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HomeMy WebLinkAbout008-1024-90-000 ST. CROIX COUNTY ZONING DEPARTMENT -c ,,4S BUILT SANITARY REPORT 0 Owner t h cc, Property Address 7 P { City /State egal Description: t Block -- Subdivision/CSM # t /4 U V4, Sec. �_, TaN -Rj(,, W, Town of = T ON: SIC TANK -- DOSE CHAMBER -- HOLDING TANK I nufacturer ize ST/PC, / 9W Setback from: House _5Q Well AIA PAL, 2-s� iufacturer Model (, )rO L`� Id tion (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: u ti Width 7_ Length Number of Trenches Setback from: House 4�Z' Well A �A P/L /s�U Vent to fresh air intake ELEVATIONS Description of benchmark l o $d �y �;,� Elevations Description of alternate benchmark Elevation Building Sewer ,7 6 X ST/HT Inlet 3 ST Outlet PC Inlet PC Bottom Header/Manifold .� 3 Top of ST/PC Manhole Cover i S Distribution Lines( Bottom of System O OD O ( ) Final Grade 5, e r Date of installation / / Permit number State plan number 7tiN �. ) 3 3 Y65 Plumber's signatu i<cense number DateiO /&/ cJ Inspector Complete plot plan NOTICE. Piease • rotvi a be foilowi • A pParly�retc sho ing everything within 100 feet of the system. • Two 4orizontal` n e oirgs center of septic tank manhole cover. \ I • Show alternate benchn�ar�, Jf applicable. i PLAN VWtW .� _ , M � T RECEIVED o C Lr Lr SAFE` & BLUGS HIV. 1 I u! INDICATE NORTH ARROW i , Wisconsin,Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, x.15.04 (1)(m)). 353124 Permit Holder's Name: ❑ City ❑ Village (q Town of: State Plan ID No.: P e * of Eau Galle C BM E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: trp , C) , 0 1 Q V °t Q IA�I I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � �2m gO-D Benchmark o?•oZg crD cZ Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet I�• 3�{ TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic >100 T NA Dt Bottom Ib `� � :�U Dosing 5/ of / JF - NA Header/ Man. Q �`g I'D II- Z3 Aeration NA Dist. Pipe 2• atZ I O(. 19 Holding Bot. System 3.571 ISO . (ob' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand s, �e� gc,6 `k'C t over Z Model Number �� "�� GPM a*_\ fGc j Q a TDH Lift,A.�'ti Lri s l i p �y Syetem v5 TDH y3• Ft POA 4 �� � � 0 .6 Forcemain Length 2 iy I Dia. 2 N Dist. To Well z •I�w� SOIL ABSORPTION SYSTEM BED 1°REidE1 F Width Length t No. Of Trenches PIT No_ Of Pits Inside Dia, Liquid Depth DI MENSIONS 7 ' 1 14 1, .%-2t DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER 1� t `! �_, Model Number: System: °+G OR UNIT DISTRIBUTION SYSTEM Header! ar�ifold y Distribution Pipe( r f x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Z Length Dia. Aq Spacing 1 t /�( r (0 ID 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 El El No ❑ Yes [] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #110 /S/ ` iInspection #2:1 199 / Location: 484 233rd Street, Baldwin, WI (NWI /4, NWU4, Section 9 T28N -R16W) - 9.28.16.126 2.6 'W = 9 q .fa0' C CL > 6 - s- y q P(8--) Plan revision required? ❑ Yes ® No <_ 1 a Us othe side for additional information. 11 q "S D X71 (R 3 �IC C18D� O VA/— Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e t e , . r E } E 6 } F g s 3 33 1 t , . r °e a S e e , a F i ,. . r ..n.,.em ..j:.. .,.. . �......... .. R me..v, .... _.... }..�..,. i...... ^� .....M�,... _p ..,. ,.. .,. .. x ., ....w m y. .. P ...r. ..� �....n� }... �. -i t ' � 4 3 i i i a 4 4 , s 3 1 e } � 4 n u f a S } o. e 4 � y _ a W_ e e f y $ t a g 4 3 i a 4 � m E rm a 4 µ P ..e.. �.. ..,. e. � a .... P4...... ,.a S• .. 4. � a ., ,5 t .. 4 ..,........ , � � i SANITARY PERMIT APPLICATION S afety and Avenuen Vi sileonsi n 201 W. Washington P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm Lode Madison, WI 53707 -7302 •'" Attach complete plans (to the county copy only) for the Sys on not less County than 8112 x 11 inches in size. ST CROIX J :, ? I �(� St to Sanitary Permit Number • See reverse side for instructions for completing this app �on : ;�( 1 s 4. Personal information you provide may be used for secondary purposes i - -, e 3'-�� ?,; us application (Privacy Law, s. 15.04 (1 ) (m)]. p v -• - - heck if revislo to 8 fNFOR ' S7 vRpi„ St a Plan I.D. Numbe ITE ID 175434 I. APPLI ATI N INFORMATION - PLEASE PRINT A N ans. ID 233469 ✓' Property Owner Name CARL PETERSON +()R- C IW#�k4Loc DENNIS PETERSON =' NW 1/4 �,q W T 28 , N R 16 R(X) Propert Owner's Mailin Address ` pt r'; Block Number 457 233 RD SREET N N/A City, State Zip Code Phone Number Subdivisions Name or CSM Number BALDWIN WI 54002 1 (715 )684 -3645 II. TYPE B ILDING: (check one) ❑ State Owned P cit Nearest Road Public Ej 1 or 2 Family Dwelling - No. of bedrooms 4 f Town of EAU GALLE 233RD STREET III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 008- 1024 -90 { 4K�W q -1212, 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. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ------ System ________ System_____________ Tank Only______________ Existing 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 []Seepage Bed 21 [2 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit X 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: { _2- eey v V 1. Gallons Per Day Leq bsorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 600 ire d (sq. ft.) roposed (sq. ft. (Gals/day . ft.) (Min. /inch) / Elevation 500 500 XXX .5 N/A 100.6 meet 1 102 - 9 Feet Capacity VII. TANK in allo s S ite Total # of Prefab- Fiber- Exper INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank 1200 1200 1 MIDWESTERN PRECASF ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 800 800 1 1 MIDWESTERN PRECASIF ® 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbe�gnature: (No St p MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 220292 1 715/772-3278 Plumber's Address (Street, City, State, Zip Code): o r W1 999 77QT14 AVENITE. SPRTNG VALLEY WT 54767 IX. COUNTY / DEPARTMENT USE ONLY (Includes Groundwater ate ssue issui A gent Signature No Stamps E] Disapproved Sanitary Permit Fee 9 9 9 ( P ) Approved 1 ❑ Owner Given Initial Surcharge Fee) Adverse Determination z -' : !')cj X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: / „ eru. r s r59art� 'tsi� Curr�.ti.t 11c4 r•r C�dk l Pe lersc�N_ SBD- 6398 (11.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber l 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 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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 i 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 sconsin www•commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 22, 1999 CUST ID No.268093 ATTIC POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/22/2001 Identification Numbers Transaction ID No. 233469 Site ID No. 175434 SITE: Please refer to both identification numbers, Site ID: 175434 above, in all correspondence =with®the =agency. St. Croix County, Town of Eau Galle NW1 /4, NW1 /4, S9, T28N, R16W Facility: Dennis Peterson FOR: Description: Mound System - Four Bedroom Residence Object Type: POWT System Regulated Object ID No.: 476780 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of constructionf 