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HomeMy WebLinkAbout008-1086-20-100 Q c a) o M 0 ° C C G L h oc a� 3 N C O N 0 w v 0 U N m Q y d 2 L 0 . m —O t � N 'C w O a j O Z .� Z t .0 U C O C @ LL O N 3 c c€ Q o C7 a I 3 M I a� 3 Z " E US Z Q d o N a m M F Z �I C O z 2 z a 2 c E � C C o 0 z z N _ .. a z 0) 1 LO y c co E N �. m � d C cn C .2 d i 0 O N IZ C N 0 to fn to -2 v r z r ' I' 3 3 3 a C Z O O O • wa ;� � � a � m J U m rn rn � rn ooi ai I r a � N L LO � r O r to }o of O O N Yl O C N C cl �+ o g a o m E © £i N F - : O d C C Q IL p O E N t_n 77 Q (D C C .y W N N W C L N O S4 O M W Y M O N Z --� Cn ::€ CA 4) m a O •v d `�� A v a t O rn Wisconsiv Department of Industry SOIL AND SITE EVALUATION REPORT Page ! of Labor 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 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. D© K - /U - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R E E B D TE (s `l PROPERTY OWNER: PROPERTY LOCATION s�1�,� ¢ GOVT. LOT IJY >r� - 1 /4,S J2p T ,N,R !fit) W PROPER OWNER':S MAILING ADDRESS LOT # BLOCK* SUBD. NAME OR CSM # I qq 0­s b' CITY, STATE ZIP CODE PHONE NUMBER [:]CITY OVILLAGE D9OWN NEAREST ROAD [?9 New Construction Use K Residential/ Number of bedroom (3 [ j Addition to existing building [ ] Replacement [ j Public or commercial describe Code derived daily flow 50 gpd Recommended design loading rate N P bed, gpd/ft _ z-. trench, gpolft Absorption area required tP bed, ft 2a Q trench, ft Maximum design loading rate bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) /© /. ft (as referred to site plan benchmark) Additional design / site considerations 2Pn rT m b v Parent material _ 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 fors stem [Is ®U ®S O U O S 9U ❑ S � U 0S nu ❑ S Nail l SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft P Boring # Horizon Texture Consistence Botrtdaly Roots in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. Bed 17rer& �a SI ? in lF yr) } 3 11MAI.M. a to - 1 1 0,e - 2A S ,Z k m F 2 CS z s ,� Ground 3 7.-33 )6 4311 5 - , / a m si� /)7 os l f elev. / v - 5 l0 V o s ,L -- V . 2' ft. . � f 3 � Depth to limiting factor At /f Remarks: Boring # ' ?; : X ` - �"J U .z/ J C��id m i�IQ C�J ZM 1,3 z x a D s11 z M 5b k CS z-F -s 6 1 -3q /D 41V 0 S l m sbk yyl Pr. C S 1-7, 1 , z . 3 Ground ` 2 fg elev. 1 59 - ,t 5 7,' Q '� 7 y - s o s rn Depth to limiting I u w i factor 5, A 1MOIS7 UCf1 t Remarks: —, c cR . , CST Name : — Please Prin ¢ S Phone: 5 Dad ddress: 1h ' 7 P//0ll/og"te GUiSG , �/7 $ Signature: a ���•�r�1 Date: l umber: PROPERrf OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # M Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdaryi Roots GPD /ft . in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed w& )� - ;4ti Ground 1 6 /3 s, l M p Depthto - S 5 K limiting factor 3 Crn'� �� -id►+S Remarks: gcme Boring # Ground elev. _ Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # Ground ft . Depth to limiting _. factor Remarks: Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 338922 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: Kraemer Joel I Town of Eau Galle CST BM Elev.:. I Par nsp. BM Elev.: BM Description: cel Tax No.: 008 - 1086 -20 -100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Alt. BM Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft oss H ead Forcemai n Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 131 S.T.H. "63 ", Baldwin, WI (N1 /2, SW1 /4, Section 30 T28N -R16W) - 30.28.16.455A -10 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r AP € 4 } i } _ i e � i f r } w a I � t t F a e a a � 1 t ..a.. m .... _.. �, —.. € E t e a t r ma m. sem �m 3 S e»� e mem....we € # 3 t # r i m x j # a F F a e. a �_ . i 4 ` t e.. �. .. e .,� ... e ®m.e. . ..