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028-1038-40-000
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Y C N c U a � O C O L L 1 - p o f � - O C L E— � .N� 0 3 Q mH.S2mc me 3 w 1 CD Z C-4 v Z `- 0 N H Z c 1 II O O Z a U m z v o m (D z i E -p 2 (N 1 ro � c I . W p L_ ti O U O u N p = = z a) I rn d d N 0 O c $ ° I a > > o ��- N 'N m c CL B y J U Z Z �V � tE (D w E (D a_ a j o N c c a� m Q Q <n Z U) a r) v � o I I �J 0 3 E 1 O p d O LO �Ql ° c N O v- 1 ': c d o o 0) V O � o a o ayi _ °' :° 7 N N M Z U °' '0 m _ N E E r M I- O O p f6 U i.i o N fn Z- �- d U) O � I ►L '� � T 1 Rs r r \ v1 — f V w dt CL 1 E m v c a� 3 Q V d i ST. CROIX COUNTY ZONING DEPARTMENT! AS BUILT SANITARY REPORT Owner � "`�� Chi 4 Property Address City /State sT cox co ut4v ►V OWNGO Legal Description: Lot Block Subdivision/CSM # '% ua S(r- t /4 5 W ' /4 Sec. , T N -R W, Town of j'uS2 Eli PIN # �' 3 . C �1 No NUo of See 3 51 A SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer /' l dk t _ 7 h'r e � ze 5/PC /R b Setback from: House le Well? P/L - `d � Pump manufacturer ^ , t Model Alarm location " (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Widt Length Number of Trenches Setback from: House - - - 1 'S' 6 ' Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark lG L', , ' 1 / ��/ �G.` Elevation e' o Description of alternate benchmark 4 0 5• `' " Ao4 "PL? _ Elevation 22w Building Sewer ST/HT Inlet C ST Outlet �—' PC Inlet PC Bottom / I Header/Manifoid Top of ST/PC Manhole Cover ` Distribution Lines () () ( ) Bottom of System Final Grade () () () �u� ��� 6,AS`e' 9 Date of installation ld 1`ermit number °� -7 State plan number M5 6 Plumber's si nature _ 6 License number 227 < 16 l Date /xO Inspector 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. PLAN VIEW C� lot ,J �i�l• v �a INDICATE NORTH ARROW "oViscon'sin Department of Commerce Safety and Buildings Division P RIVATE SEWAGE SYSTEM Count�;i,. CROIX • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita f?46o.: Personal information you provice may be used for secondary purposes (Privacy l s.15.04 (1)(m)]. Permit Holder' EI2��� Town of: State Plan ID No.: RICKS09l s N ffk jWx_ CST BM Elev.: Insp. BM Elev.: BM Description: Parce1J2#lo- 1038 -40 -000 TANK INFORMATION ELEVATION DATA A9900012 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic l�� Benchm Dosin g1 0 2 SS (DP. / rte Aeration Bldg. Sewer Holding St, C Inlet „ i0a,oy G• TANK SETBACK INFORMATION St /44t Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 1-30 .3 �1, NA Dt Bottom �, .� Dosing ` 13 /✓� r �f $' NA Header/ Man. Ivo? S5 Z Fq Cq�� Aeration NA Dist. Pipe 19 /.7 Holding Bot. System �. 3•Sr °� ✓ PUMP / SIPHON INFORMATION q,,) ej gym Final Grade Manufacturer (� 6 J (A S Demand A) t. (3 kki .7,6 g9 7y Model Number -nn . �PM TDH Lift ,Z j Friction System z,, TDHI/� Ft ead oss Forcemain Length Z t ' Dia. H2� Dist. To Well SOIL ABSORPTION SYSTEM '7q BED / E Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM I N a DIMENSION SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeOf Mo Number: System: *pv I' '"�,� OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 1 " i �/ Length Dia. 2 Length y7 �f Dia. Spacing � 3 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.) '`y ,l' 3 LOCATION: RUSH RIVER 27.28.17.235A,SW,SW 121 RD T Platt.- t/1?� �,3j 6 ) ?. • ,v— G&. Jew 2 tick�e/ %yc�fi {+� A 14. AA � f� `� P J V A 64 Plan revision required? ❑ Yes [ _No Use other side for additional information. 7 ? O 1. l 1 SBD -6710 (R.3/97) Date Inspector's S nature rt. