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HomeMy WebLinkAbout030-2117-70-000 i 0 N O y . 0 0 v 3 1 3 � v U) f N N 0 O ' N . co W C = D < C A L C.J Q ** O Q q j ? !A Cl) CQ N MA F N N a. 0 S (0 6 m CA v o 0 0 C7 C N (� < (p O W 0 N O 3 p 3 O ^' to O O .y. N O O (D CD (n a ° n N p W J COD W N _ O i (O — w v, n. N c � o t tr Z A O C/) -� 0 00 o 9. N to w 3 N ' m zT v v cn A l� O p 0 W (n ' al m N N N C d N 3 �1 N Q 3 - N Z z o D p n) p v CD y vy S C W CD 0 C1 Q 3 0) D Z CD ' z A p U) n p A n c - a < o A z o m O 0 CD A C w cD z CL F I � o " cn co H z I W CD '� a N co a CD a o' — I N Z G O O C, o I I y I ' � h C I I I � I I o N I Q V I a CD Op b Efl 0 r V O O O N i O ti `L and Human ela6oru� SOIL AND SITE E V A L U ATI O �C�, ' dhT ~' _ Page of Division of Safety & Buildings in accord with ILHR 83.05, VVi d:'Code ZL ' 'r I- C �: '- C' Attach complete site plan on paper not less than 81/2 x 11 inches in size. PlaA must include, but not limited to vertical and horizontal reference point (BM), direction and % of 10 pe, scab qr,„ PARCEL I.Q. dimensioned, north arrow, and location and distance to nearest road. 9g p icy' 1p�10 _ l0 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION t ' ; ;rtirlr R I DATE PROPERTY OWNER: £V R tv V �,EF- Z G 6 E PRO ERTYLOCATION ,�� 4 _ CW S u c�V rJ 1 !tJ c . �'tJ }4 °} T 3 0 ,N,R 1 e[ E ( W PROPERTY OWNER':S MAILING ADDRESS. LOT # BL AME OR CSM # T--uTl_)\ZE \ ZU � IV f�wLC &Y J �U \� '1 — I )AJ W - t11 1 L tZ-lQ CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE QrOWN ' NEAREST ROAD W\ _�'St"t kl) S(Io)6 (1I S) 386 -$6 ST_ SrsPN 0-`y V` [X] New Construction Use Residential / Number of bedrooms [ J AdditiQn to existing building (J Replacement [ J Public or commercial describe Code derived daily flow 4SO gpd Recommended design loading rate bed, gpd$ 0 � Z trench, gpd/ft Absorption area required \, Oy - 3 bed, ft S61.S trench, ft Maximum design loading rate "D bed, gpd /ft • trench, gpd/ft Recommended infiltration surface elevation(s) q - O WT* c It (as referred to site plan benchmark) Additional design / site considerations Z. Mze3Ctfe5 Lmet�l­ 3'K 6 LS' w /> JGI} CfYPP MY s LpE WWX Ll The C. "MBeR S Parent material Flood plain elevation, if applicable w A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for stem ®S ❑ U ®S [I U ® S ❑ U ®S ❑ U IB S E] U ❑ S mil SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Texture Structure Consistenc GPD /ft g ce Barclay Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. G Bed Trw& C�-k Z 1 sl Z. 12 WL``1^ c-S S •6 Ground 3 a�'-yy 6'yfL - 3I y — s) le23 b17_ �-q �� OS elev. \ 01.5 ft PA Depth to s -t o b 0 39 Y4 — - limiting factor ` •oZ Remarks: Boring # s ! ) 2 1 �3 l b1_ w,`Ei ck, — . S . Z �� y0 1D �2 3 L 6 — S l ► Zvrt Sb'yr ►n`�- _ S - . S .� 3 'Ao )iw-f kZ Ground elev. S3 �o - I 'S `i e� D S vv1 e, — •� - � 1 01.0 It Depth to 5 k 'z� -q 10 H. R- limiting factor � q �l Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: ) Q 1 _ _ 7 _ Date: 4 8 ` CST Number: L ( 22025 F 1 r PROPERTYOWNER \M ZEGGi SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # D-'-O - Oy 0 - Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft .: ,. :.. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I Z �3 -�LZ 1u`c►Z 316 s Z.vn sbk ►n�Ft- Ground 3 i l2 6 .S `i fZ 3 y �, o S9 I �S elev. S F � Ob- S 14 A - IS l o '-c►z y/y — S o s� r� I — •� i . � Depth to limiting factor > °L S i i i Remarks: Boring # a -ll St Z�s ,� 0 `2 %Z 316 si I Z�r sbk Ground elev. ft. 4 Q -1bY 10 1 1 f2 Y Depth to limiting factor „ Z 9 Z ! > toy Remarks: Boring # 1 0-12 3lZ - ` s 1 1 2.