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HomeMy WebLinkAbout030-2042-30-200 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SAM[TARY REPORT n "� Owner Property Address 5"8 City /State 14 -- Legal Description: Lot :; Block Subdivision/CSM # Nw '/a NE ' /a, Sec. �� , T 3 N -R W, Town of St SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / Of 0 / Setback from: House / °• s Well `-(- P/L ! 7 Pump manufacturer At. A Model Alarm location & FI , (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: T� Width S Length 7 s Number of Trenches .2, Setback from: House -3d " Well 7 Lo P /L G B Vent to fresh air intake ELEVATIONS Description of benchmark d, 1_, e tr� 119� Elevation Description of alternate benchmar aP, � F _ Elevation 9 . s Building Sewer q '? , 3 1 _ ST/HT Inlet 9 9 - a ST Outlet 9'7 Y PC Inlet /V �. PC Bottom N. A , Header/Manifold Al. A. Top o ST C Manhole Cover Distribution Lines Q UxJ 9 9.8 E .J# Ye, - 7'7 () / Bottom of System ( 9 9 (2) 9 q , 1 9 ( ) Final Grade ()) 1 0 1-3 6 / n 1 ,3 8 ( ) Date of installation !o / 7? Permit number 33 g a Y State plan number Al R, Plumber's signature L3 T License number 9,7- - 7 71 o Date 6 /►e /99 Inspector Complete plot plan l 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 a N � • 6 � 83 4 q rV I 1 .01 A�17, oke I OX � J. ;2 7 � y "go , � "'0 l C. 7A' -y TNDIC ATE - NORM ARROW . "Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 5 CHL IX Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 338824 Permit Holder's Name: ❑ City ❑ Village 0 Town of: State Plan ID No.: SOLFEST, DARREN ST. JOSEPH CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: /GJ J ;,� 030- 2042 -30 -200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3. , /O Dosing Aeration Bldg. Sewer y </,;, 9.3 Holding St It Inlet -1 // 57 i TANK SETBACK INFORMATION St /Ist outlet 4/.'76 q9 , 041 TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet irl Septic ��� a ' , ' NA Dt Bottom Dosing NA Header/ Man. S.0 � s; 7 Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand'�� ' Model Number,., GPM TDH Lift Lrict Head TDH Ft (J — y i , ,.: .0/ Forcemain L th Dia. HH Dist. To Well 7 F SOIL ABSORPTION SYSTEM BED / TRENCH Width Len th f No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION �� DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER Model Number. '�1A 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 STd e xx Mulched Bed /Trench Center o Bed /Trench Edges / (( Topsoil ❑ ❑ No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 26.30.20.493E,NE,NE 192 COUNTY ROAD E j. Plan revision required? ❑ Yes 9No Use other side for additional information. SBD -6710 (R.3/97) Date I v or's Signature Cert No. Safety and Buildings Division NVAsconsin SANITARY PERMIT APPLICATION 2 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 5 , f . G t a than 8 1/1 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 3 38�� Personal information you provide may be used for secondary purposes k it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number !. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMAT! N Property Owner Name Property Location NF 1/4 /Jr 1/4, S o'tb T 3 v r N, R to E (or)� Property Owner's Mailing Address Lot Number Block Number City, State , Zip Code Phone Number Subdivision Name or CSM Number 'n..tr w� 5''�a/"7 (1j S' )A4l -y338 s9 4 38 V*-e , 3513 N. TYPE OF BUILDING: (check one) ❑ State Owned 3 0 of a Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF S�t`' C. E Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Num r(s) 1 ❑ Apartment/ Condo ©_ 3o- Yz 30 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. