HomeMy WebLinkAbout030-2117-20-000 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REI.VORT
Owner f
Property Address
City /State
� J
�71 C� SC�'l , /,U q
Legal Description: -r
Lot �_ Block — Subdivision/CSM # V)h l f+ud 1�r � e 3o, 9, 9?l63
N t /4 ag t /4, Sec. q, T3aN -R-L—?W, Town of PrN. # _ o7 & 2
_..._ 030 - a<17, Z,o 1 100
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer U)ets r Size ST/PC / lo Setback from: House !0 Well > SD P2 0
j D
Pump manufacturer Al vpv 5. _ Model S Ik y
Alarm location s eta
(HOLDIN TANKS ONLY)
Setbacks: S ice road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width $ Length 7 7 Number of Trenches
Setback from: House ' 76 Well M P/L 8 Vent to fresh air intake 70'
ELEVATIONS
k 1 1 6, ,
Description of benchmark � .� root �- o wrz�rr Elevation Q6
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet /60, 2 2 ST Outlet PC Inlet
PC Bottom 96 , Q Header/Manifold Top of ST/PC Manhole Cover 6 3. &
Distribution Lines ( ) / 4 3, 7 O ( )
Bottom of System( )63, () ( )
Final Grade O O ( )
Date of installation / / Permit number State plan number 176 7 4 3
Plumber's signature C r License number 2 «l J Date - / /G/ btu
Inspector �a..
Complete plot plan �
I
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 1roN "o
La
Iva
(,Je ts;, 5' � &,k
4 10`
INDICATE NORTH ARROW
I
wiscnnsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
Saff&y and Buildings Division
INSPECTION REPORT St. Croix
j 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)]. 353247
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
Vieregge Construction Town of St. Joseph ,? NO3
CST BM Elev.-.. Insp. BM Elev.: r BM Description: « cel Tax No.:
dU . I a . ZO 10 `` I�' s y Pve - CSC B Par
M * . ) - pendin
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Icy 6 Benchmark , g' r D Y ,20
Dosing Alt. BM 00
Aeration Bldg. Sewer
Holding St /Ht Inlet g 38 oa ZZ.
TANK SVaJCCK INFORMATION
TANKTO P/L WELL BLDG. Air to
i ntake ROAD iat
Air
Septic a NA Dt Bottom 94 , gy
Dosing L a NA Header/ Man.
Aeration NA Dist. Pipe /03,-�-Z
Holding Bot. System 1 0 3- 0
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand St cover `� 4'(� 0 3• �o "F
n q� Model Number c'S1�(I�. .GPM 8 L �y3R o �,L p 2,0
TDH Lift L.0 Friction y ob System TDH yp,34Ft
oss H
Forcemain Length �0' Dia. 2" Dist. To Well
SOIL ABSORPTION SYSTEM
( 9k q / T41lE"eM Width r Leng 1 O PIT No. Of Pits Inside Dia. Liquid Depth
M N I N b DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Mod Number:
System: 5 Y - —" OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold .� Distribution Pipe(s) r f �� x Hole Size x Hole Spacing Vent To Air Intake
Length V Dia. Length= ia. Spacing � L L S /A ct �� _ ---T
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/Tr nch Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 12—It /94 Inspection #2:
l i Location: 304 144th Avenue, Somerset, WI 1 /4� S I , Secti 1� -R19W) - 19.30.19.
1.) Alt BM Description = 8.0 04* e-- -
2.) Bldg sewer length=
- amount of cover=
C &) l 3.) C ntour = +
,,,,,,a,�,,,o� W luau (C
Plan
0 vviisiion r' equir�eti? ❑ Yes N No
Use other side for additional information. Z-r a jeo I 4-++t
SBD -6710 (R.3/97) Date {1 _ In Signature Cert No.
reG•� .
