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HomeMy WebLinkAbout024-1019-50-300 ST. CROIX COUNTY ZONING DEPARTMENT, AS BUILT SANITARY REPORT 4� Owner o S 1 rl C _ Property Actdress d City /State 2 L 1 0,;Q of r , Legal Description: Lot L_ Block -- Subdivision/CSM # Csyn UOL J,4- 4 _ L '/ 1LW /4, Sec. , T -RjjW, Town of P IeA S601 47, i086�_ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 6(J -L S cI' Size ST/PC 10160 Setback from: House I 7 Well -- P/L Z Pump manufacturer Model 1 Alarm location l f y E 1✓� Ste' (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: m1) U -rX.t Width , Length c /1 Number of Trenches Setback from: House `71 Well P/L /_ Vent to fresh air intake �Z7 ELEVATIONS Description of benchmark c P y c- e ip c Elevation �, U Description of alternate benchmark 19o&2� Pc AWe� Sr��G e-j&1r Elevation d 9 Building Sewer 99 . 1 9 . ST/HT Inlet 0 a ST Outlet PC Inlet PC Bottom 94 Header/Manifold `�ot ylo Top of ST/PC Manhole Cover 99. Distribution Lines ( ) Z t Bottom of System Final Grade () L 622 7 () () Date of installation `7 1,R Permit number � �c State plan number Plumber's signature Lt - License number J Date a/2 Inspector Keel Complete plot plan � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. I c,� � o PLAN VIEW d i� 6 17 o My 6 a� � INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit 1 IX 344510 Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. Permit Holder's Name: ❑ Cit Vill e T vvn of: State Plan ID No.: LANSING, DENNIS WEA A °QTLY .21 8 12 CST BM Elev.: Insp. BM Elev.: BM Desiription: Parcel Ta No.: o'(,._ 5 aS �24- 1019 -50 -300 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 6, � t3z��� Benchmark •� pt(, I Dosing # 4 13. Q, 92 Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. Air i to ntake ROAD rA Inlet Air Septic > NA } Dosing ?�� ft jq NA Header/ Man. lc 4$ Aeration NA Dist. Pipe Holding Bot. System .Z' C(b D T PUMP / SIPHON INFORMATION Final Grade Manufacturer De and S t50 Model Number *)� GPM Lift ,Q Friction ��� Systems. TDH2Z• t Forcemain Length gs` Dia. H ` Dist. To Well SOIL ABSORPTION SYSTEM t Width I I Length t N Tre ches PIT No. Of Pits Inside Dia. Liquid Depth DIME N I NJ 5 Z DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of r , l,e 4 CHAMBER Model Number: 0 System: T U OR UNIT DISTRIBUTIO YSTEM Header/Man Id Distribution Pipes) _ / u x Hole Size Hole Spying Vent To Air Intake Length � x t Dia. "' Length s Dia. T6 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 3 6 DCA rP ION: PLEASANT VALLEY 16.28.17.108E SE SW 174 30 PH 4VENqE go tj&ta, Plan revision required? ❑ Yes ® No _ ,s 2 fo Use other side for additional information. - fl0 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. T 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i : : , i �.. ... w _ s . t : ! i s 3 ; z a _ 4 j { � 3 I ti S v e r „. a .. ... a € .m.. ,. F e a i = � a i _ € t e _ _ v : I : ,.... ......_ ... 6 ... _ _ ...... .... ......_ ,.. ;..... ,, t .. _...... .�,. _ . �... r : � y . � S t e m _ s. a = _,� 1 .m.. _ :�..• _� � �. . =.a. ma �. .. _ s . »...... ,......mm --z qq em.. ,.- .. .S =.