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an Systm - e System Tank Only Existing System Existing System ---------------------------------------------------------------------------------------------- B) CK A Sanitary Permit was previously issued. Permit Number .3 $ 8 P1 Date Issued - 5 JA — ! f 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 F J15eepage Trench 22 ❑ In- Ground Pressure �� 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 O Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Iq S "1 5`o - 7 6 - 0 ( 9 Y. 3 G Feet 4 e6'10 Feet Ca aclt VII. TANK in allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tank Septic Tank or Holding Tank °� /000 W -+� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ Cl ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) F MPRSW No.: Business Phone Number: c,Jat��,- �� �rr -, W s -1 -1 / -� �P� -33 �- Plumber's Address (Street, City, State, Zip Code): 96 s A� IX. C UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issuing Ag t S ture (No Stamps) e. � Surcharge Fee) Approved ❑ Owner Given Initial / n�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 everynew /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 mainstwater 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. No r ca rt I<n � �,�► 8 v `y. - 7 - 710 Oj 9 , r I? Al 3 ° ° f Ito LA p 3 t a 33 98.59 F ("I Q 0 ce wa ¢�1ace px c.v%4 (xm" by Art Wtge.rer on � 2 SCALE I►? = .3 0' Tom Nelson BM Tod nf' �o ,� e ��c 0 tA . E . 3. f , ^b• Wisconsin Department of commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental DY Design Attach complete site plan on paper not less than 8% x 11 In ches in size. Plan must County include, but not limited to: vertical and horizontal reference point (13M), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Plea$e print all information. Re ' Personal information you provide may be used lbrs;acondary Purposes (Privacy Law, s. 15.04 (1) (m)). Dat G I Property Owner Property Location Knefelkam , Norman Govt. Lot NE 1/4 NE 1/4 S 26 T 30 N,R 20 W Property Owner's Mailing Address ' ? C% Lot # Block # Subd. Name or CSM# o��•G �.a,,�*'� ,� � *-- � , 1 Knefelkam City Se ip Code,. fi ❑ City ❑ Villaqe MTown Nearest Road J� r� o ti t StJoseph CTH E New Construction Use: al / Num ;t)f Dons 3 Addition to existing building F - 1 Replacement P ' riscribe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpolft- .6 trench, gpd/W Absorption area required 900 bed, f? 750 trench, ft? Maximum design loading rate .5 bed, gpdM .6 tr ench, gpdff Recommended infiltration surface elevations) 94.30 ft (as referred to site plan benchmar Additional design / site consideration This evaluation is being conducted for a residence already under construction- gravity fed system t Parent material Loes s Over Glacial OutWash Flood lain elevation, if icable NA ft ble for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank itable for system N s n U m s nu m s n u n s l� u n s u n s u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles I I structure GPD,% goring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. lConsistenco Boundary Roots Bed 1 Trench 0 -36 7.5yr5/4 - fs Osg ml ew 2f .5 .6 2 36 -53 1 7.5yr5/4 - A Osg ml cw If II 5 ? .6 Ground 3 53 -96 7.Syr4/2 - s I Osg I ml I - I - I .7 .8 elev 98.87 It Depth to < limiting s factor >96 0 Remarks: 2 1 , 0 -17 ! 