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 06/21/1999 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 - 4:00 PM jswim @commerce.state.wi.us WiSMART code; 7633, INDEX SHEET PROPERTY OWNER: DENNIS PETERSON 457 233RD STREET BALDWIN WI 54002 PROJECT NAME: DENNIS PETERSON PROJECT LOCATION: NW 1/4, NW 1/4, S 9, T 28 N, R, 16 W MUNICIPALITY: TOWNSFUP OF EAU GALLE COUNTY: PIERCE CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Name: Bennie Helgeson Sign 7 Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: June 16, 1999 j?.0.'f -�•�� Collyditiono ►y 4� CpMMERC DF:PARjMS�F Oi A 1LDING v�s�a RECEIVED _ L-5 NOENGE JUN 1 7 1999 SEE co�� SAFETY & BLDGS DIV. 'I f - plat PICK $S c VA { t a �m r A • � �' � �,L:orr� oar 8 � L T I ll, PUC PAP c I o p ^ i RECEIVED 1 re�cS�c1� JUN 17 1599 I SAFETY & BLDGS DIV. ul I j p i 4U i I c R. P. p Ii)ner. ..��en�i,� ` e��P.rso,-. Page _. Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand ,E /c�. /L�•9 N � y G Topsoil = = = =_= F �. !Oo•� ...1 E D 3 b E(ca. qg. G % Slope. Bed Of 2 % Force Main Plowed Aggregate From Pump Layer D / Ft. E / Ft. Cross Section Of A Mound System Using F Sy Ft. A Bed For The Absorption Area G / Ft. A �_ Ft. H .S Ft. Signed: B Ft. License Number: K b Ft. L Q3.:)- Ft. Date: J 7. 3 Ft. Ft. Force Main W Ft. L 1 Observation Pipe ---," A -- -------- - - - - -- ------------------ - - --•I w ° - -f ---- --- - -- - - - - - -- Distribution Bed Of 2— 2'2 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ern►S Perforotad Pipe Dololl / 0 End View End Cop ) Perforated v ,y PVC Pipe Permanent End Markers Jo ►`o c� °e s Holes Located on Bottom are Equally Spaced .a r' PVC Force •Alain 4 * From Pump PVC EN4 Monllold Pipe CAP I" Pvc. Aiclrlbullon.•. Pipe Lott Hole Should Ue Next To End Cop Distribution Pipe Layout P _WS R S X S Y Signed: Hole Diameter Inch License Number: Lateral Inch (es) Date: Manifold Inches Force Main " a Inches d r7c /e5 peI �eC�rreL 3 7 Ott-) r) e.r i eve v cs • SEPTIC TANK 8 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE �---- WARNING LABEL 7 4" CI RISER & 4" MIN. 18" IN. 6" MAX. INLET , ' ' ' GAS- WATER TIGHT SEALS TIGHT �� VAPPROVED A SEAL JOINTS WITH APPROVED -I- ALM APPROVED PIPE PIPE 3' �-- � ON 3' ONTO ONTO SOLID C SOLID SOIL SOIL PUMP OFF ELEV . ��•� FT. — — P OFF RISER EXIT D PERMITTED ONL: IF TANK MANUFACTURER, HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC J DOSE n� . MBER DOSES PER DAY: TANK MANUFACTURER: TANK_ SIZES SEPTIC /mod GAL. DOSE VOLUME INCLUDING DOSE GAL. - >,0.3e-( C- RI:- FLOWBACK: L• y ALARM MANUFACTURER: �- @ CAPACITIES: A = INCHES = GAL. MODEL NUMBER: SWITCH TYPE: cJ B = 2 INCHES = GAL. PUMP MANUFACTURER: Ent C = INCHES = / GAL. MODEL NUMBER: W o SWITCH TYPE: D = INCHES = �/ gAL• ur7 oc� RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC REQUIRED DISCHARGE 7.Yy VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE - �y FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . — 2.5 FEET -- .. + FEET FORCEMAIN X `3,1 FT /100 FT. FRICTION FACTOR ,7y FEET TATAL DYNAMIC HEAD ::5 �1y FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S - "7 1 '; WIDTH ; DIAMETER LIQUID DEPTH SIGNED: LICENSE NUMBER: DATE: WON MIUMMIMMEMIN \MIMMIiMEMMINIMEN������� , pMINIMMEMIN MENEM � �� �"RIMMINORIMMIN No MEN WE IMMISM-am NEON MEMOMMI �i:0aM ��� \����� ►���MENNEN MEMO mm"IMMONw\M1141 ONE mom mmma\mm► onMRIMI`.MMEMS ■a OP ENS ammummo►m►m MEN 0 - - mmmomomr►mm�ii�!