„m m =w .g. _. m mmmm a : _ m w ® f f ( � F i € u s a v; ° s S n s: i w { Vi sconsin Safety and Buildings Division S ANITARY PERMIT APPLICATION 22010 B Washington Avenue 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 �� C� © f X than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check it revision to prev iou§ a Icatio� [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Ow er Name Propert Location �' 1 /4, S T Z , N, R 1 7E (oro Property Owner's Miling Address Nu 1 S Lot Number Block Number c 91E T ­-1 City, t to Zip Code Phone Numb r. Subdivision Name or CSM Num er II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it� age Nearest Road f Public 1 or 2 Famil Dwellin ❑ VII - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ' �. �• . 108 1 ❑ Apartment/ Condo Q Z /Q 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. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ------ System -------- System _____________ Tank Only____,_________ Existing System ____,___ Existlnq System B) 11 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 JAWound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 Q Vault Privy 14 ❑ System -In -Fill Ict--+5- V11. 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 457b 1 Required (sq. ft.) Prop ed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation .J 7 / 0/1 73Feet / meet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer s Name Concrete st on- Steel glass Plastic App Tanks Tank Septic Tank or Holding Tank ❑ ❑ ❑ ❑ Cl Lift Pump Tank /Siphon Chamber 41 00- AV ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT6 elf I It , the undersigned, assume responsibility for installation of the onsite sewage system sho n on the attached plans. Plumber's N e: (Print) Plumber' Signature (N S mps) MP /MPRIW71o.: Business Phone Number: Plumber's Address (Street Sity, State, Zip Code): c� _� A W l IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Per a tlndudesGroundwater D ate Issued Issuing Ag Si ature (No Stamps) �pp roved g ❑Owner Given Initial Surcharge Fee) 3 l / 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 maybe 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. il. 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 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; O) 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 1340 E GREEN BAY ST STE 300 ` SHAWANO WI 54166 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary April 05, 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 3101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 04/05/2001 Transaction ID No. 218186 Site ID No. 169323 Please refer to both identification numbers, SITE: Site ID: 169323 above, in all correspondence with the agency. ST CROIX County, Town of PLEASANT VALLEY; 30TH AVE i nT+ II L1t11+ )A n t / T•1OLT T 1 •'9TT7 ,. DENNIS LANSING RESIDENCE FOR: Description: MOUND SYSTEM FOR DENNIS LANSING Object Type: POWT System Regulated Object ID No.: 458953 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. 