI50TION PIPE.. _3L_�hEET + r",I►JIMUM NETWORK SUPPLY PRESSURE , ; , , © FEET + FEET OF FORCE MIN X � F �ofGFRICTIOU FACTOR. S. FEET TOTAL OyWAMIC, HEAD = f , 7 . FEET As per-manufacturer gal /in. , , Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) e Septic Tank Capacity (gal) 0 Soil Absorption Component Size (W) b 1 1 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, ands stem use within or below the limit of reliable operation. Y s pe anon. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead p ye to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PL, J9 6 171� - 2, 73 CO A j C 71.E 6 � 7 �` � - 7 j S 3 WARRANTY DEED Document No. Tho REMO'S O FFICE _ -- RE3064 294 Exam "( pt from fee: e. 77.2512r) r �1 //�� CO. ST CO VVI T141S DEED, made by HKOld M w and Jo M. MoUyi, HushwW and Wife RtVd for P�'d APR 3 1995 grantor, conveys and warrants the property described below to the State of Wisconsin, &t 9:45 A. M Department of Transportation, grantee, for the sum of One Thous - T11ro Hund red y� Ten and N0 /100.Qollars ,A10,Q01 t • = UW NOTICE OF RIGHT TO APPEAL J1 Re sn; of D eeda Any person named in this dead may make an appeal froM - the amount of compensation within six months after the date of recording of this deed as sat forth in s. 32.05(28) Wisconsin Statutes. For the purpose of any such appeal, the amount of compensation stated on the deed shall be treated as the award, and the date the deed Is recorded shall /� ,O f be treated as the date of taking and the date of evaluation. 1 Other person having an Interest of record in the property: coolisin o ayanmertt N Trenapertatton --� -- T 1 e W. c)r`rooent M e. Eau are, w, 64701 >w This is not homestead property: (Tax key # 040- 1063.20, 040- 1062.60, 040- 1056 -50{ LEGAL DESCRIPTION IS ATTACHED HERETO AND MADE A PART HEREOF BY REFERENCE. Hafold (' Lr i �N1tt11, (1rU,rrrri,,, hpnrrrt „a ISienNUrol IONS1 Mwro IPrint Nonal m Isipnature) - ,sate of Wisconsin I se. Joann# M. Moaow .sue C'G'/ County ) (Print Name) On the above date, this Instrument was acknowledged before me by the named person(s). 6�� 44” (Print Nome) (Sionatute, Notarr Pubic. Slate of 4i wcwu N tstenature) Print or Tyee None, Notoy Public, State of WYwconaW remt Name) (Hate Camm"On Exoaat Project I.D. 7200 -0421 This instrument was drafted by the Wisconsin Department of Transportation. Parcel No. 14 11 -1 -94 s,r' FEE Title in and to the following tract of land in St. Croix County, State of Wisconsin, described as a parcel of land being a part of the southeast quarter (SHI) of the southeast quarter (SEt /a) of Section 15, Township 28 North, Range 19 West. Said parcel includes all land of the owner in the following described traverse; Commencing at the southeast (SE) corner of Section 15, thence S 86 °37'46 "E for 120.62 feet to the Point of Beginning; thence N 33 * l 5'58 "W for 226.31 feet; thence N 31 *39'54 "W for 886.02 feet; thence N 65 °03'36 "W for 186.63 feet; thence N 26 °55'02 "W for 103.08 feet; thence N 27 °49'12 "E for 109.33 feet; thence N 31'39'54"W for 100.00 feet; thence N 42 °55'58 "W for 1473.91 feet; thence N 88'39'10"W for 313.54 feet; thence N 47 °06'17 "W for 430.09 feet; thence N O1 °09'05 "E for 25.72 feet; thence r 08 *50"55"R for 212.76 feet: thence S Ol °09'05 "W for 25.51 feet; thence S 49 *31 ' 17 "E for 98.11 feet to the beginning of a curve, said curve having central angle 061 *28'16", radius 211.48 feet, chord bearin g . S 81 °09'00 "E, and chord distance 216.16 feet. Along the said curve for an are distance of 226.89 feet to the end of the curve. Thence N 24 °53'12 "W for 129.82 feet; thence S 8$ °50'55 "E for 432.66 feet; thence S 24 °41'58 "E for 29.15 feet; thence S 32 °16'55 "E for 291.00 feet; thence N 01 °21'46 "E for 18.05 feet; thence S 32"16'55 "E for 600.00 feet; thence S 41 * 16'15"E for 384.41 feet; thence S 40 °02'44 "E for 1005.66 feet; thence S 33 °27'36 "E for 913.42 feet; thence S 26 °25'59 "E for 138.09 feet; thence N 86 37 46 W for 394.71 feet to the Point of Beginning. All bearings contained in the above described traverse are Grid Bearings oriented to the Wisconsin Coordinate System, Central Zone. Containing 0.49 acre more or less. Project 7200 -0421 (Page 1 of 1) Parcel 14 ! .�. (D n tD 'Q �• • 67 CD (Jj r. 0 cn K z in Z o A 2 -� ? rC • o ro a (D � r rl rn w n CD CD s o - I - I ' r�+ m :3 c o N CL �. 3 N ro N W 1 7� W N O 0 co (D OD 00 CD o co Cb n tQ R1 O Til H H A C C CS m v, CD D C m zc; � v' a Ern c 2 c .� N 3 O CD cn ` ` N (D Jt.. l�A .r. N U7 cn C lei A .�. y o 0 N N y D Nv c r •ova — . 0 = .1A. 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Parcel M 15.28.19.239E 040 - TOWN OF TROY 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 - MORROW, HAROLD D HAROLD D MORROW 314 HWY 35 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 30.310 Plat: N/A -NOT AVAILABLE SEC 15 T28N R19W THAT PT OF SE SE LYING Block/Condo Bldg: SWLY OF HWY 35 & NELY OF OLD RR R/W EXC P239D & EXC PT TO HWY PROJECT 7220 -04 -21 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) HWY35 INC 040 - 1056 -50 (218D) 15- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 12/17/1998 593935 1387/507 TI 07/23/1997 1116/278 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.000 10,000 103,700 113,700 NO AGRICULTURAL G4 28.310 5,400 0 5,400 NO OTHER G7 1.000 10,000 130,800 140,800 NO Totals for 2007: General Property 30.310 25,400 234,500 259,900 Woodland 0.000 0 0 Totals for 2006: General Property 30.310 25,400 234,500 259,900 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 J VVD L-4� cky 31,0 5'33 --- IV51.1 1 k. Plb. # 60 PROJECT DETAIL DATA SHE 3./70 P ,, � NAME OF BUSINESS � r /`J"Ed'T1' } j11L - .