/��� ,MEN MMINIMMUMMIMM10- NEWSOME OMMEMINUMI M No�■ MOD 3885 WIN SIZE/4" Solift MEN MEN . ■ENEM MENEM NONE No EMEMENEENNEEMEN MEN��e��■ MMIMMINIMMEMIKE MEN NONE MENIMMOMIN MENEM MEN MEN PR MENNEN 1 4 MEN ,ii���►����������NONE MOMM■ MINIMME ONE ■UNIMMIUMM► MMUMIN MIMMOMMEN�■ mmmmm ■■ oomm"IMMINIM■ ►IMMINIMMEME■ MENEM MINIMM MIMMIN IUMIMIMMMMMM■ �������1����► MENNEN Wisconsin Department of Commerce SOIL AND SITE EVALUATION r C*vision of Safety and Buildings Page of Bureau of- integrated Services in acco rdance.vvith - -s.; ILHR 83.09, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. PI must' `~\ , include, but not limited to: vertical and horizontal reference point (BM), sib^ percent slope, scale or dimensions, north anew, and location and disl :30 t r Parcel I.D. #© A- # UCiO'�0 Z4 --9C� APPLICANT INFORMATION - Please print all fnformOdn.f Revie ed by Date Personal information you provide may be used for secondary purposes (Privacy t. $ (1) / Property Owner (3 u t r C} '7 lion t"(�r p� 4<tSoH �W . De n1/li s P� QrtS : <:.._ ._. S' 9� W 1/4 l�i /4.S T S ,N,R / E (or W Property 6waee's Mailing Address u- )-e-r' ; ". dot+ Block# Subd. Name or CSM# 3'.J _54 r - < e _ — City State Zip Code Phone Number ❑ City ❑ Village 0r1 Town Nearest Road l �clu� bU t 15Ctw I � 33 rc� E3 New Construction esidential / Number of bedrooms Addition to existing building Use• � �— 9 9 ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow X00 gpd Recommended design loading rate . S bed, gpd/ft . to trench, gpd/ft Absorption area required !, bed, ft 6 trench, ft Maximum design loading rate o " bed, gpd/ft trench, gpd4l Recommended infiltration surface elevation(s) /ob. 6 ZSIT. n { aC� ft (as referred to site plan benchmark) Additional design/site considerations NSF Fc 7 ! K y� Parent material t3[) ev — Flood plain elevation, if applicable � ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S CYu 19 C3 ❑ s 0 u ❑ S E3 ❑ S 2v ❑ S SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g Texture Consistence Boundary Roots in. Munseil Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 - o� — / �s � i�E S 4. -> 5 v __ _ 'V Ground 3 -gyp c i Slay. Depth to limiting factor Remarks: �� cJ -C L- g Boring # 13 �3 y- a 4� - f ' i F S Ground 7 k 'p � elev. tt . Depth to limiting factor min. Remarks: CST N e Please Print Signature Telephone No. Address // Date CST Number u try '0 SOIL DESCRIPTION REPORT PROPERTY WWAR 4nI S /c'I' evSo` Page of- PARCEL I.D.# O GYM — 16 2 Boring Horizon Depth Dominant Color Mottles Structure z 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench y 5 SIC r i u Ground 2 V S elev n - ( © Depth to limiting factor min. Est H,L".1) Remarks: Boring # / �- El �.� cc, t S' Q � J _,j ) d G Ground elev. asst, ' Depth to limiting factor � Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 3 _ / U S' , to f u Ground elev. �71�ft. Depth to limiting factor in. Remarks: 6s #' 6 Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) I toCa.7Ul P r�- c ad- � er eo r 0 P - By 1 519 Al 1 , B. } 0, R. P. l�.ob q 0 � �rc po6 act' 4t �� ly i j�ow.e � f f r ` i i A S So'IOLC�G'L 4 Wisconsin Department of Commerce SOIL AND SITE EVALUATION - Division of Safety and Buildings Page / of 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 siz$: Plan must County - include, but not limited to: vertical and horizontal reference point (pmj, direction and percent slope, scale or dimensions, north arrow, and location andbistance to nearest road ' I.D. # APPLICANT INFORMATION - Please print all inkwmatiQn.. R by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1)`(m)) Property Owner j?, �� r - ; Pn5li ty Location toe I Tr . -� _:;.9veat . � ,UL�1 14,S T N,R E Property -Q* so'. Mailing Address c:. cr! `. ` Lot # Block #, Subd. Name or CSM# City State Zip Code Phone Number ❑ Cit V Nearest Road ty ❑ g Town t IAc. LU 1 460L ( 7/5) ea - X C (5a,1( -e I ' D 33 r< k � 51 rc R New Construction Use: Df' "dential / Number of bedrooms _! �4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow X00 gpd Recommended design loading rate • S bed, gWF trench, gpd e Absorption area required Soe bed, ft2 5&� trench, ft Maximum design loading rate bed, gpd/fl gpd/ft Recommended infiltration surface elevaton(s) W (as referred to site plan benchmark) Additional design/site considerations )e Parent material f� e r -) e,— Flood plain elevation, if applicable VA — ft S = Suitable for system Conventional rM�,ouunnd In- Ground Pressure Tan AT -Grade System in Fill Holding k U = Unsuitable for system ❑ S [r } - u L'7 ❑ U ❑ S � ❑ S 9 ❑ S 2'U ❑ S 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 13 I 6_ IoV- :5 Ina Ground elev. s a el Depth to limiting factor a G u'• Fs) 1 i Remarks: Boring # ha ki cL Li , 5 wl f' J S ' r Ground 7 elev. ft Depth to limiting factor min. Remarks: CST N e (Please Print) / Signature Telephone No. J �'�•7 P �lc'l c�sa '7%5 7 Address a Date CST Number L�C ;� SOIL DESCRIPTION REPORT PROPERTY R 2' , 1h' S f of Page of ` PARCEL I.D.# r Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench r k u IYK Ground b- C ft. = Sc 1 p 4h 7 - a S Depth to limiting factor '1 _in. Rema Boring g I , `-� Ak El A 1J o NL w Ground p ��, k naG- elev. Depth to limiting factor �_in. , Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # - 13 3 k WIL L Z - 5 - 61 rh U,� u S' Ground elev. 97�ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 177• A4 A rch E ( e— v. 1 4, W)- a 0. R. P. I cr %ob L P uc P s i° �rc �Src� �Cx►wAtcLT� t���. HCj. r Vr�„�. f I P () P-e e I NELSON' SUPER VALU 7 EL:715 -684 -4224 Sep 20 99 17:04 No.002 F.02 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND + OWNERSHIP CERTIFICATION FORM Owncr/Buyer .02. Mailing Address Property Address l (Verification regyjtod from Planning Department for new construction) City /State parcel Identification Number C�C3 S ` L 9 6 LH.GALS ><PTIONT V Property Location N� ' /,, �� tl,, Sec. JL T a9 Iii -R W, Town of 2e� Subdivision , Lot # Certified Survey Map # �, C) , Volume �3 , Page # J Warranty Deed # 9 3 _5 ` . 'Volume S , Page # (a 09 Spec house 0 yes V no )rot lines identifiable 0 yes 13 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 toaster pturnber, journeyman plumber, restrictodplusuber 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. Uwe, the undersigned bavo road 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 yea exp iration dat 1 j l D SI03NATUR}3 OF APPLICANT r ATI3 O WNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownor(s) of tht , p t roperty described above, by virtue of it warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT ;i DATE * * *''t• 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 f r o m the Re g istor of Deeds office certified survey ma if refewnce is made in the warrant a co of the c y Y deed PY p NELSON' SUPER VALU TEL:715- 684 -4224 Sep 20 99 17:05 No.002 P.03 NIL 0"d -•c 5 =0 two (Orate err b1aCOttaLtt 2".1k qfa aa. abw s... M� 1 �.►.r,.. y 0" co" "Qvinrw UL This Indenture, Made this day of February A. 10 . botw#tn Helon Petoreon j Party o /the first part, sad Carl A. Peterson, Jr, and Leona Peterson, husband and wife, as Jcint tenants, Pardo 4 of t he second part tlitntzattD: rhet the said part y of the first part, for and in consideration of the sum of "Good and Valuable Consideration" to her in hand paid by the said part iea of the second part, the race /pt whereof to bereby oonlessed acrd acknowledged, sae given, I.