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: d O� w ' f l � i i Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Visconsin I n 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 81/2 x 11 inches in size. I-V Cro • See reverse side for instructions for completing this application State Sanitary Permit Number 3DO Personal information you provide may be used for secondary purposes [I Check if revision to prevlo application [Privacy Law, s. 15.04 (1) (m)]. S&4e State Plan " L N er I. APPLICATION INFORMATION -PLEASE PRINT ALL NF RMATION �n / tr,s' �`� Property O ner Name Property Location h 044: t T ( j1 /a 1 /4, S T �� , N, Rl / 7 E (or) W Piope Ow 's Maili dress Lot Number Block Number city. stp Zip C Phone Number Subdivision Name or CSM Number 94 Nr- v� ( -4 B - PE F BUILDING: (check one) ❑ State Owned ❑ It Q g Nea jstRoad� p village R1 , Public 1 or 2 Family Dwellin - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ;L-7. Zg , 1 35 1 ❑ Apartment/ Condo 1 6p-& 10 U — 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. -�a New 2 ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. Repair of an System ________System _____________ Tank Only E S ExlstingSystem __, __ Existing System _________ B) ❑ A Sanitary Permit was previously issued. Permit Number 3;tq6 Date Issued V. TYPE OF SYSTEM: (Check only one) Fbv' W il v(,� Non - Pressurized Distribution Pressurized Distribution Experimental Ot er 11 ❑ Seepage Bed 21V Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTIO SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/daa sq. ft.) (Min. /inch) Elevation J 6 �0 Feet Feet Cap acity VII. TANK in Ca allo g Total # Of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks eptic Tank nk �a0 v S� C S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank ber g6U ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VM STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews a shown on the attached plans. Plum is Name: (Print I P e;rM Business Ph Num Plumber's Ad / dress( tr et City,St i CZ it u/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes GroundwatI e Issued Issuing Age 1 nat a (No Stamps) Approved [I Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 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 dwher'sname and mailing 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. V1. 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'g name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for 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) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. t Safety and Buildings 2226 ROSE ST • LACROSSE WI 54603 -1905 Visconsin Philip G. Thompson, Governor lip Edw. Albert, Acting Secretary Department of Commerce January 04, 1999 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 01/04/2001 Identification Numbers Transaction ID No. 203858 Site ID No. 165471 SITE: Please refer to 1 n numbers, Site ID: 165471 above, in all o `�s enbe with the agency. -- St Croix County, Town of Rush River ^ SW1 /4, SW1 /4, S27, T28N, R17W / Timothy Erickson & Joan Kasten Erickson'►�� z0 FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 443576 ` Y4 " O OH a1 J Yp Y g J ' f The submittal described above has been reviewed for conformance with applicable Wisc ` in Adtnihi t�alx€ Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. -J The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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 12/21/1998 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 qq - 1b erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 4 � ` Page 1 of 6 I MOUND SYSTEM' FOR A BEDROOM RESIDENCE tv�iZ - QVJ -tiw o sZ:L: 54 FrKJO — - LOCATED IN THE S� /4 OF THE SL 1/4 OF SECTION .?jl ,T _LZ N, R 17 W, TOWN OF COUNTY, WISCONSIN. INDEZ RECEIVED PAGE 1 'of 6 TITLE SHEET D 2 2. 199 PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTWfETY & BL06S. 01 V' PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR -ylr -,oT" �n �Zy 30� s� - - - -- C di�LO fo cE . � � GOMM 11.DI�GS " p�PARZMti 'E AN Vt pE NGE E� GORR�� PREPARED BY WECEE:;tEFR E3 C3 I L -TEST I NC AND ` ,�`deotNN DES = G411 S�R�1 I CE � S CO N � ' tiy o F.O. BOI 74 421 K. ISAiII ST. � � .••' ''� R1VEF. FALLS. V1 54022 .J = ARTHUR L. JIS- 4L., -OIbS WEGERER 0.915 P ELLSWORTH, WIS. IGI JOB NO. mil$ -300 PLOT PLAN Page Z. of 6 L 1 Scale 1 "= Vx,0' ,_ FZcET- ��•OP7Y U'Ie s r PVC t�lp� ►.i��� y 3 J - s CJ n e ro P 0 ` z-o of =Z � , O p SOT 0 to 17? `s y„._ Q R � r `TD BE ►rT L& So k�o _?j, Or h ou", — �D � LAST zs F -�-or1 `�^P�►vks. NOTES •1. Elevations shown are existing ground elevations unless otherwise noted. 