�.. E t � 5 i .e,e s.ae.. o 3 B � I } cc � . ........ .... a,.., x e .., re.. .t ......b.. b.. s..,., p . e ... .... q..m _ .._ �.. —fv r. �_.- .&,....».......�. ......««.3 �T 2 7 t o i k { � k E � A �,� Safety and Buildings Division sconsin SANITARY PERMIT APPLICATION Poe Washington ington Avenue Department of Commerce In accord with 1LHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County / r— , than 8 1/2 x 11 inches in size. S;,,- !4p ir y • See reverse side for instructions for completing this application State Sanitary Permit Number 2 (Privacy law, s. 15.04 (1) (m)]. 2 Personal information you provide may be used for secondary purposes ❑ Check 03$101 revision to previous application State Plan I.D. Numb 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION d Propvy Own Name e o ation _1 ;r- /Y �a 1/4, 5 _S5 T �ZO3 , N, R l.6 E (or) Property Owner's ailing Address Lot Number Block Number l� � 40C- /c 41 /it e ep 7 CIV, St to Zip Code Phone Number Subdivision Name or CSM Number CV 11. TYPE F L ING: (check one) ❑ State Owned !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ ° Town OF rGL U-- III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo f ® �4 166 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. 12g. New 2 ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of S. ❑ 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 tither 11 []Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation - gyp 3 90 t . �- y ,� Feet 9 Feet VII. TANK Capacit in gallo Total # of site Fiber- Plastic Exper. r Prefab. INFORMATION Gallons Tanks Manufacturer Name Concrete Con Steel glass App. New Existin strutted Tanks Tank Septic Ta mg Tank / ©�© f ^ - 4 S -G-y ❑ ❑ ❑ ❑ ❑ lift Pump Tank /Siphon Chamber ® 6 8 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MPIMPRSW No.: Business Phone Number: Plum is Address (Street, City, State, Zip Cod ,J / IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater a e ssue issuing Agewignature A roved �� Surcharge ree) �� J Ef pp ❑ Owner Given Initial qr> Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: tom �S SBD- 6398 (RA 1197) DISTRIBUTION: Original to County, One copy To: Safety 6 Buildings Division, Owner, Plumber Id b �54 CROP ,72,1 TIC T ACT."T.M1. T .1 11 1 MD MVNEIRISIN CERMCATION FOF.A Jo 131 (vc-tirlema0v rcqSjrrz, ftx:, Placwag Np_rttwz( for new c0v_(tuktd0u)_ P.Urcj , ldw6fi Niumbea- L9 Y" Sx. Town of Lot # V!an:am(y DerA Val, . 1mc par> S,Iw.bottv, 0 ytw Qrno Lot lines idaitiflable M ym D. no DT6c tz er-*tT M= Yt= Or Mao; i,=c&A by 9 U%= Ylat Ym PA16w d"wSyecm tqd tMI . a ,.Ta fma 1 v tcr. im &- X40 4T4= iL I q. I& pwpcay Qw=. ap= to s6euto St ank Z Dc&dmat x =ffi=6o f ttwd: by 4w M44) ` is in PWP= OPcO =If&= "&or(2) aft= mq)mbm wd p=qug (if n=uwy). &c tq*ob*u less tbpCCt V*c v ft set a' s ad toy &c DcpacWjca*fCmnmc W the Dcpuftag*rKxfttai Rcw=c:S of iv%*46, CadgWaan WI&9Yd=habc=miutaiacd wig k comptd t ft SL Cmix COM* Zw figb� . mwvtd&30 days-of do dm YM C)*Xfioa &t— GNA OF APPLICANT DATE skt=mbcn this form amt= to &c best of my (out) bwwl J(wc) rat (ftt)!