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: r
1
i } p g }§ y
} S
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mm 9
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-3v Ilk Lf q*�L Atk-, Safety and Buildings Division
SANITARY PERMIT APPL Q 201 W. Washington Avenue
Asconsin
In accord with ILHR 83.05, Wi Ali �� P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syst pa� i s county
than 81/2 x 11 inches in size. ' < (�;_.rl
t
• See reverse side for instructions for completing this applic State unitary Permit Number
Personal information you provide may be used for secondary purposes S T GI�OIx ❑ Chec# it revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. — . `
�,,a �,pUN7Y SIaRe an I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL I C,F QFFI �6
Property Owner Name ?fopert 1V ocot
1rl c V14 1 1 g T 30 , N R 9' 4w(F)
'Property Owner's Mailing Address Lot Nurn Block Number
is a
City, State Zip tocle Phone Number Subdivision Name or CSM Number
(
II. P F BUILDING: (check one) ❑ State Owned Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Town of t5't- COL. n -
III. I BUILDING USE (If building type is public, check all that apply) Parcel T a x Nu
1 F1 Apartment/ Condo -�'`�'
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Hom 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 1 ❑ 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, Ig. New 2 ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
- ____,System System Tank Only Existing System Exlstl2gSystem
8) ❑ 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 f � '( � -T I� 42 ❑ Pit Privy
13 ❑ Seepage Pit ( g Y�2a1 43 ❑ Vault Privy
14 ❑ System -In -Fill 2�
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required_(sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation t
��D f ,') 7 �. 0 3.0 Feet / ys Feet
Cap acit y
VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturer r s Name Concrete st noted Steel glass Plastic App
Tanks Tank
Septic Tank— krzldiw� 00o 14 ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank (Poo H ❑ ❑ I ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) PI er's Sign t e: (No Stamps) MP1P*PR&yV -N0.: Business Phone Number:
d - j 5+c!.4 nor
Plumber's Address (Street, City, State, Zip Code):
8 O * 'l 1✓er �a / /s, Gu,T q0 Z
IX. COUNTY / DEPARTMENT USE ONLY
11 Disapproved S nitary Permit Fee (Includes Groundwater ate Issued Issuing gent Signatur (No Stamps)
Surcharge Fee) J�L,
10Approved ❑ Owner Given Initial ?
Adverse Determination N2 s• M �t��"' UAa ALA
X,CONDITIONS O F �►PPROVAL /REASON FOR�DISAP RO V�A � �
SBD- 6398 (R.1 /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:
1. Property owners name and mailing address. Provide the legal description and parcel tax number(s) of where the
P Y ' g 9 P P )
system is to be installed.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) 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
1r' PO BOX 7162
MADISON WI 53707 -7162
TDD #: (608) 264 -8777
i scons i n www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
November 16, 1999
CUST ID No.267341 -� ATTN. POWTS INSPECTOR
WEGERER SOIL TESTING & DESICIPG ` " . ZONING OFFICE
421 N MAIN ST ` ST CROIX COUNTY SPIA
PO BOX 74 �" .�"p 1101 CARMICHAEL RD
RIVER FALLS WI 54022 ( , E HUDSON WI 54016
RE: CONDITIONAL APPROVAL Identificatio hers
APPROVAL EXPIRES: 11/16/2001 ; _OQ l ' Transaction ID N<176713
Site ID No. 184083
SITE• Z t ` Please refer to both identification numbers,
Site ID: 184083 above, in all correspondence with the agency.
ST CROIX County, Town of SAINT JOSEPH
NW1 /4, SW1 /4, S19, T30N, R19W Lot: 2,
Facility: EVAN VIEREGGE
FOR:
Object Type: POWT System Regulated Object ID No.: 636921
MOUND / DWELLING 450 GPD
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:
• 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.
