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HomeMy WebLinkAbout024-1019-50-200 a 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)). 353262 Permit Holder's Name: ❑ City ❑ Village ❑ of: S (0 3 4 ate Plan ID No.: nIMAR t"M Town of Pleasant Valle t 276 , 45 - 1 = T�a,�s• (0. CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: s0 , c7 " . Z) � C ST 6 M1 _�_ 024-1019-50-200 TANK INFORMATION ELEVATION DATA 1 (k.2$, 11, TYPE MANUFACTURER CAPACITY STATION �qBS HI FS ELEV. Septic �J � -�- 2S'a �S Benchmark 3 it) " �3 /ay. 0 Dosing l�C Alt. BM ZS ��.�Z4 �p4•(a� Aeration _ Bldg. Sewer Holding St /Ht Inlet 60 � 9Q, TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. VV,enttake ROAD Dt Inlet Septic /au ` / 2 — NA Dt Bottom , / ' 6 L Dosing - 35 -/ NA Header / Man. 2, r G Aeration - NA Dist. Pipe Holding Bot. System a,S3 / lo PUMP/ SIPHON INFORMATION Final Grad Manufacturer mand. Z �t cover Model Number a�. o GPM C3►k f 9`�i �� /dy- �, 0' TDH Lift ip L oss H iction � System TD H 7,44 Forcemain Length ( 0 1' Dia. 2 Dist. To Well S ` SOIL A PTION SYSTEM �--J "Jk TRENCH Width < Length ( No. Of Trenches PIT No. Of Pits Inside Dia. i th IM N t DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC M acturer: INFORMATION Type O r CHAMBE Moe u r: System: �S / r7 > 1 0 ' --------------- OR DISTRIBUTI N SYSTEM 2lto " z Header / M Distribution Pipe "' a x Hol Size x Hole Spacing Vent To Air Intake Length Dia. A— Length Dia. Spacing �p SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7Bed th Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center /Tr ench Edges Topsoil ❑ Yes N ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: s/ /" Inspection #2: -J--4 Location: 1738 30th Avenue, H moron �W11401�5 (SE 1/4 SW 1/4 16 T28N R17W) - 16.28.1 . 108D 1.) Alt BM Description r S , ) p 3 4 ((p ` = 2. Bldg sewer len h = - amount of cover = (82 °ji L_ (p (. SG o"� t (q) 3.) contour= �3 Plan revision required ❑Yes K No Use other side for add tional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: H a a f w : I E a } S ? t j i . _.w. ... ...._ � t g Submit to non - enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin municipalities for new 1 PERMIT APPLICATION Safety -and Buildings Division and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) SEE INSTRUCTIONS ON BACK OF YF _ -- Personal information you provide may be used for secondary pw T S ` ' .k T .d�a„ ? .. �,� 5Y•\N 'fin; Last Name First Name R if N s 7 ' -i Street Address City : State Zip Code Telephone No. (Include area code) t j Building Address Subdivision Name Lot # Block # 7 _) ? 30 C1 Legal Description Parcel No. Z" 1/4, L-,,/ 1/4, Section T N, R ! E or i 6 -.,,y . IV 1 Family 0 Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump -.❑ 2 Family ❑ Boiler [` Central AC ❑ Other: RGY y Nat. Gas L.P. Oil Elect. Solid Solar Space Heating ❑ [ ❑ ❑ ❑ ❑ ,. Water Heating ❑ ❑ ❑ ❑ ❑ (1�TD O y ATI' ® Site Constructed Concrete ❑ Masonry ❑ Treated Wood ❑ Manufactured ❑ Other (speci » ,►A '7. TIIAED BULDIN`G ....`2'' 'Living area , = Square Feet $ 0 7� I vouch that all the above information is correct, and understand that the issuance of this permit is fora mkstratiye purppses only. I understand that onsite.construction inspections will not be performed by the municipality, but that form D *lling Code,` - chapters Comm /ILHR 20 -25, still applies to all new 1- and 2- family dwellings and must be complie I u �jIVf 0hat the , issuance o is ermit es not,relieve me of compliance with other applicable codes and ordinanc s. s 2000 ;.. Lo Applicant's Signature Date "Signed 000NTY MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION Y AND BUIL Town ❑ Village ❑ City ❑ County