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 03/29/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 KEITH A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US code: 7633 i $�= - l �1 �,.,, �; v --� 4 - Page of 6 C\, MOUND SYSTEM � A 3 BEDROOM LOCATED IN THE SE, 1/4 OF THE SW 1/4 OF SECTION 16 , T Z8 N, R 1-7 W, TOWN OF \lf1L.L" ST. c.Rolx COUNTY, WISCONSIN. j,AT � ^ - F ZS - ►'i - UCiL , �Z � p prG E 3 y 7 b .: -_ _ ~__..._ _.__ INDEX PAGE L 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW +CROSS SECTION : OF K ovw L� PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT , .PAGE 5 of 6 PUMPING CHAMBER Le-oss Sfc.7io,4 s Rfp.G s. PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR Q�1Vtv�S L.►�tvSSt.JG _.__ __ C.� p SbL-�iJS Oti7 ��v S'�12 -U �70lV, I N C. Z U 6 H'I�STNvT ST PRREPAP,ED BY WEC3EF;,*E SC] I 1 TEST I p4 C.3 n AND. DE z C_sP4 SERw I (-- ® �� � .� ✓� �� ®,� P.O.w.T S• P.O. 001 74 421 N. MAIN ST. {�•�• •~ • ARTHUR L. Conditionally RIVEP { M 4022 a D -9, R 5 as s P c��swoaTH. rs. APPROV� DEPARTMENT OF COMMERCE e b ps I G [VISION OF SAFETY AND BUILDINGS IN• Nts9eaPl SEE CORRESPONDENCE JOB NO. qq ` 5 PLOT PLAN Page Z of (� ' Scale 1 "= r � 4 j _ 3� i � �o rvur eoM,PA -q-- ov2 �5�s'r�v'z.e 8. I I r I s I s I , I CoMrovrz �.loo.� S' M a q-lly y of fib( �, I • Q I N2. L01.'15 ` zs • I PoL� - S Io'OF (4 " PVC 3 BbR,r -� w L To 8F P( Lm - r So' F-xO "Ova C'rr � `yT ZS' FMM `rWKA,S . t� ST 1 t ti� n�= 6 tl c.rx t L-6'r AS - I 'N�V�Z'c \ � 1 l'v 5 � �1T.o1✓1 N1UV1�h� . N * ST• 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 l oon lboo gallon capacity manufactured by wy�s�Z. C�yC«'T6 ��ZOt�I.►C�'S' wLPcZ -LVoo 5. Bench Mark M.lbo.o' oN Z` 1 EttGq, 31.4 " biA eve CAPE �► /L�1'TTt 6. Divert surface water around system to prevent.ponding at the u phill side. • Page 3 Of • Approved Synthetic Covering �sTM c 33 Distribution Pipe Medium Sand H �G Topsoil F Elect. 101.1 S 3 " , e 3 % Slope (Force Main Plowed Trench of k"-2k" From Pump Layer Aggregate Undisturbed D '1.o Ft. Soil E \A5 Ft. Cross Section Of A Mound System Using F D. Ft. I Trench For The Absorption Area G 1 p Ft. A S Ft. H I• S Ft. 6 `iS Ft. I t5 Ft.. Linear Loading Rate= b,U GPD /LN FT J 8 Ft. Design Loading Rate= 0.3 GPD /SQ FT K Ft. L 9 - 7 Ft. in W 2S Ft. L Force B K main �— A -- - - - -_— _-- -__ - -- - eviz.S PVT „ U \�Pll g Il•� W Distribution Trench Of 2 - 2 2 �+D Pipe Aggregate t Permanent 1 Observation Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page L / Of (, Perforated Pipe Detail 0 End View ) Perforated End Gop \` PVC Pipe Install permanent at end of each lateral \ Holes Located On Bottom, Are Equally Spaced Q / End Cop * ti PVC Force Main Distnoution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Loyout P 3 y.S Ft. X Inches Y 3 6 Inches Hole Diameter ��y Inch Lateral 1 «f Inches) Manifold Inches Force Main " Z. Inches of holes /pipe 17- Invert Elevation of Lateral s Z -ZS Ft. �Z x l - 1� - ► U. o� x 2� 2 u 8 G p" I ti Place lst hole from tee with succeeding holes a 36 i n te rvals . ee g t Last hole to be next to the end cap. Combination SeptXc;Tank and PUMP CHAMBER CROSS SE CTION AND SPECIFICATIONS' PAGE S OF VENT CAP WEATHER PROOF JUUCTlow SOX . 