Loading...
HomeMy WebLinkAbout020-1331-10-000 j 0 cnp 3� 0 3 n 3 :* r1 (n S 'S z (A z C N O N. S -N O a N O (D O '2 D_ (D O V N O !� H1 N Do N N Q CP L N \ N C.0 p j W N - z U 7 Wm (D O W 0 N N N N N a j N O (p O V 0 0 0 C C N O A N �_ W O O N O W 0) N 3 fl. O °- fly p ~ y N W O C V � (n z V W m (3 ° N fl a N 00 00 N W Q O O O O Q O O O O L z j CD N O (o V Ut W 0 Zo� i� n 0 N (o (o O0 3 Q cn cn cn m O Cu m - CD -N CL m c N ca A A _0 O z z O C 0 ° D D ° N N d Al O CL !�1 • (D 0) W ° O � fD C N -I N I c C n N W (D (D G O j z 0 P 00 y Z Z W a 7 T 0) C o a CD z N O i III fi y A a ti N O O i z 0 N (D I Q Q (A p CD i b jv a =oo t �a 71�r �a�1 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count8 . CROIX • INSPECTION REPORT GENERAL INFORMATION (ATTAC RMIT) SanitaP1N7'SV-: Personal information you provice may be used for secondary pu ses [Privac L s.15.04 (1)(m)]. Permit Holder's Name: r; ± iIla ❑ Town of: State Plan ID No.: OLITOR, RONALD U17 CST BM Elev.: Insp. BM Elev.: BM Descriptio Parcel D2OQ -:13 31 - 000 TANK INFORMATION ELEVATION DATA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �? �� pv Benchmark Dosing t Y , , . b /, al M , °► 7 Aeration X Bldg. Sewer Holding ti S Inlet /p.-6 TANK SETBACK INFORMATION d PA Outlet )( TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet X Air Intake Septic (P ' a-� / N)p. NA Dt Bottom �� •� Dosing lr 33� NA Header/ Man. Aeration X X NA Dist. Pipe a Holding �_ ,� ' Bot. System 0�, J2� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift i��4 friction Syste TDHIM Ft Loss mead Forcemain Length Dia. �t Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r' No. Of Trenches PIT No. Of Pits Inside Dia. LiquiDepth DIMENSIONS '� DIMENSION x SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: x INFORMATION Type of CHAMBER model Number: System: VIA OR UNIT �L DISTRIBUTION SYSTEM Header /Manifold Distribution Pipes i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. � I I Spacing / (q of 3 - "02 S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /S•a� xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil (p ef Yes ❑ No RYes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 23.29.19,SW,NW 737 WALDROF FARM ROAD 1 c rc _ � 4r, ­t­­ : ics1 /_74 9 9- A,9 �. ; / T _ /3. F( / Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. F_ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i I , � 7 Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with ILHR 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 than 8 112 x 11 inches in size. 15 • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check`if bv"ision to previo�pli tion [Privacy Law, s. 15.04 (1) (m)]. Sate Plan I.D. Numb r -f % % C ph I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI N 51 I�! / �, / c a ? Prop ply Owner N m Property Location C C Cg 1/4 �U Cal i4, S p� 3 T 17 , N R (Or) Pro erty Owner's Mailing Agdre s Lot Number Block Number City, Staf e Zip Code Phone Number Subdivision Name or CSM Number T II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ Village Public W 1 or 2 Family Dwelling - No. of bedrooms Town OF 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbe -3. A9. 19 . 