of: �5UTNG r p1NCIPTY NI7MB�« N l ngLoeafloo �T SBD -8254 (8.2/98) ; White - Issuing Jurisdiction Pink - State Within 30 Days Yellow - Applicant INSTRUCTIONS The owner, builder or agent shall complete and provide all required information on the application form down through the Signature of Applicant block. This data is used for statewide statistical gathering on new one- and two- family dwellings, as well as for local administration. When completed, submit to local municipality having jurisdiction. Plan review or building inspections will not be performed by the municipality. PERMIT REQUESTED: • Fill in building address. • Fill in legal description of lot, subdivision name, lot number and block number. PROJECT DATA: • Fill in all numbered project data blocks (1 -7) with the required information. All data blocks must be filled in, including the following: 1. Type - Check only "1- Family" or "2- Family" if that is what is being built. In other words, do NOT use this form if only a new detached garage is being built, even if it serves a one or two family dwelling. 2. HVAC Equipment - Check only the major source of heat, not any supplemental sources. Mark central air conditioning if present. Only check "Radiant Baseboard or Panel' if there is no central source of heat. 6. Living Area - Include any finished area including finished areas in basements. For two - family dwellings, include total combined areas. 7. Estimated Cost - Include the total cost of construction, but not cost of land or landscaping. SIGNATURE: • Sign and date application form. ------------------------------------------------------------------ ISSUING JURISDICTION - This must be completed by the AUTHORITY HAVING JURISDICTION. Check off MUNICIPALITY STATUS of issuing jurisdiction, such as town, village, city or county. Fill in MUNICIPALITY NUMBER OF DWELLING LOCATION. If issued by a county, indicate the specific municipality number where the dwelling will be built. Fill in name of person issuing permit and date building permit issued. PLEASE RETURN PINK COPY WITHIN 30 DAYS AFTER ISSUANCE TO (You may fold along the dashed lines and insert this form into a window envelope.): Safety & Buildings Division P O Box 2509 Madison, WI 53701 -2509 C 3� Safety and Buildings Division S ANITARY PERMIT APPLICATION 201 W. Washington Avenue Vi sconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce 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. , CV I K • See reverse side for instructions for completing this application State Sanitary Permit Number 3 S­3 24 Z Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N 1 2 Propeqlpwner Name Property L � o 5 ation ^ Lk I, E1 /4 1 /4, S 16 T Z r Nr R /? X (or) 1U►� Property Owner's Mailing Add r ss Lot Number Block Number 1 758 3 /,>tu -e 3 City, tate Zip Code Phone Number Subdivision Name r CSM Number GJZ 5 4>15 ( -+- SM J 3 FT II. TYPE F B L IN (check one) ❑State Owned It Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF I� 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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. t�New 2. [ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ________System _____ Tank Only Existing System Existinc�S� stem 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'B Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure _� -� 42 ❑ Pit Privy 13 [] Seepage Pit t S X/ 0 43 ❑Vault Privy 14 ❑ System -In -Fill © j VI. ABSORPTION SYSTEM INFORMATION: 1 _ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation ( 1 /43D /v 7- Feet A,, Feet VII. TANK in allo Capacity Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing structed Tank Tanks / Septic Tank or Holding Tank El El 11 ❑ 11 Lift Pump Tank /Siphon Chamber 7 -� 1 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's . Sign a ture: � (No amps) P /MPRSW No.: Business Phone Number: A . Plumber's dress (Street, City, State, Zip Cod G 'Y.,' "` � / /: Z� Z IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) A roved r � pp []owner Given Surcharge Fee) � � � `Z �_ g � 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 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. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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 isto fill in name, license number with appropriate prefix (e.g. MP, etc_), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 *Mir sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 15, 1999 CUST ID No.226524 ATTN: POWTS INSPECTOR ZONING OFFICE ROGER L TIMM ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES; 11/15/2001 Identification Numbers Transaction ID No. 276751 Site ID No. 184079 SITE: Please refer to both identification numbers, Site ID: 184079 above in all correspondence with the agency. ST CROIX County, Town of PLEASANT VALLEY; 1738 30TH AVE, HAMMOND 54015 SEI /4, SWI /4, S16, T28N, R17W Facility: THOMAS BRUNSHIDLE 1738 30TH AVE, HAMMOND 54015 FOR: MOUND, 600 GPD Object Type: POWT System Regulated Object ID No.: 636912 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes . and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 11/03/1999 i FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA L SHANDORF OWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 Thomas Brunshidle - Mound Transaction # I I Location: Lot 3, CSM vol 5, pg 1363 SE 1/4, SW 1/4, Sec. 16, T 28 N, R,,17 W Town: Pleasant Valley pl County: St. Croix Date: November 1, 1999 cE �1GS Owner: Thomas Brunshidle Address: 1738 30th ave. Hammond, WI 54015 r Plumber: Roger Timm Signature: License # MPRS 226524 Attachments: 6748 -Plan Review Application SBD 8330 page 1: cover 2: ' calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve I , I page 1 of 7 r system Calculations One family residence A' bedrooms 0 'Sg allons /s ft per day Loading rate 9 4 Depth to ground water ">, 28 in Depth to bedrock ' in Cross slope S/ % Force main length S-+ ft of z in Manifold /header length 1-4(N ft of in Drainback �' gallons Lateral length @ ccs•o ft pf 2 in Lateral elevation ft (bottom of pipe) Lateral hole size �f in @ �O °' o in ( ° f t) spacing 'X0 holes /lateral, holes total Lateral volume 1S "s g gallons Total lateral discharge rate 3 ' ¢ gpm @ ' ft head Elevation difference t"� S� ft i Friction loss ° '�' 3 ft @ 2� gpm Total dynamic head �� "$ ft Pump /sij�ton �% gpm @ 2° ft of head Manufacturer S , Model k- Dose volume �LD l0 gallons Lift /sit>Xon tank x 1zsO ' ° gallons Septic tank , 12rO gallons Measurement pump on & off ' 3 in Height alarm from tank - bottom in Reserve capacity �"�} gallons calcs page of I SCALE 1"= y O '. I �.' x t oo• � r e.�e. b � (,tot .o� . l n � . o c`•�•S•o.w• VC s t ' s►ll _ Wt. too . o o rOt�.:aw m 6 N lQ 1Z ci 14. •+�/V �y �O 11.4Y. 9V T i • S3 a, g 1'70 Ylt a7'. I -. 1 /t•� wa.Z��� ��vX a�C a.v d 23 •z' I • � 1 4 r► V � L w+► 2.1C' 2 ;• 2 � I wo •O ` 1to•g� X: ` /L S TL� Qww �.r »:V' \:►`►4A►� � r- w•�a••1 � :.. a... �p T:..� .�, • . �`�' _ �..1..�. 1 ,.-1- a�.Jl 4o.»�•a,. `01��'0•... l: »e �, � ° 0� /(� •�-� <s•� � 1 LZ ct ' wE�rll ERpaoJF IL .JUIIGTION LOCKING C0v6.R fit Qy1CK D��G�wWCt --1 4~ C.T. IwRMiilaMMwM 12• 9 b .� Arilf / N x. V1o'ri 3 r0 WDIVU"EO 4 "C.t. Soil. 24 LD. Vf-wT uw K"U" a MIN. Air 2q }„ WQX ppPBOVLQ A C•t. "T auN ra BAFFLES �AL 3' on . pin - 4 . 