4'C.I. VENT PIPE , APPROVED LOCKIAIG ' M 000 MAWHOLE COVER �vtTli _.1 FRO R„ � � wARt.Il1.16 Ll46EC.. - ./INDOW OR FRESH A_R INTAKE b n I y�IUS1becnor.3 PIPe PROVIDE I — --- 11JLE T AIRTIGHT SEAL . _ � I v APPROVED JOIAI7 w 84FF��S - A I I I APPROVED JOINT: L.I. PI PE OR i III w /C.I. P1PE�� / Tank construction ALARM shall comply with I II ILHI (83.15 and 83.20 8 I l I ow C I i LL a6.b- EV: fT. PUMPS - -� � OFF D COIJCRETE LgL U . 5 V • 13 BLOLK 3" APF'Ro, K15ER EXIT PERMITTED OWL IF TAWK tAAUUFACTURLR HAS SUCH APPROVAL SEDOINE SEPTIC f w� �cT - l�oe SPEGIFICATIOKIS DO5E w� ccpjc r?_� WUMBER OF DOSES: S PER DAy TA"K MALIUFACTURER: TA WK SIZE: �bUQ bOQ &ALLOWS DOSE VOLUME r ALARM MAUUFACTUR.LR: IWCLUDIMG 5ACKFLOW: 1Sd.rJ GALLOWS MODEL lJUMBER: l01 H - W CAPACITIES: A= IuCHC50R 301 CALLOUS ���Jw IIJCHES`OR 33 ' G LLOAi$ SWITCH TYPE: B = Z r lS o. S PUMP MANUFACTURCK: I t:_Z�S C- 9 WCHES OR GA MODEL NUMBER: l�1E 4o D. -7 H�E5 R 1.9 GALLONS SWITCH TYPE: MOTE: PUMP AI1D ALARM ARE TO 5L MINIMUM DISCHARGE RATE 610 96 GPM W5TALLED ON 5EP CIRCUITS VERTICAL DIFFERENCE CETWCEU PUMP OFF AN0.D15TRIBUTION PIPE.. NS ' FEET + MII mum WETWORK SUPPLY PRESSURE . . . . . .. . . , , 2 . 50 0� • FLET + LAS F EET OF FORCE MAIM X 1 F�OtLFKICT10" FACTOR_J F E E. T TOTAL OyNAMIC HEAD = Z I.06 FEET Pump chamber DIAMETER II IMTERAIAL DIMLWSIOW� OF TANK: LEAIGTH ;WIDTH _ ;LIQUID DEPTH 3 6 BOTTOM AREA — - 231 = GAL /INCH AS PER MANUFACTURER = 6 -12 GAL /INCH ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to 30 li W H 25 8 E Z 20 6 q J = 15 J 4 F a - F— O 10 ~ 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division'of safety & Buikkngs in accord with ILHR 83.05, Ws. Po Code • 44,f " rr virtu l ah (- 2 0 9 COUNTY ST . C t2.o lX Attach complete site plan on paper not less than 81/2 x 11 inches i 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. pE�D ttQc APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWEDBY DATE / _J/ ?/? / C'b PROPERTY OWNER: PROPERTY LOCATION G L.IF_� W t ev (, Gew. t9F S E 1/4 S W 1/4,S 1 6 T Z$ ,N,R 1 E (or W PROPERTY OWNER' - S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER DCITY []VILLAGE MOWN NEAREST ROAD RVU IE� t- n_Q SVozz (MI5) yL S6Z �'� S T V R��N 30 `n+ RAE• [Xj New Construction Use [A Residential / Number of bedrooms 4 [ ] AddttiQr to existing building [ ] Replacement [ ] Public or commercial describe Code derned daily flow 60o gpd Recommended design loading rate y bed, gpW ' trench, gpd/ft Absorption area required 5 b Q� bed, ft S oo trench, 111: Maximum design loading rate' S bed, gpd/ft - 6 trench, gpolft Recommended infiltration surface elevation(s) V 0 k . `) S ft (as referred to site plan benchmark) Additional design / site considerations lljUi � w /f3 x 6 3 8 ED . fif N. N-Z o C- S Pvlv0 F:� t-t_ , Parent material _ G t- lx r[ Py l., 'T"1 L.L Flood plain elevation, if applicable N It S = Suitable for system CONVENTIONAL I MOUND IWGROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑ S E U [a s o U C] S CR U [] S O U [I S ®U [IS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence eaxxlaly Roots in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed rends q; - 0_9 cm I?- 3 m 1Z - S�� Z`{'z 6Ft .. Z o _ Z� 1 a`? 2 3/ �, - g i � I Z rn 3 � � fir► Th C� , Ground 3 zy -vo S '1 R. 3/ - s [ l c°- 5�4L btU`Pb i:�, - .