1Oyr3 /3 - sil 2msbk I mfr I cw I 2f I .5 .6 2 ! 17 - 32 10yr4i6 - l Sit 2msbk mfr cw 1f 5 6 Ground 3 32 -44 7.5yr4/6 - is I Osg ml cvv I - .5 .6 elev I I cw I - 7 S 99.08 ft 4 44 -62 7.5yr4/4 _ S I Osg Depth to 5 62 -96 L 7.5 I - s* Osg , ml - I - I 5 .6 limiting factor >96 Remarks: * w/ bands of fs 7.5yr4/4 CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Ricltuiuixi, WI 54017 6/3/99 227387 234 4 PROPERTY OWNER: Knef,&ww, Norman SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Environmental Bv Desian Horizon 1 Depth I Dominant Color Mottles Texture 1 Structure 1 onsistencel Boundary I Roots GPD/ftz z r r. z. h. in. MunseN Qu. S . Cont Color S S Bed ' -Trench ........................ 3 I 0 -i$ 10yr3i'2 - sit 2msbk mfr cw 2f .5 .6 2 1 18-40 fr 1 10yr4 /4 - sit I 2msbk I m I cw I 1f I .5 ! .6 Ground elev 3 40 -641 7.5yr4/6 I - I s I 0sg 1 mi cw i - I 7 8 98.59 ft 4 64-96 7.5yr514 - s Osg ml - - .7 i .8 Depth to I I ! I ! limiting facto I I� I I I I I I I I Remarks: Ground I I I ! ! I I elev Depth to 1 imiting Remarks: I I I I I I Ground elev I ( I I I I I I ! Depth to ! limiting factor I Remarks: . _ ......................... . Ground elev Depth to I I f I I I I limiting factor I I ! I I I Remarks: [KVf 6Y 0[5 1432 120` STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 Tom Nelson Certified Soil Tester 227387 -- Registered Sanitarian SR00713 NoA-ma Kr, ep kcarn p 'Af S e. c- :L Co , 7`3 0 N R 2v Li S- . Croy Co 5 6� 3` a� a$.$-7 � o�nd��� 3z. 99.08 33 WS9 ci F f ,Q ,,, ►Z eS denc.e, IZa,�lace rlcr`'� cxrea WeSerer on oc-►91 r%4 ( Syn I a.n-pi l SCALE 1" = 3 0 Tom Nelson BMi.`r 0 -(-" �0 .,reD t„�, r_tV OLA Z\#0 IOU BM -- op oF boo ►n9 elf v c l- .q 5 � — SANITARY PERMIT APPLICATION Safe' ' and t di S A D i v i s i o n e Bureau of Buildin Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �� ! k than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit N The information you provide may be used by other government agency programs ❑ Check if revisi n to previous appIi anon [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name .,t Pro perty' Location S o L /i4 1/4, S T ®, N, R E (or W Property Ow er's Mailing dress Lot Number Block Number ' ::2. City, tate j,(} Zip Code Phone Number Subdivision Name or CSM Number 0 ` �� , ��� C - 7 1 (7/5i;Z v4 --yam .S8 6 3 II. TYPE OF BUILD G: (check one) ❑ State Owned ° vty age NearestRoa Public or 2 Famil Dwellin - No. of bedrooms_ own of ,�¢� ��/T E III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo �` • • �43 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. L ewh 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 ❑ Se age Bed 21 ❑ Mound Specify Type 41 E] Holding Tank 12 eepage Trench 22 E] In-Ground Pressure i 42 E] Pit Privy 13 El Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill 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 S Required (sq. ft.) Pr (sq. ft.) (Gals/day /;q. Feet ft.) (Min. /inch) E '?g , e, Feet Ca acit (� VII. TANK in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Exist in strutted Tanks Tanks eptic Tank I arfk Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ 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) Plum er's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: #e A- Y AV5d li a t 444 7/ _� 7YQ --33 ;2 - 'k 1 Plumb is dress (Stre t, City, State, Zip Code): rv IX. COUNTY/ DEP RTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Ag t ignat re o Stamps) Approved ❑ Owner Given Initial �� s o Surcharge fee) - 1 Adverse Determination 0 jJ lJ . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHE). -6398 (R OV94) DISTRIBUTION: original to county, one copy To: Safety & Buildings Divi. ion, Owner, Plumber r T 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 -3815. 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, 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 8 112 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. VJiWonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _ of 1 Labor. 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 S'T. 0_k1! ) lY 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. 'P E\J"Z� )►J G APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVAKD BY DATE PROPERTY OWNER:IVpjtLVj'1'iV LL.trt�1�11� PROPERTY LOCATION 1 5`ZPSL 1 SpI. ST - 6o[>z10T QE 1/4 NJ� 1/4,Sl� T 3 0 ,N,R ZA E(or PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # b 6 o by -- — cs" CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD K),B-j R LCNHUUb L-,1I S4011 Li336 '% stT'A 1 e`er , tL (� New Construction Use [J¢ Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow �1SO gpd Recommended design loading rate 5 bed, %0 • L trench, gpd/ft i Absorption area required X10 o bed, ft2 - IS C) trench, ft Maximum design loading rate 5_ - gpd!ft • 6 trench, gpd/ft Recommended infiltration surface elevation(s) ` t S • S' ft (as referred to site plan benchmark) Additional design /site considerations . - e- S ' �,-Z S' S' PTb IF: bq'ist iZe)p Parent material \_jz�ZSS` QU�M Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 9 S ❑ U 0 S El [RS o U I@ S❑ U RS ❑ U ❑ S C?U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed wch 'Z s ;,,,. -,• <X Z q -3Z 1oHSL_ 3l 4. 1 S) l Zm S �k Yh CS 1 �-(' • S 6 Ground 3 2.- SS 'I-S �i tZ ul c - S d 5►. 4 fL Depth to limiting f > 8 '' Remarks: Boring # o -►o �u-t.z L - s,1 z sb �n�t- elm z •5 - �A..� -� =' Ground 3 Zz -�t S'f It �t16 — S & o s � m 1 i '9 r ev ft /� }: ' ,�,~ y ✓' Depth to limiting _a f factor - ��� 0 �N Remarks: _ CST Name; Please Print Arthur L We e r e r Phone: 71 S - 4 2 5 eger,er Soil Testing & Design Service - P.O. Box:.. 74 River- Falls,WI 54022 Signature: Date: CST Number: M00576 OWNS S o y Ff` ST •`2 3 PROPERTY OWNS SOIL DESCRIPTION REPORT Page O PARCEL I.D. # A El l!') &) C- 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 1 o_g � 0�2 3 L3 - s b c w Zf ,S , x Z 9 - 3�{ 10`ItZ 3/� sti f Z.yn Sbh 1M`�1 C S 1 v� • S . L Ground 4 ^ S G!. o S g wl C S '1 •43 elev. n 9 .8.6 ft. `1R yl _ `rS U 3g V11 1 -S '•• Depth to limiting factor Remarks: Boring # ch, Z� s E ll ' L _ s i t Zv►1 s bi m `� e s l v • S Ground o s o) M a , . elev. �7_°l3 �U� cR- v/ ° Iq• S ft. �S O Depth to limiting factor Remarks: Boring # :��• � I o -9 ���2 s !� _ Si l Z`Fsb ct�, z� •s • � S ° t - �� toti 3/6 s i J Zvn SIJ�t Yn h C . S . 