2� . pN - Ir�asTU�w. W EGTION�r } GRO�wo 4 C. \0-s" r LCv, PuMtP I p •• b „ CoauE1'� . ow ���• 6c0CoC SEPTIC S PE C I F l'CATI 0AJ S T K MANUFACTUiICR: � WLIMAEK OF DOSES: 3 PER DAU TANK SIZE: it%LLONi DOSE VOLUME LAR MANUFACTUILGR: iT \" vO INCLUDIIJ& OACKFLOW: ' �° GALLONS MODEL NUMp[R: 1 1 CAPACITIES: A= WCHES OR 4 ' gW►LLOwS v.wwv ti� 2 "1 2.16 �u N s L W S P E ON 0 OWITGN Ty L. C 4AL PUMP MAAIUFACTURCR: i C• 1a•3 iWCHE5OR 166 6AL6,O — MODEL WUMDER: L '� O 0• �' IN�;HLS09 L IP•} Z OALLOWS SWITCH T%IPC: PUMP AIJD ALARM ARE TO 61L MINIMUM\ OISCIIAR" RATC _ -kA ~ GPM 1N5TALLE0 OW 5LPAKATC CIRCUITS VERTICAL DIFFEREWA OETWECN PUMP OFF AMD DIATRIOUTIOW PIPE.. } � FEET I + MIAIIMUM NETWORK SUPPLY PKtSSURE , . , _ FCCT ♦ FEET OF i MAIW X Y mortFRICTIOW FACTOR..._ FEET - --. ��+ ► TOTAL DyWAMIC. N� [ p ' g01 FEET � ILITERLIAL. DIMLWGkO/JG OF TANK: LEN6TN I UID ��..,.� ;WIDTH r.� ; L q DEP M ODEL 1 MO Vertical Sump Pump EPO4 EP05 • • Wks I GOU LDS , � . I a I Pump Specificatim METE RH FEET Up to 40 GPM '° MODEL: 3871 Discharge /H" size 1'b" NPT ° 30 Solids: maximum • Motor I T Single phase: 115V H Materials of Construction s - - Brass/thermoplastic 15 Enos Features and Benefits To • Top suction eliminates impeller clogging. z S • Corrosion resistant construction. o qp ,0 !0 90 40 so uaow, • Float actuated switch. 0 z , 6 H 10 i WAIN CAPACITY METERS FEET MODEL DVP03 Pump Specifications Features and Benefits • 4 h and 1 /2 HP • EPO4 impeller- semi -open design with pump out vanes to protect Up to 60 GPM s mechanical seal. TH Maximum head to 32' n • EP05 impeller - enclosed design Discharge size 11'/2" NPT P g 9 3- N . Solids:' /:' maximum for improved performance. 4 Y s ? Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides 0 o bearing construction. superior strength and corrosion 0 H To Ts M Ho 36 3• 3H +• u.S.s� resistance. Single phase: 115V 0 s + • • wn►jAr • Cast iron motor housing for CAPACITY Materials of Construction efficient heat transfer, strength, Cast iron and durability. Thermoplastic . Corrosion resistant threaded Stainless steel stainless steel shaft. • Available for automatic and manual operation. • GSA listed models available. All Models are designed for continuous o ration and feature stainless steel hardware. R o WmwnsinDepartrnentoflydusby, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations 9wisicn of safety & Buildrgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BR, direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. per? APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION / 2 R?EWED BY DA g PROPERTY OWNER: PROPERTY LOCATION LE" VQ lES GOVT. WT 1/4 SLV 1 /4,S S b T Z$ ,N,R \-) E( PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # V O \2k} 91 8 0 `Tl} ft . 3 — csM VoL . \Z - 3q [6 CITY STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE [)MOWN NEAREST ROAD �cW I X12. �tttt S �1 Syo z.L (l lS) 2 5 _ 56Z9 \�rtt 3tJ `M [)4 New Construction Use JXJ Residential / Number of bedrooms L/ [ ] Adddkn to existing building I ] Replacement [ J Public or commercial describe Code derived daily flow b �J'Z gpd Recommended design batting rate _ bed, gpolft -- trench, gp(W Absorption area required S 01 3 bed, ft S DO trench, ft Maximum design loading rate - 5 bed, gpd/ft - trench, gpdM' Recommended infiltration surface elevation(s) % It (as referred to site plan benchmark) Additional design / site considerations "u"%-A) w/ W �6 3 "Inl 1, L}wt N - Z " 01= S P, M L Parent material "t— I Pre 'rl L - Q Flood plain elevation, if applicable y'- A - ft S = Suitable for System CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system 1:1 S 0 U 19S 0 U ❑ S 199 ❑ E 0 S M'U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Coto' Gr. Sz. Sh. Bed Tench � o -� 1p� -tIZ 3/Z — sit ` Z�sb1R w�`F1� �S �� -s •b Z g 2.0 ► R fly s t I Zrrl s un lrrt `fit- Ground 3 2032 - SIR3l el ev . fft. 4 3 2-1/9 1.S'-clz -Y/4 � s1 tinv'f� 3 •`f Depth to limiting factor 3'Lv Remarks: Boring # , o - 1 6 L 3/z — Sr1 z'�sb1 tZ V/y mi► - S S Y lZ 31y 1_ 1 C- S � Vr I» U'ft- C K�) — y ' • S Ground sc y — ?vP • Z elev. y � y_U 6 7 ' S yR �// �7 Ll s/$ s1 �►, \off ft Depth to limiting facto IV Remarks: T Name: — Please Print Phone: Arthur L. We erer 715 - 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022" Signature: Date: CST Number. M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of____ PARCEL I.D. # — �}U 1 N 6 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Y o Fsbh �- a s , , � ZM sbh M cw S ,L Ground 3 )s -LB -� • S `t R 3 [ y elev. e / 9. S ft. 2is` Su -, S V r L V/y - ).S y IL 51a G r s Depth to w L o limiting factor i Remarks: Boring # E l l Ground i elev. ft. Depth to limiting factor Remarks: Boring # 1 1 11 0= 04 1 i Ground i elev. It. Depth to i limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: j �nn_aa�nro nS!�rn I PLOT PLAN Pa 3 of 3 SCALE 1 "= 4 O ' . y . ,v o d r`1 oT �'.Ohp (qtr OR i p _ 1 eLgc 5 ' 31y'' DMA . pvc p1Pk w /try , 1 ZS' I OO��j use 'Tu t3T Uj'�ST ZS P17 ut" � v`�„�z F c.dTt►a��s lv tak;-: AT u� B1r � 1 -X. -fl � X � 0 � JC — s d•pn,,� W eClOri1 s�tilt.i� -_.. _ o- 3S m i h� q -Z Z ( 715 ) 4 2.5 - 1 5 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department oflndusby SOIL AND SITE EVALUATION REPORT Page of Labor and Hunan Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in sae. Plan must include, but not limited to vertical and horizontal reference point (BM), drection and % of slope, scale or PARCEL l.D. # dimensioned, north arrow, and location and distance to nearest road. ? E rlJ ®I ll) C APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION LE" w \' � E GOW-WT SC 1/4 stu 1/4,S0 T Z$ .N,R V) E PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # w \Z 4 C) I 8°10 `T 3 — C3" 34 I6 CITY STATE ZIP CODE PHONE NUMBER []CITY ❑1IILLAGE [MOWN NEAREST ROAD btu 1Z 'Fft-tLS Lv S yo it C) 19 - t 5 , s6Z9 s+�- v t'tt 30 `rTF ffUE . [)4 New Constnx:tiori Use [X) Residential / Number of bedrooms L/ [ ] A" to existing building I I Replacement [ I Public or commercial describe Code derived daily flow "On gpd Recommended design bailing rate _ bed, gWI? trench, gpd/9 Absorption area required - S up bed, ft S Igo trench, ft Maxfinum design loading rate - 5 bed, gpd/ft2 _ (- trench, gpo1ft Recommended 'infiltration surface elevation(s) \031-0' ft (as referred to site plan benchmark) Additional design/ site considerations w/ »'x 6 3 — SN� ry I " uwl � 2 4 or- S f+M 17� c-L Parent material P -L T? L Q Flood plain elevation, if applicable ft S = Suitable for system COWENTIMk MOUND "ROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑ S to U [g S ❑ U ❑ S [ U ❑ S 0 U ❑ S mu [IS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botnd3y Roots GPD /ft in. Munsell thu. Sz. Coat Color Gr. Sz. Sh. Bed Tiench l�HtZ �-s'I R_ Y!y s t f Zh, s Gh rn'Ft- oC�., - _ S . Ground 3 20 3 2 S `1 R 3 / y - ' L \ t• s bh nl U iv, � el ev . IL 2-_Y - 1. S 14 sz y/4 f 5 K a- s 1 a Depth to limiting factor Remarks: Boring # tiiz- 3 ! z Sit Z s d1t r �� c S �{ Z g zza t o y D_ S/! y Mil- Clv 3 3Y "7.S.yR31y L 1 cs�1� 1nU -f1- C�v 'y •5 Ground elev. �y -y 7 -S `>'R S// �7,f 4R S L 1JP • Z low ft Depth to limiting factor 'I V Remarks: CS T Nano.