1 -3 J5 1 E] Apartment/ Condo d ,� v — 1 3 31- 16 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. New 2. ❑ Replacement 3 E] Replacement of 4 C] Reconnection of 5_ E] Repair of an ---- System ....... - System ___ __ _______ _ Tank Only _ _ - _____ Existing System _ - _ -r - _ 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 KMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -I n -Fi I I VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 15. Perc. Rate .6 System E]ev, 7. Final Grade Required (sq. ft.) Proposed (s . ft (Gals/da /sq. ft.) (Min. /inch) Elevation ysc� a, Fe Feet Capacity VII. TANK in Ca allo s g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks �ooG ❑ 1:1 1:1 E] El Pump Tank ber °— G�S� El ❑ 1:1 1:1 11 PONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' gnatu : (No St m s f MPMPRSW No.: Business Phone Number: Z112Z t/22&& Plumber�A dre s(Street, ate, tip ode):,,, ` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuin en ignature (No Stamps) Approved �07-N urcharge Fee) �� / ❑Owner Given Initial oS / Adverse Determination � � / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) 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 e6clul fes 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. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) crass section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. I L ---------------------------------------------------------------------------------------------------- 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. f ' Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 I sc0nsn Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce October 09, 1998 CUST ID No.267341 ATTN.• POWTSINSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST _ _ ST CROIX COUNTY PO BOX 74 g 1101 CARMICHAEL RD RIVER FALLS WI 54022 ,� t.` ' ^� Ifh1DSON WI 54016 RE: CONDITIONAL APPROVAL �`��- APPROVAL EXPIRES: 10 /09/2000 ;` -` VII Identification Numbers Transaction ID No. 180727 ST ;ti �� Site ID No. 161428 SITE hX f ` ?v' Please refer to both identification numbers,; Site ID: 161428 ,r�ti� ING p F above, in all correspondence with the St Croix County, Town of Hudson ' r �. .',` `, agen SW1 /4, NW1 /4, S23, T29N, R19W Evergreen Estates Subdivision - Lot 11 Richard La Casse FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 428886 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(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 construction /instal lation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. &rard y, De_ R DATE RECEIVED 09/30/1998 FEE REQUIRED $ 180.00 M. Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us i • Page of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE W 1 /4 OF THE WW 1/4 OF SECTION Z3 ,T N, R_W, TOWN OF VOSo Iy . ST c�t1UC COUNTY, WISCONSIN.. INDEX RFC sqF SF � ��FO PAGE 1 •of 6 TITLE SHEET FT PAGE 2 of 6 PLOT PLAN ` PAGE 3 of 6 PLAN VIEW -CROSS SECTION-: �l' PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT GS PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE p.0 ally PREPARED FOR Col &t,On LA C ssE cLS e� ID �2Z,o DRkljoo\�: LP\1JE N-v0 sow, wi s 4 v � � �.F�'�t' %` cS =•' PREPARED BY WEGEE;tER SO I L - TEST 11\ (3 t37itt DES 3C GIV �SEFZV I CE °gyp �► F.O. BOX 74 421 K. KAIK ST. RIVEF. FALLS. KI 54022 WECE EA 7I5- 425-0145 FLLS I A"i �..N. JOB NO. 98- ZS3 - PLOT PLAN • Page Z of � Scale 1 "= SO ' 1 k-4 it; OF 5 Lo V1 WT \\ 'ZOO c� B..Z \ t:. too 14 titT e5'elpf r \ oR DA51T11z b T A% ftNu'm 2$ �MUV\Z l'.1 N 101,5 /c3. w ��• to 2.S \.a► T `S NOTES .