Sin rely, DATE RECEIVED 11/08/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
J MES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(608)266 -3937 ,
JQUINLAN @COMMERCE.STATE.WI.US WiSMART`code: 7633
cc: EVAN DON VIEREGGE
I
Page of 6
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
LOCATED IN THE M \-`Z 1/4 OF THE S W 1/4 OF SECTION V� ,T N, R 19 W,
TOWN OF ST• use 1+ S`t'. C�•LU1X COUNTY, WISCONSIN.
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION,
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
.PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
EvkK) V.c�irE74`6 - - -
v F.OAV-T-. .
_ �.i'VUSOiv LtJ{ S40I6 A P
,'J
DEPARTMENT OF COMMERCE
p1VIS1014 OF SAFETY AND BUILWNGS
PREPARED BY (J SEE CORRESPONDENCE
��g48C ®bl
WEGEE�EFR SO 31 L_ TEST S NC ut
AND,
�� 47�g'�� `m
� acrrHUa � `
P.O. BOX 74 421 N. MAIM ST. w c ^ R
RIVER FALLS. VI 54022
715 -425 -0165 w_
fig
b�R
JOB NO.
PLOT PLAN
./. Page Z of
Scale
y �J�Lr� -�'}{
�'N"NIrR Z f Z S •''
R 0 `Rll�1 or 10 /
a I �O NuT �u►'��tg-q' OiZ
'O b1SZv�� ` vt S fete
�I
Svgs���
LO el O
3 � � 145T1+
v �T •
,o -
_ 8
L ks
NOTES
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Y required)
3. Install 4" observation pipes with approved caps. ( -2-- required)
4. tank to be )%%) buo gallon capacity manufactured by
W �� \1Z �y Q4 R tZUO Crs - W�-V cT -16o0
� Z..eTE
5. Bench Marks S I°c�uVE
6. Divert surface water around system to prevent.ponding at the uphill side.
i
Page 3 Of
Approved Synthetic Covering
Trs c.33 Distribution Pipe
Medium Sand
H -- G
Topsoil
F Elev .
3 E D
b
9 % Slope
Bed Of - %2 Force Main Plowed
Aggregate From Pump Layer
D Ft.
Cross Section Of A Mound System Using E Ft.
A Bed For The Absorption Area F o-b Ft.
G 1.0 Ft.
A Ft. H \_S Ft.
Linear Loading Rate =a• GPD /LN FT B u7 Ft.
Design Loading Rate= p.`}.GPD /SQ FT 7 1G Ft.
J — 1 Ft.
K \- 1 Ft.
" + 7 Position L 69 Ft.
of
Force Main W 3 1 Ft.
—L
Observation Pipe
8 K
r -- - --- --- - -- --- - - - - -_
i --
A I - -
W � - - -- --------------
- ------------------ - - --.I
Distribution Bed Of I ?
2 2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchbr securely)
Plan View Of Mound Using A Bed For The Absorption Area
b
Page ti Of
Perforated Pipe Detail
0
End View
Perforoted
End Cop) a y PVC Pipe
1. o�
� `onc
(� aS Install permanent marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
i
P
PVC
Manifold Pipe
,
* PVC Force Main
Distri ution
Pipe
Last Hole Should Be I
Next To End Cap
End Cap
P Z Z Ft.
Distribution Pipe Layout
S �_ Ft.
X Y $ Inches
Y L! $ Inches
Hole Diameter Y Inch
Lateral 1 <<Z Inch (es)
Manifold Z Inches
Force Main " Z Inches
# of holes /pipe 6
Invert Elevation of Laterals I 1 03 - SFt.
Place 1st hole �� t �from center of manifold with succeeding holes
at y$' intervals. Last hole to be next to the end cap.
Combination Septic;Tank and
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE S OF (p
-VC T CAP WEATHER PROOF
JUIJCTIOKJ BOX
M"C.I. VEMT PIPC APPROVED LOCKIPJG
' –•1O' FROM DOOR. MA►JHOLE COVER kA-;'Iv
,W1UDOW OR FRESH wAAnJ1tJG L.AeEL.
