HomeMy WebLinkAbout042-1071-50-020 r
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count t' Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanit1181gTNo.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 ( 1)( m)).
Permit Holder's Name: ❑ City ❑ age E own o :, tate Plan ID No.:
B loom, George Warren ownMip
?T'Ks lb 311 436
CST BM Elev. Insp. BM Elev.: BM Description: ParceO I 10071 - 50 -000
TANK INFORMATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic c OCJ Benchmark
Dosing L,i L d So Alt. BM , � 3
Bldg. Sewer ' 7
olding /Ht Inlet X3.9 95.63
TANK SETBACK INFORMATION stil it
TANK TO P/ L WELL BLDG. Air I ntake ROAD
ir
Septic > /�$ ` 01 ` NA Dt Bottom
Dosing t > 6 $' ` ^- 3 l ' NA Header / Man. ) u2.0 3
-
Aerat L
NA Dist. Pipe 1,02,03
olding Bot. System 3 . 1 O ,{ 3 `
PUMP / SIPHON INFORMATION Final Grade,
I
Manufacturer _&9eX f a�' Demand St cover
Model Number B ? JGPM
0
TDH Lift 0,.35 Friction a LeD SystemZ TDH ,k< Ft
L He
Forcemain Length 1 \ID Dia. 2 1 / Dist. To Well (�$
j SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length , o. O No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 S a DIMEN I N
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA nufacturer.
INFORMATION Typeo , , , CH ER umber:
System: " $� �-(? >) r3 UNIT
DISTRIBUTION SYSTEM
Header/Manifold f Distribution Pipe(s) , / x Hole Size x Hole Spacing Vent To Air Intake
Length A!! Dia- Length 340 z S Dia. f 2 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ''nn
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulchediek1
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] N s El Yes ❑ No -
COMMENTS: ( lnclude Wc le l e t ns ec ion : oo spec o
Location: 1347 County oad 1T, tc0 erts, W 1 � �� �f 1!4 26 T29N R18W) - 26.29.18.403
1.) Alt BM Description. =
2.) Bldg sewer length = 3 0' ,�"� _3
-amount of cover = �7 � c ��"^ �f�.�e g �
3.) contour = Y. 1 3 = /00• y
Y) 4khl klt Se_+ - P 10W" j
,c:)f (tl er - �v u'r w4velt(rctf S (�
av
Plan required? ❑ Yes $j No
O e other ide fora ditional informatiQp. (( Z� O W-tI, ..� leas -F t2 D -6710 (R.3/97) to Inspect ignature Cer'
i
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Visconsin r P O Box 7302
Department of Commerce In accord with Comm 83.05, Wis dM.`twei Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syste , oA pape�rny less Cbt ty
than 8 1/2 x 11 inches in size. a , `'
�� .. °`'•" �� St at nitary Permit Number
• See reverse side for instructions for completing this applic err
3 0
Personal information you provide may be used for secondary purposes C 1 � if revision to previous application
IPrivacy Law, s. 15.04 (1) (m)].
3 (� a. t2 an I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL I M 3 q el 3
Pro erty Owner Name � Propert Locat. J
�yLV ✓t &L �o 'L a; ...,. 1 /fir. L T,4 T, N,R (VV(or)W
Propert Owne s Mailing Address Lot er . -- Block Number
/ &�, 1 -( 4, l z )
City, State Zip Code Phone Number Subdivision Name or CSM Number
_e v10 dr-
II. TYPE OF BUILDING: (check one) ❑ State Owned - 5 Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms �J 15 1 OF � e 't"�
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Z G Z 4. �� y 3
1❑ Apartment/ Condo L O L1 2 16 7 S Oaco�
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. N New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ System -------- System - - - -- Tank Only Existing System -- -_ -_ -_ Existing SSystem -- - - - - --
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy
13 ❑ Seepage Pit S X -r 43 ❑ Vault Privy
14 ❑ System -In -Fill (O. O
VI. ABSOR S YSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Lt 5. v Required (sq. ft.) Proposed (sq. ft.) (Galsiday /sq. ft.) (Min. /inch) Elevation
FF�' 3 ?.5 , 3 ? 5 �/ 1 6!'� U vfeet Feet
VII. TANK Capacity
in gallons Total # of Prefab. Fiber- Exp
INFORMATION Gallons an Manufacturer's Name Con- Steel .