&C0WuCt(S)Of dc Pro" d=dW above„ by virtue of a ws=nty flood =ov &d i Vjc&aof Dw& OTcc. 0 AFMCANr DATE "I dds APPUCIttocc a cftmpod wunaty dead fiat dw Register of Doe& otrwe & COPY Of the cettirtad vzv► rap if ttfcct= is WJL& in the wamttty deed Wiscop4n Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety �[nd Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338922 Permit Holder's Name: ❑ City ❑ Village [� Town of: State Plan ID No.: Town of Eau Galle v.; Insp. BM Elev.: BM Description: Parcel Tax No.: 60 / L r r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P • /0p J Benchmark �, 3d 3 lo G Dosing 6 0 6 Alt. BM • ° rd jot. , J ]AMT1ThTrr- B ldg. Sewer 0 L ?/, H o g & Ht Inlet Id. 1 -Z— TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. A ir ir I ntake ROAD A Septic 7 /UU , 3 Z . NA Dt Bottom a Dosing ��AO' `� 3 / t Z r NA Header /Man. 'p' Aera,t, n NA Dist. Pipe H g Bot. System Z•y ° z. s PUMP/ SIPHON INFORMATION Final Grade Manufacturer ✓� Demand co ver � •S� Model Number 3 7-. P M SJ 160 TDH Lift Z w Friction Z e I System.. TDH Ft Forcemain Length OU I Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM kW TRENCH Width Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Depth DIMENSION Ti� 2 DI MEN I SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM' L IN nufacturer: INFORMATION Type of C B System: �( 73V > 75 OR UNIT DISTRIBUTION SYSTEM Header /Mani Id it Distribution Pipe(s) r / �� x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Z- Length Dia. 2 Spacing V , 4 Y 6 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.) Inspection #1: /d / 6 / In spection #2: /o Location: 131 State Highnway Highway 63, Baldwin, WI (N1 /2, SSW1 /4 Sectio 30 T28N - R16W) - 30.28.16.4555A - 10 / f u Z0, J 7� r o f eve✓ 4Ala 7'/ Plan revision regdred? ❑ Yes q No Use other side for additional information. Z LZ ,( SBD -6710 (R.3/97) Date Inspect Signature Cert. No ADDITIONAL COMMENTS AND SKETCH C SANITARY PERMIT NUMBER: 4 E s ' { j Y s............. e, ..e....... .. .. �...� .. ...� eve... ... �.. .e,�. m. ... a . ._ ,.,. ...m ., n ..� .� e... �e E° v jj {, a te. ....a- ..ay.. _ <. _ ...... '..,.�....,... .. ,�.... -..... a.a .-,,,. s . ,...... .. ._.... ,. .. _ ... ,.,, ..... _ .. .. .... ; ..,.... -'�e` a 4 e i i S E t e e s 4 .. ..... i mm ea � g f e i 3 ; e e F r w a e e 3 x Y # } ..... e e a d s 4 s 1 a M «e e { J i d a a ... .. ,.�.w b.m . ta�....... m< . .�,.� .. .,...... ,. ...... <.�.e. ,. .J�. A f - s E a � m v ..... e� i i ..� .�.. ... <..� ..�..� s V%;� Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue in accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 0 . Attach complete plans (to the county copy only) for the system, on paper not less County than 8 t/2 x 11 inches in size. ...5z C 4,0 / y • See reverse side for instructions for completing this application State Sanitary Permit Number 38t 2.'Z Personal information you provide may be used for secondary purposes p check it revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan LD. Num I. APPLICATION INFORMATION - PLEASE PRINT ALL INF R ATION � Prop" Own Name VperLvLocation - / -y fW4 SS 114, S 3 T 2,9 , N, R 46 E (or) Property Owner's M ailing Address Lot Number Block Number /..2 4 ? LAG/ t 4:p T CIV St to Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ ° row OF e4-t A-it U� 111. BUILDING USE (if building type is public, check all that apply) Parcel Tax Numbers) -2 _ 1 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. 