--.Rem Print Arthur L. We erer Phone 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 9� -Z81 -2 Date. 3 _ Cie N M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Z O Page _ of,, PARCEL I.D. # FYI� 1 N 6 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh, Bed Trench Ur 0 -2) 1 tJ 'i tZ � I s1 I T v - SA" t't M SS a S . S , L Z 8 -tS - )• S ti ll y! si Z►„ sbh Y) C -IS , Ground y „ , e g , Ll , S elev. � s It. lj� -i's y rz vj � •s y 2 s! a Gr s e) o »� `�►� - �n . Z Depth to limiting i factor I A Remarks: Boring # 13 { Ground elev. ft. Depth to limiting factor i Remarks: Boring # Ground elev. f ft. f i Depth to s limiting factor I Remarks: Boring # i Ground i elev. ft Depth to limiting factor Remarks: �nn.aaonin ncmo PLOT PLAN Pa 3 of 3 SCALE 1 "= Lk p I _ 1 N ' LA W 3 114 C 1�lPF W/Ltff { , �SKV� DO NOT �X - 5\Mtg 1 I x-101 S op��jti'1' v� ��� t 1.02...0' , SSE to E PYT UekS'f Z.S PU4 l "'IULAJO . x_ LV�TLL �• •, � • 4 SO� t � Py � SE�Sw / O o Sw SE .J JC SbPCt.� l� = boo • W �IOtJ S�1L�__•- - - o- 3 oi 1ti I V O T)+ ST. 97 -Z$ I -Z (715 ) 475 M 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �-� OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address k Property Address ��' f h 46-( (Verification required from Planning Department for new construction) City /State *n Parcel Identification Number LEGAL DESCRIPTION Property Location 1/4, s '/4, Sec. )& , T -N -R t 7 W, Town of Subdivision 051A Lot # 3 Certified Survey Map # _!5 "zz> , Volume Page # /.34. Warranty Deed # y 'Z- , Volume Page # Spec house ❑ yes �il no Lot lines identifiable ;K yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber 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. 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 30 days of the three year expiration date., SIGNATURE OF APPLICANT 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 th property described above, by virtue of a warranty deed recorded in Register of Deeds Office. - A Yia / / SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 7 1422 PAG State Bar of Wisconsin Form 1 - 1982 t�a02092 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS DOCUMENT N0. ST CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Glen . M,. W*?,SA , ,a- vnEIrrie.d.... 04- 27-1999 4:00 PH person .. .................... W RRNMIfY DEED .. EREIPT D . ..... ... ...1111 ......... .. ... 11.........11... CERT COPT FEE: ... ....................... ........1 111... ......... I ............ COPT FEE: ..... Grantor. TRAIIM FEES 97.50 RECORDING FEE: 10.00 and .. Tho.. mas-P... Br. unshidle .and..Carolanne- Brunshidle, PAGES: 1 . hVSb4nd. si1d..W.l f.t ..$S.. s.thXV.iY.QFShiR . marital..property.. . . . ... . ...... _ ... -1111. _ _ . _ ......... 1111... _.... _...1111. ... ............... .. ... 1111..... ......11...........11.......... ............................. 1111 .. .. -.. 1111........... THIS SPACE RESERVED FOR RECORDING DATA ............ ............................... 1111 ... .............. 1111 .. Grantee, NAME AND RETURN ADDRESS WITNESSETH, That the said Grantor, for a valuable consideration River Valley Abstract ....... ................................... ............................... 206 Second St. conveys to Grantee the following described real estate in St. Croix Hudson WI 54016 County, State of Wisconsin: 024- 1019 -40 -000 PARCEL IDENTIFICATION NUMBER Part of the Southeast Quarter of the Southwest Quarter (SE} of SW}) of Section 16, Township 28 North, Range 17 West, described as follows: Lot Three (3) of Certified Survey Map filed March 4, 1998 in Volume 12, Page 3416, Doc. No. 574320. I This ... is not _, - homestead property. 00C (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging: And Grantor,,.__ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, roadways, and restrictions of record and will warrant and defend the same. Dated this 1111.. v5 --�� ...... ...... day of ..... April ................................. i9 99... (SEAL) (SEAL) • : Glen M. Wiese ........... ----------- -- ............................. (SEAL) (SEAL) a ' „arrgr•Hq ..................... ............................... ... ............................... A...