HomeMy WebLinkAbout002-1044-50-100 r
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ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner !,
Property Address 3 t� aL �i / 83 2 2 d rti 5
City /State 46g l eO 1,,J, ,v /jl ,
ST CPOx
COUNTY
Legal Description: ZONING CWFfc
Lot 2 Block Subdivision/CSM # 3
'/a ' /4, Sec. 4`L, T,,MN - RzW, Town of lI Id, , y PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer ,1 'ded e g 7e&-4 Size ST/PC 1.21fQ / Q4 Setback from: House Well P/L
Pump manufacturer Xc:,, Model F Q
Alarm location 14le Z, s
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Azf� ,o l- Width 2_ Length �— Number of Trenches
Setback from: House . .5_ �, Well 54. P/L 1-4' Vent to fresh air intake
ELEVATIONS
Description of benchmark '7�� e -e Elevation
Description of alternate benchmark Elevation
Building Sewer r ST/HT Inlet 7 f e' ST Outlet PC Inlet
PC Bottom Header/Manifold 1`a .79 Top of ST/PC Manhole Cover 9,7, 1 1 , e
Distribution Lines O 9:?, 7S O ( )
Bottom of System () 9'1 eff () ( )
Final Grade () 9 3, � () ( )
Date of installation CS/ /99 Permit number 339 60D State plan number 7Z(o�
Plumber's signature License number Date
Inspector ke v V
Complete plot plan �
IK
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
Q�
a
3 M,
T
0
/ N
INDICATE NORTH ARROW
r T
t
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT
• GgNLRAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: S1 CRO
Pei sonal information you provice maybe used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 339000
Pe H�-i99'6 N amk ERRY ❑ CityB ❑p Villue Town of: State Plan ID No.:
ZZ& - 73
CST BM Elev.:- Insp. BM Elev.: BM Description Parcel Tax No.:
� " ; L C�Qt 002- 1044 -50 -100
OL � TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 12470/m Benchmarks r t(y' 101 91,
Dosing 6 , 2.
L
Aeration Bldg. Sewer G, G �a .6
Holding St /Ht Inlet Q
TANK SETBACK INFORMATION S
TANK TO P/ L WELL BLDG. Air I to ntake ROAD
Air
Septic / pip NA Dt Bottom 63,3 9 3. 9f
Dosing ( Dp c F 5 NA. Header/ Ma r& ` oZ oZ Tp' - /
Aeration ISIA Dist. Pipe a,Z
Holding Bot. System 3. ° 2 Isga4L t1,
PUMP/ SIPHON INFORMATION Final Grade * 5 }
Manufacturer p Demand
Model Number p T 1? "GPM Ih 3 KA r t , 2S p�, 3 5 T o S_
TDH Lift L Cdy System�� TDH Ft y 9o?. ye
Fi
Forcemain Length - 35 1 Dia. a " Dist. To Well
SOIL ABSORPTION SYSTEM
AgaXTA ENO Width / Length r No. Of s PIT No. Of Pi Insid id Depth
DIMENSIONS DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH
INFORMATION TypeO Manufacturer:
SETBACK CH M4 B
System: M �� UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe( x Hole Size x Hole Spacing Vent To Air Intake
Length `f�.3 '1 2 — Dia. �- Length Dia. Spacing rIq
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) �(� -,aN.
LOCATION: BALDWIN 19.29.16.284A,NE,SE 834 220TH STREET
i (2, &;�
ii 0 , VA!vX c a "
Plan revision required? ❑ Yes CK No
Use other side for additional information. O3 19 1 01
1�
x
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: t
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Safety and Buildings Division
' SANITARY PERMIT APPLICATION 2201 B W. 3
Washin ingtonAvenue
Visconsin
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code 0
Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. ::s^ c
• See reverse side for instructions for completing this application StateSanitar Permit� r
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
P tom 1 14 1/4, S/ T 4r , N, R E (or) W
Property Owne s Mailing Address Lot Number Block Number
O O re I
City, State Zip Code Phone Number Subdivision Name or CSM Number
Ca(!✓�`.d �f,� ( ) C Sh z a F DI
11. TYPE ILDIN : (check one) ❑ State Owned ° it Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ° T o I w a n OF / .,f/
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) (ai 2A i (�
6o � - 16 yy- 56 r 4 0
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 gwi New 2 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
- _____System ________System _TankOnly______________ Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only on
)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21,E 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
4p' d Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) q Elevation
�� d /� • -0 Feet Feet
VII. TANK
Capacity
in allo 5 Total # of r Prefab. Site Fiber-
INFORMATION g Gallons Tanks M anufacturer's Name Concrete Con Steel glass Plastic Exper.