Gall Tanks concrete glass Plastic App p
New Existing structed
Tanks Tanks
Scf ti or an L'U� l'1'l� c� Gr1GS "t ❑ ❑ ❑ ❑ ❑
Pu er L ' ❑ i n 1 ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility or installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signatu o Stamps) /MPRSW No.: Business Phone Number:
�� �� A �� 3 ? 5_ ?ism Gay - 6G
Plumber's Address (Street, Cit , State, Zip Code)
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Z S- pd Surcharge Fee)
Adverse Determination ,
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL (oddP . ��. _ �
�i sc��6c s a ��,,:. ,,o.rrcc, Ad cam. 7�, YoYp,
, (a 5 a YO( 74c 4o4 S3S /� � rS p f e YoSA t`ln4S pa.> ot 7�n G4 / i zrn �:.
SBD -6398 (R. 4199) DISTRIBUTION: Original to Co nty, One copy To: Safety & Buildings Division, 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 orplumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
S. 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:
1. Property ovyne '!r name and mSiling address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete 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.
Safety and Buildings
• 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
Visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
June 01, 2000
CUST ID No.691727 ATTN.• POWTS INSPECTOR
ARTHUR L. WEGERER ZONING OFFICE
421 N MAIN ST _-�, qT CROIX COUNTY SPIA
PO BOX 74 w`�,�: — 11 OJ CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
} ntio h
PLAN APPROVAL EXPIRES: 06/01 2002 _a Ide ficati ers
L Transaction ID No 319 36
G Site ID No. 193184
c ,4
SITE: n Please refer to both: identification numbers,
Site ID: 193184, George Bloom Proposed Residence ,° above, in all correspondence with the agency.
St. Croix County, Town of Warren `
NE1A, NW 1/4, S26, T29N, R18W
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 666177
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats.
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force
on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not
change.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation /operation.
ARTHUR L. WEGERER Page 2 6/1/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, (� DATE RECEIVED 05/25/2000
FEE REQUIRED $ 180.00
FEE RECEIVED.$ 180.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WiSMART code: 7633
• Page ti of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE N'� /4 OF THE NW 1 /4 OF SECTION Z 6 ,T Z � N, R �S W,
TOWN OF COUNTY, WISCONSIN.
INDEX w
PAGE 1 'of 6 TITLE SHEET 4 14A �
PAGE 2 of 6 PLOT PLAN
PAGE of 6 PLAN VIEW-CROSS 3 V OSS ECTION : S
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT "OV
.PAGE 5 of 6 PUMPING CHAMBER,
PA
GE 6 of 6 PUMP PERFORMANCE CURVE .,
PREPARED FOR
G �1ZGL ewn�
�l H�1� ccv�sTcw p,O ,W - T • S '
ctind it[O"a l y
J �ppp
0) ,
pF c lmte
DEPAR�SAf Y AN U►tDING�S
DIVIS�Q
PENCE
P1EPARED BY SEE GaRRES
L EGEE SC7 I L TEST I t jca
AND.
DES I (am S1EF w I CE � `sco/v y
P.O. BOX 74 421 N. NSAIR ST_ �'�•' �'�
RIVER FALLS. NI 54022 ARPhup
• WEfiER£R
715- 4,,-0165 na ,sP
1 ' TM,
ti wr.
w••
IGIy
JOB NO. 00
PLOT PLAN
Page
Scale 1"= L4 p'
OTIi
o.s �►i �
13p Tlf ST
soo'�
J
J
� n
"'�OF �LkDVC
_S
e ?