1 anent markers at end of each lateral. Z r 2. Install perm ( Q 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be\ Z001 1 6 0 Q gallon capacity manufactured by 5. Bench Marks SEE "O U E 6. Divert surface water around system to prevent.ponding at the uphill side. Page 3of 6 L , ' Approved Synthetic Covering t�sT► c 3 Distribution Pipe.: Medium Sa nd _ H �G Topsoil F Elev q . p ,i 3 E " b % Slope Force Main Plowed Trench of 2" - 2" From Pump Layer Aggregate Undisturbed D S o Ft. Soil E 1 - 435 Ft. Cross Section Of A Mound System Using F b- Ft. I Trench For The Absorption Area G .a Ft. A S Ft. H I. S Ft. B %010 Ft. I 1 S Ft. Linear Loading Rate= 6, '� GPD /LN FT J q Ft. Design Loading Rate= p.3 GPD /SQ FT K \ 2 - Ft. L 7 - 1 4 Ft. -A+te e Position of Force Main W 3Z Ft. L B K Mn+n- A �c- -- -- - -- w W Distribution Trench Of Pipe Aggregate 1 Observation Permanent Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page 44 Of . 6 Perforated Pipe Detail ` End Via- Perforated End Cop) PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop x PVC Force Main DislnDution Pipe Last Hole Should Be Next To End Cop Distribution Pipe Layout P Ft. X 31 Inches Y 3–) Inches Hole Diameter Inch Lateral 1 I' - ?-Inch(es) Manifold — Inches Force Main Z Inches § of holes /pipe 1 b Invert Elevation of Laterals -Z Ft. 1 6 yC �. ��- t 4 -�Z� z� 3�. �K GP/•�1 �t Place lst hole �?' [ Zfrom tee with succeeding holes at intervals., Last Last hole to be next to the end cap. Combination Sep'tc;.Tank and PLI•MP ; CHAMBER CROSS?.SECTIOM AKID'.< SPECIFICATIOMS ' X AG#S, . S ` �F" • , -VEIJT CAP WEATHER PROOF JUUCTIOU BOX 'i�C.I. VENT PIPC APPROVED LOCKIhIG, t ? 10 "' FROM DOOR, MAN HOLE - COVER iVt' - dIWDOW OK FRESH' wAt2NlrrlG L.P.6E;. -' ALP, IUTAKE t f cor�pu�r r i tj 6 M PrX 4" MIU. I � � I B' MI►1. y�IN*e. w PIPC PROVIDE I — -- IK1LE T AIRTIGHT SEAL I I f I II v BAPFL�S I III A PPROVED J01AlT: APPROVED JOINT A I III w /C.I. PIPE�- w /C. PIPEOr' Tank construction I II ALARM► shall comply with ILHR 83.15 and 33.20 a I I I i ow C I I �z .ZO LLCM. FT - -� ` OFF 0 COLICKETE L` qs 9LOCK 3" APPRovFI: RISER EXIT PERMITTED OIJLy IF TAWK MAUUFACTURER HAS SUCH APPROVAL BEDDINQ SEPTIC I 5PECIFICATIDKJS DOSE TAWK MAN UFACTURER: "LblL )f�� WUMbER OF DOSES: 3' S8 PER DAy TAWK :,IZI`: ,Z'� X800 GALLOUS DOSE VOLUME t INCLUDIAI BACKIFI. � bEi' 4 GALLONS ALARM MAWUFACTUILER: MODEL WUMBER: CAPACITIES: A= 101 INCHES OK '{oo -O GALL01J5 SWITCH TUPE: B = INCHES OR � r, �LLOUS PUMP !''IAWL1FACTURCR: y U L�S C r O INCHES OR WS GALLOWS MODEL IJUM6ER: 3 $ , j ��04 D C1 INCHES OR 1%q. CALLOUS SWITCH TYPE: I"1L'�Z�uIZ "`� MOTE: PUMP AND ALARM ARE TO bE MIMIMUM DISCKARGE RATE GPM 3 1 �_ ... INSTALLED DA7 SEPARATE CIRCUITS - 1.30 VERTICAL DIFFERENCE DETWEEW PUMP OFF AIJD..D15TRIBUTIOW PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESsu 2.50 FE.ET + ZO FEET O F FORCE: MA Y, 3 " -1 q F�oFr.FRICTIO►J FACTOR.. 0' FEET TOTAL Oy1JAMIC HEAD FEET DIAMETER Pump chamber 3 `� IIJTEKLIAL DIMEIISIOWU OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER = Z t _y S GAL /INCH .. Goulds z« Submersible r . Effluent :f'.O p 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in 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. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design 1 /4 " maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal rotection. • Total heads: up to 24 feet. with three prong grounding p SA Canadian Standards Ass ociation ■ EP05 Impeller: Thermo- • Discharge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers d in "F" o "AC " length, 16/3 SJTW with plastic enclosed design for end . • Mechanical seal: carbon- g improved performance. ) rotary/ceramic - stationary, three prong grounding plug 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 s 30 — - -- � .-5GPM components. Pump: EP05 • Solids handling capability: c 25- -- --- - 1 /4 " maximum. 4 W— __ - - _. - - - - -- • Capacities: up to 60 GPM. s 20' - -- — — - • Total heads: up to 31 feet. • Discharge size: l' /z "NPT. Z 5 _ - - -_ - -- • Mechanical seal: carbon- 0 15'; - - -- -'— _— __ rotary/ceramic- stationary, 4 BUNA -N elastomers. o l EPOS • Temperature: 3 10 -- - - — 35 - - - 104°F(40°C)continuous EPO l 140 °F (60 °C) intermittent. 