6 : >. Ground O L — j ft. Depth to limiting 1 factor Z a i Remarks: Boring # c M y Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) .y PLOT PLAN Pa 3 of 3 SCALE l °►16 1,4� geZ >ZQa� ETI y / �. grlrtZ O f 'C 6 s.3 eL9� 6 4q Uv�`n,PC� 'R43v Ckt�S OR 1 ZxZS �`�'O 0 1 A - TVJZ - -I" 4A Z - \ELN, `t`1 � 6�.1 Spllz� Z� tjhovF G1zou�p ,v vSE - Nv 8E �rT - L S ' FT StOYti )- - PtReA_ . �Ir C - M , E R8- 3 9 (715 ) 42.5— 14 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page __ of 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 I.D # .0 l� 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» G APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION R EWEDBY DAT �9 PROPERTY OWNER: tVpR \� PROPERTY LOCATION 3U X12 S : bP,k,Qi�j 4 S`S?P_\ s Ot_Fg� GO.a. LOT QE 1/4 W 1�7 1/4,S11. T 3 D ,N,R Z C3 E (or PROPERTY OWNER' :S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # a 6 o Q-oLEV - t>" 1 �3Vt - — p Nt-6P osVZo �s�I CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD MOAJ R,ICOhUJ kjI 54 017 htS) zv _ W338 ST • I C'Tw ` ei w [>Q New Construction Use [J¢ Residential / Number of bedrooms [ ] Addition to existing building [ J Replacement [ ] Public or commercial describe Code derived daily How. `ISO gpd Recommended design loading rate S bed. gP(W ' 6 trench, gP(W Absorption area required qA O bed, ft - 1S O trench, ft Maximum design loading rate • 5 bed, gpd/e • trench, gpd/ft Recommended infiltration surface elevation(s) °L S . S ft (as referred to site plan benchmark) Additional design/ site considerations Z `M0jQ, f - ZN01A S s Im Lt= bks tz N Parent material \-j,�.ZS OUQI�c S py uj' wpr,s W Flood plain elevation, if applicable QN R • ft S = Suitable for system CONVENTIONAL I MOUND I "ROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem E S ❑ U ®S ❑ U WS ❑ U OS ❑ U as ❑ U ❑ S ®'U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bm Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rRent o - � ►o��z 3LI — s1i Z�sbh rn��. cw z� •s •� +••:ti. Z °f -32 kp42 3l� � S � 1 Z-rn S�k yr� �1- cg 1� S � Ground 3 2.- SQL 1 • S `f fZ ul � - S 4 G\. � S `� vvt � - •� • � elev. 4 -� fL Depth to limiting fac tor Remarks: Boring # [} : _W0xn 1 p -10 `NL3 s, 1 Z�s� Yn'f� �� Z� •S ?i4 � >. �rM Ground 6f- 0 S� M 1 - '�'• ' elev. CID_b It Depth to limiting factor � �I 'Remarks: CST Name: - Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box.74 River- Fa11s,WI 54022 SgnaUue j. Date: �_ CST Number: 48 - M00576 PROPERTY OWNER 0 t- F EsT SOIL DESCRIPTION REPORT Page Z•of 3 PARCEL I.D. # I N G Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Barry Roots Bed ITrench 3•• ,S Z -3y VL — s I Z. s b t 1M C S ) v , s . L Ground 3 3y -�f 1• S `t 2 I(, S G}. o S g W, — 1 •43 elev. 9 .8.6 ft. 46 -8� �v tz VIV m -S Depth to limiting factor G' U i Remarks: Boring # El I V— l 1 1 p�-t, R 3 13 � s �` Z`� d k Wl,'j �- Cyv 'L`! • S j• 6 l L _ s i 1 Z►� S �� m` e S u 3 3N z.s �rtz ��G S �6� o sg wt eS. •`Z . Ground lev a s ft. s c, Depth to limiting factor > °G3 Remarks: Boring # I El 0 -9 tu�ttL 3 l� si 1 Z`Fsb 0_L z,� •s ?. 3 Z8 S2 1.S �fIL V ` Ground S �C Gt- u S S n'l 1 CS � •� ` td O L1. j ft. TS U S 9 t • S i b Depth to limiting factor 4 i Remarks: Boring # F<w3 i Ground i elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) _3 - PLOT PLAN Page 3 of 3. SCALE 1 " = ' 0 6v 4 / B MV�,j / ErL I oQ tiZX�s '� S•� ' 1 o �Y•�C`rj - 1sv ��.p' at.� S�[F...