HomeMy WebLinkAbout016-1073-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safeiy and 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)]. 344699
Permit Holder's Name: ❑City ❑ Village R Town of: State Plan ID No.:
Glenn Tirn Bet Town of Glenwood x.147 cjs
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
°n •a rte- Q r 016- 1073 -10 -000
TANK INFORMATION ELEVATION DATA a`I , a'U, (.S0 Ala.
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic um „-- �� Benchmark A2— it4ct2 crp, a
Dosi ng Alt. BM
Aeration Bldg. Sewer (<, dP
Holding St/ Ht Inlet
TANK SETBACK INFORMATION H
TANK TO P/ L WELL BLDG. Air I to ntake ROAD
Air
Septic NA Dt Bottom (Z- 20 91?, Z
Dosing >300 li oZ NA Header / Man.
Aeration NA Dist. Pipe 2 00,6
Holding Bot. System ¢a I0.
PUMP/ SIPHON INFORMATION Final Grade ,
l( Isar I8`+
le Manufacturer Dem St cover ` D
Model Number � L o�'�GPM 1ST Cr„V1 a, � O Z.
TDH Lift( p�O�x Lriction X95 Systema* Sf TDH`Q 0 Ft
oss
Forcemain Length.v5 Dia. He u Dist. To Well
SOIL ABSORPTION SYSTEM
aECO TR H Width Lengt No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIM I 0 kS L DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC�! G Ma
INFORMATION TypeO CHA Model Number:
System: 0D �' NIT
DISTRIBUTION SYSTEM
Header/Manifold u Distribution Pip eis) �9�^ ( µ x Hole Size x Hole Spacing Vent To Air Intake
g Z Length ` rn� Dia. Spacing N //(
Leng lQi Dia. `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: 11 /0/91 Inspection #2:
Location: 3047 130th Avenue, Glenwood Ci , WI (SE1 /4, NW1 /4, Section 34 T30N -R15W) - 34.30.15.513
�•$ a / ,, m4o c HT = y -
a
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Plan revision required? ❑ Yes X No
Use other side for additional information.
ZC SBD -6710 (R.3/97) k ate C��` S Inspector's Signature Cert. No.
•
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
Visconsin SANITARY PERMIT APPLICATION 201 B Washington Avenue
Department of Commerce In accord with Comm 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 C
than 8 1/2 x 11 inches in size. C f^o /
• See reverse side for instructions for completing this application State Sanitary Permit Number
3q 6Sol
Personal information you provide may be used for secondary purggses ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. D q,+ 1 z v3_99'`"a.• ��e�►% p `� .
l't�T _ State Plan I.D. LD. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Ow Name rope Ay
� y I_ S va � d 1 /4,S T ,N,R or
Property Owner's Mailing Address, ; Lot Number Block Number
A, 22 7/f
City, 5tate Zip Code Phone Number Subdivision Name or CSM Number
z- fd f. "'nor �� (71 ')
.TYPE OF B IL IN : (check one) ❑ State Owned Vi l l age l Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ? own of C'��r! /.r�ODO1 130 nv .
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) �q- 3p ,
1 ❑ Apartment/ Condo alb - /6 7-3 — AP 000
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/ Mote[ 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. lew 2 E] Replacement 3_ ❑ Replacement of 4. E] Reconnection of 5. E] 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 'Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit t 43 ❑ Vault Privy
14 [] System -In -Fill M"
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
J
Required (sq. ft.) Proposed ( sq. ft.) (Gals/day/sq. ft.) (Min. /in ) Elevation
/✓ .� Feet 400 03 Feet
Capacity
VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank /ZS0 gp �� ODO ' / st✓'�'� El El ❑ ❑ El
Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
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 tamps) MP /MPRSW No.: Business Phone Number:
D.
Plumber's Address (Street City, State, Zip Cod ):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps)
Surcharge Fee) Q
PoA pproved ❑ Owner Given Initial OD
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
7
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 pumpee 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.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the folT owing: 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; Q 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
2226 ROSE ST
LA CROSSE WI 54603 -1905
Vhiconsin Tommy J Thompson, Governor
Brenda J. Blanchard, Secretary
Depart of Commerce
March 17, 1999
CUST ID No.6306 ATTN.• POWTS INSPECTOR
BOLDTS PLUMBING AND HEATING INC ZONING OFFICE
820 MAIN ST ST CROIX COUNTY SPIA
PO BOX 87 1101 CARMICHAEL RD
BALDWIN WI 54002 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 03/17/2001 Ide Transaction ID D a N ers
iroo. 2141
Site ID No. 168326
SITE: Please refer to both identification numbers,
above in all correspondence with the agency.