�( , elev. r � 9 9 •$ ft Y y0 �. /L L - / fi'_s /g S CE 1►+� `mT�• - Nom: • Depth to limiting factor Remarks: Boring # >x 1 o S 1 Z` z L - s i 1 Zw - 3 Z33 Z.S-tvt -1 - 6ha1 \CS�0k MV eh, Ground elev. 3� - S 0 - 1 S `1 R'// r c o w► `Fl. - ti�� Z 1 z, ft L g ti tz 13 6 s l Depth to limiting facto 3� y Remarks: TNarne:- Please Print Phone' Arthur L. We erer 715 - 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 ` Si nature: Date CST Number: M00576 PROPERTY OWNER wILS G SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. fl Consistence Texture Boring # Horizon Depth Dominant Color Mottles Structure Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `1.1 ( 3 1 o —g 1 O`! l Z � 3 1 Z s� I Z `F b>T 1n�`F� a,s 1 •� • S . 6 Ground a 1 -SyR 31 _ G►-s) e Sb►z yn �� C1J — .�( •S elev. V". U t. y 3 3 -U7 -1 S `1 iZ y/4 t y 2 313 G�- 9 c- 1 IM ` 1- — Nib • 2 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor \ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground ` elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1 "= 1 413 ' X . 2. �C�T R9 SttOwr� 3, A MovM> wt R b'�c 63'I?qb lSzowlAL �oi2 3 BtiR= ooiu�e. 1 I 3 ° } T -� b o ►J r e.0� P RAT . 80 I oR � �S`NR.6 . tot? I I I u� I g Z' 3M� -(�L_ IAirs.0 0+11 `fit? OF - 7 `'t}t6N, Sly' Dtq. RUC �i�N wl�h'T'tl Q 0�'�'t1►� Q F � tsO Nz... to t.ZS 1f Q h�� F -Sw � Sw SE x 3 O Tai O. 4 tit l'V 30 • R1 ENE _ t`IO llrt sT• S� 1� =8op • 1 9� - 7_81 - t'l ��, !?mot (1Y I `�' ( 715 ) 4 .5 -n7 As M00576 CST Signature Date Signed Telephone No. CST # WiiscorWnDepartrnentoflndusby, SOIL AND SITE EVALUATION. REPORT Page__�_of 3 Labor and Human Relations Division of safety & Buldmgs in accord with. ILHR 83.05, Wis. Adm. Code COUNTY - ST . CTtro1X 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 (Mq, direction and % of shpe, scale or PARCEL LD. # dimensioned, north arrow, and location and distance to nearest road. PeQb I /VC APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION p EWED BY DATE PROPERTY OWNER: PROPERTY LOCATION G W 1-F L eew.bw 5E 1/4 &W i/o 6 T ?$ ,N,R 1'1 E ( ar W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK If SUBD. NAME OR CSM # W \Zq I 190 - M RUE. - - I CSM Uu% - P-9 �4t� CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WOWN NEAREST ROAD Rw E-fr>`.c.S, s� ozZ_ (CIS) yL 5629 �'l s T v RLL 30 `n+ ►RvE. [� New Construction Use [A Residential / Number of bedrooms y [ ] Addifipn to existing building I J Replacement [ J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate y bed, gjxW - trench, gpo1ft Absorption area required 'S U CJ bed, 9 S oo trench, ft Maximum design loading rate' • 5 bed, gpdA1 • 6 trench, gpdlt Recommended infiltration surface elevation(s) 10 k - "1 S It (as referred to site plan benchmark) Additional design / site considerations Ylot)'A� w /b' x 6.1 ',8 ED . 1" 1f", \Z. � oC S PVvp F; LL . Parent material G p yt ` �_L Flood pWn elevation, if applicable 4y A • It S = Suitable for system cON 9MONA1 MOUND IN- GROUND PRESSURE AT GRADE SYSTEM IN M HOLDING TANK U = Unsuitable for stem ❑ S Z U IRS ❑ U ❑ S f2� U [is ®U [] S ®U I [IS O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Wtties Texture Structure Consistence Bound3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITmrch `? 