� 3C �CV�, 6���' *J`J l�M'1 Z - �t�U • `t m w S'01 cL , Z� ►'�$ovE 61ZOU1�Jp vSE BE YrT 'U'ST ZS ' 1= F-&I 34d I"E i. MOA . r 9 (71 5 ) 425 - 1400 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer a W r js: N 7` Mailing Address S Cde rr7J lam, � '1.r Property Address q G (Verification required from Planning Department for new construction) City/State Parcel Identification Number 0 O ? — o r .2 00 LEGAL DESCRIPTION Property Location IVF- ' /,, AIE ' /., Sec. 26, TAN -R i O W, Town of Subdivision Lot # Certified Survey Map # 3 ' b' _ , Volume _ :� , Page # .3�! Warranty Deed 7 20 ' , Volume + /3.57 , Page # Spec house ❑ yes Brno 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 master plumber, journeyman plumber, restricted plumber 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 system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three yW expiration date. //]] SIGNATURE OF APPLIdkNT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of roperty desc " above, by virtue of a warranty deed recorded in Register of Deeds Office. SfWATURE OF APPL CANT 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 'I'l-L IT5 7 D ,c .1 :56 11AR Or- WISCONSIN 1-01M 2 1 NVA R RA N TY 1) U 11) DOOMWNT W' Norman C. Krefelkamv) and K- L. REGIS70% OFFICE felkamD, A /k/ a Kathl --- -- ST. CROIX CO., WI een' k n husband and wi fe SEP 16 1998 - M. $617iist_anff_qtiHE". x __ Darren I a nd - ­ - - - - --- - __ _ _ - q ( PM olfest, husband and w ide as marit3 su rvivorshi p nrope t R• Igor of 01040 mis C; nr1f n, n t lircon DA NAW ANn Aft' SON APIIYJF ", tite ioll,,win de,anbcd real - In St CLO1X stalcof Wisconsin GWIN LAW HRM S.0 430 SECOND STREET HUDSON, W15401&1510 030-2042-30-200 PAO( it I(IlNllf;::All­h '40. A parcel of land located in part of the NEh of the NE's of Section 26, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin, further described as: Lot 2 of a Certified Survey Mato filed September 2, 1998, in Volume 12 of Certified Survey Macs, at page 3513, as Document No. 586348 in the office of the Register of Deeds for St. Croix County, Wisconsin. jRA�ISFER i not n > , I not I T� WITH ND SIEUECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded erb=rbrances beyond the term established by law therefor. ["mcd tills 15th September 98 -tell — � -- /��� (SEM) *Norman C. Kne e Kathleen L. Knefe (SCAL) A 1IT I I U N H C A Y10N ACKNON•I 1A)CMENT of Norman C. Knefelkamr) SI-Pre of Wi,.C4111%ill, and Kathleen r, KnefelkamD Si mber j ., 98 I-_1fo'(_.__'­- 011s da J _�ppte the above named tGw i n Hugh N (it not, authl,ri--c I 1w It" Atty. haghl. 1-71. Ckqi,n, (WIN IV FIRM, S.C. 430 Second St., Hudson, WI 540 C(­IlIl\. Wk 0� FILED 586 348 27 _ SEP 0 2 1998 V, 3 KATHLEEN . Cswof CERTIFIED SURVEY MA 4� s LOCATED IN PART OF THE NE1 14 OF THE NE1 14 SECTION 26, T30N, R20W, TOWN OF ST. JOSEPH, co W F 3 ST. CROIX COUNTY, WISCONSIN. W SCALE IN FEET 1 " = 100' Z O o o n 100 0 100 200 3 33, / L W < w w < UNPLATTED ----- LANDS � ---------------- ---------- - - - - -- 4. W m S89'52'1 9 "E 433.63 - W a w 397.84' "s 5.7 / } W m 19 Z 0 R ^ 0 WW F Q? W N LOT 2 4.053 ACRES 176,568 SO. FT. / � , S 3.229 ACRES EXC. R/W ZS O 140,655 SO. FT. A / �� �� rn O z o °0 Q a ,n N -j w NE CORNER tLI I ( < SECTION 26 I I C Z I o► N ac Zia of T �! CP ; 5 - < IUJ 589'28'48 "'W 305.97 �" to _' o° w z p N89'S 2719" � 2 Y1L3.1 — ._._" 3t �.'a 3 N89'S _ o -- - - - z SOUTH LINE OF THE NE1 /4 OF THE NE1 /4 M. p d N 0 i� 198 � W UNPLATTED LANDS �',,,J i' ChUtX '.,. �t •ta , f'nnClPhwilYN! L Ignpa,�; LEGEND Parks f,:rvr�nih�e, . R .»rx�nScld ALUMINUM COUNTY SECTION CORNER ,0. ,�t' ER ye,�t MONUMENT FOUND Ei /4 CORN PREPAK�Jw 1" X 24" IRON PIPE SET WEIGHING SECTION N DARREN AND' WLFEST 0 1.13 LBS. PER LINEAR FOOT 860 COLEMAN ORIW!? O NEW RICHMOND. WI 54017 ................. 