` f-s b 1 m `F� e-w • S i�� >< Z )n -3b 10 Y& Ground b1Z vyl K` - C- �o ft. 4Z-10g ) u `l P- r Depth to limiting 3 (1/1 . 3 i factor ?tog {' j Remarks: 3oring # i ............... : ,round ;lev. ft. )eplh to imiling actor Remarks: _ PLOT PLAN Page 3 of 3 SCALE 1 "= S ,js Pjf %2R S w —u 1 0 1 0 s o�`M G�i�s r. S t`t �v►�`p u A.) S CJ t�"�p 6 �^tlYtprt_, J J -�v em fit. tip s v �s7 .4 L � 01 ^+ LoT 6 y 3r1i+ 1 - ez. lod.o oN tiD "�tIGH, scc�" DI ft. PW R pe w1LA'fN. 2 W�l(._10 �E � ls?h�'T SD Q1ZO►1 `TTt.��.JCftCTS , -- L4CP�10�1 Sh""i C;3 Sit 1 " =800' r • tV5T1► oT '1 3 1 2 r1vE. . Y ` �• f 1�1V.'S 1 •oT �i � �O 9 9 " �8olz H..i -��• zzozsy ( 715 ) 42.5 -m h5 CST Signature Date Signed Telephone No. CST # LabooandDepaatme SOIL AND SITE EVALUATION REPORT Page 1 of Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S 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 (Blot), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' O to _ 1pl(Q _ 1Q APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: EV t� V �i�E- 2 G 6 E PROPERTY LOCATION _ �l `1Z-� G r; �0►JS`j�U c`nQ }� )1U C . }J`,,3 1!4 S 6j 1 /4,S V° T 30 ,N,R 19 E (00 PROPERTY OWNER' :S MAILING ADDRESS• LOT # BLOCK # SUBD. NAME OR CSM # F-vTI��E \ZUa N �EHM &� �cu�� -- I - I w'trt'�-Z LL z�a CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ZVOWN NEAREST ROAD styli t L`J) S q U 6 () 1 5;) 386 - $ 6 9 9 ST_ Scj s �" `-1 '\\/ ` [X] New Construction Use Residential / Number of bedrooms 3 [ J AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 4SO gpd Recommended design loading rate bed, gpd/ft 0 Z trench, gpd /ft Absorption area required bU.3 bed, ft S 6 1 .S trench, ft Maximum design loading rate 1 bed, gpd /ft •8 trench, gpd/ft Recommended infiltration surface elevations) 9 � - C I13- `C C� ft (as referred to site plan benchmark) Additional design/ site considerations 177_C�JCWeS l;*t Cli- 3< (,L,S " 1'J /1jGl+ e_"K IIY S I,DE'Q) JpeX Ler�,'i Cttf1r13 Parent material (zu � S E & - . Flood plain elevation, if applicable " A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ®S ❑ U OS ❑ U ®S ❑ U RS ❑ U O S ® U SOIL DESCRIPTION REPORT Consistence Botnclary Roots Texture Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft ( in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Trends N 1 0 -t0 to`-1 t�- 3 L Z C-S - 5 •6 Ip Zw,S -S '6 Ground 3 a P - 3 1 lz Yrl elev. ft uq -So Depth to 1 //V — 0 ,S9 Y , l — - • z3 limiting factor > LOB Remarks: Boring # Si1 z` -sb\rz c " - .S .� Ground 3 \10 10 R 3 S 1 I �Sbk M it 1 el ev. ft S3 _)o �.S� 231 — IS M o� o s � vvt �, — •� -� S o -q 10 4 t Depth to 4 1 limiting factor 7 J_ Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: �(,, �'""72 �? g Date: CST Number: - ) I -7 �? -8 -`1� 22 Y PROPERTY OWNER V 1 @1ZEGG V-- SOIL DESCRIPTION REPORT Page? of �• PARCEL I.D.# D-3O 1 Boring # Horizon Depth Dominant Color Mottles GPD /ft Structure Texture consistence in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. BounclarY Roots Bed Trench vn Z S�IZ - Cv � s 6 S i l Zvrt S b k vrt `Ft- cS g elev. Grou 3 �z=� 6 7 . s `t R 31 G� o S9 ri1 CS • "1 1 pb -S ft. _qS 1044 --Y /y - S os� �I - •� i•�3 Depth to limiting factor " ; i Remarks: Boring # .'.,.........