- LOCATION ' ..7 7Wc street or highway city or township county LEGAL DESCRIPTION OWNER SIT Fc' ih'Trd , ,) f — �.,« ti Mai 1 ing address �I, ;2 !, N` ` A " el ARCHITECT OR ENGINEER Address ZIP PLUMBER /:. �: ;, G Address zi 1. Check appropriate building usage( and fill in the information requested opposite each usage listed: Existing building New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant ......... Car spaces Restaurant ................. Seating capacity (10 sq. ft. /person) ( ) Dining hall ................. Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages .. Number of units: 2 persons /unit 4 persons /unit TOTAL NUMBER OF UNITS ( ) Churches .................... ............. Number of persons Kitchen Yes No ( ) Bar or cocktail lounge ...... Seating capacity (10 sq. ft. /person) ( ) Nursing or rest home ........ Number of beds ( ) Mobile home park ............ Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store ................ Number of employees Number of customers T10 sq. ft. /person) ( ) Service station ............. Number of cars served (daily) ( ) School ...................... Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building .. Number of persons (total all shifts ( ) Apartments .................. Number of bedrooms ( ) Other ....................... Specify El o4 Li G. /,.� - 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes No Dishwasher Yes No Automatic clothes washer Yes No Automatic potato peeler Yes Other . , . (Specify) No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned L-�, 0 Gx'3 Percolation test results - AT TACH PERC OLATION T EST AND S OIL BO RINGS REPORT SHEET COMPL OT SIDE f Seepage trench bottom area planned width linear feet depth Of �i Seepage bed area planned /` %, width T linear feet �� depth Seepage pit planned 'y: outside diameter t I depth below inlet depth /l1 'Sf .> f ; <71 .1 � e . 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION r P. 0. Box 309, Madison, Wi "nsin 53701 8 Approved: Address. - %�.T f r� Date. SPAR 3 0 1972 l /ez o Z I P%!-,' L THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date % - 2 INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY REGULATIONS OR PERMIT REQUIRE- MENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY THIS APPROVAL S! BE VOID IF NOT INSTALLED W i".HIN TWO YEARS FROM THE DATE OF APPROVAL 3 /70 PROJECT DETAIL DATA SHEET NAME OF BUSINESS LOCATION ;f street or highway city or township county LEGAL DESCRIPTION OWNER ' Mailing address I ' ARCHITECT OR ENGINEER Address ZIP PLUMBER �' - , 1; Address , r i ZIP / 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant ......... Car spaces ( ) Restaurant Seating capacity (10 sq. ft. /person) ( ) Dining hall Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons /unit 4 persons /unit TOTAL NUMBER OF UNITS ( ) Churches .................... Number of persons Kitchen Yes No ( ) Bar or cocktail lounge ...... Seating capacity (10 sq. ft. /person) ( ) Nursing or rest home ........ Number of beds ( ) Mobile home park ............ Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store ................ Number of employees Number of customers TI ft. /person) ( ) Service station ............. Number of cars served (daily) ( ) School ...................... Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building .. Number of persons (total all shifts ( ) Apartments .................. Number of bedrooms ( ) Other ....................... Specify 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes No Dishwasher Yes No Automatic clothes washer Yes + No Automatic potato peeler Yes Other . . . (Specify) No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned Percolation test results - ATTACH PERC OLATION TEST AND S OIL BO RINGS REPORT SHEET COMPL OTHE SIDE • � s Seepage trench bottom area planned width linear feet depth Seepage bed area planned width r linear feet 'r <' depth Seepage pit planned outside diameter depth below inlet depth { 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 44 4 Approved: Address: Date: ZIP THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: - INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY REGULATIONS OR PERMIT REQUIRE - MENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY SEPTIC TANK PERMIT N0, REPORT ON SOIL PERCOLATION TEST AND SOIL BORINGS TO DIVISION OF HEALTH - PLUMBING SECT14M P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code PERCOLATION TEST Test Depth Character of Soil Hours Water Test Time Drop in or Level Inch`s sites Number Inches Thickness in Inches Since Hole in Hole interval Second to Next to Last o Fall lot Wetted Ovemigftt in Minutes Last Period Lest Period Period Ons, Inch Example P - 0 3 6 11 Top Soil 30" Cog 26" 25 Yes or No 30 1/2 112 112 60 �i rr 6 LY RECORD DATA FROM MINII9UM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B O R I N G S• Minimum 36" Below Pro osed Abso tion System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 72" 72 Black ToR Soil 12"t Clay i8ls Sand 18 Gravel 24 - YA4 0 I 6 <r RECORD DATA FROM MINIIM OF 3 B01M HOLES PE OF OCCUPANCY: RESIDENCES Number of Bedrooms OTHER (Specify) Number of Persons FOO WASTE GRINDER: Yes No Dishwashers Yes No Automatic Clothes Washers Yes No E FFLUENT DISPOSAL SYSTEMS NEW EXTENSION ADDITION REPLACEMENT Tile Size - No.Lin.Feet Trenoh Width Depth Number of Lines Seepage Beds Length Width Depth Tile Size `� No. Lines �.. Seepage Pits Inside Diameter � Liquid Depth I, the undersigned, hereby certify that the percolation tests reported on this fors were made by we or under my super - vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE► NO. ADDRESS DATE SIGNATURE Wisconsin Department of Health