EIS �r Z F►`1_ ....
z s- D • are
w � -� v .ate Pkr_ `RsT' So' r-,11ZFF ft0Ux-V 3
- 7 ► ueY T Z S r F:1Z.
n a I
f
LL; Lpp.p ON GV+ I1 131 _ — goVnK OF
a"* 2 _ Lzt . q"1.a onJ % l` GH , 3Ly' b14.
NOTES - -
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( z required)
4. Septic tank to bel bg3ol6SD gallon capacity manufactured by
k t u C-
5. Bench Marks SE)E�i emoUt!
6. Divert surface water around mound to,prevent ponding at the uphill side. -
Page 3 Of b
Approved Synthetic Covering
�sTM c 'a3 Distribution Pipe
Medium Sand _
_ _
Topsoil H_ IG
3 E
D
b
y % Slope
Force Main Plowed
Trench of %2 " - 2kil F
Aggregate rom Pump Layer Undisturbed D \. Ft.
Soil E 1 • Z Ft.
Cross Section Of A Mound System Using F O•b Ft.
I Trench For The Absorption Area G N•a Ft.
A S Ft. H I• S Ft.
B -- )S Ft.
I Ft.
Linear Loading Rate= b GPD /LN FT J _� Ft
Design Loading Rate= o.3SGpD /SQ FT
K Ft.
L Ft.
Alternate Position of Force Main W 2 S Ft.
L
B-- K
A -
W � Distribution Trench Of 2 - 2 2
Pipe Aggregate
l Observation Permanent-/
Pipes Markers
(Anchor securely)
I
Mound Using I Trench For Absorption Area
Pag Of
Perforated Pipe Detail
0
End View
End Cop Perforated
PVC Pipe
Install permanent-marker
at end of each lateral
Hales Located On Bottom,
Are Equally Spaced
Q End Cop
* " PVC Force Main
DistnDution
Pipe
Lost Hole Should tae
Next To End Cop
Distribution Pipe Layout
P w.?5 Ft .
X IrnchPs
Y 3o Inches
Hole Diameter ttc�. Inch
Lateral Inches)
r�
Force Main .; Inches
# of holes /pipe 1S
Invert Elevation of Laterals Ft.
lSxl l�- h -SSy- 2-- 3S•I a
b
Place 1st hole IS from tee with succeeding holes at So intervals..
Last hole to be next to the end cap.
Combination Septic -Tank and
PUMP CHAMBER CROSS SECTION AND SPECIFI ' PAGE S OF (�
• VCUT CAP WEATHER PROOF
JUUCTIOW BOX
'i VEMT PIPC , rAPPROVED LOCKING
� 10' FROM Door., MAIJHOLE COVER K.71V
- WIMDOW OR FRC5H ? wA(ZIVIIJ6 L N EL,
ALR IIUTAKE �
It MIN.
� �. le•Mlu.
IAILET �U 1 FKrzzt6ctr - e4,p PROVIDE
AIRTIGHT SEAL
Approved A f �
III Approved
joint w/ Tank construction I if joint w/
PVC pipe shall comply with I II ALARM PVC pipe
ILH;; ('3.15 and 33.20 >s f I I
f 1
I I
c ON
• I
g3.IS
CLEV. FL __1
PU MP --.�,
OFF
0
COAJCKETE
l s 2 -co BLOCK
}
RISER EXIT PERMIT(ED OIJLy IF TAIJK MAIJUFACTURER HAS SUCH APPROVAL 3"APPRoyEt
BEflO i N �
SEPTIC E SPEC,IFICATIC)KIS
DOSE
TAWKS MAMUFACTURER: IJUMLiER OF DOSES: PER DAB 3'3
TAl.IK SIZL: ILL) L6 so GALLONS DOSE VOLUME z
ALARM MAUUFACTURI<R: S • u� - Tw S tff -jQ INCLUDING OACKFLOW: �S3 GALLON:
MODEL 1JUMBER: 1C3L t\w CAPACITIES: A= 304,
IAICHCS OR GALLOWS
SWITCH TAPE: _ Y' OLCLZ
8 = 2 INCHes °oR 3 � 4 GpLLOUs
PUMP MANUFACTURCR: zlll� C R c _tUCHES OR 1ST GALLpIJs
MODEL NUMBER:
D = INCHES OR 1 GALLONS
SWITCH TYPE: C°UVZS' MOTE: PUMP Af.ID ALARM T C
MINIMUM DISCKARGE RATE 3 5 • I GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD D15TRIBUTIOW PIPC.. -1 • - FEET
+ MiultAUM METWoRK SUPPLY PRESSURE , 2 . 5 ' FEET
+ -�S FEET OF FORCE MAIN X 'Z'q3 F T "Z, S$
IoofLFRICTIOIJ FACTOR., FEET