< Z U -28 f O'1. R 316 S1 I Z►►1 Sbk vvl`�I� C-S >::.. Ground s�riz Yy S 1 C5b> Vhb`F}- -5 l ee l 6 ft. y ��' -lU lO If P- Y /Y Depth to limiting I factor (oy Remarks: Boring # 3 1 7 - — s �1 z�S mfr �w - • .6 >o-3b 1(3 `t yl6 yr)�� Ground 3 3t, -�Z 1 -S YfL 31y — S� CSb1Z Yn V`Fh CS -�{ S �o ft. l{Z -io9 t o `12 , Depth to limiting factor i ? toC) Remarks: 3oring # ,round s llev. ft. )epth to imiting actor Remarks: _ •�l n•r •rnrt� ��r PLOT PLAN Page of 3 SCALE 1 "= s�s Sw 1 0 10 -1- lv soj`n1 , ;j� r., n IN l`ni�- a _� tom. Lo s 3 62.5 B-1 i5 6 Z - S _ • 8-z � U 5f � LoT 6 y J �� • Bvg V vt[G4, 3LT' Dt R.. PVC pipe w /LA" . S°n'Lt � -E00� r � .� t45TT► T 6 ba T F3 � 1 �o 9 8ott 9 715 ) 42A-0•1 6 5 CST Signature Date Signed Telephone No. C ## 0 ° �� M 2 \ ƒ■ z z k® m 8 S m • e - « £ Q E g o Co CL _ _ , . _ g § ■ \ [ § E \ 0 D ) / --4 o % a , 'T - Z § § / 2 CD @ G 7 E / o E a © m , 0 � $ � e .. o : \ -0 CD c CD § : Q \ - $$� \ Z © \ § / �. / § _§ < 2 E ch � co z o 2 o 0 o g § 0 k c § § § Uƒ k T v Q i e 2 D > 0 � J / / ( §- ƒ } k R =r \ a o C § z § 2 -1 _ CA o E , ■ z e - « § ( X & 7 CL +z) [ ■ : § --I © I E § z ; m ® @ 2 . � { ® > ; CD § « \ � \ / k 8 $ � § � ® � � G i � ■ 0 ° W � � � ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner f U Q n l e w e!R Q Property Address City /State Lega escription: �/rt Lot Block Subdivision/CSM # N 0 1 /4 ' /a, Sec. ° �, T 30 N -Rj�W, Town of -S+. PIN # 0 30 - 0 v - 6232 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 'Nei S t Size ST/PC Imp/ Setback from: House vZ O Well '/' P/L /06 Pump manufacturer _ Model Alarm location (HOLD TANKS ONLY) Setbacks: Se road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width 3 Length 6,�, 5 Number of Trenches 2 Setback from: House a Well .7f P/L Vent to fresh air intake 7 5 ELEVATIONS Description of benchmark " 7 4 o Elevation Description of alternate benchmark To o f 06 Elevation / a/ , Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System () () ( ) Final Grade () () ( ) Date of installation `� /o'4 Permit number State plan number Plumber's signatures License number �� J'" -L15 / Date /.;?r/ ?r Inspector Complete plot plan x 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 • �' v av'& d f V 0 INDICATE NORTH ARROW Wis consin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 344632 Permit Holder's Name: ❑ City ❑ Village ❑ TWwn of: State Plan ID No.: Viere e Evan St. Joseph Township CST BM Elev.:- Insp. BM Elev.: 7BM Description: Parcel Tax No.: 9O .O cs0.a` 0 Lime., PVQ- c9 - glat -- 030 - 1040 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t • 2 OID, Dosing Alt. BM Aeration Bldg. Sewer 3 I'3 cj8 f f Holding St /Ht Inlet 3.42 TANK SETBACK INFORMATION St/ Ht Outlet 13.68 TV 59 TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >f00 ' 4 < - Lo < NA Dt Bottom �---- Dosing NA Header / Man. 3,11 � 27419' Aeration NA Dist. Pipe 1 '77- Q r Holding Bot. System 1 S7 3 gf 15 % g5:93 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover lot. ;1-4 � Model Number GPM TDH Lift Friction System TDH Ft L oss Forcemain Length Dia. Ff Dist. To Well SOIL, B RPTION SYSTEM BED _ RENCW Width r Length No. f renches PIT No. Of Pits Inside Dia. Liquid Depth DIME N SrCYN 3 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu urer: SETBACK ' � " CHAMBER INFORMATION Type Of �--- OR UNIT Moe Num er System: a - u DISTRIBUTION SYSTEM Header/Manifold y 1 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake I Length& Dia. Length Dia. Spacing > s SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over n 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.) Inspection #l: cl/c29T 991nspection #2: Location: 1428 Cntry Tk V, Somerset, WI 54025 (NW 1/4 SW 1/4 19 T30N R19W) - 19.30.19.140 1.) Alt BM Description = garage floor 2.) Bldg sewer length = approx. 