AL_ S aw.3auIT
t
�IOZ.S GRA I G
:9
y "INSraN --
PROVIDE I - - - --
W LE T AIRTI6MT SEAL I III V
• � +yFFL� S � I I
APPROVED JOIUT A I I APPROVED J01AITS
W /C.I. P1PEaR Tank construction I I I W /GI. ?IPE;Kp -C
shall comply with
I III ALARM
ILHR 133.15 and 33.20
I I oW
C I l
°tZ-6� I
FT.
ELEV. PUMP -� - -�
� OFF
D C0Q FLETE
�Z- l70 BLOCK
5
bU7
RISER EXIT PERMITTED OWLti IF TAWK MANUFACTUREER HAS SUCH APPROVAL SEDDINQ
I
SEPTIC E SPECIFICATIOKIS
DOSE 1b00
TAWK MALJUFACTU%LCR: C NUMBER OF DOSES: _ PER DAy
TAWK tIZC: ldb0 /L GALLONS DOSI< VOLUME z �33.�
ALARM MAWUFACTUILCR: S•J �.�TRA S`� l IMCLUDING BACKrLOW: GALLON,C.
MODEL NUMBER: CAPACITIES: A= I OR 301.0 GALLOWS
SWITCH Tti PC: w1� z�( 8= I►JCHEs"OR 31,V G( LLOWS
PUMP P' AWLIFACTURER: w1 L 1 X1 C- RUCHES OR GALLOWS
MODEL NUMBER: SRS D. 8 IAICHES OR l33'�d GALLOWS
SWITCH TYPE:
{D
OTE: PUMP AMD ALAR �ARRE TO 5L
MINIMUM DISCHAR z�3,o�, PM IN5TALLED ON SEPARATC CIRCUITS
GE RA
VERTICAL DIFFERENCE DETWCCU PUMP OFF AWD..DISTRIBUTIOW PIPE., 10'83 FEET
-{- MINIMUM METWORK SUPPLY PRESSURE ; 2.5U FEET
+ ° t FEET OF FORCE MAIN X 1' FYoFtFRICTIOU FACTOR_. FEET
TOTAL DYNAMIC. HEAD = ET
Pump chamber — DIAMETER k.
IPJTERPJAL DIMEWSIO4 OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH
BOTTOM AREA - 231= GAL /INCH
AS PER MANUFACTURER GAL /INCH
TOTAL HEAD I N * FEET V64 91-ti£N
p o
o
0
N
O m
C-) O
D
- 0
D W _
n O N D
H O
� D _
C7
H
1n O L -�
O �
H
0 o N
z cn
c.n 3 o m
M o
+' Z
X ° C
H � frl
z O
C m
m °
0
W
N
O
(D
O
W
O
O '
O
O - N W -P Ul W J m lD
TOTAL HEAD IN METERS
Wisconsin Department of Industry,
Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3
Division•o #Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), dre i % of slope, scale or PARCEL I.D.
dimensioned, north arrow, and location and distance to esf4da 0 3 O _ IoYp_ Jp
APPLICANT INFORMATION PLEASE PRIN I�F
, A.(: OR IJ A T' R" ' \ R IEWEDBY DATE ", ;'•�
PROPERTY OWNER: t /'• t. ! /F, PP OP TY LOCATION Lo ll
�)1fi N V \E1'� GG ` ,� - Go Ivr=( T 11J'JlJ 1/4 S W 1/4,S \) T 3 ,N,R 1 j E (or " 1
PROPERTY OWNER':S MAILING ADDRESS • i -; 1 �g LOT BLOCK # SUBD. NAME OR CSM #
�ZO� NR1 1E1t f� Zw L tj�� ST - — w L �'I vz) 6
CITY, STATE ZIP CODE ,B E UMW ITY OVILLAGE ZTOWN ' NEAREST ROAD
1p IL
[� New Construction Use (>(J Residential / Numn4 of Ile r rli - [ ] Addition to existing building
[ J Replacement [ J Public or commercial descr
Code derived daily flow - gpd Recommended design loading rate • `l bed, gpd/ft • � trench, gpd/ft
Absorption area required bed, ft - trench, ft Mabmum design loading rate • 5 bed, gpd/ft -� trench, gpd/ft
Recommended infiltration surface elevation(s) 1 Oy. o' ft (as referred to site plan benchmark)
Additional design /site considerations N lI W K b ►-J/9 f x b 1' 8 D Rat wl S k S' TR Env et} (- 3 BURM)
Parent material Flood plain elevation, if applicable fQ `A . It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitablefor system OS O U 9S OU OS O U ER U OS EIU OS ®U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Bourrlary Roots Bed Trerldl
in. Munsell Du. Sz. Cont Color Gr. Sz. Sh.