1 - 1 O'l TL 31 2 - s i Z` - 6k m �y c S 1 • S 6 Ground 31 _ ' s ,5 elev. tv� 9 - ft Y yo �.S Lm V/4 F; S ti re- s ./$ Se ► O �cn'�• - • "L Depth to limiting fact Remarks: Boring # 0 8 Lo'L 2 3 1 2; 1(3 IL 31 L S1 { Z n1 3 bI Y►'r 3 Z. 37 Z S`l1z fly - Grsl lcsbk )n V 'f�- c tiv - •� 'S Ground elev. 1 rA.Z. fL 1) S O - 1 S '2- V/L 3 Ll R 313 G- S CJ 1 z -\ rn �6 - 1�►l� • Z Depth to limiting factor Remarks: CST Name: Please Print Phone: Arthur L. We erer 715- 425 -0165 V e m g%rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: d Date: CST Number: _& 9�_2 -8t -3 3 -1 -993 M00576 PROPERTY OWNER VJ eS C SOIL DESCRIPTION REPORT Z PARCEL I.D. #t Page _ of ` 3 - Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed TJ 3 0 —g ►o� tL e z — s� I Z `�sb rn`F� A' L •� • S , f; Z g Ip`c1Z 31 :� si l Z>K m�i^ rlv - - s • b Ground elev. C,hs 1 1 �-Sb►Z yri � C1J - q .S 10k. Z ft. y 3 3 -u1 S `7 2 y/b ' I '� tL 3 J3 Ohl hit `�1- N� • 2 Depth to , limiting ; factor Z' i Remarks: Boring # E3 I i Ground i elev. ` ft. - Depth to i limiting factor I Remarks: Boring # E Ground elev. , ft. Depth to ! limiting factor s ; Remarks: Boring # 13 i I Ground eiev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) P LOT PLAN Page 3 of 3 . SCALE 1 "= �a - EtGC�T R� S�{pi,iN �• _�sE ='To QE rLCjr�C= 3, A h o\:)IJD Wt`r1.4 R - 6' K L - 1 J?gD VS �. - -ZS, I ;. •- t�-'bo NOT e.owtp }�eT . 00 I opt �slt►�.6 g.3 i �� 3 I�"►2.1R 1 I zs• � I B. ( - - - -� 3Z el.• g �L- Iop,O� 0►�1 'ta1� OF -7"tti6N, 31y. D1q. 1?U f - \r-z wr W«m -z ( sfwZ - tom &XT oISr,RIa) � a� �T ��m sT S t�- ,tor -� w, evn�•p c�+.S�vv�Z �.. t o � : , s Qu�r+ o� �L3o 0 X Qg ��E_ Sw � Sw SE x 2. 30 TH PN E o. 4 'Tts kVE - - ( 715 ) 42 %4 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND xO� WNERSHIP CERTIFICATION FORM Owner/Buyer J)eA//V 1 e' G� /-/U S��V Mailing Address G �� �u `�` l'2 S� ( _5(02 Property Address AVE , (Verification required from Planning Department for new construction) 4 City /State Parcel Identification Number d LEGAL DESCRIPTION / Property Location '/4, ' /4, Sec. < , T� ff -R (7 W, Town of Subdivision �' —� , Lot # Certified Survey Map # `7zL�2D , Volume 1 Z , Page # Warranty Deed # , Volume 1 � /- /g , Page # Spec house ❑ yes P-no Lot lines identifiable N-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 um in ou p p g t the septic tank eve three ears or sooner, P every y o er, 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 g q rements 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 day , of the ee y r ex 'ratio date. r , 2 " /1 SIG TURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to tic best of my (our) knowledge. I (we) am (are) the owner(s) of the p perty de ribed ove, b vi e of a warranty deed recorded in Register of Deeds Office. SIGN 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 VOL HlSw 139 60 JL z 2a KATHLEEN H. WALSH Docume -*Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., MI RECEIVER FOR RFQORI This Deed, made between Glen M. Wiese, a married W12 -lg99 