22'. - amount of cover = >18 ". Plan revision required? ❑Yes CK No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _a e e mm �.....n _ , am, € i f 3 E s € , z ( € & SSS € .w m� i �a S j jjj E .�,....._ .,,.. ...�.....�.�.....,...,� ¢ ..a.. .� .� ;.._.a.m.... �... __a— .__.._ . ._ ...,�,._. � . — _.F�..�_�..�,_._�..._ �. Vi s ' consin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 Box 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 than 81/2 x 11 inches in size. �- I6_60I y� • See reverse side for instructions for completing this application State Sanitary Permit Number 344 W32- Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location /�j� T'1 V e C i 1/4 SW 1/4, S I C3 T r N, R' ` of Property Owner's Mailing Address Lot Number Block Number g a KCL qn City, State Zip ode P one Number Subdivi ion Name or CSM Number NtudSor� I.t�Z 5HO IG 6- II. TYPE OF BUILDING: (check one) ❑ State Owned Nearest Road Public JR 1 or 2 Family Dwelling - No_ of bedrooms Town of $f •..1 S OTy -%/ III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1 C)30— 'O q0 ' �0• I "' 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 online B, if applicable) A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System -------- System ------------- Tank Only -------------- Existing 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 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SY ORMATION: -- 1. Gallons Per Da 2. Absorp. Area 3. Absorp. Area 4. Loading Rate erc. Rate 6. System Elev. 7. Final Grade Re fired (sq. ft.) Prop sed (sq. ft.) (Gals/day /sq. ft.) (M1 ./inch) Elevation 5Q '?to Feet Feet VII. TANK Capacity - -- ftnjaffons Total of Prefab. Site Fiber- plastic Exper. actu INFORMATION Gallons Tanks anufrer s Name Concrete Con- Steel glass App. New Existin structed Tanks Tanks Septic Tank&*+Fekiiwg -Te9* I00Q ' itzer On It I EL ❑ 1 ❑ ❑ ❑ ❑ 1 ❑ I ❑ ❑ ❑ I ❑ 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 is Signature: o Stamps) MTlIV1Pfl9W Mu... Business Phone Number: PawL C.s - aasy s ► C7K s s Plumber's Address (Street, Cit , State, Zip Code T: q4l� . __RV4ex F&I\S I0T 540Z IX. COUNTY / D EPARTME NT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin Agent Signature (No Stamps) Approved ❑Owner Given Initial 416 Surcharge Fee) 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, ett.); 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, §ection of the soil absorption system if required by the county; E) soil test data on all 5 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. 3 y` PAC Z_ i r U ��rt,c �1'tc7Yj hum W1 i�.� , �Z," ►fi�UVE Fi��Sit�_= G2+YDE i� \oo v Gt�c �v LEstzu - Calve_ I� LUG OvTL� lb FVNIZC�' ?ILlev.0 CZ.OSS _ S �z-T10 N el �p a vo M \N 6C� -fC0 sots F ILL �1Gli CRPRCI'(�( S 1�JEWIND�l2 - - - -- L�C-H LUr1 t_1Z'S 5 L61-Wj Lt Ct1.1 sN Np, O� G La Owner's name San. Permit No. H63.05 PLOT PLAN Show: ��--�� t=j Location of building served ER Dosing chamber E3 Septic tank Q Vertical/horizontal reference point Building sewer F System elevation is ° 16•D Effluent system Q Well Replacement system area Q Property lines w /in 50' of system Ell Distribution boxes �,� � Scale = fi =` , or dimensioned NPR Pump and controls: 1=1 Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist, Pipe Gal..per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: C) tt"�p06 9 ZL p s e 6Z S 8-i troop CZh L C4AJ iN S Tl P m J h;y Qo t^ oh, r S_Z lL f1 1 i 0 J Z J n • 9Mt�l 3r1i+ -t - fZ �od.o o►� 1p "�tlG�{, sca DAR. PVC F►�� w /crlfiT/. �� w�uuZo ;aE Per Lft&T Sfl' Tr 'T� evies . _ By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, St.CroixCounty and thegt.