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be \poplbSO gallon capacity manufactured by �'\ b w ESTE�N X:>VZ_k�r, A 5. Bench Mark U .' tbo • b' ON l" R-O►.� PIPE 6. Divert surface water around system to prevent.ponding at the uphill side. Page 3 Approved Synthetic Covering �sYM :c 3 3 Distribution Pipe Medium Sand Topsoil =�.H .._ G F Elev: 10 3 � In b % Slope Force Main Plowed Trench of ,2 "-2.1,2" From Pump Layer Aggregate Undisturbed D t,0 Ft. Soil E \,•\S Ft. Cross Section Of A Mound System Using F o• t Ft. 1 Trench For The Absorption Area G N• Ft. A S Ft. H 1• -e� Ft. B -- )S Ft. I \ S Ft. Linear Loading Rate= It.•b GPD /LN FT J $ Ft. Design Loading Rate= o - N GPD /SQ FT K 10 Ft. L ° 1 S Ft. e usition ee Main W Z�) Ft. Force B K Main W" Distribution \ "-Trench Of 2 Pipe Aggfegate 1 Observation Permanent Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page Of . 6 Perforated Pipe Oetoll — 0 J """ End View ) Perforated End Cop.) .oe�c >1 PVC Pipe i. Install permanent at end of each lateral Holes Located on Bottom, Are Equally Spaced Q End Cop P �•'1 * PVC Force Main i pistnoution Pipe Lost Hole Should Be ' Next To End Cap Distribution Pipe Layout P 3q• S Ft. X 3t Inches Y 36 Inches Hole Diameter !Jy Inch Lateral 1 Inch(es) Manifold Inches Force Main " Z Inches # of holes /pipe \'Z- Invert Elevation of Laterals Ft. 4 Place lst hole from tee with succeeding holes at 36" intervals.. Last hole to be next to the end cap. Combination Sept,.ic; Tank and S OF b PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS' PAGE. • - VEIJT CAP WEATHER PROOF iLIUCTIOIJ 86X y' -C:I. VENT' PI'PC APPROVED. LOCK110ra ,; FROM DOOR, MANHOLE COVER t"Ji* . j11JDOW OR FRESH wNSLIinia LI�BEC.. ALR WTAKE S a0wDulr s IJ 6 hnx. I �"Mlu. • .(�yM161, I(sfZ,A I � 18' /MIIJ. y PIPt ' PROVIDE -- IAIL.ET — AIRTIGHT SEAL 84P1=L�S I I I APPROVED JO1IJT: APPROVED JOIAI A � I I (( W /C.I. PIPEP'C W /C.I• PIPEaR Tank construction I I I shall comply with - I I I ALARM ILHR. (83.15 and 33.20 o i 1 I I 0M C I I °13. I LLLV, T. PUMP —� - -� OFF COKICKETE Q3.00 BLOCK S DDINC, D RISER EXIT PERMITTED OIJLy IF TAUK M E. AUUFACTURR HAS SUCH APPROVAL BEDOtN4 SEPTIC E 5PCC.IFI C ATIOKIS DOSE �� UUMDER OF DOSES: 3- 4 PER DAB T/.WK MAIJUFACTURIZK: TAWK 51ZL: tOUO /6S0 GALL.OIJS DOSE VOLUME I ALARP AUUFACTURC.R: S.S. �L�LTRU S�j�'}'015 IMCLUDIUG OAGKFLOW: � '1 M GALLONS MODEL IJUMBEm �� l �AW CAPACITIES: A= 12 0 IIJCHES OR D I O GALLOI,IS SWITCH TYPE: �� B= - 1 IIJCHES�OR G( LLOUS PUMP MANUFACTURER: CjOVL -DS C= 9 I u [HES OR GALLONS MODEL UUMDEK' 35 1 D- 21 IMCHHEESt,OR V& GALLONS SWITCH TYPE: MOTE: PUMP AUD ALAiIR ARE TO bE MIMIMUM DISCKARGE RATE Z �S' G S GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AIJD.DISTRIBUTIOU PIPE.. °`- FEET + MIIJIMUM METWORK SUPPLY PRESSURE . ; ... .. 2•SO FEET -1- Z S FEET OFF /1111IJ X 1 ' 61 FYoo►i.FRIC11otJ FACTOR.. La i FEET TOTAL 09UkMIC HEAD = b FEET DIAMETER Pump chamber 36 IIJTERIJAL- DIMEIJSIOIJ� OF TAIJK: LENGTH ;WIDTH - ;LIQUID DEPTH BOTTOM AREA - 231 GAL /INCH AS PER MANUFACTURER = � .p• . ' GAL /INCH n� 60F 6 Goulds _ Submersible ........... Effluent Pump EPO4 EP05 APPLICATIONS Fasteners: 300 series • Fully submerged 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. tic cover with integral handle Available for automatic and • Farms Motor: and float switch attachment • has P, • EPO4 Single e: 0.4 H manual operation. Automatic