2130 FN person, Grantor, and Dennis M. Lansing and Amy J. I Ttr KO Kavaloski - Lansing, husband and wife as survivorship marital Ezt>IPT property, Grantees. CERT Coot► FEE: COPY Fal WitnesseM,, That the said Grantor, far a valuable TANS 3 FU: &&SO consideration conveys to Grantees the following described AIMS= 1R'� Pas: 1 r9al estate in St. Croix County, State of Wisconsin: Lot Four (4 of Certified Survey Map filed March 4, 1998, in R Am Volume 12, Page 3416, as Doc. No. 574320, Register of Name and Return Address Deeds office, St. Croix County, Wisconsin. Located in part r F 4 L' of the SE% of the SW /., and in part of the SW /. of the SEA, all in Section 16, T28N, R1 7W, Town of Pleasant Valley. 024 - 1018 -50 -300 (Parcel IderWfication Number) This is not homestea- property. 1 Together with all and singular the hereditaments and appurtenances thereunto belonging; And Glen A Wiese warrants that the title is good, indefeasible in fee simple and free a nd clear of encumbrances except easements, Covenants, conditions and restrictions, if any, ,nd will warrant and defend the same. Doted this 30 day of March, 1999. A6, Ik4� ' 'Glen M. Wiese �: c>- Ln AUTHENTICATION ACKNOYCWGPPNI Q7 Signature() _ _ �. t WISCONSIN. ` i COUA� ,_ Personaiy came before me thy , r Msrch, 1999, authenticated this _ oay of .1999. ttre above named Glen !A Wiese to Me Known to be the person who executaad the foregoing instrument and _ ge the same. , l Signature , O^ Type or print name Sigaaues I TITLE: MEMBER STATE BAR OF WISCONSNP: TWO tx prim name (If not Notary Public, State of W ons� authorized by §706.06, Witi. Stats.) My commission expires 0 ' �(� `� 1 THIS INSTRUMENT WAS ORAFTEO BY C. L. Gaylord, ", torney at Law River Falls, WI 54022 1Mrtias of persons signing in any ,-p-_4 s7:.v40 be type) ,x primed bek: n (Signatures may be "Ihonlicated or acknowledged. 80h are nut necessary.) 1lee+r tw . Prcite•s«na :s Compam Fond du w;swn, ', wo_tc S 2020 FILED 9 MAR 0 4 1998 2 4 390 a' pi a"'u > < 2 Z > � U - (4 D � • Ins WEST LINE OF THE SE 14 OF THE SWI /4 �-< � Z m 1 r- I Z 'I 1 X l P" ` `::' ` N00'21 50 "E 925,39' FENCELINE (TYPICAL) --I Z;0 3 , -1 jar <<U F NCEIIN IS A 892.72' �7 Q� �7 1 O.Y' +/- FROM LOT COAtj P n � o D x iw Z 32.137'. A ' imp N m'' \�� v r, f*1p l 892.72' tv OD - --4 3 < I= < 31.80' 568.5 384.21' i o 9 _ _ b4 :c r 1 In c 31.61' . 508.21 384.51 �. z a y v,� m e92.72' Z rM ? (n N, Vv e. ti b a m to rq � � ,v v n.r Q j( A D, FO ;, ►� NO0'21'50 "E 923.48' d 40 30.74'; --' 892.72' y I ice'" �► � J' 'G � I � D K �rA C cn Ln Ln ell CID b SO C) 2ZE tA yn 01 I�Ic)1 -�. D p� 0 g V? IC-31 , 6[ I � EAS INE OF THE Wt /4 m lo; -' Z `t N jw I. I\ ICA �.,'' N 524 0 32' ,E z WEST LINE OF THE SEt 4` z N 9" 1 7 A79 � ;3 (N01'27 "W, 452.35') g o A N01'31'04 "W 452.48' oN c l' 29.12' • 423.36' � (n z> o C Z � N 00 9;. 0 t co N z to m J 00 4,. o rn a Crl l 4b ,. tr -P I h a S � N 00 1 ITj IJ I 29.02' ' b N >CD 1 9 1 S00'14'52 W 919.§3 V 00 FENCEIINE IS WEST 0.B' +/- > z m FROM l0Y COR o, BEARINGS ARE REFERENCED TO THE L UNPLATTED LANDS SOU L E OF THE SW 1J4 Of S�CTION • -------------- - - - - -- 18, ASSUMED TO BEAR 5589'58'17 W. •- --+oie 12 nase -V-" - -.. AA t Wisconsin Departmen of Indus WISCONSIN ADMINISTRATIVE Safety and Buildings Division Labor and Human Rela ions,' BUILDING PERMIT APPLICATION (Wis. Stats. 