2- 3��u 1 I - - s 0 00 10 0 30 40 50 GPM L -L 0 2 4 6 8 10 12 m3 /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 83871 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or. PARCEL I.D. # ozg - tp3g- V O dimensioned, north arrow, and location and distance to nearest road. % I r nvW C)_2-$ - D 39 -8o- -zo APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION �(�II(�lbl� R D ( �aIDATE qq PROPERTYOWNER:�' PROPERTYLOCATION 'Nt 1atN - uv , .D t - scc 3y _r))-I ^l S W 1/4 L%'31 /4,S ZI T Z ,N,R 1`1 E ( W PROPERTY OWNER'.S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST IN tC�S�tv�wl sgalb ( 4z'6- Oflaq � W\) c - � - r %l [ j New Construction Use pq Residential / Number of bedrooms [ J Additi n to existing building p4 Replacement [ ] Public or commercial describe Code derived daily flow bwb gpd Recommended design loading rate bed, gpolft trench, gpd/ft Absorption area required SOS bed, ft Suo trend►, ft Maximum design loading rate y bed, gpd/ft • trench, 9pd/ft Recommended infiltration surface elevation(s) 0 19 • o ft (as referred to site plan benchmark) Additional design / site considerations V1 pv 1W w / S ') , - lop' `CTEKve V . M Uvl )yw! l$ "O F 3f',1 Ft L-c Parent material S�t_t I SM N t-t eSJT au zt2 T Flood plain elevation, if applicable H A - It S = Suitable for system cONVDmO 1AL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑ S ®U I 0S ❑ U ❑ S ®U [I S ®U ❑ S RJ U [Is O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots ch E GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed re -a3 do �z — sit Z`Fs m A- a- v 4 s • Z � -2, 1. (J` 4tZ3lL si cj Z- •(�s�1r< r�l.s� �- S - .y • S Ground 3 2 3b lo` Y! e S�tv2 31y C� Ck -�2 elev. Depth to limiting factor Remarks: Boring # o - o`-t tL 3 t i - SL \ Z'FSb k w►`fi- 0.,S 1 vp' • s - 'Z Sl e.l 2.'�'sbl� a 1, es lo`ltzyl3 �SH2 Ground elev. \ ; Depth to limiting factor i ST Remarks: r NG ry T Name: — Please Print Phone: Arthur L. We erer 715 -4 �-0. . egerer Soil Westing & Design Service -P.O. Box 74 River Falls, Sgnature: Date: CST Number: 1Z- ZI. -`)8 M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z:ot 3 i PARC EL I.D. O Z6 - X038 —4 0 f'ftiD OZ $ — L u 39 - &o — 7_o O Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 0- 8 �p .�1 Z . — sl1 Z`FSb Yv►.`� �S � u� , 5 •b Ground 3 IQ 3'► 10 `2rz- L3 el 5 1 1 it - v Q>M elev. (: . Z ft. Depth to ' limiting factor Remarks: Boring # 13 i Ground elev. ft. Depth to limiting factor Remarks: Boring # is f i Ground ' elev. ft. ' Depth to { limiting ` factor i Remarks: Boring # 13 Ground elev. it. Depth to limiting factor Remarks: SBD- 8330(8.05/92) . PLOT PLAN Page 3 of 3 SCALE I"= q W S V ) r p $`N1k1 C �TL. to a o' 6ry 11 " �t1GA,S1�/ u D1�Q- _ wltPr-N Oki q "1iIGH, 37UN biA. t I I J i ! � 1 iY • L- 0 10t ? t ZY , ni • N� ( 715 ) 42 .q - 01 65 14 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations . ` Division of Safety & Buildings in accord with ILHR 8105, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but �-. C2•CIIX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 1f oz.g dimensioned, north arrow, and location and distance to nearest road. Ar p OZ-$ _ \ p 39 - zoo APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REV D Y_ DATE PROPERTY OWNER: PROPERTY LOCATION ', j, - MUM - ww r- sm Ft* ' TIM Q'iT " ta JCCkZtsJ F p i 3igU Z e0Y tt9T S W 1/4 .S► 1/4,S Z."] T Z e ,N 1`1 E( W PROPERTY OWNER' :S MAILING ADDRESS LOT # I BLOCK SUBD. NAME OR CSM # P_o . aox s4.1 — — CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST NAD Sit d l L (� IS) 14 Z6 w 38`f � U S!-� �1 V C`�} _ `I [ J New Construction Use N Residential / Number of bedrooms _ [) Add'ikn to existing building Replacement ) ) Public or commercial describe Code derived daily flow 60b gpd Recommended design loading rate bed, gpd1ft2 • trench, gpdAt Absorption area required SOO bed, ft SbO trench, 11 Mabmum design loading rate y bed, gpd/ft ` •S trench, gPd/ft Recommended infiltration surface elevation(s) a q • O ft (as referred to site plan benchmark) Additional design / site considerations w1 Uu 1. by / S Io0" `C1�ve V . M itul k u!!, l$ "O F- Sf'%_;h FIL-L Parent material SlL SM N me�JT ou '=_R Flood plain elevation, if applicable 1y A It S = Suitable for system CONVENTIONAL MOUND W- GROUND PRESSURE AT -GRADE SYSTEM IN F LL HOLDING TANK U= Unsuitable for stem [IS ®U 0 S ❑ U [IS N U 11 S EI U [IS RI U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rt Idt .:4A :.