1f 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 nMound 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation SD 3 E '— �j' Feet /4 Feet VII. TANK Capacit gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Ta mg Tank -5 - e ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber e _ c9, 4, 6 e ❑ 1 ❑ 1 ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (NO Stamps) ' MP/MPRSW No.: Business Phone Number: Plum er's Address (Street, City, State, Zip Cod IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued issuing Agen ignature (No Stamps) A roved Surcharge fee) pp []Owner Given Initial �� CCU Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber L INSTRUCTIONS = x 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. 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 1 Department Use Only. - Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to thLcounty. 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. t� Safety and Buildings • PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 Visconsin www.commerce.statemi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 04, 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 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 05/04/2001 Identification Numbers Transaction ID No. 223507 Site ID No. 171527 SITE: Please refer to'both identification members, Site ID: 171527 above, in all correspondence with the agency. ST CROIX County, Town of EAU GALLE S30, T28N, R16W JOEL AND LYNNE KRAEMER FOR: Object Type: POWT System Regulated Object ID No.: 465477 MOUND / DWELLING 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes r 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • Deep and thorough chisel plowing must be done to the absorption area to break up any compaction or platy 4 soils which may exist. • 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' SEE COF 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 04/26/1999 �PLAN FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 AMES B QUINLAN , POWTS REVIEWER BALANCE DUE $ 0.00 Integrated Services (608)266 -3937, JQUINLAN @COMMERCE.STATE.WI.US 1� cale f ��tl Ppik .1 t � r— .} Page of 6 MOUND SYSTEM A�' FOR �I�� A 3 BEDROOM RESIDENCE 4,b# t7 S $ma 8 y, ass tJl(z far- VwvtOaN)Ptt. b� lly or- a , OjV LOCATED IN THE -- 1/4 OF THE -- 1/4 OF SECTION 30 , T Zb N, R i W, TOWN OF GAu� , S'T. CLzuUC COUNTY, WISCONSIN.. l.o _1 o F : CSkw4 U o c , -T3 Pt1= GE --1-S3 = -- INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION. PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR �'o� FYhn, L`-t l�l F tc2 f� E hEl? � 2 b 6 LOC�C 1�-vZST' .RESPONDENCE PREPARED BY WE+GEF- SOIL_ TEST AND. 0 ®��� ®Neae e� F.O. 001 74 421 K. MR ST. RIYU.. FXU. KI 54022 W G RER 2 715 -4�.r -0165 El S.""" L L � y JOB NO. 49 -7S PLOT PLAN Page Z of 6 Scale 1"= � g w► tk-I q8 >e$ \010 • `" � -ZS � � ao �� cewh,�rer 1 O �✓ ti�a r --r Ci -9 3 6DR`M to o y'tPv I j 3 h �tlz "Dtt�, pvc w! L6°T}f- -- P�T U_ t -a T so' r-eo M fft__ NOTES' existing ground elevations unless otherwise noted. 1. Elevations shown are Z required) 2. Install permanent markers at end of erovedacapsl•( Z required) l 4" observation pipes with app . � Septic tank to be X040_) ba? d • by 3. Instal 4 gallon capacity manufacture 5. Bench marks= I&I (,. hill side- Divert surface water around system to. prevent .ponding at the up Page . l Of -6 F • F Perforated Pipe Detall 0 End View Perforated End Cop.) ce� e PVC Pipe Install permanent at end of each lateral I Holes Located On Bottom, Are Equally Spaced Q End Cop i Q �'t PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe_ Layout P qS Ft. X LCO Inches y 4o Inches Hole Diameter /y Inch Lateral ) / Z Inch (es) Force Main " Z Inches # of holes /pipe y Invert Elevation of Laterals 100• Ft. 14X1• \7:16.38xZ; 3Z.