TOTAL DYNAMIC. HEAD = �?` FEET /
As per manufacturer 1 gal /in. Liquid depth 38"
HEAD CAPACITY CURVE 3 7/8- — 6 1/4 -- •=
3D MODEL "98" 4 5J8
8
25
3 5/8
= 6 ® I
a
+ +
0 15
14 4 vz. g 4 3/16
0 10
2 3S_ 1
5. 1 1/2 -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 HEAD/FLOW PER MINUTE
EFFLUENTAND DEWATERING
CAPACI 12
HEAD UNITS/MIN
FEET METERS GALS LT
5 1.52 72 273 3
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 1, Integral Float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - /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)
D98 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) hole J -Pak, for watertight connection or splice.
CAUTION
Forinformationon additionalZoellerpmducts refer to catalog on CombinaticIn Starter, FMO514; Piggyback All installation of controls, protection devices and wiring should be done
by a qualified
Variable LevelSwitches, FM0477; ElectricalAltemator, 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 Con troVAlann 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.
r
MAIL TO. P.O. BOX 16347
Louisville, KY 347 Manufacturers of..
SHIP T0: 3649 Cane ane Run Road r�77
Louisville, KY 40211 - 1961 r&4VTy )a!/A/PB�/iMCE �9V9
PL/MP f0, (502) 778.2731.1(800) 928 -PUMP
FAX(502)774-3624
Wiscorisin Department of Industry SOIL AND SITE EV A L U RPi3RT Page a of 3
Labor and Human Relations s
Division ,of Safety & Buil�ngs is: Adm. Code
• in accord with ILHR 83.
•,`;;�'' � jSPUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in za Flan must include; but ST ' LK
not limited to vertical and horizontal reference point (84, direction ark . 10 % of slope, scale or P CEL 1. D. #
dimensioned, north arrow, and location and distance to nearest road.} r 1 f0 L.(1 - ) Q 11 - S Q)' '
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION D Y DATE
J: a
PROPERTY OWNER: PROP L AT10N /
G Q4R-G t=. ' MKsb `F'1'PdZ Lf BWom 1/4 ` 1 /4,SZ 6 T Z 9 ,N,R LB E (w'L
PROPERTY OWNER':S MAILING ADDRESS. L # ; BLOCK BD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER (]CITY (]VILLAGE .®TOWN ' NEAREST ROAD
3 S, MJ I S g 0Z3 (IiS) -149 -3389 (11W),_"+
[>' New Construction Use [>c] Residential / Number of bedrooms 3 (J AdditiQn to existing building
j J Replacement [ J Public or commercial describe
Code derived daily flow �A SZ gpd Recommended design loading rate -:: bed, gpd/ft - trench, gpd /ft
Absorption area required `* bed, ft 3_L trench, ft Maximum design loading rate - S bed, gpd /ft trench, gpd/ft
Recommended infiltration surface elevation(s) 1 Z, 1.O ft (as referred to site plan benchmark)
Additional design/ site considerations - A6U►vN wl s' x "1 S ` t��,Qj . M W I X (J )-1 LZ" OF s" I -t L L
Parent material s1 L'N S �Ol�1L T Ok)Zz 6LA t A n LL Flood plain elevation, if applicable K..1 fa ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK
U= Unsuitable fors stem ❑ S ®U 93 S O U ❑ S O U [IS ®U ❑ S rA U 0S O U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots'