-anted, bargained, told, remixed, released, aliened, conveyed and confirmed, and by these presents do en give, grant, bargain, sell. remise, release, alien, convey and confirm unto the said part iea of the second pert, their heirs and assigns forever, the following described real estate, situated is the county of St. Croix and State of lVisconsla, tn-w(t: The Northeast Quarter of the Northeast Quarter (NMA of NEA) of Section Eight (8) a r.d the Northwest Quarter of the Northwest Quarter (NW o NW) of section Nine (9), Township Twouty -eight North (28N), Runge Sixteen west (16W). This deed is executed by the grantor herein in saatisfacticn of the tests of that am- tract dated July 27, 1972, and recorded with the Office of the Register of Deeds, St. Croix Countj. Wisconsin, on August 14, 1972, in Volume 487, on pages 633 and 634, further reserving to the grantor the rights are set forth on the foregoing referenced contract which are as follows: reserving unto herself for an long ae she lives, the right to live in the house, the meane of ingreea and egress to the acme, the use of the garage, the uce of garden space and the use of the wall. fi TRMsfER tugttbtt with ail and singular the hereditaments and appurtenances thereunto belonging or is saywipe appertaining; and all the estate, right, title, Interest, claim, or demand whatsoever, of tb.+ said part y of (he krst part, either in jaw or equity, either In possession or wectency of, in and to the above bargainer) premises and their hereditanrents and appurtenances. 'Cc ilabt t<ttb to ilolb, the said premises as above described with the hereditaments and sppurtenancee, ttrtto thr said parties of the second part, and to theirheirs and assigns FOREVER. Urlb 16t Oilib Helen Peterrsora for horeeXT and her heirs, executors and administtators, do convenant, grant, bargain and agree to and with the said parties of the second part, their heirs and sssigna, that at the time of At enstaling and delivery of these presents alto is well seined of the premises above described, f { as of a good. Sure. perfect, absolute and Jndafeadble estate Of inheritance is the law, in fee simple, and that the same are free and clear from 811 isoumbrances whatever, and that the above bargained premises in the quiet and veaceablo possession of the said part iea of the NELSON' SUPER VRLU TEL :715 -684 -4224 Sep 20 99 17:06 No.002 F.04 vof 549 4111 10 second part, their heirs altd 801900, ndelrtst All and treq prrma or perso", lrwtull? clalndfil the whole or any part thereof, they will forerer WARP.ANT and DSP'XN!). yn U111aro0 U10treat, the sold parr y of tho drtr part Ambereunto set her band end Arad this 'L day of Febraetry . A Da !077 Signed and Sealed in Presence o1 , f3.riZ fU >� Zti 4 - ..._(Seal) - __(Seat) _ (Seal) otett of Ultoronotn, $t �, Croi x -- Cotrnty.l Personaddy Carne before me, this �` day of tebruary . A. D., 1477 , the above named Helen Peterson to rte known to be the person who eirecated the foregein rument and acknvwledg of the same.. , r J oJUL q,.jfe$t Notary public, kPlr oemnrladou a]cl[IotxiB yermanen J It ylM Araftad by � _._.�.?ihn C Neatintten, Attorney B aIdIdA Wmnali •� IR.A.-4'r �! wM tav� Pro+r : mt dl lrr�rreo� eo M rwa�i.d d" Lra VWh4 to bo w Wor-m- amo­ or r *r Wm* A .9 or C'J C'r h O A4 r NELSON' SUPER VRLU TEL:715 -6$4 -4224 Sep 20 S9 17:06 No.002 P•05 ni FILED _ ju 0 1 1999 � e SAtNLtEN H.