`R�:::K 1 S' 1 Z ' - k b1 YYA- a. S Z 2 2y LO�t R3lt, si C-1 Z �s�k r�s� C- - ,y • S Ground 0 2 Y ! e s'-t uz 31 y C cs Owl — ►.Ip . Z elev. Oa-'z ft. Depth to limiting (actor Remarks: Boring # E l O�-tVL- 3 ! i - S' Z t 1 U`F • S Z $ ZZ t O `,! R 3! b _ S 1 e 1 2 'Fs b1 a s . �( € ,S 3 2Z 10 `tR - yI� �SS41 S Ground elev. qa S ft Depth lo limiting factor Z_2." Remarks: T flame: - Pleasi} Pant Phone: Arthur L. We erer 71.5- 425 - 0165 egerer Soil Tess: eating & Design Service -P.O. Bo ,x 74 River Falls „W.I54022 S• nature I R' -3i3b ' Date. lZ_21� 00.576 PROPERTY dWNER SOIL DESCRIPTION REPORT ..Page Z- .3' PARCEL I.D. #! O ZF0 - 1038-4 0 f" Oz $ - L V 39 - &o - O Depth Dominant Color Mottles Structure GP DM in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. Boring # Horizon Texture Consistence Bound3y Roots Bed Trench 3 Q-% 1O 31 Z - SL Z`�5�0 yv1`F . 0..S 1 u 5 2 - � - 1Q ►0`1123/ - Sic_1 Z`�sbl r�s� eS '�.�_ �."' :°�.. Ground 3 Iq 3 ) b `2 2 1 e t S 2 �J C 0 M ° • Z ft. Depth to limiting i fac tor Remarks: Boring # Ground elev. i ft. Depth to limiting factor , Remarks: Boring # _.. i Ground elev. ft. Depth to limiting j factor ! Remarks: Boring #. 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 'z PT PL Page 3 of! `' 3 SCALE;A"= q0' l� r� p SY '1}t 1 ETL. to t o' oN 1l'' 1�1Gt ,ETC/ ° DIt}. PVC �tpF W /Lfl�'M . 3 h**?_ - I T L. *ns Oki 0 ,' 1 416N, 31v"b)q. � ��z 3 J 1 � �^. L_F-� F} � ' • �'1, O Z ry `\ N q� -3oo L (715 4 2t - 0 169 14 00576 CST Signature Date Signed Telephone No. CST # i STC -1.05 SEPTIC ,TANK MAINTENANCE AGREEMENT St. Croix County �� 7 �UYER _ �� �� �-1 C�r-S U N MAILING ADDRESS p - - DUX Sy r U�SDw PROPERTY ADDRESS (location of septic system) obtain from the Planning Dept. CITY /STATE Nl c t. o�= raw l t o1= PW '(rye ot= Sec -Tuuv 3 4 RED PROPERTY LOCATION Sy 114, Sl v U4, Section Z;l , T Z$ N -R. 0 W TOWN OF Rua � k V ST. CROIX COUNTY, WI SUBDIMION LOT NUMBER CERTIFIED SURVEY MAP — , VOLUME PAGE - , LOT NUMBER , • 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 licensed septic tank pumper. What you put into the system can affect the function of th6 septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. L .. SIGNED:_-' -' DATE: k I l CF . St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 Tb $ -_ �pvt P,ation: form is: -�to be completed in fu1T ` and`` signed by the' owners of the owner( $)* property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be, for resale by owner /contractor, (spec house), then a. second form should be retained and completed when rthe . _property: .is. sold - and submitted to ` this office With the appropriate deed recording. ------------------------------------------------------------------- Owner of property S0 lU �T�J �,R LCD S 0 N N �L- Ni. - fJ4v .�,i of S� 3 Prh1p Location of property Sw 1/4 sw 1/4, Section i:j ,T 3 B N -R 1 W Township Nzt,vs \k 21 U 10Z Mailing address Sy. l CUO sc'm Address of site Subdivision name *? A . Lot no. NSA Other homes on property? Yes No Previous owner of property X tiv SZ. pfn�D In My L. N`l sTG'R Total size of property 60 Nl-tz'z� Total size of parcel 60 fmtze� Date parcel was created _ � 8 , t q 7 n C. Lftlyb C,pLy Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes ✓ No Volume �3`)b and Page Number 38 S as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register ister of Deeds as Document No. S q 0 b4 S , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ture of Applicant Co- Applicant Date of Signature Date of Signature 404/1999 10 :14 608- 785 -9330 PAGE 02/02 Safety and Buildings a 2226 ROSE ST LACROSSE WI 541303 -1905 hSconsirn Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce January 