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rTterd
a - Q - tD `�t.IZ 31 Z
$ Z m sbk rn` cS - s
Ground 3 tq _3 y . S `� R 9i y - S J 1M V'�L- C S _ • 4 . S
elev. t
C a.0 ft y S9 • S Ll 3 1 y
Depth to QZ'. Pj AJ S 1v i C v S IUA/S 0f= S
limiting
factor
3y "
Remarks:
Boring #
D -b0 tp"t23 - s)� Z,mSb12 WI'�h c - -S �
Z � Z )ti 3Z � �� sz 3! 6 - s i 1 Z �-s bh h>ti�Ft- c ►,� = . s .�
Ground
elev. VAZ - SLt 2.31y - S`trZ m'�t
Depth to .S Sb- 6g • - 1 S R Y&
limiting
factor
Remarks:
CST Name: — Please Print Phone:
Arthur L. We erer 715- 425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022
Signature: O -Z1 Date: -a- Vt--00 CST Number.,
220254
PROPERTY OWNER S:�Su3 SOIL DESCRIPTION REPORT
Page ? of ' 3
PARCEL LD.# O ( 4Z. - l01 l - So
Boring # Horizon Depth Dominant Color Mottles Structure
in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD /ft
dl
>> Bed T rErl
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CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer /L 6e i� 6z—v o P9-7
Mailing Address ! Z 6 Z^ 4 y / Z ,��8 � 66/' sq 0 Z 3
Property Address 13y 7 C7'1 77 ���- -s C!/ S-_q O 3
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number 2 " «' 2 '} y
LEGAL DESCRIPTION J
Property Location NC '/., W I /,, Sec. Z6 , T� 9 N -R W, Town of W A7'4
Subdivision Lot #
Certified Survey. Map # , Volume , Page #
Warranty Deed i# Z- 3 `� 2 -- , Volume Page #
U house ❑ yes " no Lot lines identifiable ❑ yes ❑ no
i SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, h rein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating tha your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of three y e piration date.
/ /3,00
IG OF APPLICANT DATE
OWNE CERT IFICATION
(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 pr rty desc " ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
SI ATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
i
i
' G
09
STATE BAR OF WISCONSIN FORM 3 -1999 G234$2
QUIT CLAIM DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Mary C. Bloom RECEIVED FOR RECORD
05 -23 -2000 9:30 AN
EXEMPT 11 DEED
Grantor, and George P. Bloom
CERT COPT FEE,
COPY FEE:
TRANSM FEE:
RECORDING FEE-. 12.00
Grantee PAGES: 2
Grantor quit claims to Grantee the following described real estate in
St. Croix County, State of Wisconsin (if more space is
needed, please attach addendum):
Recording Area
SEE ATTACHED LEGAL DESCRIPTION Now and Return Address
Warren W. Wood, Ltd.
P. O. Box 99
THIS CONVEYANCE IS 14ADE PURSUANT TO A New Richmond, WI 54017
JUDGMENT OF DIVORCE RENDERED IN THE
CIRCUIT COURT FOR ST. CROIX COUNTY,
WISCONSIN, NUNC PRO TUNC TO JANUARY 6, 042- 1071 -50 -000;
2000, CASE NO. 99 — FA - 115. 042 1071 - 60 - 000;
Parcel Identifuxtion Number (FIN)
This is not homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests. 042 - 1071 -90 -000; and
Dated this 20th day of April 2000 042 - 1072 -10 -000
Y 1 1
• • Marro - C Bloom
r
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) of M STATE OF WISCONSIN )
M C Bloom
) ss.