o -°► �o-i c� 31z — S wtf - �S - •s .�
Z q -Z 1 D 1 1 %'Z- 3l6 • S •\
Ground 3 Z z 3 2 S Y R 31 y — Gt- s 1 to s b k wl v `F1� C w _ •`� 'S
elev.
0 4 3Z - S Z.S �I� fly - s6H o sg wt 1 �S — >-� •�
Depth to S 4S _6 y 1 u H rz `! / tf �` S Q SL , ,,,1 1 C S _ . S. L
limiting
factor „ 6�E 1 `� 10 "t R `f l V ->_ S '-f 2 s 1 ti S 0 m} — �� •
Remarks:
Boring #
} O - l.0 ►o�- ttz31 — sil Z.'� yn`{�b- eS - •s •6
.� R- S'1 Z� S Kok n2'Ft- e-S "' • S , �, j
-t lz �1b S�r�SAS s;
Ground
elev.
f
Depth to
limiting
factor
Z1y
Remarks:
T Name: - Please Print Phone:
Arthur L. We erer 715- 425 -0165
dress: -
egere Soil Testing & Design Service - P.O. Box 74 River.Falls,WI 54022 •
Signature: `. /. - Date: r CST Number:.
220254
I
I
- 1
PROPEMTYOWNER V \�TCZgG6 SOIL DESCRIPTION REPORT
PARCEL J.D. d Z�`I . b d b _ 1 py D - Page Z of 3
Boring # Horizon Depth Dominant Color Mottles
fn. Munsell Texture Structure GPD /ft
��- >.�•��� <::: >: >:> Qu. Sz. Cont. Color Gr. . . Sz Sh Consistence Bour�ary
Roots
` tz 3 t 2 — s i I Z Bed Trench
37
Y r Z 3! '�� ►�'h
G� sI Z s1bk V`E�
elev. S
3 3� -Z s ovv-,
l uy.0 ft.
Depth to
limiting
factor i
3�" I
Remarks:
Boring #
Ground
elev. i
R.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft. }
Depth to
limiting
factor j
Remarks:
Boring #
1 ;_
Ground
elev. f
ft.
Depth to
limiting
factor
Remarks: _
PLOT PLAN Pa 3 of 3
SCALE 1 gy "
�3r'i4FL — L, IZA z
to`�liL6H, 31 DIA. �� Z �pW PtUe
L.o l Ll PVC �?iP� W�l rH1"rF
i
o� o
w� r�ovr� w
O
v /
\ r
t�u T
a.z
LoT 2
S =nLt ) "= 8005
r iVSTTi
Y 1�I T
_ a
�S
� ZZ01s�
( 715 ) 42 -0169
CST Signature Date Signed Telephone No. CST #
Labor T and Human * Reis;; W - "'' J U I L A N U 3 I I t EVALUATION REPORT Page N of :t)
Division of S afety 3 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
S'C •
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), dire % of slope, scale or PARCEL I.D. 0 'PPk-v-LT OF
dimensioned, north arrow, and location and distance to e f3�a . , j� 010 . IoYO- 10
APPLICANT INFORMATION PLEASE PRIN FORhiATTON'� REVIEWED BY DATE
PROPERTY OWNER: t ElvFfl PKOPENTY LOCATION
Ell Pf N 1�_ GG 1/4 S W 1 14,S T
1 3 0 ,N,R E (or W 1
PROPERTY OWNER':S MAILING ADDRESS • - SUED. NAME OR CSM #
�ZOB Iv�ME1zf� 6 ST 6 � — LOT V BLOCK # w�l L �ZvD Ste.