�� G1�M Place lst hole 10 from tee with succeeding holes at WJ intervals.. Last hole to be next to the end cap. ...._ ._.. -... Wisconsin Department of Industry SOIL AND SITE EVALUATION ,REPORT Page of 3 Libor a3rd Human Relations Division ofsafety & BtnkGngs in accord with ILHR 83.05, Wis. Adm. Code, sT - CFA 1.�C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but- PARCEL IA. # not firnited to vertical and horizontal reference point (BR. direction and %of slope, scale or Oo S - l I)K _-?-z _ too dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION N t hL or= w$t_ SAN 1 "f -'S- GOVT. LOT : 114 — 1 14,S 30 T ZZ ,NR L b E (a PROPERTY OWNERS MAILING ADDRESS. LOT # BLOCK # SU _ NAME U L, # 12 b 4� L.oelrtiki�t\�..ST" 1 _ CSt'�i U o L 1 Pfr6G 3 5 3 9 CITY, STATE Z1P CODE PHONE NUMBER nCITY ❑1IILLAGE ((OWN NEAREST ROAD 13 -�W Ir%j ijI S (`l0 68q t-1o61 63 [ New Construction Use 1x4 Residential I Number of bedrooms 3 [ J Addition to e*ting building [ ] Replacement [ ] Public or commercial describe Code derived dally Row S 0 gpd Recommended design loading rate ___ _ bed, go__ • 3 trench, gpdtl? Absorption area required 3 bed, 11: 1 - 15 trench, 11 MaDdmum design bading rate rup bed, gpd/ftt ' 3 trench, gp� q 9. 6 ft as referred to site benchmark) Recommended infiltration surface elevation(s) ( � Additional design / site considerations Y1 w/ L,' x 9 y ' `T)M�20'tf • M) "vt H u M X?- C S A_ p Fi � Parent material Lo ov - G %--A L In Flood plain elevation, it applicable 'N A ft S = Suitable for System COW9MONAL I MOUND WFGR"D PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system CIS ®U IRS O U 1 0S ®U [is ®U I 0S ®.1J ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Colorer Texture Structure Consistence Bogy Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerhdi h 1 p -� ► tp� tt ZL Z - S t 1 Z T Sbk v`'1 1r- I 1 v'P Na • 3 Q Ground 3 ty -ZZ ►0`1R clt� - St1 z�sbk `�� �S )v�- •S � 1 qg 4 zz -3u S`tR Sly - St cl 2m S�k y �.�,„ c$ •c( €, S Depth to S 3o_SS -S 2 3/y � firniting factor 30 Remarks: Boring # t, Za Z SUh WtA- a-S 7- ' S Z Z %\-\,S Nz`"m y11 S1 1�P1 r+�'Fh a 3 15 -1 10 c-1R y!3 Ground c S — • y . S elev. �g_Z� �. S `.L / - s�G1 Zwl S�\z lot �� S u, V\o M '�- ,gyp ' L - Depth to limiting factor - - Remarks: T Name:- Please Print Pt'°ne. 715 -4 2 5 -016 5 Arthur L. Weizerer Y e m g%rer Soil Testing & Design Service- P.O.. -.Box 74 River Falls,WI. 54022 ' ;6 Date: CST Number: _. signature: °l9 -�S y_ Z 1_ 220254 Y 4 PROPERTY OWNER SOIL DESCRIPTION REPORT Page?-of 3 PARCEL I.D. # 00 8 •- Mjb _'Zp A30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnch y � � S � ` '2.. `FSbtt wi.'F► a. S 2, � • S . L, 10 ti.tz Yl-b - St I 1 apt Yn'Ft- a-s 1�•� t.�� < 3 Ground 3 V3 -ZO fv (-j [L V/3 St yw -to elev. L) fc Z.c, 2.(� �.S�fR31 - s�c1 Zrn sbk tm�F►- cg - ,q 1 ,5 Depth to S 7 - 6 - ").S WR3 /y ��.S.1ILS IF, limiting facztar� a Remarks: Boring # 4 Ground elev. ft. ' Depth to limiting factor L ------ Remarks: _ Boring # Ground elev. ft. Depth to limiting j factor 1 Remarks: Boring # , 13 Ground elev. ft. . Depth to limiting factor Lj Remarks: nn OQ't(1rf� %rr1n . ' . P t OT P LAN Page 's of 3 SCALE 1 "= SO ' b3o_pp' '�ci • gr� �-1 a8 b l� e.q8 6 CP qq.V g�3 � in, 9g � DLO 6 . $•� zy ' / � -z/ �- - k— DO 1NlST t I PR E T ovz. -9 J SI < 3Sof j ► �iME I I i y� 3� �'�'l - �--• 100.4' oN 1ti � ti1G l� , �''2. "Dl �, pvC P 1 PL W l LA'fN . _ � , I _ 4►'"! X4 - �_ . '� 4. S' 6ti �'' O l A � R� Pt PE t_oT CoR1+.JC�2 . i F1fi U T SO' l-'PUH KA I CI cl ( 715 ) 4 .S -m h5 I400576 CST Signature Date Signed Telephone No. CST # I CL" I •TIC TA�JK fl I 1� I.' ME1 T AND '11 CBRTIPWATION POPA O"VIN TUo 131 S. 14 revived firm 1 11=ng D(pr(alm for new con-, pro L--�, tion 's A Y, Lot Certir,10A stin're Vfppg - -5--p Volume- Page # Wan D'efA' ff Page 0 �zo 2 Lot UnCS id.