04, 1999 CUST ID No.267341 AT POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD .RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Ident' cation Numbers APPROVAL EXPIRES; 01/04 /2001 Transaction ID No. 203858 Site ID No. 165471 Please. refer to both tidentification numbers, SITE: Site IA: 165471 above., i i. all correspondencc the agency. St Croix County, Town of Rush River SW1 /4, SWIM, S27, T28N, R17W Timothy Erickson & Joan Kasten Erickson FOR: Description: Mound Object Type: POWT System Regulated Object III No_: 443576 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The sabmittal'has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with The designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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, whjcb may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquirics concerning this correspondence may be trade to me at the telephone number listed below, or at the address on this letterhead. Sincerely DATE RECEIVED 12/21/1998 FEE REQUIRED S 180.00 FEE RECEIVED $ 180,00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 FM jswirn@cornmerce_state.wi.us commerce_state.wi.us ' W5, I Wisconsin Deparfinent of Commerce PRIVATE SEWAGE SYSTEM ` — sat6ty and Buildings Division count bT. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarlYnyv.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)]. Permit Holder's Name: Town of: State Plan ID No.: KASTEN— ERICKSON. JOAN aeglp1 f CST BM Elev.: Insp. BM Elev.: 7M Description: Parcel btW- 1038-40-000 TANK INFORMATION ELEVATION DATA A9800581 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se l70 Benchmark 0,�� Dosin Sub Aeration I A d Bldg. Sewer Holding St/ Ht Inlet q 7 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Z, Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeOf CHAMBER Mo Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: RUSH RIVER 27.28.17.235A,SW,SW 121 CTY RD T (I - v� 4, 2 Pr: �- l�ucC oYt zr ,L — tx44 4v an I Z - 1 - Plan revision required? EM] es [9 No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's ignature ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: , SANITARY PERMIT APPLICATION Safet and Buildings Division N*I 201 W. Washin ton Avenue P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, Wl 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County _ than 81/2 x 11 inches in size. CA � 7� • See reverse side for instructions for completing this application State sanitary Permit Number 3a4�ga Personal information you provide may be used for secondary purposes C �, [:1 Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 7 j State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT AL fit! L INFORMATION Property 9.wner Name Property Location r� p. _ tic g IOU Sa /a �� 1 /4, S � � TP , N R E (or Property O ner's ailing Ad s Lot Num Block Number �o / Citw Statd t Zip Code Phone Number Subdivision Name or CSM Number TYM.r ( ) (. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road [] Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax umber(s) �a � —�D 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, fNew 2 E] Replacement 3. E] Replacement of 4 E] Reconnection of 5. [] Repair of an _System -------- System ------------- Tank O -------------- Existin�System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 JaVault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 17 al Grade / Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation b ,0b ""�`. -- Feet V ' Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App- New Existin structed Tanks T nks Septic Tank or Holding Tank 1.206 r�,�� ®' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl Wo 1 ❑ I ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa m shown on the attached plans. Plumb r'sName: (Print) PI 's5ignature: ( o % �ps) /MP� � Busin�Nur�r: l � Plum ber's Address (Street, City, Stat Zi Code): fa , )4� Xuie IX. COUNTY / DEPARTMENT USE ONLY [:]Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved C] Owner Given Initial 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. i 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. k appropriate x depending ns system Type of system. Chec approp . a bo dep g o y 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; 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. 