ant Seoul Services Plb. #67 3/70 Division of Health ' SEPTIC TANK PERMIT APPLICATION TYPE or USS BLACK INK A. OWNER OF PROPERTY Name Address (street, City, Zip Cods) B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Cheek Ones CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSt Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler US NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION Names Address: License Numbers MP Signature of Applicants MP RSW Address: H. (To be Completed.by Issuing Agent) Date of Application Fee Paid fi Permit Issued (date) Permit Number Agent (Name) Fors Town, Village, City, County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tanx and the.tnird copy of the permit (oanary) to the Division of Health. Checks and money orders should be :pale payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY RETURNED (Initials) (Date) See Corres. FEE RECEIVED VALID. No. PERMIT NO. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COWLETE OTHER SIDE i F �a k � 4 a "o �s E a Nk I I i 'i d -n Q p S i � T N u i %A t7 s o- In cr X 4 –r { } r 1 4 n V� vi u o P (Mb rb 7 N CA o 11 L A r -1 tA (j I I 7 6 � rb 4� ? D p j CA Q .. oc? (^ p rb r 0 to \ �` LA S O O r - f S T 1 s P p� O Z-:- C[ 1 , z a y r v 3 w u V O J O x oc 7Z At �r vv �s At I rQ?rAC a c p V) .� �-� X s � w � b Washe►- D�YQr , O k _ �oaJ o Vt4c U � 3 N tJ �. V ..D .z L A N $ S " i LAI a ci _ o � o O � ac T ' J w F a Y . p hi R� s ry i n j C l V ill Y .L 0 p LL - x L 8 as � ^+ � � oc O . J 3. g � ' Qo [S H H f' µ „Q -r . r Q. 8 V )i in b Vv'N'��. ui r � f • 1 +� 0 J 1 ' Vt A 0 L Q OU Q \ \ E I/4 CDR. SEC. 15 �I - QL+ LoJ'i -'SI? 23 NE 114 SE 114 3E //4 1 236 A y 5 i 239 A 1116/278 238 A HWY. o D 23 //4 SE //4 - SE 114 \ J j 2­9 239E 9 090 23. SEC. 15 177— '— A , 3/ z 1-110 3.5 STC - 104 , AS BUILT SANITARY SYSTEM REPORT OWNER Q r ADDRESS SUBDIVISION / CSM# LOT # SECTION T,- 0 N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4 •� oa M rr r � v C.4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. j0 6 BENCHMARK: �� ae ro ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer. �/I; W er � ��o eq5� Liquid Capacity: ,�O Setback from: Well --­' d06 House j Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location -:SOIL ABSORPTION SYSTEM r i Width: Length Number of trenches Distance & Direction to nearest prop. line: f i Setback from: well: ___'Yeo �5 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade 9 DATE OF INSTALLATI PLUMBER ON JOB: LICENSE NUMBER: 3 INSPECTOR: 3/93:jt r Wiscon;inyDepartmentofIndustry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: PeJjbWOld R elb a fk E] City El Village R PIA "Z of: State PI o.: CST BM Elev.: CiCl Insp. BM Elev.: BM Description: X Parcel Tax No.: D' O -' TANK INFORMATION a ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark X00 Dosing Aeration Bldg. Sewer Holding St / Ht Inlet 7, /0 ` y y , 3 TANK SETBACK INFORMATION St/ Ht Outlet -2,3 0' 9q / TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic saS' 'aoo �/O � NA Pt Bottom Dosing NA Header/ Man. -9 ' cry_ ' Aeration NA Dist. Pipe S 0/3, Holding Bot. System g, y/' 9a. C1 y ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ✓-IA 'Aj Model Number GPM TDH I Lift Friction I System TDH Ft ad Forcemai n Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /� DIMEN 1 N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty peO CHAMBER Model Number: System: `�cp 5s 7� .X�v i tl1,4 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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 w Bed /Trench Edges GYa/ �/" Topsoil ❑Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.15.28.19W, SE, SE, STATE HIGHWAY 35 oe Plan revision required? ❑ Yes g No Use other side for additional information. 10 3/ 1 96 SBD -6710 (R 05/91) Date 9 sp or's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. . • See reverse side for instructions for completing this application State Sanitary Permit Number , -0 ?d/ The information you provide may be used by other government agency programs heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name R 1 p y Locatio $ T , N, R E (O I /'u Property Owner's Maihn Addr ss Lot Number Block Nur�be�� d11 City to f Zip Coe Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit�t Nar e! t Road VII age 3' Public 1 or 2 Family Dwelling - No. of bedrooms Town of �� G�'1 l E] L- 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number // / _ 2 1 F Apartment/ Condo C J / C `aL ✓ ��' 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 F1 Church/ School Home a 12 Sta ash 5 E] Hotel/ Motel 9 Office / Factory 3 ❑ Other: specify IV. TYPE OF PERMIT: (Check on y o heck box on line B, if app able) A) 1. g New 2 ❑Replacement 3 ❑ Replacement of 4_ ❑ Reconnec Ion o 5, ❑ Repair of an _____System -------- ------------- Tank Only Existing System ____ ____E ---- ---- 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 r � 11 Seepage Bed 1.2X4" 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade / Required so. ft.) Propo e sq. ft.) (Gals/day /sq. ft.) (Min. /inch) D Elevation l4 6 i y , �� / �. d Feet C e Feet Capacity VII TANK in Ca s gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks nn Septic Tank or Holding Tank JNL' ? {�$� rCC�'i 9 V T ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT ),the undersigned, assume responsibilit for installation of the onsite sewage s st m shown on the attached plans. Plumb is Name: (Pri t) PI b Signature: , o f t mps) MP W No Business Phone Number: P umber's A ress ( treet, Ct 5tate , Zip ?d d IX. C UNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary P rmit Fee (includes Groundwater ate slue Issuing A Fit Si tam Approved ❑ Owner Given Initial Surcharge Fee) / Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -63915 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divreion, Owner, Plumber INSTRUCTIONS 1 t 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 -3815. 