points. Heavy duty sump 115 or 23 V, 60 e: 0.4 H0 models include Mechanical • Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering automatic reset. preset at the factory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump:'EPO4 built in overload with construction. Plastic Semi -open design • Solids handling capability: • automatic reset. ■ EPO4 Impeller: Thermo - /4 maximum. Power cord: 10 foot AGENCY LISTING • Capacities: u to 55 GPM. standard length, 16/3 SJTO with pump out vanes for p r mechanical seal protection. Co. Canadian Standards Association Total heads: up to 24 feet. with three prong grounding E EP05 Impeller: Thermo- • Discharge size: I NPT. plug. Optional 20 foot p (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "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 9 30 5 components. i Pump: EP05 8 • Solids handling capability: c 25 3 /; maximum. a W. • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. g • Discharge size: 1 NPT. Z 5 • Mechanical seal: carbon- } rotary/ceramic - stationary, ° 4 15 v3 L BUNA -N elastomers. j PaS Temperature: 3 10 104 °F (40 °C) continuous va. rj 0 140 °F (60 °C) intermittent. 2 £PO4 5 \ 1 3 0 0 F 10 20 30 40 50 GPM L _L L L L 0 2 4 6 8 10 12 m CAPACITY 0 1995 Goulds Pumps, Inc. Effecti M ay, 1995 Wisconsin Department Industry SOIL AND SITE EVALUATIO Labor and Human Relations N Page / of Division of Safety and Buildings in accordance with S. ILHR 83.09, Wis. 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 ST G�oi X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # PeND G-- 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 q IIOA9340 L-41VP L'o/P Govl..Lot SGV 114NW 114,S 2-3 T 2 � ,N,R E (or)(0 Property Owner's Mailing Address F S T Lot # BlockIf Subd. Name or CSM# 337. 1 iVAJa:sorA- Sr . �� L CT . �� �vERIr v 7 5T�-TES City State Zip Code Phone Number Nearest Road 11&, f. J'1 ST PA L- NfN� �s 1 (� z) ZZi- 5S5S � Civ p vinage %R ar k. A�Elw_y R,9 . New Construction Use: ETRasidential / Number of bedrooms 3 — L4 Addition to existing building ❑ Replacement ySv - El Public or commercial - Describe: Code derived daily flow & 0 0 gpd Recommended design loading rate bed, gpd/fl _trench, gpdM Absorption area required bed, ft trench, R Maximum design loading rate bed, gpd/ft • 5 trench, gpd/ft Recommended Infiltration surface elevation(s) 1 ✓ r EE / 3 it (as referred to site plan benchmark) Additional design /site con ations S� �.t /� -� sYs T . Parent material 5C-5 8 t T ' 5 4r",6 — E 110-P '!s • Flood plain elevation, if applicable N� ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 0 s a6 EK CJ u I O S Lei ❑ S ©- p s O s SOIL DESCRIPTION REPORT Boring # rHodzon Depth Dominant Color Mottles Structure GPD /ft2 In. Munseil Qu. Sz. Cont. Color Fi Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench i o-7 /0 YX 3/ s I^•f2 C S /7 y .5 z -- 2 o Y 31 � -t Ground elev. Depth to limiting factor LE Remarks: Boring # z 49_1q 10a 316 �Fs el , Y S Ground 17 A Y,, S�� ✓ .� '� ; . elev. Me? 16 Y 6 SiC& /fs�i mow► �� ' 4 Depth to limiting factor 3 _In. Remarks: CST Name (Please Print) Signature Telephone No. ROBERT `2tL6Ri CST"' �' 7/,5'• 3gee Address Date CST Number Ilihirlpht i tes t �y ��� C57' L Vet_ Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGi 1 PROPERTY OWNER /' SOIL DESCRIPTION REPORT Page of 3 PARCEL 1.01 L j w 6 ` Boring Al Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 17L y 5 2 -1 o y J7Z- 17C Ike Ground S 3 /O S' l SIC elev. 0 Depth to F 2� S Qi S' i*4 QG 7 ; •� limiting factor 3-5— in. �� !