Site ID: 168326 a e . p_ - � y
St. Croix County, Town of Glenwood
SE1 /4, NW1 /4, S34, T30N, R15W
Facility: Tim Glenn
FOR:
Description: Mound
III
Object Type: POWT System Regulated Object ID No.: 454947
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.
Note: Changes to plan resulted from telephone conversation on 3/17/99 between the designer and this reviewer.
A copy of they 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 03/10/1999
` 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 WiSMAl2 ,gpde:
BOLDT's
"V LL L
"W Ld J 1
.j j"eAj R
PLUMBING & HEATING INC.
"Serving You For 40 Years"
820 Main Street Baldwin, W154002
(715) 684 -3378 Fax (715) 684 -3144 Page Of 8
Date: 3
°} Mound System For
01 A b edroom Residence
•; 31"`sc i
Located in the - 1 /4 of the Nl ) 1 /4 of Section ,�, T3T, R
Town of G'�e r, t yoo , Sf C,-o; x County, Wisconsin.
Index
Page 1 of 8 Title Sheet
Page 2 of 8 Plan View Cross Section
Page 3 of 8 Distribution Pipe Layout
Page 4 of 8 Pump Chamber
Page 5 of 8 Pump Performance Curve
Page 6 of 8 Soil Evaluation Report
Page 7 of 8 Site Plot Plan
Page 8 of 8 Mound System Plot Plan
p,p.VN.T•s•
C,11ditiona lt y
A P P P ON ED Prepared For:
ENT Of CO L
[)EPA R fE Np LDINGS
p VIS ►
SEE CORRESP ENCE
7/5- 0l 9- 5383
Prepared By:
Dale Hudson
Certified Soil Tester / Master Plumber #220863
PagejOf S
Cross Section Of A Mound Using A Trench For. The Absorption Area
A-S M
Medium Sand Fill � I ° F 6" Topsoil
3 E 0
Trench Of 2" - 211" Aggregate,
Plowed Layer
6" Below Pipe, Covered With D /D Ft.
Straw, Marsh Hay Or Synthetic Fabric
E / /L Ft, Ft.
F - 75 Ft. H Ft.
Plan View Of Mound Using A Trench For The Absorption Area
Force Main
Distribution Pipe
Permanent Markers Observation Pipe
A o - --------- - - - - - - - ---- - - - - - - -- - - - - -.
W I B 1
r K
I
\Trench Of - 2 Aggregate
E' L --
A Ft. I Ft. K /Z Ft. W Ft.
B _]_C.� Ft. J Ft. L // Ft.
�� License 2
Signed: �,� G �,-�� Number: ZZo853 Date:
Of
Distribution Pipe Detail For Two Lateral Network
Holes Located On Bottom
Are Equally Spaced -PVC Force Aain End Cap
I Y X rX PVC Distribution Pipe
P P
X
* Last Hole Should Be Next To End Cap
P Ft. Hole Diameter y Inch
X Inches Lateral Diameter A Inches)
Y qg Inches Force Main Diameter Z Inches
# Of Holes /Pipe
Invert Elevation Of Laterals 9 9-53 Ft.
Signed:
License Number: 2ZOg5 ,5
Date:
SEPTIC TANK & PUMP CHAMBE CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF
>— 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
FINISHED GRADE 4" CI RISER W/ PADLOCK &
6" MIN. WARNING LABEL
ABOVE GRADE —�_ --4" MIN.
18" IN. 6" MAX.
L l
i
INLET
I '
WATER TIGHT SEALS GAS-
. ,
TIGHTS ,
4 BAFFLE P' SEAL i APPROVED
CI PIPE i ALM JOINTS W/ CI
3' ONTO B ON PIPE 3' ONTO
SOLID SOLID SOIL
,
SOIL C PUMP OFF ELEV .9 I6 FT. -- I OFF '�^ RISER EXIT
D PERMITTED ONL'_
IF TANK
Cie Y, O J`.3� MANUFACTURER
3" APPROVED BEDDING UNDER TANK HAS APPROVAL
.3I'M CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE `1
TANK MANUFACTURER e� 5 NUMBER DOSES PER DAY: 7
TANK SIZES SEPTIC I GAL. DOSE VOLUME INCLUDING
DOSE CSO GAL. FLOWBACK: jz5.r�/� GAL.