App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank d ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber �( UCI l t e r ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature (No Stamps) 1 &4OfMPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip ode).
/v ?G
IX. COUNTY / DEPARTMENT
US O NLY
❑ Disapproved San tary Permit Fee (Includes Groundwater to ss a wing Agent nature ( . ps)
y A roved Surcharge Fee)
pp Owner Given Initial
Adverse Determination ; 5 1 � I
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
r
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 - 3151.
To be complete and accurate this sanitary permit application must include:
I. Property owne�'s name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 81/2 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
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264 -8777
isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 20, 1999
CUST ID No.267341 ATTN• POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY SPIA
PO BOX 74 t is 1 } ,' f' 101 CARMICHAEL RD
RIVER FALLS WI 54022 `�' �HbT,DSON WI 54016
RE: CONDITIONAL APPROVAL :n 1 --�
APPROVAL EXPIRES: 05/20/2001 Identifica ' hers
Transaction ID . 22673
Site ID No. 1728
Please refer to both identification numbers,
SITE: �, '�K1r,, -,
Site ID: 172806 k above, in all correspondence with the agency.
ST CROIX County, Town of BALDWIN; 22TH ST .J
NE 1/4, SE 1/4, S19, T29N, R 1 6W M :
KERRY HANSON 22TH ST
FOR:
Description: MOUND SYSTEM FOR KERRY HANSON
Object Type: POWT System Regulated Object ID No.: 469447
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 05/13/1999
-—� FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
KEI H A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM
KWILKINSON @COMMERCE.STATE.WLUS WiSMART coder 7633
1
Page of 6
MOUND SYSTEM
A BEDROOM
LOCATED IN THE MIE 1/4 OF THE 1/4 OF SECTION T '�-9 N, R W,
TOWN OF $4 Q ST'. t -(zu COUNTY, WISCONSIN.
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW+CROSS SECTION ; b F MDU 4 a
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT ,
.PAGE 5 of 6 PUMPING CHAMBER t—'Rzss. SECTlo4 E SkC5•
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
PREPARED BY
WECGEE:RER SOIL - TEST I t
AND. d q® y
DES I GtV SEERW I CE � " \s c ® s`A�
P P.D. BOX 74 421 K. KAIK ST. J J*
Conditionally F ALLS. KI 54022 WEGE
715- 4�.r-0iS`a � etisv��Rnt,
A ���
DEPARTMENT OF COMMERCE
•.......
DIVISION OF SAFETY AND BUILDINGS d G
SSE CORRESPONDENCE S 1 ��
Z2��?3`f
JOB NO.
PLOT PLAN
Page Z of
Scale 1 "= Sp'
N 8T USr L NE lS >
c 3v1 t* I
�I
�
x s � ��es -rL'� c�w►�+- Z
Z
� !1l
S.I
\ B +3 • \
tic, $4 \\3
'bDtioT eohP� oR °p�hv�.� �..�. ml'�•0
1 zAS , N\La `its ".0) of 't cH Cil •o '
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. ( , required)
4. Septic tank to be 1800 gallon capacity manufactured by
5 Bench Marks �hM*L - ezC'v. �oo.o oti Z`�ot� 1�ye �tr�t
are ti—Z taeU .X3 cl'i Y-Ycl L� I Xj
6. Divert surface water around mound to prevent ponding at the uphill side.
1
Page 3 Of b
Approved Synthetic Covering
1�sTM c 33 Distribution Pipe
Medium Sand
H
Topsoil - - F Elev - . cI.Z
3 E
b
3 % Slope
Force Main Plowed
Trench of 2 " -2 2" From Pump Layer
Aggregate
Undisturbed D l.o Ft.