100' ROADWAY SETBACK LINE OWNER 2" IRON PIPE FOUND N ?RMAN KNEFELK AMP .,1[li" CENTRAL NUMBER RADIUS ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT TANGENT 1 1320.00' 02'27'04" S23'48'59 "W 56.46' 56.47' 52235'27 "W S25'02'31 'W 2 232.00' 37'20'24" S06'22'19 "W 148.53' 151.20' S25'02'31 "W S12 *17'53 "E 3 1287.00' 01'50'32" S24'07'1 510W 41.38' 41.38' S23'1 1'59 "W S25'02'31 "W 4 265.00' 37'20'24" S06'22'19 "W 169.66' 172.70' 525'02'31 "W 512'17'53 "E Vol. 12 Page 3513 I £t5£ a6ed Zt'1 •90Tnpg so; BVTUOZ AlunoO XTo� * 3S agl logwoo uMos eauTadoaddg pug aoT 30 aga , taoxed 0 ssaoog par og do asap ao buTsegoand aso ;aS 'p 'S"T dtgsuMOL taoaed Cue buT T , suoi�etn as P� satnz aoaQd Roes azis IOT mrouTuTM spueT30A a -C a c� dvm sTgl uo uMOgs t pue �ClunoO 08 3 23S o f g oa ds sT (g t ) x ato we •pagog dasor de �CananS paT�Tlaa� stgl gig �C ;Tlaao �Cgasag I -as agg Aq paeoaddg sT W 'NO • �uospnu SKM y 9t0i�S IM - lnuteM ZTZ SV'19f l00 oul • BUT,&gAauS Pue st y n 00S1M A0 e6Oa aatggZ C • ames buTddau pue buTltaeane o lvauno, 8113 ;o eoueuTP10 O UAO.L 9113 P� xToiO I S 8113 ; v E'9EZ saldL'10 uT gdasor IS aul Pule salnlelS uTSuoosTM : a taosep uo pue i aule glT,� p rcTdmoo Attn3 eAeg I � � F q. 8113 ;0 OTgos Ol uOTleluasazdea ;o.suoTsTnoad luaaano aOTaalXa ;ilaao Os ' P ., pa�Canans , AananS pat ;tlaa0 sTul gegl I -409=00 g sT deW •paooaa squemosee P ug OIL" 'H S•' ' (laaalS Pug suoTloTalsaa6Ta of loe s Cgns g 1 loosed pagTaosap anogv ;o slueuanoo P �gM - ;o -lg - uIOZ) peo?I u�►os a0; •bS 89S'9LT) saaDv � (•gd f :100;; �S'9bt o 3 u-rod agl o ESO'79 sutgluoo T aoaed pagcaosea •butuuTbaq as OZ'TST 'auTtaaluao 'auTtaaluao PTeS buote '8N£S,LtoZtS nos uagl 1199; ES'8VT seanaeo tes ;o Dag aril buoTe 'At =agl m atb saansgaug T pug anano F. sagaq e paOgo asOuM ,'VZ,OZOLE a ;O aanlgnano Pug M ,aAano s nip= loo; 00'ZEZ asogM 'At =agsga aneouoo ,auttsaluao pTes buotg 'MuT£'ZbuoTE ; o luTod aql of laa; OL'ELT s ue ansnO pigs ;o 0811 8113 as Lfii' 95 ' au TTaluao P a aceaq psogo oouagl =g 3 sasnseam P� M "AZ3ajsaAglaOU ane ouoo � AtaalsaM glnos aOuagl laa; 9bu�S tealuao asogM aaalS LiIOZ) peon uAOI asogM 'UVOILZOZO' saanseanu at as 00'OOS g a goo; 00'OZEt g uo luTOd g buTaq 68S anano sn-tp of laa; E9'EEv '$u6T 0 pies buotg Mr6TAZSo6 L, ;o auTtaaluao agl as ST'ESE OUT,[ gl nos autt ul 'SuTt.LOoOON aouagl u T 30 luzod agl of laa; Er+'LTEo auTt glnos buTnuTluoo aouagl aqg ; t ,es ; aouagl =� /t$N 0 i� /t$N 6uotg 'MuTEaLSo pies 6uotg Mu6t,ZSO68 q /TSN pies ;o autt lsga 9113 8113 le BuTOUawwo� 8113 0.3 laa; Tfi+'$TEt TES ;o aauzoo lseaglaoN aouagl =9Z uOTloaS P ' a zaosap SMO'[t0; Sg Q q. dasor 'IS ;0 uMos 'MOZ�I N El :uTSUOOSTM #IIuno0 xToa, o l � /TSN 8111 ;0 lagd a pedde�u P� pT tp ao uoTloaS ;o b /tSN 8 11 11 O UOT3091Tp 8113 Act legl ;.la, I 9Z , dw xta3aUN Ue= 'aatgez 'r SeTbnoa opa� elLins aneg I uzsuoosTM Qaa a alstba2i. �Cgaaag ' oA9AanS PugZ •ponuTjuoo LZ ' 6 J 6 Ilk :R s 1 � try z , cv s -r r4 a r 'j CL rrf ID co th �A 0 N i Y � . c \ 1 � tr -r � r •I- r try •e ti.• —1 � •v i AKER GB -60R `* r e Ir -! i I I / I °• / t S I I t • Gfl 'v I _ .'.. e I \ � I y i I • ;o;0%. m r x GO ; Q I z.t LA t tv I ru ILI C ' 5 SPIC LVES t a r r .a We • ; i 1 M I Y 3 r 1 Y it I x II r c I to .( y Ill• W " J -{ _ � r -t yr o I .r I u • FIELD WORK date drawn scale ALL AMERICAN HOMES, INC revisions system 28' WIDE 1 STROY 1/17/97 P N B 1 3/16' ALL AMERICAN HOMES" INC GEORGETOWN SERIES page • drawing • 8 COA co.) 1418 South 13th Suve tike drmw!>rt P -0, Ik A 415 GC OQC V A tom. l fd*nal 46733 • _ _. _ 0 4 6' 6 C ' 3 2 B 5' I,,+'