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 rer?lacemen,, reconnection, or repair- V. Type of system Check appropriate box depending on system type. VI Absorption system information Provide all information requested for numbers ? through 7 VII anl: i,ormation Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and rra ftcturer's name, indicate prefab or site constructe and tank material. Cor #ete for a11 septic, pump /siphon and holding tanks for rhis system. Check experimental approval only if tanks receives' 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. PlLinnber must sign application form lX. County / Department Use Only X. County,` Department Use Only. sp'clflcat : no'. ` >ma,ler `l , 8 112 x mc;t i;,' t„ : t'" -- county. h'. p l ans must i.i. to - .ca, ow "il h i ?Olding �i- I.(;�, septic .A!, .1 .',lv•<'�_ ��i�ir:e orsi s0iI __Jrt1i!of la e - ,f Chet >J !( erved, ;n �', -tor . ,, e cur 0t) �� �.�. I' _�]uiiedL: ielUU`_t; E,I sJ `'std <._u siZing nf�7r;Tlat�on GROURIDWATFR SURCHARGE '..he , or, of surchargf -, i nurnbe� of -it j PF o 'c which cz t.. cSt : rcll;srges are Used for r 1 )d es h: e anda rds • J i t i SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 5, 1995 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95 -40480 FEE RECEIVED: 110.00 HDM TRUCKING SE,SE,15,28,19W TOWN OF TROY COUNTY OF ST CROIX NON- PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based PP Y on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic /holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. - The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanita.ry wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. - The discharge of hazardous wastes to a private sewage system is prohibited by state and federal regulations. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. SBDA -7997 (it. 10/94) ti Y f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Page 2 June 5, 1995 PLAN S95 -40480 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, and M. wim Plan Reviewer Section of Private Sewage. (608) 785 -9348 1014R/ 2 cc: ST CROIX SBDA -7987 (B. 10/84) CONVENTIONAL SOIL ABSORPTION SYSTEM Y • FOR Page 1 of }� �Ck- Gft'IZ.g16� fllvp DFF S95- 49480 LOCATED IN THE SZ�' 1/4 OF THE 1/4 OF SECTION t ,T ZZ N, R TOWN OF S C �LUU( COUNTY, WISCONSIN. INDEX AECE /VE PA GE 1 of 6 TITLE SHEET J(/a PAGE 2 of 6 PROJECT DATA PAGE 3• of 6 PLOT PLAN PAGE 4 of 6 PLAN_YIEWrCROSS SECTION PAGE 5 of 6 PUMPING CHAMBER • PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR l-�DM � tv G Sp CSL..�IO&Le X3.1 U �1Z. F'it �lS, kJI S ��ZZ PREPARED BY A ARTHUR L o WEGLRER t WEGEf�ER SQ = l_ TEST = hIG SLLS:VORTH, .� Z wrs. AND I3ES I G�i SEFcv = CE •:•• 44 �SIGIA s P.0- aQF, 74 421 K. KAIN ST_ an RIQEF F91S_ VI 54022 pi" 16 14'g5 JOB NO. '21 S-111 PROJECT DATA Page 2 of 4 S95 -x0480 This proposed building will provide inside truck parking and will contain office space and bathroom facilities for a maximum of 8 employees. One floor drain is also included. A catch basin in the truck parking area is also included which will dispose of snow melt, etc. and has been approved by the Department of Natural Resources. Wastewater 8 employees at 20 gpd = ----------------- - - - - -- 160 gpd 1 floor drain at 50 gpd = --------------- - - - - -- 50 gpd 1 catch basin at 100 gpd = -------------- - - - - -- 100 gpd Total = - 310 gpd 310 divided by 0.3 loading rate = 1033.3 sq.ft. required. A 12' by 87' conventional bed will be installed to provide 1044 sq. ft. of absorption area. Septic tank 310 + 750 = 1060 gal capacity required. A 1250 gal Wieser Concrete septic tank will be installed. V 6t)5 4� 0 J 19 11�SvL P14� �2tlh1 SL �Rfl11u Ft LLp co`1 tr 1 Folz VvST PRc� - eTtQN wv(e S ugCT �D 5ttw -� dV 10,OF IIYPUC Po r r S �c ve .WVQS% Z o � w Sin c ` `+3 wt ►ir i s 6 tP N. o� M LAj L%r�,. R 3, o' 1 . -1 5 s I I R Le h` i a X96 j pRIViNTE s d s r EM oal L°t 4S 3 01V kn� o S `! U x J LABOR & H r :A RELATIONS w DEPT. OF IND RY, L , ,,,., OIVIS N Of Y A IN BL`+ N'3S J y 1 NOTE: \ BM #1 Elev.100.00' on spike 1 above ground in 10" dia.wood post.. BM #2 Elev.99.00' on concrete base of chain link fence post. Well is more than 150' NW of site. I OF S95 -40480 -8� 31 � 3 ` U \S�jZ1BUT10►.1 p1 �E ~� G, 12' ptP� y " VEF.1T pipe w/ t� �PRuvt�p CHP AkT Lt"� S T lz "ASOVE F= 1�1sH� GRADE --'r FIN G2�be � 14 H/-\Y -) \3M A�p1ZOVED S` 11J'R1E TTY u 0 o f vtiJ Co h TO Zi�2v I�GG RE6ATE �ERt= OrZA�D'� & Kuann Rau ilk• OF IKDU5T8Y, IAS M113 g I GS piylStON E p�NCE SE =.TE I NER PLUMB u ELEC INC 7154258818 P.01 State of Wisconsin 1 DEPARTMENT OF NATURAL RE SOU CES 101 South W0. r Stgpt ox 7921 Wi8CONSIN Madison, Wieconsi 53707` vRFT. OF NATURAL RESOURCES TEL SO$. 