Soil E 1.15 Ft.
Cross Section Of A Mound System Using F b•2, Ft.
1 Trench For The Absorption Area G 1 a Ft.
A S Ft. H t- S Ft.
B Ft.
1 Z Ft.
Linear Loading Rate= �''� GPD /LN FT J 8 Ft.
Design Loading Rate= 0.35 GPD /SQ FT
K Ft.
L Ft.
" Position of Force Main — W 2S Ft.
L
J �
use
B K Main
A -------- - - - - --
y
W Distribution Trench Of
Pipe Aggfegate
Observation Permanent,/ Markers
Pipes
(Anchor securely)
r
Mound Using I Trench For Absorption Area
• Page q Of .lam
Perforated Pipe Detail
0
End View
Perforated
End Cap. . PVC Pipe
Install permanent
at end of each lateral
Holes located On Bottom,
Are Equally Spaced
Q End Cap
rt-t
PVC Force Main
4
Dist noution
Pipe
Lost Hole Should Be
Next To End Cap
Distribution Pipe Layout 48.33
P 4 4r , -t Ft.
X - 2r Q lnches
Y Inches
Hole Diameter << 4 Inch
Lateral IItZ Inches)
Force Main Z Inches
# of holes /pipe \ S
Invert Elevation of Laterals '17-5 Ft_
1Sx1, 11 1'7_ SSx 2z- 3S.1 CPA,
u
Za 0 .,
Place lst hole
from tee with succeeding holes at � intervals..
Last hole to be next to the end cap.
Combination Sept;ic and
-PLFMP CHAMBER CROSS SEC TIOM .AkID SPECIFICATIOUS PAGE S .OF
-VElJT CAP WEATHER PROOF
JUUCTIOIJ 80X
H'"C.I. VENT PIPC ; APPROVED LOCKIMG
�:. 10' FROM DOOR. MANHOLE COVER wtV
'.lI NDOW OR FRESH wP+RtN10G L -N%EL.
A_RIIJTAKE S cor.+putT
q Z* r "Ill. GRADa
PROVIDE
IIJLET AIRTIGHT SEAL
APPROVED JOIrJT A I I ( APPROVED J010
W /C.I. PIPEOR Tank construction i III W/C L PIPE�P'�
ALARM
shall comply with
ILH� '<;3.15 and 33.20 a
Ow
C
LLEV. FL PUMP - -�
r. OFF
D COIJCRETE
_ B Z.00, BLOCK
kPP'Ro RISER EXIT Pr_FmTrED OWLtI IF TAIJK MA►JUFACTURER HAS SUCH APPROVAL 1
BEDD
SEPTIC E 5PEGIFICATIOLIS
DOSE F1 -tbk„ Z f�1 1?N2ilc6s'1 WUMISER OF DOSES: ' 3 PER D"
TAWK MANUFACTURER:
TAWK :,IZE: `1100 �80o &ALLOW DOSE VOLUME t
ALARM MAWUFACTURC.R:
S. _Q� zp S`ts'`i� 5 IMCLUDING BACKFLOw:
MODEL ►.LUMBER: ,mil "W CAPACITIES: A = 9 IQCHC50R L l o " GALLOUS
SWITCH TYPE' r i Z"cUR (r 8= Z IAICHES OK q_ 1 G( LLOUS
HUMP MANUFACTURER: CaOQ\-DS C- 2 I OR 168 " q GALLOUS
MODEL AIUMBEFU C�l)� D- 9 INCHES OR � ,a Q' S GALLOUS
SWITCH TYPE:
Y"I ° L- tJRt MOTE: PUMP AMD ALARM AR TO 6E , 1z
MIUIMUM DISCHARGE RATE 3S ' I GPM INSTALLED OU 5EPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AIJO,.0I5TRIBUTIOU PIPE.. a ' " � S FEET
t MIWIMUM METWORK SUPPLY PRESSURE , , , , . .. . . . . 2 FLET
+ ZA F EET OF FORCE MAIN X Z.LLJ FY oFLFRICTIOLI FACTOR �' FEET
TOTAL OtIWAMIG HEAD = FEET
Pump chamber DIAMETER = 38
IIJTERUAL DIIKLWSIOW� OF TAIJK: LEnIGTH ;WIDTH ;LIQUID DEPTH �
BOTTOM AREA 231= GAL /INCH
AS PER MANUFACTURER = '��� GAL /INCH
C iw- b
Goulds
Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
• Homes components. Available for automatic and tic cover with integral handle
Motor: and float switch attachment
• Farms manual operation. Automatic p
•Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■Power Cable: Severe duty
• Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing
115 V, 60 Hz, 1550 RPM,
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction.