CITY, STATE ZIP CODE E UMB CITY ❑VILLAGE ETOWN ' NEAREST ROAD
NvOS07J , LJ 1 S S NZD
K New Construction Use [,�J Residential / Num o [ j Addition to existing building
Replacement [ j Public or comme
Code derived daily flow - gpd Recommended design loading rate • `l bed, gpd/ft . trench, gpd/ft
Absorption area required bed, ft - trench, ft Maximum design loading rate • S bed, gpd/ft -� trench, gpd/ft
Recommended infiltration surface elevation(s) Oy o' ft (as referred to site plan benchmark)
Additional design /site considerations wl�v ►-I /S'x -b "s g�j 8 D fz t w/ S'>c S T1z�v eta 3 8�1L'�1�
Parent material \ - o `l S Flood plain elevation, if applicable tJ PA . ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for stem ❑ S O U a S ❑ U ❑ S O U ❑ S O U El S ®U [I S ® U
SOIL DESCRIPTION REPORT
Texture
Boring # Horizon
Depth Dominant Color Mottles Structure Consistence Earrkry Roots GPD /ft
in. Munsell 11u. Sz. Cont Color Gr. Sz, Sh. Bed Trench
I
o - tort 3) z — s i 1 Z'Fsl� mfr �S - • s .�
Z a -z l L) `i 2 Z �sbk Yn ` - �- - • S .�
Ground 3 2i - 2 S `Y f Z 31 y — G>r s 1 eS b k h 1 V `F1� C W •y - S
elev. ;
t 32.45 Z 1z,31y S 6H O Sg I �S _ . - 1 =•g
Depth to S qs-�y 1 C3`1 TL Y
Bmitin g
factor64 2 <' `�
� y - - �•s�.t�SJti �s o g9
eA tv zf JQ OF 2.S` %Z S
Remarks:
Boring #
� o -�,o � o� -t�31 z - s i I Z.� - sbk rn�.. eS - S•�
Z � Z to Z� to `1 R � � — S7 J Z'FS b1z n2'� �S • S .1, I
s \4 t_S /e s;I 1�sbk h�•Ft� c� - .z .3
I
Ground
elev.
It
Depth to
limiting
factor
, Z- 7 M
Remarks:
CS T Name.--Please Print Arthur L. We erer Phone: 715- 425 -0165 j
Add ress:
egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022
Sgnature: Date: CST Number..
•�q -�(7 - 220254
i
PROPERTY OWNER SOIL DESCRIPTION REPORT
PARCEL I.D. #__I c) l py p _I p Page Z of Z
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture Structure
o _9 , � �� 31 Z Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bouxlary Roots Bed Tfn�
✓ Y�
SYf 3/y 6r sf ZM S�bz mV�1-
Ground �I.S�2 S,/P, s 1 4w.
elev.
1 ey.0 ft.
Depth to
limiting
factor
3
7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
i
Remarks:
3
Boring #
tt i
i
Ground
elev.
it.
Depth to
limiting
factor j
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks: _
PLOT PLAN Pa 3 of 3
SCALE 1 "= y0 '
� - �, IoV - z' ory �'_'►�i - 'L.t.l;�b - �N
a
O , y O
t -11
LoT 2
�oc�pr�1 S`R."Tc� I
sc�� 1 "= 8005
r
t45TT!