6.2627 TELEFAX 608-187-3579 G#Orps E, Msyir TDD 608-287-6897 S*crttsry May 10, 1995 Harold Morrow HDM Trucking 50 Glendale Drive River Falls, WI 54022 SUBJECT: CATCH BASIN Dear Mr. :Morrow: This is in response to a letter written on your behalf which was received on May 5, 1995 that requests approval to connect the catch: basin in the HDM Trucking building to a septic system. The facility is located at SE 1/4, SE 1/4, Sec. 15, & 28, N, R 19W, Town of Troy, St. Croix County, Wisconsin. The letter that was sent stated that the only type of waste that will be allowed into the catch basin is wastewater and other waste which do not contain volatile organic compounds. Washing of trucks will be accomplished by using only biodegradable cleansers and no non. biodegradable de-greasers will be used. Wastewater will drain into a trench will allow majority of sediment to settle ou.t. Periodically, the trench will be dewatered allowing the sediment to be collected and disposed of at a sanitary landfill. With the use of the catch basin, any remaining sediment will be allowed to settle out and the oil grease, c.nd other petroleum products will float to the top of the water. The catch basin sediment will be disposed of at a sanitary landfill. The petroleum products will be removed in a timely manner and hauled to a recycle for proper disposal. Any vehicle waste that drips or spills onto the floor must be wiped up or absorbed with a solid absorbent material and disposed of as a solid waste. The general principle for these types aF systems is that they are clean, well managed operations where only clean water is allowed to enter the catch basin. Based upon the information provided in the letter that you sent and the conditions stated above, the Division for Environmental Quality finds the inclusion of a drain catch basin acceptable. Please remember that this is only a recommendation to the Department of Industry, Labor, and Human Relations (DILHR). Approval from DILHR for both the inside and outside plumbing is still necessary. You should know as the owner of the property you are responsible for any environmental contamination originating from the property. Failure to properly manage this system may result in soil or groundwater.contaminatton. The Department suggests that you post notices in conspicuous places within th building which indicate the activities that are not allowed so that if anyone else would be in the area he /she will be reminded of the limitations. A STEINER PLUMB & ELEC INC 7154258818 P.02 Y£ you have any questions about the contents of this letter, please call me at 608 266.7715. W Sinc rely, inney, a ewater Specialist u of Wa ewater Management cc: Peter Skorseth - Western District Paul G.J. Steiner, Steiner Plumbing,. N8230 945th St., River Falls, WI 54022 e a n .l g 5 1 � i Wist:onsin Department of Industry SOIL AND SITE EVALUATION REPORT Page � of Lebo; and Humali Relations M,+iuion of safety & Buildngs in accord with ILHR 83.05, Wi Adm. Code COUNTY S�'. C1Z01.X 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. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION � L.l CVrj N G GGVF LOT SIEE 114 SE 1 /4,S \S T ZAS ,N,R 1 q E (d PROPERTY OWNERS MAIUNG ADDRESS LOT # BLOCK # SUBD�� CSM # So GL t> ��lU�� CITY STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®fOWN NEAREST -ROAD iry Z. ( s� oZZ t ?t s `t�} �s" New Construction Use[ ) Residential 1 Number of bedrooms [ ] Ad ft� to e»assting building 1 Replacement ( Public or commercial describe - ;.A.,-eh- 6trR -/! 6E - S L'l� 1 F+ D. c� 8 Code derived daily flow 3l4 gpd Recur mended design loading rate o _ 3 bed, gpdW o trends, Absorption area required �1�3 W, 9 -1 S trench, ft 6MaAmum design loading rate ° bed, gpM? A • trerlCh, f Recommended infiltration surface elevaf on(s) 0 l 3 •O It (as referred to site plan bendan IQ Additional design/ site consider0oris �Z x �7' c0 Ny \1 nNllrt PIED. Parent material 2 J V-4 Ov Zwty9N Flood plain elevation, 'If applicable Nz• A • ft S = Suitable for System CONVENTIONAL MOUND W-GROUND PRESSURE AT -GRADE SYSTEM NJ FILL HOLDM TANK U Unsuitable for PIS 0 U 0S ❑ U Pg S [:It ms O U as O U 0S to U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botnd3y Roots GPD /ft in. Munsell Qu. Sz. Cora Color Gr. Sz. Sh. Bed ffmnch 13 0 -18 w-t.R. qb6 — S F►t.t- o s V�) a,s Z A-Z? Xo`1R- - ! 1 %t1 I Z.w► T,4 ac,s — o.S o, Ground `'tw 313 S ��Sbk m`�� �S � o•S °.� elev. s s 1 1 s 1�1z dC _ S g`t• 3 ft 36-60 1� l 1i 3 � 6 — l 1� V �' t , u �..� o. Depth to 60 -13 �o`i n- V /` �'� s S 10 yn limiting factor Remarks:. Boring # O'1 v. 2. l I I Z b It WL TIC OL'$ � O . S 0 • � ! Ground elev. � 5 ft S b6 - twi(z- Vj S o 9 9 Val o,� 0.8 Depth to limiting tactor C v J Remarks: CS T Name:--Please Print Arthur L. W e e r e r Phone. 715 e Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: 5 - ll1 Date: � _.� `� S CST N M0057 PROPERTY OWNER IA� �TTZ -VFW G SOIL DESCRIPTION REPORT Page? of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell . qu Sz• Cont Cow Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 o Z6 �o�tz ZL1 - sit Z ►� sb w c g _ o.s u_6 Z Zb -yU lo`ttZ 313 - sit Z,`� Sl�k � �k cS a• S • � Ground 3 04 S, LO Ll R 3/(. a. y elev. a s�ft. Wilt yl6 w+ v 'E _M o. S Depth to limiting factor Remarks: Boring# 4 Z Zo-3b 1u `le 3l3 _ S i I Z.`� gbh w► 'FI.- �.� o• S o , � Ground elev. sS -1s1 !f `ttz Y!(, — S O 3 vn 1 c, c,g qS -3 ft. Depth to limiting factor \10 I ri Remarks: ' Boring # u zy t�S4 zII sil Z - m S b�t vhf. aS o . g e. S Z Ztj3$ lu`�Q 313 — s1� ZT3�1r Yh`FI� c.s o5c�,b 3 3a_q{ Lt3 - t L 3l(. — - S Y'1 SM \jqF aw - o• 3 °•y Ground ele ft. LL 3z6 l ` t!!b -- S 3g V4 - o -1 0.8 Depth to limiting factor > �Zb' ' Remarks: ! Boring # E3 Ground ! elev. ! ft. Depth to limiting factor Remarks: �nr� n ^�nin nr•nn G N 0 dV tad 1k) Z. � tw t`rt r}t, BIND � ° L' 15 O n t , - L1.°t S 1 qs4 3 J 7 � � g (4 3 o NOTE: BM#1 Elev.10O.0O' on spike 1," above ground in 10" dia.wood post.. BM #2 Elev.99.O0' on concrete base of chain link fence post. Well, is more than 150' NW of site. o[. q-7 ( 715 3 425 -0165 - M 00576 CST Signature Date Signed Telephone No. CST # . ":- r� G�:rir'� Safety and of Building SANITARY PERMIT APPLICATION r Bureau of Buildin Water System. 