ALARM MANUFACTURER: f , Z-_1 C�r CAPACITIES: A = Z O INCHES = 'WO,31 GAL.
MODEL NUMBER: X - ?
SWITCH TYPE: /-✓ rc,u B = 2 INCHES = �3O�6Z GAL.
PUMP MANUFACTURER: 610N /off C = $,Z INCHES.= GAL.
MODEL NUMBER : c 3/ (_
SWITCH TYPE: /e� y'GurY D = 12, INCHES = 193.,'7L
REQUIRED DISCHARGE RATE Z?.nB GPM PUMP & ALARM WIRING AS PER ILHR 16. 23 WAC
?.75'
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . .' ' . . . . ' 2.5 FEET
+ .SO FEET FORCEMAIN X /. /O FT /100 FT. FRICTION FACTOR .
55 FEET
TOTAL DYNAMIC HEAD = FEET
to, Q
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH �� DIAMETER
LIQUID DEPTH
SIGNED: 1��,� ���.✓ LICENSE NUMBER: DATE:
1/88
Performance Submersible Effluent
Curves Pumps -5- o -
METERS FEET
30 100
SERIES: 3885
SIZE
-1 RPM: VARI DS
ES
.. . ..... . ... ...... . ......
513M
5
x 20
6
o
A�
z
. .... ........ .. .
40
0 . .....
10-
N
. . . . . ......... ......... ........ . . .. .........
26-
... . ....... ... .
0-
20 40 60 80 100 120 140 160 U.S. GPM
'"'� CY>
�O m
0 20
Olt FLOW RATE
GOU LDS PU INC.
WATER TECHNOLOGIES GROUP
SENEC'A FALLS NEW tUM Bt48
METERS FEET
120 SERIES: 3885
SIZE: 1 /4 ' SOLIDS
35. RPM: 3450
110 5GPM
30-100 5 Fr.
90
w 25- 80
70
20-
z 60
I X
-.1 15- 50
10- 30
20 — — —
5-
10--
o L o l — I
0 10 3 20 30 40 50 60 70 80 90 160 110 120 U.S. GPM
0 10 20 30 m
CAPACITY Effective July, 1993
®1993 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A.
W, S' -' n e N" '_ _ L), _ +
?? 138853450
-/ - 6 e
Wiscot pin Department of Commerce SOIL AND SITE EVALUATION Page < of g
Division of Safety and Buildings
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent dope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all Information. Reviewed by Data
Personal inlonnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner / Property Location
Govt Lot SZ- 1144&)1 14,S3 T3O,N,R 15 id(odg
Property Owner's Malting Address Lot # Blocc# Subd. Name or CSM#
z /-5 sy: I A14
Z State 23p Code Phone Number El city ❑ Village I Town Nearest Road
w )i , ,Alpo ^r.J .5i/ol 1 ( 71 ) ze /6 -5383 6' /e �voo /30' = ,9 ✓� .
�C] New Construction Use: JN Residential / Number of bedrooms 3 Addition to existing building N
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate ` 2 bed, gpd/ft - - - 3 trench, gpd1ft
Absorption area required 375 bed, ft -3x75 trench, ft Maximum design loading rate r 7� bed, gpd/ft ° J r trench, gpde
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design/site consid rations ` ,, /
Parent material S1 �f V �1r/JT �� a K �.� �oQ rr► Flood plain elevation, if applicable � 1/h it
S = Suitable for system Conventional I Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S 0 u 2 S El u ❑ S B U ❑ S BU ❑ S 'M u ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/11:2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
13 l0 YII 3 Y A 1 A rl S�� ZC -5 LL /0�r Q 3470
Ground 3 - /o YR 32 C 2 o l 751A 78 S /''� m �,r G w zvv ' 3 • `�
`J
.57. -Sp /a YK YZ— 75Y-P! ICs I» 7— 'F a y
Depth to
limiting
factor
Remarks:
Boring #
j . o -� /oY s ►tic. Z r - TLk I r 0 5 -3 c o - :, 3
,Z Z / /o Yr S" A'�4 r- aw 3 -Z ; -3
3 - scs
21Z Noe) ccv z> -3 . y
Ground Y 1 3 1 - 3 40 YN 'l e— C Z of 7° Z f -3
973' �.