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 of installation. z�� ( AE:�� a;)-. � -- P um r signature icense o. u L-t:--- Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page N of • Lahr,( a4 Human Relations 9 Division of Safety S 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) , n an o f slope, scale or PARCEL I.D. # p/M- p� dimensioned, north arrow, and location and distance ne 0 3 O _ (oY0- l0 APPLICANT INFORMATION PLEASE PRI L INFORMATION`' .!'% REVIEWED BY DATE PROPERTY OWNER: ; PROPER LOCATION EV N V 1E1Z t; GG ` i _ 1J'�J 1/4 S LQ 1 /4,S N° T 3 O ,N,R 4 E (or " ) PROPERTY OWNER %S MAILING ADDRESS T ZkOT , -- BLOCK k SUBD. NAME OR CSM ;t \Z 08 �R�'1E1-�P 6tiJ ST CROIX '�/ — Wy[�� L_ CITY, STATE ZIP CODE NU G ❑VILLAGE EITOWN ' NEAREST ROAD 9 IOE Z-. So S'Pl•� �TtAPO�� 1ZD . pQ New Construction Use [xJ Residential / Number o * ob s [ J AddibQn to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow - gpd Recommended design loading rate bed, gpd/ft ' 3 trench, gpd/ft Absorption area required - bed, ft - trench, ft Maximum design loading rate 5 bed, gpd$ • b trench, gpd/ft Recommended infiltration surface elevation(s) _TD 1 It (as referred to site plan benchmark) Additional design / site considerations 3` L �lG >`►L1Z Parent material Lo LTZ S �.•t_ Flood plain elevation, if applicable KtJ L) ft rU 7Unis;uitab1e4r le e f or ystem CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN HOLDING TANK s stem ❑ S ®U ®S ❑ U ❑ ®S U I 111.1. 111.1. 2 S ❑ U ❑ S [9U ❑ S ® U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture I re Consistence Bajxl3y Roots GPD /f Structu in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerrtt .� S)'1 Z4sbtiZ M4� C - S - • S _ 6 1 Ground 3 2S_SO 10`18 31 �, - S�'1 Ztm Sbn- h?`� elev. 1 L ft. So -6� lz s�2 5�4, s it 1i_Sb'� ha `Fh • _ . Depth to limiting factor S O Remarks: Boring # o -l� l �`-I �L 3 IZ — Si \ Z`F�b `m't��r �w . S • 6 2 Z » - \10 l vLl sz �l i, — si l Z rrl S b1•r Yn `fir e.S _ • S - I Ground 1 1 1 CS D` r 1 'F1r C S 3 � o ft 4 S3 �o S `12 3! o S Depth to limiting factor Remarks: T Name : — Please Print Phone: Arthur L. We erer 715 - 425 -0165 44 d - egerer Soil, Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022 Sgnature: !- Date:. CST Number:. r 9 220254 r I PROPERTY OWNER SOIL DESCRIPTION REPORT PARCELLD.p 1pyp - 10 Page z of 3 Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Texture Roots Qu Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Tiench �IAJ S Gro 3 �1Z=76 �. S `1IZ 31y S 1 ,g pgg �1 - •� .� � oo.s ft. Depth to limiting factor 4 j � Remarks: ! Boring # . ............ .,.,.:::::: € Ground elev, i ft. Depth to limiting factor Remarks: Boring # REM t Ground i elev. ft. I Depth to limiting factor i Remarks: Boring # Ground #! elev. _ It. Depth to limiting factor Remarks: _ .. no�inrr+ •,r ., ' r PLOT PLAN Page 3 of 3 SCALE 1 2 0 J B x�z 9 0 1 1 1 v i gy„� H O L uT re LuT -7 O sJl�t} BM it - CU0.13' UN l g 3 1 'Jlfl • PV CSI? 'f"�/, salt+ - _ `rte toI -b th t4STN to 8 fl0., 14,.9 Y Gt'l�ti� .