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. �q , &-&� • See reverse side for instructions for completing this application State Sanitary Permit Number a l l0 70 6 lication The information you provide may be used by other government agency programs El Check it revision to previous IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATI -PLEASE PRINT ALL INFORMATION Prop O ner Nam Propert Location rhkc I h 1/4 114, S T , N, R E (or)o Property O w,[1e Mail g umber Iddress N � ,p Lot Number Blo k _ Cit Sate , Zip d Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit ear R ❑ Village 3 Public 1 or 2 Family Dwelling - No. of bedrooms Town of 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( / 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 ash 5 [] Hotel /Motel 9 E] Office/Factory 13 151 Other: specify ' i IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. tit New 2 ❑ Replacement 3 ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an _____System System Tank Only System Existing 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 aSeepage Bed id Ix 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GallonjPer Day 2. Absorp- Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade �ILI) ((ffOO Requi ed (sq. ft.) Pr p d q. ft.) ( ials/day /sq. ft_) (Min. /inch) !� Elevation d 1. S ICI Feet ?3V11j Feet Cap acit y VII. TANK in gallo 5 Total # Of Prefab. Site Fiber - plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete stCon- Steel glass App. Tanks Tanks «,�y Septic Tank or Holding Tank �( J QU(} 1 C j ! 'eec, t L 79 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ f ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews shown on the attached plans. Plumber's Name. (Print) Plu r Signaturejo tamps) M o.: Business Phone Number: Plumber's Addres (StreAt City tat , Zi e : ; er A A yod IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued, Issuing Age t Signature (No S raps) Ap E] proved Owner Given Initial / Surcharge Fee) Adverse Determination J �� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO -6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divr ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. 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 produce: approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Compiete plan, and specifications not smaller than 8 112 x 1 I inches must be sui,wit.ted to tl;e county The plans must ins Iude the fo ,cw1rg: A) plot plan drawn to scale or with complete dimens u location of holding tank(s), septic or -1lrhe ir_ai rnent t,inks, bu 'ding wells, v, �i ,r rn.ims /water se 1:ce; streams and lakes, pump or siphon t anks, di uution bores; soi! absorption s�- stems; replace r nt system at 3s, i:l the location of the building served; 8, horizon :.al >nd vortical elevalJon reference points; C) cornpletesped h1 ;)s for pumps and controls; dose volume; `. euation di {for. ncer.; friction'css; pump perforrnanc° -ve; pump moc,ei ane pump manufacturer; D) cross section absorpticr, systen) if required by the county, E) soil tes a a or, a 1 15 form, an.' 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. I The monies collectec through these surcharges are used for monitoring groundwater contamination investigations and establishment o' standards i I _ ' SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relatio - December 6, 1994 2226 Rose S,tree'� La Crosse i Wir 54603 A. �O t WEGERER SOIL TESTING ; ARTHUR WEGERER 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 I RE: PLAN S94 -41517 FEE RECEIVED: 110.00 HDM TRUCKING SE,SE,15,28,19W TOWN OF TROY COUNTY OF ST CROIX NON- PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. - The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. - The discharge of hazardous wastes to a private sewage system is prohibited by state and federal regulations. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. 88D- 8998(R.O1N1) SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Page 2 December 6, 1994 PLAN S94 -41517 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sinc ' o raim Plan Reviewer Section of Private Sewage (608) 785 -9348 7297R/ 2 SBD4M (R. 01191) CONVENTIONAL SCIL ABSORPTION SYSTEM - FOR Page of S94 „41517 LOCATED IN THE SiZ 1/4 OF THE SE 1/4 OF SECTION �S ,T Z$ N, R 19 W, TOWN OF !�0`'1 Ste- C�1X COUNTY, WISCONSIN. INDEX Pape 1 of 4 TITLE SHEET Page 2 of 4 PROJECT DATA Page 3 of 4 PLOT PLAN Page 4 of 4 PLAN VIEW -CROSS SECTION PREPARED FOR \ _ A U 1 tV G 50 G�.�L�hl -E �RwEZ- F- tLLSjwj Sy ")zZ g Q�4�saea�� b OP Qi PREPARED BY ASTHUR L. t EiLS!' ✓ORTH, 4p t9 ° VrfS. vo LJEOEf�ER SOIL TEST I h1G z AND � �, • PN Z, 1 "e• ti DES I Gilt SE�v I GE ® ® S I G1 F.O. Sol 74 421 K. KAIK ST_ RIVR MLS. YI 54072 �e- c 1 `! 715 - 47"16] Jos NO _ �/ - C3 PLOT PLAN Page 3 of 4 ti Scale 1 "= 1 M0' p } b DtuUL� J Q � J P� �Og�� ipoF v'nv� 1000 Gil�, ►UI eSe\ COf.1c12C'�t ou 40 f �� g•1 I �t S►JOw \S - M %rz Ree joVkD V- ► -- E�►S INSv�h'CE `c1S �� C-UD� "N �RuutO�, \ o J Sew PPL n (I lly C®ndi B- Ql ms\ n P R�IA g• 3 7 . Of puSZPY A gp p p 6U�1.QEN�S �.� , U a � SPOT 2 � f a r f � NOTE: B11#1 Elev.100.00' on spike 1 ? ''above ground in 10" dia.wood post.' BM#2 Elev.99.00' on concrete base of chain link fence post. Well is more than 150' NW of site. '0V Ca} Eiji 6�R� �af75�i�c�'� C➢ � 82. to F j o g .fanny vs eihey plan aviv rcgizrred ,fos that s�4 _7Z i N2' o�sTRl�vTO>v PIPE E sel p,(,E SYSj F.r it io nally ED O �ma � N NµpN R y "VE►.ST PIPE ►�'� �� tN RPPRuvtD ^�° Dom' Div AT Lt - I:'i S T ►Z"A P oNaEA �rJ�1sH� GRADE --'► E,GOR S F=l N �� GCa�IUE, t So t L ! t t_L �(Z F�a.xtr�tvF1 t CZC °I Z. OF v1,3 - Ll"PvC Dt;TR)rlo )oAJ ►/,Z, If To Z jet a G G tZ E 6 A TE Wl t PE TO i SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations ti _ a June 5 1995 2 226 Rose Stree J ` `i ,I �C La Crosse WI X03 / v WEGERER SOIL TESTING 421 N MAIN STREET C PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95 -40480 FEE RECEIVED: 110.00 HDM TRUCKING SE,SE,15,28,19W TOWN OF TROY COUNTY OF ST CROIX NON- PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional. approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. - This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, W is. Adm. Code, to determine if plan submittal and approval is required. - The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanitary wastes directed into this system. The Department of Natural Resources must. be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. - The discharge of hazardous wastes to a private sewage system is prohibited by state and federal regulations. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. This plan submittal approval will expire two tears from the approval date, or if a sanitary permit is obtained, plan approval will. expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. S13DA- 799718.101941 i ■ SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Pag June 5, 1995 PLAN S95 -40480 Inquiries should be directed to me at, the number listed below. Please refer to the plan number shown above. Sin erely, .rard M. Swim Plan Reviewer Section of Private Sewage (608) 785 -9348 10I4R/ 2 cc: ST CROIX SHOA- 799718.19 /941 r .r a STC - 10S SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 4 (' t o ' AS MAILING ADDRESS J L� U irV IC PC PROPERTY ADDRESS 3,1� Am 5 /! et — SAS (location of septi system) Please obtain from the Planning Dept. CITY /STATE � r ff ( /2(� /1 W PROPERTY LOCATION S 1/4, 1/4, Section, T N -R W TOWN OF -" I ST. CROIX COUNTY, WI SUBDIVISION ff LOT NUMBER CERTIFIEDSURVEYMAP ,VOLUME PAGE LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system_ St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St, Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and retumed to the St. Croix County Zoning Officer within 30 days of the three year rxpir tion ate. 7 SIGNED. — �. ' DATE-:_ - - - -- - - - - - -- - St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, W1 S4016 S T C - 100 .0 x This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when j the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property /✓ M Location of property_ = 1 /4 Ef 1/4, ection N -R f/ W Township Mailing address G 11 d� k Address of site L " 3 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel C' Date parcel was created S7C�1'` TZ1, 1 s Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes _2� Volume '�Y2 and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in V?Vice of the County Register of Deeds as Document No. j , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in t e 9� of the County Register of Deeds as Document No. { Signature of Applicant Co- Applicant J Date of Si nature Date of Signature IL " 'DOCUMAT N0. STATE nAR OF WISE FORM is ' ► ASSIGNMENJ OF l ,ONTRACT l ' V(1L 547 �r<,f3-13 THIS S►ACI RLSIRVID FOR RECORDING DATA - International Cryo- Biological Services, Inc. a Minne REGISTERS OFFICE corporation authorised to do business in Wisconsin, I ST. CROIX Co., WiS, ` _ -- - _ -- _ - -- —. -- -- .- - --. —. herein called Assignor. R6-"d. for Record ►his 6r. h whether one or more, for a valuable consideration, hereby ---- -- y grants, uugn, transfers and day Of J9n Harold Morrow , A.D. 19,77 mot ' : 30 A M. - ____— l -- - ----- -- --- _--- ---- - -� — . herein called Assignee, whether one or more, thr=r Purchasers) interest in a certain Land Contract - Rephfer of Deals ea.a the __. 15th _. __ -. say of . --- January -_ , 19 _ 72. 1 executed by John J. Moelter and Georgine Moelter, his wif e; _. —Apd Lyles W,_Moelter and Ilene Koelter h is wi f "" .yior4, aye & Rr i -- -._- - -- - -- as Vendor to Altorn :yi • L -- Jasep�lt._ Shuster —_ -_- 113 _ _I", �,I .at - -- __ RNs , F.Hs Wnc ensin Ps Purchaser on certain land* in the County of _St. Cr State of Wisconsin, together with (the indebtedness therein re(emd to and) all the nfttt, lifts and interest of the Aui in and to said lands, which Land Contract was recorded in the Of(Jse of the Register of Deeds of said County, on the. _ -__ 20tlI_ dsy of 1 Jan 9 /O ul volume __ -_533 139 33 )' 6+ 1 _ of Deeds, on page .—. __ as Document No. _ The Assignor hereby covenants that there is now owing and unpaid on said Land Contract, the sum of - - �eVd n — - - --- - -- _ Dollars, and also utterest at ____ per cent per annum from - _ that he is the owner of the above described interest In the land contract and has good right to assign the same, and that the condition of the title of Assignor's interest is the same as at the time of recording the land contract. I •and assigned by Joseph M. Shuster and Patricia Shuster, his wife, to International Crye- Biological Services, Inc., a Minnesota corporation, on the 24th day of September, 1975, by document recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin, an the 20th day of January, 1976, in Vol. 533, page 142, as Doc. No. 331171. MA:V S >- R FLT Executed at ` this ds of December 19 76 INTERNATIONAL CRYO- BIOLOGICAL SIGNED AND SEALED IN PRESENCE OF SERVICE (SEAL) A. H. . Rqj an, President (SEAL) By• E. c P. GraKam, Secretary (SEAL) (SEAL) 1 Signatures of wthenticated this day of _ _— 19 — • I Title: Member Sta'e Brr of Wisconsin or Other Party • Authorized under Sec. 706.06 viz. �I STATE OF Wi600""N County. Personally came before me thi he atx,ve named _. __ _ day of December — 19 7 A. H. J. Ra � amannan and E. P. Grah respect - ve y resLd - en and �ecsetar •I of Itternational Cry -B to logical Services, __ Tnc. - - - - -- s on bnIialt of - said corppr- o me known to he thr prrc who executeA the foregoing nstrument and acknowledged the same, ation, and that they had authority so to o. �i 'his instrument was sir efted by C. L. Gaylord, Attorney ;..:. T �4. c n n�a�:.