101.63 (7) & 101.65 (3)) Submit to non- enforcin municipalities for new 1 - and 2- family dwellings. SEE INSTRUCTIONS ON ACK OF YELLOW COPY. 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Site Constructed Concrete Masonry, ❑Treated Wood ❑ Manufactured ❑ Other (specify): ..� �:;`C_;i:iiii:ytk� f:. �:•�''''. ij: �': `: ^}:�' >:<:Yr ?::j'2':ii•':::�:j �i;:;{ �'':`:?:::<: ii:: j'<::::::::": >.i::�:�:':j:F:`�'..y�i >j}i'{� ,i'i: $:; i:• iYi 'rfy:!�:y{�iiF { !'ri'<r:i!t�:f i�:: } .�i:i�$i::�:; 5 :;:;i: }� . ?y�i:i ":•':� i:{.�. +::k• . � ....... ............................... ....... .. . . ........ ..........:.... .::............................ .. ��...���AT�I�. R .. .. :' }n .^:v' :. ":O }:•: {,i y ,'i. •{. i }::::ii:• }i:f iY Living area = a Squ Feet $ Z"06 1 present that all t e above information is correct, and understand that the issuance of this permit is for administrative pur oses only. Onsite construction inspections will not and shall not be performed by the municipality which has not assumed jurisdiction per s. 101.65, Wis. 5tats.. I understand the Uniform Dwelling Code, Chapters ILH 2O -25, still applies to all new 1- and 2- family dwellings and must be complied with. I realize the issuance of th's ermit does not relieve me of compliance with other applicable' codes and ordinances: Ap Ica t s Sig to a Date Signed MUST BE COMPLET D BEFORE SUBMITTING TO DILHR: Town Villa City unt of Y Village o C ❑ 9 ❑ Y ❑ - y Where Dwellin It!11!►'1' NI - ( Located -Y Iwl't' 154013.11x~ c% :> r, SBDB 9254 (R 09194) White •Issuing Jurisdiction Pink DILHR Within 30 Days Yellow Applicant INSTRUCTIONS. The owner, builder or agents shall complete and provide all required information on the applkdtion form down through the Signature of Applicant block. This data its used for state wide statistical 1 gathering.on new one-'and two - family dwellings, as well as for local administration: When " completed, submitto local municipality having jurisdiction. PERMIT REQUESTED: • Fill in building address. e Fillin 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. If project is a community based residential facility serving 3 to 8 residents, it is considered a single - family dwelling. 2. HVAC Equipment Check only the major.3ource 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, includetotal combined areas. A. 7. Estimated Cost - Include the total cost of construction, but not cost of land or landscaping. SIGNATURE: • Sign and date application form. ISSUING JURISDICTION: • Thismust be completed bytheAUTHORITY HAVING JURISDICTION. Checkoff MUNICIPALITY STATUS, such as town, village, city or county. Fill in MUNICIPALITY NUMBERIOF DWELLING LOCATION. If issued by a county, 'irkkate the specific municipality number where the dwelling will be built. Fill in name of person issuing permit date building permit issued. RETURN PINK COPY WITHIN 30 DAYS AFTERISSUANCE TO: p DILHR - Safety & % uikngs Division P.O. Box 7969 Madisod WI 53707. j f ' f`