�71��►L. 7 l S `2 _ zzoZS`l (7 15 ) 425 n1 n5 CST Signature Date Signed Telephone No. CST # L7 A %..i%va,a vv MAN a i SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C FORM )wnerBu er V r C Lam- C _- Y flailing Address e� ce ! n a � 1�� 'roperly Address C- Q �� � -- (Verification required fp6m Planning Department for new construction) i ;ity/Stat , ���� Parcel Identification Number ,EGAL DESCRIPTION l / ec- 'roperty Location ' /s, [r1L ' /., Sec. T._; Rj_�-_W, Town of G� Wbdivision iya �i�/� - G / %� el Lot # � i�-� 7 :ertified Survey Map # , Volume _ Page # arranty Deed �� ®���5 . Volume Page # ipec house yes ❑ no Lot lines identifiable yes ❑ no ►YSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance onsists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system as 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 nasterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system s in proper operating condition and/or (Z) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards of forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification ,tating that your septic system has been,maintained must be completed and returned to the St. Croix County Zoning Office within 30 lays of three year exp' on )ION ATURE OF APPOICANT DA DWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of he prope5y described above, by virtue of a warranty d recorded in Register of Deeds Office. Lo ROKAOW&OF APPLI ATE « * * * ** 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 survcy map if reference is made in the warranty deed 600$9$ KATHLEEN H. WRLSH WAIL LINTY DEED REGISTER OF DEEDS DOCUMENT NO. ST CROIX CO., WI RECEIVED FOR RECM 04-07 -1959 4:20 PM This Deed made between MARVIN O. RADKE, a WMMYY DEED single man, Grantor and VIEREGGE CONSTRUCTION EXEMPT 0 COMPANY, INC., a Wisconsin corporation, Grantee, �v �Y FEE: Witnesseth, That the said Grantor conveys to 118515FED FEE: 484.00 Grantee the following described real estate in St. Croix s�it 10.00 County, State of Wisconsin: A parcel of land located in the SW 1/4 of the NW 1/4 and the NW 1/4 of the SW 1/4 of Section 19, T30N, R19W, town of St. Joseph, St. Croix County, Wisconsin described as follows: Beginning at the West quarter corner of said Section 19, thence NOOo18'36 "E 55.42 feet along the West line of the NW 1/4 of Tax Parcel No. 030 - 1040 -10 Section 19; (bearings referenced to the West line of the RETURN T �•�,��� �•� Northwest quarter of Section 19, assumed to bear North 12& 00o][816"13); thence S89oO4'41 "E 1229.07 feet; thence South y OOoO2'08 "W 55.42 feet; thence S00QO5'O2 "W 481.68 feet; thence Southwester feet along the arc of a 833.00 feet radius curve concave to the Northwest whose chord bears South 33009'09 "W 909.04 feet; thence S66a13' 16 "W 169.50 feet; thence N89005'06 "W 388.36 feet; thence Northwesterly 187.90 feet along the arc of a 233.00 foot radius curve concave to the South whose chord bears N67o39' 11 "W 182.85 feet; thence S89a14'38 "W 27.63 feet to the West line of the Southwest quarter of Section 19; thence NOOo24'09 "E 1255.54 feet along said West line to the Point of Beginning, containing 1,539,526 square feet (35.343 acres) more or less, and being subject to all easements, restrictions and covenants of record. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this ;' day of April, 1999. (SEAL) Marvin O. Radke STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally came before me this day of April, 1999, tl3 abovo named Marvin O. Ra_dke, to me known to be the person who executed the foregoing instrument and i9*led ' me. Notary Public, State of Wisconsin My Commission is permanent. THIS INSTRUMENT DRAFTED BY: Robert W. Mudge, Attorney MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016