,
Depth to
limiting
factor
3/ in. Remarks:
CST Name (Please Print) Signature Telephone No.
/.e "� ; o5 - - 337 g
Address Data CST Number
<,?Z �; S�, i ��r�v �J, 5���� 7- Zos57 3
SOIL DESCRIPTION REPORT '
PROPERTY OWNER P490 Of
PARCELID.#
Boring # Horizon Depth Domir>e d Color Mottles Texture Structure Consistence Boundary Roots 2
IM Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed . Trench
3 I 0- /O Y Y3 /l/D rI C S� C$ 14 0-5 .ace, Z • 3
Z V Zy io YR shy �� 6 s/ �n �',� a L-? 3,r- • Y -
Ground .3 `� /O YR 6/L /t/O n G Sc, I /c S n? C (.J 2- , , . , - °Z : • 3
e lev .
it -36 WK y Ud 7• 1 9 -Sr-
Depth lo
factor
Z 8 in.
Remarks:
Boring #
Li
Ground
elev.
ft ;
Depth to
fimitin9
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD,le
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench
Boring #
Grouted
elev.
ft
Depth to
limiting
factor
' Remarks:
Boring #
13
Ground
elev.
Depth tt
to
pmf
factor
In. Remarks:
SBD -8330 (R. 07/96)
w►'1E. *. � � 6 7 b
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in ayoh S. ILHR 83.09, Wis. Adm. Code
J t`� �,,�
Attach complete site plan on paper not less th 18 11 inch in size: Pfalr ust CoCounty include, but not limited to: vertical and horizon ran d ce to irection
d st", �' r•
I i
� l
d G rl ` t road.
p ercent slo p e scale or dimensions north arr �., ocat •�� Parcel I.D. #
n.,r ,Q p �
APPLICANT INFORMATION - Plea �ee�rrintaHq'f �titSh, i Reviewed by Date
�tx /
Personal information you provide may be used for dary purposetff"WYLaw, s. 15 1 (m)). G p •ja 5 v
Property Owner ;� party Location
Govt. Lot S� 1 /Wf,)114,S T ,N,R �� pf(o�
3 �a
Property Owner's Mailing Address Lot # Block Subd. Name or CSM#
s't. �4
� 7 / Sta C ode Phone Numbe ❑city ❑Village Town Nearest Road
) VFW 7� . / G' N rJ7p � a Gf/i , S 70% � 7/j ) Z� /E' X5393 - rvon �3U "t �1 ✓ �
,® New Construction Use: IM Residential / Number of bedrooms 3 Addition to existing building NX
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow Y 5 7 0 gpd Recommended design loading rate ° Z bed, gpd/ft ° 3 trench, gpd/ft
Absorption area required 3 75 bed, ft _37 trench, ft Maximum design loading rate bed, gpd/ft __ ° - trench, gpd/ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site consid rations /
Parent material _T )z /'�?ri'J �� "'d /00,> Flood plain elevation, if applicable / 1/� ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ s 2 u Im S ❑ U ❑ S 2 U I EIS 'N U I ❑ s ,a U ❑ S 21 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
y , 3d le XR1 5 16 �o c, s ,^ lc s /n � � 3 ,-► - 5
Ground : j - /n /� Z r' Z 7 SY�f / 1 57/ �'%' /r3 �r G W 2 rte, ' 3:
`
�e$I ft. Y 37- 10 Y Z / X Z_ d ? S YK 9$
Depth to
limiting
factor
Remarks:
Boring #
L3 C 5' /rI ✓ Q5 -3 co
z - l /o r $" �n r Ar 6 rn era 3
3 / 3 �a z Nome, & 0 C,W -3 - y
Ground 13 1-3 1 Ir Z 2- C Z c4 7.5 Y 98 c ) .2 • 3
elev.
t'Z ft.
Depth to
limiting
factor
Z/ in. Remarks:
CST Name (Please Print) Signature Telephone No.