*It 721)tC, M. YM C1. n43 on "I fC fit PS P==kinc VIIWLV of pimpfiq out the V&pe t crty & 2t or gocw-r, K =dcd by � i.341,- = Offic im & Ila pwpwy Ownct , apxs to s6mit 10 Crok Zxft Dvatmat it =ffi=f= Iona, sjpM by A' 1 6* fey a the on-eft sg is =PcoMoperatiag condition an(l/(ir(2) afiMkVocfi(n and pmwpisg.(if ntce=M),thr. tcp&tt*.is less g�c- UVIC6 to s have read Me abowe wq*==ft and Ww t mickk de Pivft sewage divd Od A* 6rew." by St Dqmtood of Cm sod &c Dqth..t dW Resom State o f jV� Odaisfi6n M*ft&tt YOW =Pfic sydem has boas nmiaWncd be comp and retaw to the days. of do than Yea crpiration date. St Cmi Cmly Zalhwinw w 30 GNA OF APFUCANT DATE OWNER —M�MMON I (we) oati(y that all ttat=ctb oa this foan arc tone to the best of my (oar) knowicdr— I(wc)am(aw) the own=(s)Of de PrOPWY dMclabod above. by virttic of a wa flood woor i p xg i cw of Dw& Offi SMAU*.Ii Oft APPUCANT DATE My iafOM=fiQa that Is V934wacdodnisy result i the unitary pwait big 111kod by the Z..Ig DVUIM-t. IndWe with t application: a cb=pod wananty doed from the Register of Dee& offic a copy of the certified tunny map if Mf=v= is made in the wamaty dood VOL 1.411 PACE 4 8 601010 KATHLEEN H. WALSH Document Number WARRANTY DEED.. REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Lyle N. Gunderson and Sonja K. Gunderson, husband and wife, 04 -12 -1999 10:00 AM conveys and warrants to Joel C. Kraemer and Lynne M. Kraemer, husband and wife, holding as survivorship marital property, the WARRANTY DEED following described real estate in St. Croix County, State of EXEMPT 11 e CERT COPY FEE: Wisconsin: n COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 PAGES: i Recording Area Name and Return Address Thomas A. McCormack 740 Main Street Baldwin, WI 54002 O0 0 v (Parcel Identification Number) Part of the North half of the Fractional Southwest quarter (N Y2 of Fri SW %) of Section Thirty (30), Township Twenty -eight North (T28N), Range Sixteen West (R16W), Town 'of Eau Galle, St. Croix County, Wisconsin, more particularly described as Lot 1 of Certified Survey Map, file October 16, 1998, in Volume 13 of Certified Survey Maps, page 3539, as Document No. 589195, Office of the Register of Deeds for St. Croix County, Wisconsin. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this L? C day of ti r ( ' 1998. * *Lyle N. Gunders n * - 0_�� *Sonja N Gunderson AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ r ���� l) Gvu STATE OF WISCONSIN 11,, ST. CROIX COUNTY k S h &V 6wtA Personally came before me this _ day of y 1999 the above named Lyle N. Gunderson and Sonja K. authentica d this l day of a f Gunderson to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. signature T1JdL,. -4j A c GorjmI L signature type or print name type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, My commission is permanent. (If not, state expiration date: authorized by §706.06, Wis. Slats.) .) THIS INSTRUMENT WAS DRAFTED BY *Names of persons signing in any capacity should be typed or Thomas A. McCormack printed below their signatures. Baldwin, WI 54002 Information Professionals Company Ford du Lac, Wisconsin 800-655 -2021 o ED Frr_ OCT 1 6 199 ► 2 589195 H.W roco »� UNPLATTED LANDS_ 2 1 C. S. M. 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