• Solids handling capability: automatic reset. plastic Semi -open design
3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
o Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. ". Canadian standards Association
• Total heads: up to 24 feet. with three prong grounding -
■ EP05 Impeller: Thermo-
1 plug. Optional 20 foot
' • Mechanical al seal: carbon- length, 16/3 SJTW with plastic enclosed design for e listed
end in "F" m odel
F' o" " AC".)
rotary/ceramic- stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running
dry without damage to s 30 . 5GPM
components. _
Pump: EP05 e I 25Fr i
• Solids handling capability: 0 25
3 /4 maximum. a -- -- — - - - -'
W.
• Capacities: up to 60 GPM. _
• Total heads: up to 31 feet. 6 20
• Discharge size: 1 1 /2" NPT. z s -- —� - _
• Mechanical seal: carbon- 0 15
rotary/ceramic- stationary, 4
BUNG -N elastomers. o E�<
• Temperature: 3 10
104 °F 40 °C continuous i
140 °F (60 °C) intermittent. 2
5
1 '
I I
—� 0 ° 0 10 20 30 40 50 GPM
L -L L
0 2 4 6 8 10 12 m
CAPACITY
n 1995 Goulds Pumps, Inc. Effective May, 1995
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of 3
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
'include, but not limited to: vertical and horizontal reference point (BM), direction and y e
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
" 1 �. �� Govt. Lot I V4 - 1/4 ��G1 /4,S 1,7 T N,R E (or
Property Owne s Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number ❑ city El Village [jd Town Nearest Road
New Construction Use: ❑ Residential / Number of bedrooms 4 1 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate bed, gpd /fi gpd /ft
Absorption area required G�(f bed, ft ft Maximum design loading rate bed, gpd /ft trench, gpd /ft
.,7619 Recommended infiltration surface elevation(s) q d . G e6 w1'"c� a 4 W.e ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material ��(« ,' Q. / (I ��, 1� e �' Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S X U X S ❑ U ❑ S IOU EIS Y U ❑ S 1:0, U ❑ S 91 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1A 571 M AA 4 M r tf .�
Ground L C .S
elev.
ft-
Depth to
limiting
factor
;2-6 — in.
Remarks:
Boring #
J. 6 40
Ground
elev.
Depth to
limiting
factor
k. ? in. Remarks:
CST Name (Please Print) Signature Telephone No.
1. S'c /t WL G - /al
Address Date CST Number
10 2 el
PROPERTY OWNER �T��% /'I�LE ti �P, SOIL DESCRIPTION REPORT Page ? Of .7
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
1
a
Ground 3 - t .�
lev.
Depth to
limiting
factor
;/ -in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
...........................
..........................
...........................
..........................
...........................
...........................
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
::...................
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
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Wisc(ansirt Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
tabor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
. COUNTY
Attach complete site plan on paper not less than 8 1 11 inches in size. Plan must include, but St. Cr oix
not limited to vertical and horizontal referenc ,II ($ ) r n and % of slope, scale or PARCEL I.D. #
1
dimensioned, north arrow, and location a disatiee 002 - 1044 - - 000
i' °rTearro
APPLICANT INFORMATION -PL i ORIN -F) tiINF ION R V1�
s ED 0.Y DAT
O //
� i���1,.�' ,f f�
PROPERTY OWNER: c. 1 PROPERTY LOCATION
Don Riggott ' �° ; y {;, GOVT. LOT NE 1/4 SE 1/4,S19 T 29 N,R 16 B(or) W
PROPERTY OWNER' MAILING ADDR $. ? CH Or ^w LOT # BLOCK # SUED. NAME OR CSM #
3540 Neal Ave. `� t - o,� - x r. 2 na csm
CITY, STATE ZI [lE. ~ 0 BER ;< =. ❑CITY ❑VILLAGE [DOWN NEAREST ROAD
Afton, M. 55001 '> . «..., 612 ) 4 -4 7,0 % Baldwin I 220th,
] New Construction Use [X] Residential ` � rooms 3 [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gp d Recommended design loading rate • 4 bed, gpd /ft - 5 trench, gpd /ft
Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft
Recommended infiltration surface elevation(s) 107.05 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 106.05'
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable fors stem I ❑ S 12 U ®S ❑ U ❑ S La u ❑ S EiU ❑ S CCU ❑ S CC U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed ITW&
.................