� 4 Coocc-, F M s CEPT1F IEp SURVEY MAP LOCATED I N THE NW t r4 OF THE NW I i4 DF SECT ION 9, T. 2g.4. , R. 16W. , 7OWN Or EAU OALLE, ST. CROiX COUNTY, WISCONSIN PRFPAREO FOR! DENNIS PETERSON NORTH OUARTER CORNER C SECTION 9 - FOU ..UNPIe A. r4.P. ,,,,AkRs, 4LUAf1NUM CAPPED MONUMENT NORTH 4 1 NE OF tW NW w4 N , N99• �5' £d• w 1 306. 6s'jT`' t3D5, e4;4• x.7.0 NE Got, II I 'OR ThWEST CORNER NW-NW (33 331 x SECTION 9 - FOUNP 0T,.I A ALUMINUM CAPPt'D MONIJWNT GGRT. !F. ?fP.i4R!'Ey.MAP.N,G...F.43R. WI { v ' I I � � • sea�sc' f { 4 � x w o0•E 4sR S 4'` 6$• 5e 3r.F 449. 87' 1 I is �I f 0E• : / HWSE SEPTIG� ro v u JOO' fit: >A +w SHEDS O f ( j SILO �I LOT F of $ I k5 r 8.00 ACRES ExC. Raw: 4 77' y y 14 90 °00' 00'W 479. :r ....,, A T. . ANns ) I A LfMPL A T T E0 L b J 33 ,tj i BEARINOS ARE REFERENCED TO THE NORTH LINE OF THE NW lr4, 5ECI10H 9, I % : MEASURED AS S8G IST, CROIX COUNTY COORDINAIE SYSTEM. 1 AMES M. LEGENO ts�o4 O • SET I' X e4' IRON PIP WEIGHING V4fA��' Q` 1, 0 LOS, PER L IN(AR FOOL w r I' ■ 150 E . FOUND I' X t4' IRON PIPE- �V 5 usv�� R • RECORD OiNIENSION N 0 75 1. 300 )AMCI At IfEAER 8 -1804 SHEET 1 OF 2 DATED _ ��- �1 SURVEYING 4914? IH1S INS717604ENT DRAFTED RY JIM WER VOI. Page 3681 NELSON' SUPER VALID TEL :715- 684 -4224 Sep 20 99 17 :07 No.002 P.06 it $AN �WLj° E " w W dXW - ¢WE xttEn DESCRIPTYON A parcel of land located in the Northwest 'i4 of the Northwest 1 ✓4 of Section 9, 'township 29 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows Commencing at the North Quarter Curter of said Section 9; thence;, North 96°47'21" West (Recorded as N89 °)5'24 "W), along the north line of said Northwest r ✓4, 1306.84 feet to the Northeast comer of said Northwest 114 of the Northwest' /.; thunae, South 00 °00'04" West (Recorded as S02 ° 46'08"1✓), along the east line of said Northwest' /. of the Northwest 1 4, 340.45 feet (Recorded as 340.00') to the POINT 017- DEGR4MNG; thence, Stxttlt 00 West continuing along said east line, 476.54 feet; thence, North 90 °00'00" West, 479.29 feet, thence, North 03 East, 532.50 feet to the southwest corner of Certified Survey Map Number 2439; thence, South 82 East (Recorded as S95 °50'00 "E) along the south lime of' said Certified Survey Map, 449.67 feet (Recorded as 450.00') to the point of l3eginninq. Containing 5.37 acres or 233,708 square feet, Subject to right of way for 233 Street as shown, also subject to any and all additional easements, right of ways or conveyances of record. SUR'VEYOR'S CERTIFICATE 1, James M. Weber, registered land surveyor, hereby certify That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of "tic St. Croix County Subdivision Ordinance and under the dirxtian of Dennis Peterson, I have surveyed and mapped the above described parcel of land and that this map is a correct representation thereof' aenrM1irr Dated 1114ZX 3"day of _ jytn— 1999 JAMES M. � WEBER James M. Weber 8 - 1804 &loos NELSEN -WEBER LAND SURVEYING, INC. eftm wurv, ¢ OR NOTE �o SURV��4 ✓ The parcel shown on this map is subject to State, County, and Town laws, rules and regulations (is. Wetlands, minimum lot size, access to parcel, etc). Before purcasing or developing any parcel, otrntact the St. Croix County Zoning Office and the appropriate Town Board for advice. 99142 This instrument drafted by Jim Weber SHEET 2 OF 2 Vol, 13 Page 3681 r i 428.60 :10.32 LOT 1 o C.S.M. 912439 0 M - - - -- - -- o LOT 1 126A M_ fi115 5 0 1258 2 10.32' NW 1 14 -NW 114 NE 126 728/135 � I i - -- - - - - -- - - - 'i I j