1 Owner's name H63.05 PLOT PLAN Show: t y f ;Location of building served Dosing: efiamber NA Septic tank © Vertical/horizontal reference point Building sewer System elevation is m PTw)4 Lo wr-n nl Fvzq Well NA Replacement system area Property lines w /in 50' of system Q Distribution boxes Scale = �� —� , or dimensioned ►�q Pump and controls: R Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Ga1..per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot- plan 1 F _a 111 4 ' � ��c t ��- w�c- (i7►J � .�. n2wy l.0 GA'RUTv LJ. a -Z 3lv• 0►pt puc Np'r A. /Lsv . By the granting or approving of the above plan or upon the event of a subsequent permit being issued,St.CroixCounty and theSt.CroixCounty zoning Administrator, does not* assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or af&stallation. signs ure ijicense NO. a e � ogn� � EQ.rL cr�sojv ot�1�QS vv�t�F . Sc2cd1 �en/rw�oaw 11JS'[hl..� V 1�RJ'I PR+onr� 1 / l sec-T Pp -ooF Ar- ic�,osu DAR �1 "Is G E i i sync E eaj�\\JAMQI" LIAJC auk w / 1 FF f $ 1 /vL�"T H «.q OvY T PLVG6�� eist%1Ai G ` t Oh! L- vSTEV -Q P fLQ ST \?- / 6 0o G r+rtr. 1 'r.J4t r ' Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Division of.Safety & Buildings in accord with 1LHR 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 (BM), direction and % of slope, scale or. PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. -�`� u G APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNERS= L REvj sNL, UTUbj - ZZ Et h?r1t1L' SmaxWv PROPERTY LOCATION N 11 2. - U or stc. 3y RK/Z �1 t�� TIM'1(111�C'! �Qlelz�t)►J Sol'tN S7� �c�kSUty 6 SW1 /4 StiJ1 /4,S Z T Z8 ,N,R 1`1 E( W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK s4.1 # SUBD. NAME OR CSM # P_o. pox — CITY, STATE ZIP CODE PHONE NUMBER [ []VILLAGE [BfOWN NEAREST RQAD jso)viwt SVOlb his) Yzs - - 1 1 6 0 Tz.vSN+ R1VE'i� C, T` [� New Construction Use M Residential / Number of bedrooms ' [ ] AddiVQn to existing buildiing I I Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate — bed, gVW _ trench, gPd(f? Absorption area required -- bed, ft — trench, 11 Maximum design loading rate — bed, gpd/ft — trench, gpdjft Recommended infiltration surface elevation(s) — ft (as referred to site plan benchmark) Additional design /site considerations 'PyUyk war Mau'-'b' Parent material St L` A SeO t 7't q—tj ou X12 O-A ` Flood plain elevation, if applicable .A . ft S = Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT4MDE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S S U 1:1 S .S U ❑ S S U ❑ S ®U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Baxtdary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch 'fin:: \:::4:•i`.i: 3 - io ! z s i 1 Z.`Fs bk m A- C'-S Z 2 -2! l0`1tZ3 /` Ground 3 2( 3b lob 2 yl elev. qot Depth to limiting factor Remarks: Boring # ,��� � o`�' �o�tz - - s�� Z� s'nk w�'E'� 0.,S t v� • � Rey \ 2� gyp• -t - stcl Z�s`b� r��1, (2s - � 3 2Z_� 10`11 V / Ground elev. Ga.S ft. Depth to limiting factor Remarks: CST Name. Please Print Phone: Arthur L. We erer 7i 5 �42j wegerer Soil Testing & Design Service -P.O. Box 74 River Falls, 54022 Signature: Date: CST Number: 98 —ZS� M00576 PROPERTY OWNER �ZLQ)rr.Sdiy SOIL DESCRIPTION REPORT Page - of,� PARCEL I.D. # wb 1 rt/ G Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bauxiary Roots Bed Trench U.F' Z Ground 3 lq 1 10 `1 rz— j 3 e l S SZ jl C C7w� pl h fv . 2 elev. ° l3TZ ft. Depth to limiting f actor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1 "= DLO' s I I r �) ON PVC '�IPCS W/Ltl-� . �l litZ orl S: ors, q "!iIGH, 37U" biq. i i J I B,z I— I o �r i?1.