� l © S Remarks: Boring # Lj Ground elev. tt. , 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 # Ground elev. tt. Depth to limiting factor in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor , In ' Remarks: SBDW -8330 (R. 08/95) { A Z30 v i o� 1 � a Q a l � \ o c y � � r �y A 0 �j , vi o0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Addres /�i //,.¢ © & evj Z c. 4Mjryd �' `10 7 Property Address _&I W..dd)zdkz: 4 4� d Z�; (Verification requited from Planning Department for new construction) City/State J4 u A , 6� cis Parcel Identification Number (0 -;� (O - 13 � ' /a LEGAL DESCRIPTION Property Location l t) ' /,, -AL&}'/., Sea 70 , T Z q N -R > W, Town of Subdivision e Lot # � . Certified Survey Map # Volume . Page # Warranty Deed # u l L Z `Z Volume / .� 7( . Page # y( 7 Spec house ❑ yes U Lot lines identifiable a yes ❑ no SYSTEM MAIlVTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, 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'3p days the rbar expiration SI GNATURE O ICANT DATE OWNRR 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 perry des ribed above, b irtue of a warranty deed recorded in Register of Deeds Office. / 1 // GNATURE OrAPPUC7kNT DATE I • * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** 1* 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 � L 467 591 WARPLVNTN' DEED Document Number REGITE�` 0F 'CE 4; ST, CROIX CO., W! Return Address 147U 1 1998 fz. EAGLE Y BANK, N.A. 1301 Rd., Unit 2 L '`� R f • r e: a: `!-' A{ H. 54016 ..�,. Parcel I.D. Number:e., K . LaCasse Custom Homes Inc., a Wisconsin G-rporation, _ conveys and warrants f I to to Ronald D. Molitor, a married person the followinb described real estate in St_ Croix County, State of Wisconsin: } Lot I I Evergreen Estates in the Town of Hudson. St. Croix County, Wisconsin. ;� 1 : This is not homestead property. i 41 t Exception to warranties: Easements, i.:strictions and nzhts -of -way of record, if any. ' _ Dated this day of November, 1993 s TRANSFER LaCasse Custom Homes, Inc. $ 7 _5_� �'l J TEE k « .'; By (SEAL) Richard W. LaCasse, President ACKNONN LEDC MENT _ STATE OF WISCONSIN ) ' = ) ss r COUNTY ) r Personally came before me this ! q day of November. I99$,,tho.above named LaCasse Custom Homes, Inc by Richard W LaCasse President ;Io be the person(s) who executed t the foregoing instrument and acknowledge the same- i; . • {` Notary Public ti County, XVI My commission ,:xpires THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 v s O A I Jj ,..• a. 0 3 lots Ol b Cs , `\ S o p oo O \ N ! W \' W N CD Ul n 2w a o w o0 Q m ' �; a °� > IV rn W i m I N00 °13 54 "E Z o 190.00 A r o I� I A v — i 01 m m m N N OD lU N r nom A Z I cr O�m� m N00 O D n ° �� rn 230.uo' D N n O m D U) oI om aoAm N m U) -<< c m c ?. m ° c m � z I v° 0 >< � zN A — (n (n m D • O x m n in to O -.1 m W W w m N O° z D m o -° v o w 4 m (p N r m Lp ao A z m m w Z O c �. N n m U1 p m LA I D I CO o— _ p 00 0 m o m 7 0 W N La � .......I.....�' �_. 69 . 9 33 ?'e6• � '. l lll D ° z O M O W O O \\ O6 O 01 D M m ` � Q y �, •� •, Lo+ � � a ✓�q� � �Fi fr pp ,�,v nn `: �e� 1 �i �� '1[uw �n 0 t �� � vy 9� N M • � v �. �• .� ,f t � r 1 , 1 1 � �` � � — ,- ..,.�. � 8 8 i , ,