I
iL�9 t Zti
1 _ ZZ OZ.sy
C I -ts -9� (715 ) 4 .5 -n7 As
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address o
Property Address X X V- p
(Verification required from Planning Department for new construction)
I
City/State t e Parcel Identification Number
LEGAL DESCRIPTION
Property Location IZ(,P/4, jg /., Sec.,�� T_,�LN -R4W, Town of
Subdivision , Lot #.
Certified Survey Map # Volume , Page #
Warranty Deed # � so" , Volume Page #
Spec house tkyes ❑ no Lot lines identifiable ;�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
mastorplumber, joumeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, 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 Dep of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system en maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a three y pzxp' on date.
/ ,ter
SiGN ATURE OF 4FE16ANT ATE
OWNER CERTWICATI VN
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro descri d above, by virtue of a warranty deed recorded in Register of Deeds Office.
IGN OF APP 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
aL 1417PA0.200
W DEED G IE
r ST OF
DOCUNW no. ST. CROIX CO., W
MUM FU KCW
We Deed made between MASVIN O. RAM& a . 0-1-
!!s 4s�1 at
single �. Grantor and VE 9RF.GGE CONSTRUCTION t7t iEE1
COMPANY, INC., a Wisconsin corporation, Granor, OR OR Fes,
" 6 That the said Grantor conveys to FEES *L1*
Graeae the bbw* described real estate in St. Crux M A M FM 14.10
Q"Y. Saft of W
A pond of bed locased in the SW 1/4 of the NW 1/4 and the
NW 1/4 of the SW 1/4 o(Secttan 19, T30N, R19W, town of St.
J sq* St. Crobt Camay, Wisconde described as ibilows:
Beginning at the West gwrl r comer of said Section 19, ttueace
NOQol8'36 -E 33.42 feet along the West line of the NW 1/4 of 1`ax parcel Ma- 030 - 1040 -10
Miss 19; ocarim referenced to the Went tie of the
Northwest g tts roz:a -coo : J,•
o "P9 of Section 19, sastetued oo bar North ✓ � t �' r f�
00°18'35" ; dW= S$9004' 41 "E 1229.07 leek; ttteac+t South laym's/��Q ����
00� 08"W 53.42 lead thence S00oW'02 "W 481.68 feet; tbestce SoWhwea�tfy ji61:S� feet L the arc of a
833.00 left radius curve concave to the Northwest whose chord bears South 33009'09'W 909.04 fiat; theme
966 - W 169.30 feet; thence N89o03'06 "W 388.36 lest; thence Northwesterly 187.90 feet along the arc of
a 233.00 foot radius cum comve 10 the South whore chord bears N67039' 11 "W 182.83 fact thence
SNol4'38"W 27.63 left 10 the West lint of the Soueherest quarter of Section 19; thence NOOo24'09% 1235.54
#ON along acid West line 10 the P010t of Beginning, coutainiog 1,539,326 square feet (35.343 acres) more or lens,
ad being subject to all easel nuts, restrictions and cova=m of record.
This is not homestead property.
Together with all and aingular the bereditaments and appurtenances thereauttto belonging;
And Grantor warrants that the title is good, indefinable in fee simple and free and clear of
enc and will warrant and defend same.
Dated this , .� day of April, 1999. -
/W �'�/� (SEAL)
PAa rvin O. Radke
STATE OF WISCONSIN
AS
ST. C>:nrx COUNTY
Personally came before me this day of April, 1999 abov named Marvin O. ReAk. to me
known to be the person who executed the foregoing • led '
Notary Public, State of isconsin
My Commission is pe rmenent.
TMS INSTRUMENT DRAFTED BY: -
Robert W. Mudge, Attorney
MUDGE, PORTER, LUNDEEN dt SEGUIN, S.C.
110 Second Street, P.O. Box 469
Hudson, Wisconsin 34016
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