°iJ 2 I ( 715 ) 42.5_ -0165 14 00576 CST # CST Signature Date Signed Telephone No. r 591578 VOL 1377PACE069 Document Number Doc �S Ue R WISTE., 01 1 IL ST. CROIX CO,. WI kei :'d fL: Record NOV 131998 9 :3o A.M . Roeord'tgg At+ea N me aced Reduce Address ,P, o• aO�l SY/ P=od Ideoli6ptioa Idomber (PIM "TR IS PAGE IS PART OF THIS LEGAL DOCU ENT — DO NOT REMOVE" This infor -ttioa mutibo completed by eabmittcx; dociorioit title, name 6c rcaari addicts and P/N (if regianrd). Odor infotmadon such at die dtuncn clauses, /caul d"ettpdoa, etc. may be placed on shim pa of the d4cu n m or MY be placed on additional pad" of d documcft otc: Use of dus cio„rr pace, adds one pack to your doc:anmt mid L7, 00 to die rccordint fcc. W Lrconsin sraaccr, Sy 517. wMD ( 2196 ;, ST - C 10:6 VOL D UPAA70 PRIVY INSTALLATION AGREEMENT St. Croix County,'.Wisconsin PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION. Property Owner( %): Reserved for Recording Data Mai ing Address: Sow I .w 1 S �L L Sim, 3 Y S>v C Sw L S z1 TZ N R 11 E or QW 6ty. Hi I&2e, Township of: �� S`c! - tZ 1 \3 L R Parcel Tar Number: OZ.8 -1038- O }�1W 178 1038 -� -ZOp Legal Description: Sw /Lq — S W Lj� o t= SQ"C. ZZ F)tvp N I tZ, ot= ►mow i Lq - l%-Willy ot= Sler POLL t Ki T ti, R t71 L J . � 1�c. �fv Vol ti3 PR-s� 3�S 1. No plumbing will be installed in the privy. 2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault/ pit shall maintain minimum setbacks as specified in Table 1. Table 17 Well Building Lake /Stream Additional County Setbacks Open Pit 50 Ft 25 Ft Min. 75 Ft Sealed Vault 25 Ft 25 Ft Min. 7S Ft 4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code. 5. Privies used for one- and two - family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self- closing and vault ventilators should terminate at least one foot above the roof. 6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code. 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. . This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the register of deeds in a manner which allows its existence to be determined by reference to the property where the privy is installed. Printed wner s Names: 1 � kftS�11 Q CI Z.IC T_SoN Subscribed and sworn to before m r r s ignatwe � Public Notary M M commission expires on: NOTE: This document was drafted by the State Department of Industry, Labor and Human Relations, Bureau of Building Water Systems. , VUiN 15: FAX 715 366 4687 REGISTER UP' DEED6 LVJ 1.) 4 VOL 1370mu385 , STATE BAR OF WISCONSIN FORM 2 - 1982 II 5300 WARRANTY DEED DOCUMENT No. TF � rff_EE Loren SMQQster, Jr. and Marilyn Smeester, 5T. CROIX QQtj F W1 husband and wife, survivorshipm prope arital prope Rogrod . OCT 2 8 1998 conveys and warrants to — Timothy X. Erickson and Joan Kasten'Brickson, husband and wife, as survivorship I. marital property THIS SPACC RESERVED FOR RECORDING DATA I I I NAME AND RETURN ADDRESS the following; described real estate in St. Croix County, State of Wisconsin: I L .. . ....... 0.28-1039-60 PARCEL. 1012NTIFICATION NUMBER Southwest Quarter (SW 1/4) of Southwest Quarter (SW 1/4) of is Section 27 and the North one-half (N 1/2) , of the Northwest, it Quarter (NW 1/4) Of Northwest Quarter (NW 1/4) of Section 34, Township 28 North, Range 17 West. TR�fflFER ; i F E ! �I ii I This is not —homestead property, 'i * (is) 0r, not) Exceotlon to warranties! it Subject to easements, reservations and restrictions of record. Dated this day of October A.D., 19---- I I 1 it I (SEAL) (SEAL) 1JOREN SMEESTER,. ar. �T I. (SEAL) (SEAL) MARILYN SMEESTER AUTHENTICATION ACKNOWLEDGMENT it Signatum(s) State of Wisconsin, 'I_ �' ss. �i St. Croix County. authenticated this day of 119— Personally came before me this 94 hQu day of October 19_2R_, the above named Loren Smeester, Jr. and Marilyn S m eeste r, fi TITLE! MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. St A ARY wn to be the person who executed the foregoing I d THIS INSTRUMENT WAS DRAFTED BY PAM t and ac Lb* j ; Ii STEPHEN J. D.UNLAP -1 0 K1819 Z ' _42 4 Hudson, Wisconsin ary Pu6hc, Croix County, Wis. q (Signatures may be authenticated or acknowledged. Bo s permanent. y commission is peanent. (if not, state expiration date: Z,M necessary) ban . ...... . . ...... . NIRM03 Of POM046 6121=9 In any =p=it should be typed or primed w their signatures, STATE BAR OP WISCONSIN Wisoongin LSUW Bkw* Co., Inc. WARRANTY DEED hum No. 2 - 1982 Mmaum& Wis.