..................
.................
..................
.................
1 0 -10 10yr3 /3 none sl 2msbk mfr gw 2f .5 .6
1
2 10 7.5yr4/6 none sl 2msbk mvfr gw if .5 .6
Ground 3 30-60 7.5yr4/6 c2d 7.5yr5/6 scl 2csbk mfr na na .4 .5
elev.
1
Depth to
limiting
factor
30"
Remarks:
Boring #
1 0 -10 10yr3 /3 none 1 2msbk mfr 9W 2f .5 .6
2 10 -14 7.5yr4/4 none sicl 2msbk mfr gw if .4 .5
3 14 -26 7.5yr4/4 none scil lcsbk mfr gw na .2 .3
Ground
elev. 4 26 -48 7.5yr4/4 c2d 7.5yr5/6 scl lcsbk mfr na na .2 .3
10 ft.
Depth to
limiting
factor
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th .Ave., New Righmond, WI 54017
Signature: �� Date: 6 -3 -98 CST Number: m02298
PROPERTY OWNER Don Riggott SOIL DESCRIPTION REPORT Page- 2 df 3
PARCEL I.D. # 002 - 1044 -50 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -10 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
`.,3.....,.1 2 10 -27 7.5yr4/6 none s1 lcsbk mfr gw if .4 .5
Ground 3 27 -40 10yr5 /6 b2d 7.5yr5/6 scl 2mgr mvfr gw if .4 .5
elev.
10 ft. 4 40 -60 5yr4/4 b2p 7.5yr5/8 cl M na na na np .2
Depth to
limiting
factor
27 "
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEELS SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Don Riggott New Richmond, WI 54017
MPRSW - 3254 NE4SE4 S19- T29N -R16w - (715) 246 -6200
town of Baldwin
lot #2 - csm
N
1
BM.= top of 2 pvc pipe C el. 100'
Alt. BM.= nail in Elm tree @ el. 99.60'
5 77-
Y 23
lot
�
1
8m
Gary L. Steel
6 -3 -98
AUG 2 8 1998 0.
Z KATHLE ruH w S
R egiSlerotpM�
586026 sz CroaCo., M
0
ti
CERTIFIED SURVEYMAP
Located in the NE 1/4 of the SE 1/4 of Section 19, T29N, R1 6W, Town of Baldwin, St.
Croix County, Wisconsin.
OWNER / SUBDIVIDER
DONALD RIGGOTT
3540 Neal Ave. I
Afton, MN. 55001 E1/4 Corner
UNPLATTED LANDS ( Seccttion 19 I
6' S 89" 10' 11" E 1,319.54 41'
89°10'11 "E 2691.62' 1,286.51 :33.03'
W1/4 Comer East -West 1/4 Section line.
Section 19 I
( location from ties) i
cli LOT 1� o
653,401 square feet ( 15.000 acres)
including right- of-way
636,684 square feet (14.616 acres) I �Z
excluding right-of- -way
N
S.