� A �N CO�;il NO)�7U nly. Etas. I River Falls, Wisconsin 7 �'he use of witnrc srs :5 . al r` (; .n S. =n X�7 S L; xpires) (19) _ L' E'A/ —f • l �� INJrNt Kt4NNL�IMMeeee�Ie ! / / / l .. -- • , .r ,n 1 ,•A 1, 1 their iMaturei. z rte, NOVATION AGREEMENT In consideration of the assignee in the at�aC assigned document, Harold Morrow, assuming the obLijilticlo;t n-f the original Land Contract purchaser described tai enders igneds hereby accept Harold Morrows as the 'pu place and stead of Joseph M. Shuster and Internat Biological Services, Inc. (an assignee) and so her F ,r Joseph M. Shuster and International Cryo- Biological 5etry es, t Inc. from any obligation under said Land Contract, resew Tig to themselves as Vendors, however, any and all otter`vights in said contract against the land and improvements and against Harold Morrow as purchaser. s Dated this 17th day of December, 1916. i2 (SEAL John J. (SEAL Georgi Moelter / LL (SEAL) Ly1 M. Moelter (SF.'1W Ilene Moelter STATE OF WISCONSIN) Ss. I � St. Croix County j Personally came before me, this 3 day of Degember, 1976, the above named John S. Moelter, Georgine Moeltef, Ly.l M. `4oelter, and Ilene !Moelter to me known to be the peF•aon -&'_` rho executed the foregoing instrument and acknowledged theot' nle: 1V4 �K3'„ 6.1 1C -- ount 91 n `1v clnmiss�on A GRTLORI/, iTE t ROUT, S.L. Drafted by ATTORMETSATLAW C. L. Gaylord, Attorney. 1111 CAST ELM STRCET RIVER FALLS. WISC. S40aa I _ MENT OF M REPORT ON SOIL BORINGS 2 Sg Y &BUILDINGS USTRY, G �'s DIVISION tBOR AND PERCOLATION TESTS ( 11�� , P N w 5370 HUMAN RELATIONS (H63.090) & Chapter 145.045) �` 'i '�a► �� ` LOCATION: SECTION: TOWNSHI UNICIPALITY: LOT NO.: NO.: SUBDIV OPT E: s� i /ssl/ �s Tz8N /R %9E (o ' COU WNER'S NTY: O UYER'S NAME: MAILING ADDRESS: ST • C uc otn P"S } 1 r m .VL L-o Gov S R ) U ( z7R Lv 1 Ss/o ?-Z USE DATES OBSERVATIONS MADE N, COMMERCIAL DESCRIPTION: ( PROFILE DESCRIPTIONS: P R O TION TESTS: Residence WNew ❑Replace V ,� `a($S I�3 . A. RATING: S= Site suitable for system U= Site unsuita CONVENTIONAL: MOUND: IN- GROUND PRE kNK: RECOMMENDED SYSTEM: (optional) ®S CU CAS ❑U �S C , fiU \z'A cW3\, �MW-AL ec� —' "^� If Percolation Tests are NOT required DESIGN R� on of the tested area is in the under s.H63.09(5) (b), indicate: C+ \- 0 ` indicate Floo dplain eleva ' BORING TOTAL DEPTH TO GROUP SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHI'kr ELEVATION O BSERVE D ___.... ,� - rvncurscnx iF (SEE ABBRV. ON BACK.) B -_ 1 7.6 . q(I - ? I > - 7. 6' -3' V si I TS ; 1.1 � 8n1-.,i o,B�Dn I S��y_�'3k s > > \.b' vDt2B,Si {TS B - �} �.� ' q-'I. o' )I > 1.7 ' �.3' l I � o • 8' << ; o. 8' �� � y a' 11 B- s - 7-461 46.5 11 > �.6' ),y' B B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD PERI0132 PERIOD 3 PERINCH P- P P- P P N P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. W%vvvrrt.. "M_7 L "T SYSTEM ELEVATION I t _. v F CHs iiv L N P ST n � +� F i S_ OF Ste' ES R E L 1— l S IsO ls-iW 1OF I;'6 I !! N E'_ ___ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER (optional): 'ZT $ fix. Z;?-(a W 1 SVo 1) S IS- WZ5-016 CST SIGNAT E. DISTRIBUTION: Original and one copy to ^ ^ ^' ^ `` er and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — v ,rA Jr INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 9. Complete legal description; 2. The use section must cleaiiy indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5r Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL 01 HER SY'ST'EMS ARE RULED OUT RASEC Old SOIL CONDITIONS, 6. PLEASE use the abbreviations shown r .r pro iie descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locatinrl your test locations. Drawing tc, scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and veitical e "ev<'tion rrence po[r1t aar- clearly shown, and are permanent; 9. Complete all apl ropriate boxes as to dates, nwrn("i = addirsseEs, flood plain data, percolation test exemp- tion, it appropriate; 10. If the information (scach as flood plain, elevatic,n) dons not apply, t,iac° N.A. in the appropriate box; 11, sign the form and place your address and your certification number; 12_ Make legible copi and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY V'1'ITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Texttares Lather Symbols st Stone, (over 10 ") BR Bedrock coh Cobble (3 - 10 ") SS -- Sandstone gr - Gravel (under 3 ") LS Limestone 's Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation, Rate rued s — tMedium Sand W - Well f ._ f=ine Sand Bldg - Buildinq Is Loamy Sand Greater Than sl Sandy Loarn < -- Loss Than I Loam Bri Brown * sii Silt Loam BI Black si -- Silt Gy — Gray �cl - ()ay Loarn Y - Yello v scl Sandy Clay Loarn R yeti sic[ - Silty Clay Loarn mot Mottles sc: Sanely Clay v" ' I , -- vv' sth sic Siity Clay fff - ft , fin' `air - ';r 11 C -- May cc corairrarrrj ix parse P1 Ec=.'r mrn — Mzariy, rnwr?iurn m -- Muck d — distir ct p - pioinineni HVVL High v1 ;ato " level, Six LI- ner<al soil l.extl.ires surfaco ip a'kQr for liquid rvaste disposal BM — B f0 a r VRP ...._ V.rtical R�Jwencca Point i I � TO THE OWNER: .oil test report is the first stop in secrarincl a sanitary hermit. The county or the Department may rec,,uest c" th '!S od tes' in the field pr €m to '.orinit. ksiian(Co A con of pkIns for the p7 Vate ,( sv.at,cr systrar7t rand ra p rmit applicat',,ia sut)'laitted .o the .,p,n p rate local authority in order to %i )it1C77 n ! hs° t:: €7"iFar'y rpr( art inust he €rf. :'vf;eal and po"; . d r -wor �0 th , Ad t of ariv ronstru cttCmr `• _ _ J