��� r i•�, i AUTHENTICATION ACKNOWLEIitC11N1Us Q t Signature(s) ............. .......... STATE OF WISCONSIN ; $ ... ..... ...... .1111. ............... ... ...St.,..CroiX......... County',, •� � :� authenticated this .. day of 19 Personally came before me thnlbr -t.p . 1111 day of .— April ......... . , 1 9.. the above named ........ .................. 1111... ...... .............. 1111 t .. _ ............................. _ 11,11, .. .. ........... ......................... ,.... . TITLE: MEMBER STATE BAR OF WISCONSIN ..... ., ..... 1111......... Of not ........ ... ..... ............. ............ 1111 . ....................... 1111 ............... authorized by Section 706.06, Wisconsin Statutes) to me known to be the person ............ . who executed the foreg r � pp ' strument and aj��,, w 1 g /`, the same. THIS INSTRUMENT WAS DRAFTED av c� j n . Michae H. Forecki, Attorney - . Kathleen R. Videen _ Eau Claire, Wisconsin - ..... ...... Notary Public .........Po1k I ............ .. County, Wis. (Signatures may be audwnticated or acknowledged. Both are not necessary) My commission is permanent. (If not, sate expiration date: • Names of persons signing in any ppactty should be typed or primed below their $1jamures. June 24 x0200 1 i FIY�® 8 MAR U 4 1998 ► 2 KATHLEEN H. WALSH 320 Regist of Deeds y L� UN DS ��d° W - - - - - -- - -- - r 0 rrl D y 0 0 WEST LINE OF THE SE1 /4 OF THE SW1 /4 � �j Z n = I In,r z z 0� II" Q� Z \ 0f FENCELINE (TYPICAL) � Z;o Z /70 I�31� 3333 / N00 * 21 50 E 925.39 _-� FENCELINE IS. EAST, $92 72' (7 ON c I I Z 0.9' +/- FROM LOT CORNER m ,�7 ` 1 D W 32.67' . �� 0) + V) z I r - • 1 4 . rn a . v� I z 00 X N - � m --1 '� iy`N 00 a m p, to �, ,m N c0 0 =0 d ° I �'y0� n o O o z C n C7 M TI Z7 v v w an y �m \t O n 0o Oo ; o CN, C 00 al Z £ 2 oo o N 892.72' y \ � o �! < \ /� O y� i+ m � P f� m = 31.80' 508.51' 384.21' 2 i £ ❑ ° Z _ S00 *21'507 _9_4.5_2 z _ _ Q b � r m I 0 O =O c o 3161' . 508.21' 384.51 �q i m 3 0D s ' z -0 D = tO 892.72' No w I y• r — m _ m (n N N. w N �+ N C/) I b D m CO w w e y CO i (� N CO U , u, rri U' . I o Oo Ca ° ,o co /' Ln i D \ 0 LA 0 110 ' b N J N NOO'21'50 "E 923.46' ti4 0 C ' (A oo 892.72' / Y u+ O CO 30.74'' j� �i. / � c cil w m 0) J W ch I I D O 9�dN�y� // �/ / n 2 n O O • l. v ``J I w. �D r IN;`` W i ti �/ / � mCOX - ZED ' / 501'12'39 E 595.36 D o o W � Z M� z b w cy0%/ � iC � c ;a ;u m r° N v�� N �'�,,/ �'(�S 1 I �l� z ?p-� M O D �z m oO �,• 1, I I z m�oczi z m -q c c pa v L7 D ° m 0 r -U O z Z C _ _ .� 0 ✓� 9� I I� "' vap2 z -1 X m '0 z ° C N Ln I � I Im 0m m > N W Om Dm ° N 00 �� �`'� I iCi. I I a arrlcc ° O cD �,i I ' 1 I I I�l 1 4 ] Q 2 z� r r D p O O n p� I h I 1 I• m- z v z 1 z z x o Iv i I I m m D EAST LINE OF THE SW1 /4 m y -' z �' '� ICn I I I c m o N00'20'1 2 "E __ o m N IW h I V jV1 z Z A 5245.32' z z m ti �� G7 m WEST LINE OF THE SEl /4 N ? N00'20'12 "E 472.87' LN om °o N 0 "W, 452.35') 6 0 2N(n L' Z X 0 o ° N0W 452.48' ono cn n c N z D Z m 29.12' . 423.36' 00 N 00 �C° o r - � z J IR ' -i �O 00 , m co 00 -P Cn i '� � � ;u m O LA 4 o W i b ° r� acs a �I� �f o •� c� -� z N Cyr I �. I O m m co .'n °o n 'y f ri _ m w U, r (4 k U2 +� i z n N a n (J1 I Am II a I �m W � �Nm 0 O t t V! 00 X .t b m 29.02'• 890.61' � �\ rcD m I NO m S00'1 4'52 "W 919.63 FENCELINE IS WEST, 0.6'+ /- < Z ;0 ( FROM LOT CORNER z LnZ Z °' 0 BEARINGS ARE REFERENCED TO THE oc UNPLATTED LANDS SOUTH LINE OF THE SW1 /4 OF SECTION N --------------- - - - - -- 16, ASSUMED TO BEAR 589'56'17 "W. volume 19 naee 3416