7i�5- &; F� --3379
Address / �,/ Date CST Number
I
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # won Depth Dominant Color Modes Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench
Ground 3 y Z� �'n Y1t' E �� C tO Z
e .
Depth to
limiting
factor
Z 8 in.
Remarks:
Boring #
13
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 #
E3
Ground
elev.
ft '
Depth to
limiting ,
factor
in. Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
� Remarks:
SBD -8330 (R. 07/96)
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MPIC57' 22 c
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J 1 l;11LU12L UUUNIT
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Ov
Ma 11C� rnond .
Pro P
Cit) 73
Prof f lenw00
l
Subdivision Lot #
Certified Survey Map # ' f . Volume . Page #
Wananty Deed # `t 3 Volume 1 a . Page # f -7 4
Spec louse 0 yes ® no Lot lines identifiable yes ❑ _ no
SYSTEM .MAINTENANCE
Improper use and maintenanceof your septic systcmcould result is its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every throe years or sooner, if needed by a licensed pumper. What yon put into the system
can affect do frmcdon of the septic tank as. a treatment stage is the wade disposal system.
The property owner agrees to submit to St. Croix Zoning Depacimea t a certification form, signed by the owner and by a
masterAWAME joumeymanplumber, restrictodplumberor a licensedpompervecifying that (1) the on-she wastewaterdisposal system
is is proper operating condition and/or (2) after inspection and pamping.(if necessary), the septiatank is less dran 1/3 Aill of sludge.
Vwe, the undersigned have read the above r eVimments and agree to maiaui fue private sewage disposal system with the standards
set forth, hero, as set by the Department of Commerce and the Department of Natural Resources; State of Wisconsin.. Certification
sbft that your septic system has bees maintained must be completed and returned to the St. Croix.County Zoning Office within 30
days of the da+ex y 'oa date.
SIGNATURE idF APPU&NT 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 dascnbed above, Lc of a warranty deed recorded in Register of Deeds Office.
;go/ QQ
SIGNATURE O PLICAN DATE
« « « « «« Any information that is nits - represented may result is 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
J A `
VOL T342pafl.74
S 83434 /� C7J`t 34 STATE BAR OF WISCONSIN FORM 2 — 1982
WARRANTY DEED ;
DOCUMENT NO '""..""" "`...,. ". "'"""`
Ma
ORM
LaDonna J. Hutchinson Rfr:'d tvr �!gf!49
JIL 2 2 1998
9:30 AM
conveys and warrants to Timothy W Glenn and Mary ,E Glenn - ' « `+k 1
husband and wife RA stir of 9*0t
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St Croix County,
State of Wisconsin: Van Dyk, O'Boyle & Siler, S.C.
Dat_Q1f1ce_ -8ax 127 _ . -
- New Richmond, WI 54017
016- 1073 -60: 016 - 1073 -8 -100;
PARCEL IDENTIFICATION NUMBER
016- 1073 -95 & 016 - 1074 -f0
li E 1/2 of SW 1/4 of NW 1/4 of Section 34- 30 -15.
E 1/2 of NW 1/4 of NW 1/4 lying South of Town Road of Section 34- 30 -15.
I� All that part of NE 1/4 of NW 1/4 lying Sly of East -West Town Road and all of SE 1/4
of NW 1/4 of Section 34- 30 -15, EXCEPT Lot 1 of Certified Survey Map in Vol. "12 ",
Page 3469, Doc. No. 581027.
t.
ANSFER
This is not homestead property.
7E (is not) a
� Exception to warranties: Subj to all easements, restrictions' and covenants of record.
i
Dated this day of A.D., 19 98
I�
,( A (SEAL) (SEAL)
* LaDonna J. Hutchinson
(SEAL) (SEAL)
*
AUTHENTICATION
/I ACKNOWLEDGMENT
Signature(s) �q �Otn vtA ., N�t"YGki ✓1 &On State of Wisconsin,
ss.
County
authen 'sated this �y y oof v. 19 Personally came before me this day of
� Jim ���!+�% 19 ,the above named I�
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, WK Slats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS IN LRU EN WAS DRAFTED BY
Rona
VAN DYK O'BOYLE & SILER S.C.
ce ox
New Richmond. WI 54017 Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expi rattion date:
necessary.)
• Names of persons signing In any capacity should by typed or printed below their signatures.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY DEED Form No. 2 — 1982 Milwaukee' Wes.