o ,yy
0 S 76" 0344" E N9000'00"E
Z i v 1 019.1 3 288.73 �m
255.72 `O 'D
CO) r
o"' 33.01'
� .^ m i
LU c ryy w �Z
N 'IT
z I iv
CD
8 �
� N Z I
; o
a, N
Z; Z o o LOT 2 s �a
rn a 1,081,769 square feet ( 24.834 acres) w I°
Including right-of-way �o I %
1,055,030 square feet ( 24.220 acres)
excluding right - of-way o ,
,y
N45:'18'04"W South line of the NE1/4 of the SE1 /4
32.4T 1263.48 :33.02' I
N 89" 07'38"W 1,296.50
UNPLATTED LANDS"' m
- - - — SE Comer )
Bearings referenced to the East line of the SE 1/4 of Section 19
Section 19, assumed SOl °26' 59 "E. ( spk. fnd., diecks w/ ties) g
SCALE IN FEET 1" = 250'
0' 125' 250' 500' 750'
LEGEND
-indicates section corner
monument ( as noted) GR,4NBERG SURVEYING
o - indicates 1 X 24 iron i 1239 C.T. _
P Pe ,
weighing 1.13 lbs. / lin. ft. set. New Richmond, W1. 54017
yf --�t- - indicates fence. Phone ( 715 ) 246 -7529 '
Job No. 98-026 ..,�
Drafted by: Joseph Granberg`
SHEET 1 OF 2
Vo1.12 Page 3508
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 1 S% L
Property Address 0
(Verification required from Planning Department for new construction)
City /State EMA , > , ti l�:E Parcel Identification Number
LEGAL DESCRIPTION
Property Location V,, Se- %a, Sec. /9 , T -2-�_ N -R-L�_W, Town of ST CJ
Subdivision , Lot #.
Certified Survey Map # '5"R Lklp '? (I , Volume L; , Page # -6
Warranty Deed # 4 Volume ) `-/27 , Page # 7
Spec house ❑ yes A no Lot lines identifiable P yes ❑ no
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
masterplumber, 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expira 'on date.
SIGNA PLICANT DATE
OWNER CERTIFICATION
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.
SIGNATURE 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
603597
STATE BAR OF WISCONSIN FORM 1 — 1982 KATHLEEN H. WALSH
WARRAN DEED REGISTER OF DEEDS
4 DOCUMENT NO. I ' Vol. 2JPAG 467 ji ST. CROIX CO., WI
1 `�
RECEIVED FOR RECORD
05 -27 -1999 10:15 AM
This Deed, made between Donald C. Riggott, a married
i' WARRANTY DEED
person EXEMPT W
CERT COPY FEE:
Grantor, COPY FEE:
TRANSFER FEE: 105.00
and Kerry W Hanson and Windi K Hanson RECORDING FEE: 10.00
PAGES: 1
Grantee,
Witnesseth That the said Grantor, for a valuable consideratio ii
conveys to Grantee the following described real estate in St Croix THIS SPACE RESERVED FOR RECORDING DATA
County State of Wisconsin: ;'`NAME ANLAMAWNE, INC. ( p
SUITE 200
Part of Northeast 1/4 of Southeast 1/4 of Section 191 1 190 SILVER LAKE ROAD
Township 29 North, Range 16 West, St. Croix County, NEW BRIGHTON, MN 55112
Wisconsin, described as follows: 90
-10
51)638
Lot 2 of Certified Survey Map filed August 28, 1998 I F (6 51)6381 9
in Volume 12, Page 3508, Document Number 586026. �, 3! 51q
002- 1044 -50 -000
PARCEL IDENTIFICATION NUMBER
iI
Ii
iI
�i
it
This is not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
i'
and will warrant and defend the same.
Dated this 26 th day of May 10
(SEAL) (SEAL)
Donald C. Ri t (SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Minnesota
ss.
Ramsey County. f
authenticated this day of , 19 Personally came before me this 26th day of
May
' 19 99 the above named
_Mina 1 d C'_ _ R i ggnt t a rna rr i ed perstnn
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Gregory A. Booth
t
19 Silv L R N Bright MN 55112 Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is pe anent. (if not, state expiration date:
necessary.)
a
l i • Names of persons signing in any capacity should by typed or printed below their signatures. : CINDY R. CROPPER
, , CINDY
PUBLIC - MINNES��A
STATE BAR OF WISCONSIN �a � o in Legal Blank Co., Inc.
WARRANTY DECD Form No. I - 1982 " My Comm. Expires Jan. 31, 2000 Milwaukee. Wis.