St. Croix County )
authenticated this day of Personally came before me this 20th day of
April , 2000 the above named
• Mary C. Bloom
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, ent and acknowle g�the e.
authori zed by 4 706.06, Wis. Stats.) e .t
THIS INSTRUMENT WAS DRAFTED BY • F z
WARREN W. WOOD LTD ' Notary Public, State of Wisconsin
New Richmond WI 54 017 My Commission il[ Mk(If not, state expiration date:
(Siignanuts may be Authenticated or acknowledged. Both at not tteeeasaty.) 11/10/02. •)
• Names of persons signing in any capacity must be typed or printed below their signs=. ^ vror.•• ontl• c«"r wn, F°"°
SPATE BAR OF WISCONSIN
QUIT CLAIM DEED FORM No. 3 - 1999 PEGGY J. GEISSLER
Notary Public
State of Wisconsin
i
4GL 1513 PAGE 10
Th hwest Qua rter of Section 26, Township 29 North, Range 18 West, Town of
Warren, excepting therefrom the following: the North 854.81 feet of the West
1,182.57 feet of the Northwest Quarter of the Northwest Quarter of said
Section 26; and
the West 440 feet of that Certified Survey Map filed in Volume 4, Page 989,
Document No. 366521; and
the South 797.32 feet of the South Half of the Northwest Quarter of said
Section 26.
The above described parcel contains 80 acres, more or less, and is subject to
easements over the Northerly and Westerly portions of said parcel for C.T.H. "TT"
and town road right -of -way purposes.
RECEIVED
RAY I � Zoos 4ei. � � � 6
VOL 20 PAGE 5126
BATALTW N.
CERTIFIED SURVEY 0'CO� REGISTER OF DEEDS
'R ST RECEIVED RD . RECO
Located in par} of the Northeast Quarter of the Northwest Quarter and port of 12/14/2005 82s45PM
the Southeast Quarter of the Northwest Quarter of Section 26, Township 29
North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. CERTIFIED SURVEY MAP
REC FEE: 13.00
BEARINGS ARE REFERENCED TO THE NORTH LINE OF COPY FEE: 3.00
THE NW 1/4 OF SECTION 26, TOWNSHIP 29 N., RANGE PAGES: 2
18 W. WHICH IS ASSUMED TO BEAR N89"37'28 "E.
NW Corner of
UNPLATTED LANDS
-
Section 26 -29 -18 North line of the N -1/4 Comer of
(found oluminum NW -1/4 Section 26 -29 -18
County Monument) 74.25' (found aluminum
�- - N89372B E 2612.03 = --� County Monument)
~_ -189'37'28 "E — — 717.00 -�
CTH 77
N89 3728E N89'37'28 "E 717.01' v
1 N Centerline is ` m -• cn o to
cn , c m co
.... ....................... E G+( .O«
N Z Right - of- -way line o c o
C7 g p c x o
a CD N a. 0
C3 LOT "w� a
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TOTAL AREA= x lb
::i lo, 933, 784 sq. ft. z n 3
C'> 0 21.44 acres 0 °
7> No TN `, 1~ AREA EXCILL,DOV o N y o 81
tl Fn w A -O- w o o
904,207 sq. ft. o ' 3
^' 20.75 acres C) g s
- 12' Utility Eosemen t p a t
rn oz r o
- ".- -100' Building Setback
m f
O
The existing structure housing livestock o N �e
\\ poultry on the property is currently in
\ compliance with the St. Croix County g n aE m o H
\ Zoning Ordinance. If the status of the rn 7 m N L g m no
\\ adjacent property changes, the structure may W C tv a+ s l c
\� become non - conforming and future use of �,l o m n ? o
\ the structure may be limited. N N �•y
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R-700.00' D 2.
\Z� \ A- 43'55'50" I' l - -
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Prepared by. _UNPLATTED _LANDS_ k J �o _ y a
JEO OF OWNER sue" y
Consulting Group, lnc. w o c o
n d o -a y
Phone No. (715) 246 -4319 Prepared for and at the request of 2 w ur a Co
Fox No. (715) 245 -3830 Benson Properties, LLC o ca v .4
P.O. Box 325 19260 Linden Drive x' o `� ° o
New Richmond, WI 54017 Maple Grove, MN 55369
Sheet 1 of 2 Drafted by. Michael H. Lynskey
Vol 20 Page 5126 OD
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